Developmental Outcome In Preterm Infants Research Articles

Can Erythropoietin Improve Developmental Outcomes for Preterm Infants?

A safe pharmacotherapeutic intervention is needed to mitigate neonatal brain injury resulting from perinatal asphyxia, stroke, or intracerebral hemorrhage. The ideal treatment would be readily available, relatively inexpensive, safe to use in preterm and term infants, require no special equipment, be effective with an acute regimen, be trophic in both neuronal and glial cells, and reduce cell loss by arresting both inflammatory and apoptotic cellular processes. A treatment meeting these criteria might be used globally to help reduce the estimated 920000 annual mortalities associated with perinatal asphyxia. The leading candidate under investigation is erythropoietin. Experimental data have thoroughly documented the neuroprotective actions of erythropoietin, and this cytokine is now being considered as a treatment for spinal cord injury,1 traumatic brain injury,2, 3 ischemic stroke,4 multiple … Address correspondence to Ronald J. McPherson, PhD, University of Washington, Division of Neonatology, Department of Pediatrics, Box 356320, Seattle, WA 98195. E-mail: neuron{at}uw.edu

Developmental Outcome of Preterm Infants with Severe Intraventricular Hemorrhage

Of 214 preterm infants studied at Wilhelmina Children’s Hospital, Utrecht, the Netherlands, 94 (44%) had a grade 111 intraventricular hemorrhage (1VH), and 120 (56%) had a grade IV hemorrhage.

Cortical vision, MRI and developmental outcome in preterm infants

Objectives:To test two measures of visual cortical function in the first year of life as early markers of functionally significant brain damage in infants born preterm: orientation-reversal visual event-related potentials...

Desenvolvimento de bebês nascidos pré-termo e indicadores emocionais maternos

O objetivo do presente estudo longitudinal foi comparar o desenvolvimento de criancas nascidas pre-termo, em dois grupos diferenciados quanto a presenca (G1) ou ausencia (G2) de sintomas de ansiedade e depressao materna no periodo neonatal do bebe. A amostra foi composta por 32 criancas nascidas pre-termo, atendidas em seguimento psicologico desde a internacao na UTI Neonatal ate o final do primeiro ano de vida, sendo 11 do G1 e 21 do G2. Foram aplicados o Teste de Denver-II e a Escala do Desenvolvimento do Comportamento da Crianca com as criancas, e o Inventario de Ansiedade Traco-Estado e o Inventario de Depressao Beck com as maes. As criancas de ambos os grupos apresentaram indicadores de desenvolvimento no primeiro ano de vida classificados como Normal, independentemente da presenca de ansiedade e depressao materna.

The effect of developmentally supportive positioning (DSP) on preterm infants’ stress levels

Research has proven that developmentally supportive care (DSC) improves the developmental outcomes for preterm infants.
 
 ABSTRAK
 Navorsing het bewys dat ontwikkeling-ondersteunende sorg (OOS) die ontwikkelingsuitkomste van premature babas verbeter.

Factors affecting early neurobehavioral and sleep outcomes in preterm infants

Evaluation of risk factors and short-term outcomes in the neonatal intensive care unit (NICU) are essential to identify infants in need of developmental intervention after discharge. This study examined risk factors with the potential to affect short-term neurobehavioral and sleep outcomes in preterm infants born at <31 weeks gestation. Data were obtained in a larger longitudinal randomized study of the effects of cycled light and continuous near darkness on health. Severity of neurological insults and caffeine use predicted poorer neurobehavioral outcomes; and severity of neurological insults, caffeine use, length of hospitalization and ventilator days were associated with altered sleep–wake state organization. There were no significant effects of environmental lighting on the short-term developmental outcomes of preterm infants. Early knowledge of an infant's neurobehavioral and sleep outcomes can provide families and health care providers with important information to target the utilization of early intervention services.

Developmental outcome of preterm infants after surfactant therapy: systematic review of randomized controlled trials.

To review neuro-developmental outcome at 1 and 2 years of age following randomized controlled trials (RCT) of neonatal surfactant therapy. A systematic review of the MEDLINE, Embase and Cochrane Controlled Trial Register databases, searching for RCT of surfactant replacement therapy with follow-up outcomes, was carried out. The main outcome measures were severe and mild disability at 1 and 2 years plus composite adverse outcome of death and/or severe disability. A meta-analysis using odds ratios was carried out on 13 RCT. There were a total of 2218 treated and 2090 control infants who underwent follow up at 1 year of age. There were 303 treated and 292 control infants with follow up at between 18 months and 2 years of age. Surfactant therapy was associated with a lower rate of mild disability at 1 year (OR 0.79; 95% CI 0.66-0.95). There was a reduction in the combined adverse outcome (death or severe disability rate) at 1 year (OR 0.8; 95% CI 0.72-0.89). Neither the 1 year nor the 2 year follow-up examination showed a statistical difference in the severe disability rate between the control and treated group. Surfactant therapy increases survival without an increase in subsequent morbidity at 1 and 2 years of age.

Prognostic value of EEG depression in preterm infants for later development of cerebral palsy.

The aim of this study is to examine the most appropriate timing for EEG recordings in order to predict the risk of cerebral palsy (CP) on the basis of the degree of acute stage abnormalities (ASA) in preterm infants. We retrospectively investigated the correlation between the degree of ASA and psychomotor outcome of 295 infants born between 27 and 32 weeks of gestational age whose initial EEG recording was performed within 7 days of life. Forty-six infants were diagnosed as having CP at 18 months of corrected age, and most of them suffered from diplegia due to periventricular leukomalacia (PVL). The maximum degree of ASA correlated with a later development of CP and its severity. Correlation between the degree of ASA and the severity of CP was highest on day 1 - 2, but this tendency was less clear after day 3. Specificity and negative predictive value were generally high within the first 7 days of life. But sensitivity was markedly decreased after day 3, and positive predictive value was highest on day 2. An EEG on day 1 or 2 will be useful in order to predict developmental outcome of preterm infants on the basis of the grade of ASA.

Effects of Human Milk Fortification on Morbidity Factors in Very Low Birth Weight Infants

The use of human milk as a sole source of nutrients for preterm infants has been the subject of debate in recent years. We studied the morbidity factors associated with hospitalization of very low birth weight (VLBW) infants fed human milk with and without fortification. One hundred VLBW infants were randomly assigned to two groups with stratification for gestation and weight. The control group (n=50; mean birth weight 1239+/-186 g and mean gestation 29.3+/-2.1 wks) was fed human milk only, and in the fortifier group (n=50; mean birth weight 1245+/-191 g and mean gestation 29.5+/-2.1 wks), human milk was enriched with a fortifier after the babies reached a volume of 140 mL/kg/day by the enteral route. Weight was measured twice weekly, biochemical indices of nutritional and bone status and serum electrolytes were obtained weekly, and clinical evidence for sepsis, necrotizing enterocolitis and feeding intolerance was assessed regularly until infants were discharged. Hospital stay was less than 45 days in the majority (94%) of the babies in the fortifier group, whereas the majority (66%) of the babies in the control group stayed for more than 45 days (P<0.01). Low serum phosphorus and raised alkaline phosphatase levels were seen more frequently in the control group without fortification (P<0.01), as well as hyponatremia (P<0.01), late metabolic acidosis of prematurity (P<0.01) and culture-proven sepsis (P<0.05). There was no significant difference in the occurrence of necrotizing enterocolitis between the two groups (P>0.05). Human milk fortification has beneficial effects on the growth of VLBW infants and decreases hospital stay and morbidity associated with prematurity and very low birth weight, with economic and psychological benefits for the parents.

Nutrition of the preterm infants

OBJECTIVE: To review the recent medical literature on nutrition of preterm infants, focusing on practical aspects that are relevant to pediatricians and neonatologists. SOURCES: An extensive review of the related literature using Medline, Cochrane Database of Systematic Reviews and Best Evidence was performed. SUMMARY OF THE FINDINGS: There is compelling evidence that early nutritional practices may affect short-term growth and developmental outcome in preterm infants. In addition, these practices have a determinant role in adult health. We still have to learn a lot about the safety and effectiveness of nutrient administration in preterm infants; about techniques targeted at assessing the effect of different nutritional strategies; and about the long term effects of these regimens on developmental outcome, growth and disease. CONCLUSIONS: Despite recent advances in neonatal nutrition, basic and clinical research is still necessary so that the nutritional needs of preterm infants can be better defined and adequately provided.

Predictive value of neonatal neurological tests for developmental outcome of preterm infants

Background: There is a need to identify, as early as possible, infants who are at risk for long-term neurological morbidity. Methods: To predict neurodevelopment outcome of preterm infants <30 weeks’ gestation in a population of 100 infants, we used several neonatal and neurobehavioral tests, including cranial ultrasonography, the Prechtl neurological test, quality of spontaneous general movements, and quality of sleep-wake organization. Results: The Prechtl test at corrected term age and findings on cranial sonograms both had high specificity, but the Prechtl test had better overall positive predictive power for normal neurological and developmental outcomes at 2 years’ corrected age. Developmental changes in sleep and the amount of indeterminate sleep did not correlate with outcome. Scoring general movement quality did not predict outcome and did not augment the positive predictive power of the Prechtl test. Conclusions: The Prechtl test at corrected term age (independent of the other tests) is the best positive predictor of normal neurological outcome and Bayley test results at 2 years’ corrected age. (J Pediatr 2000;137:100-6)

A Parent Administered Sensorimotor Intervention and Developmental Outcome of Preterm Infants

A Parent Administered Sensorimotor Intervention and Developmental Outcome of Preterm Infants

Predicting Developmental Outcome in Preterm Infants 1281

Early and significant correlations between the Bayley Scales of Infant Development and the Stanford-Binet Intelligence Scale (S-B) were noted in a cohort of premature infants (N=215; BW: 1601.3 +/- 707 gms; GA: 31.3 +/- 4 wks) evaluated periodically after hospital discharge. Observers blinded to the clinical status administered the Mental Development Index (MDI) of the Bayley Scales at corrected ages of 6 +/- 1mo (MDI-1;n=144), 12 +/- 2mo (MDI-2;n=63), 14 +/- 4mo (MDI- 3;n=176), and 23 +/- 3mo (MDI-4;n=161). The S-B was administered at 3.8 +/-.7 years. Significant correlations (*P<0.05;**P<0.01; ***P<0.001; ****P<0.0001) between the tests are noted below. From 12 months on, the MDI is increasingly predictive, reinforcing its role as an early diagnostic and therapeutic resource for physicians and families. Table

Randomized outcome trial of human milk fortification and developmental outcome in preterm infants

Despite potential benefits, human milk may fail to meet preterm infants' nutrient requirements. We tested the hypothesis that fortified breast milk, fed alone or with preterm formula, would improve neurodevelopment and growth at 18-mo follow-up without adverse short-term clinical or biochemical consequences. Two hundred seventy-five preterm infants from two medical centers (birth weight < 1850 g; mean gestation 29.8 +/- 2.7 wk) whose mothers chose to provide breast milk were randomly assigned to receive for a mean of 39 d a multinutrient fortifier or control supplement containing phosphate and vitamins. Breast milk comprised 47.6% and 46.4% of enteral intake in fortified and control groups, respectively; preterm formula supplements were used when insufficient breast milk was available. Overall, there were no significant growth advantages with fortification; although, when breast milk exceeded 50% of intake, fortification promoted faster weight gain (an advantage of 1.6 g.kg-1.d-1; 95% CI: 0.1, 3.1; P < 0.05). Compared with control infants, the fortified group showed 1) higher plasma urea from week 2 (P = 0.04), 2) higher plasma calcium (mean 2.34 +/- 0.01 compared with 2.27 +/- 0.02 mmol/L; P = 0.003), 3) a greater rise in alkaline phosphatase by week 6 (P = 0.04), 4) more clinical infections (suspected plus proven; 43% compared with 31%, P = 0.04), 5) a nonsignificantly increased incidence of necrotizing enterocolitis (5.8% compared with 2.2%, P = 0.12), and 6) higher white cell and platelet counts. Developmental scores at 18 mo were slightly but not significantly higher in the fortified group. This study confirmed that breast milk fortifiers can improve short-term growth (when breast milk intakes are high); but beneficial effects on long-term development remained unproven. Future research is required to evaluate potential adverse consequences and explore more optimal fortification strategies.

NEONATAL PREDICTION OF PRESCHOOL OUTCOME IN PRETERM INFANTS USING THE NEURODEVELOPMENTAL RISK EXAMINATION. † 1615

The Neurodevelopmental Risk Examination (NRE), a neonatal tool, has been shown to predict early developmental outcome in preterm infants. This study examines its ability to predict motor and cognitive outcome during the preschool years.

Developmental Outcome of Preterm Infants With Transient Neuromotor Abnormalities

To determine the relationship between transiently abnormal neurologic findings in preterm infants and subsequent cognitive outcome at 4 years of age. Prospective 4-year follow-up. Regional perinatal center in Syracuse, NY. One hundred thirty-one of 135 consecutively born infants of no more than 32 weeks of gestational age; 98% followed up from birth to 4 years of age. None. Based on neuromotor evaluations performed at 6 and 15 months of age, two groups of infants were identified. One group had abnormal neurologic findings at 6 months of age that had resolved by 15 months of age (transiently abnormal group). The other group had normal neuromotor findings at both 6 and 15 months of age (normal group). The transiently abnormal group had significantly poorer scores on the Bayley Mental scale at 6 months of age (90 +/- 15 vs 108 +/- 10; P < .001), 15 months (91 +/- 21 vs 105 +/- 12; P < .001), and 24 months (91 +/- 19 vs 101 +/- 17; P < .001). However, at 4 years of age, cognitive performance on the McCarthy Scales was similar for the transiently abnormal and normal groups (General Cognitive index, 93 +/- 13 and 95 +/- 14, respectively). The incidence of poor cognitive outcome (Cognitive index < 84) decreased from 39% at 2 years of age to 18% at 4 years of age in the group with a history of transient neurologic abnormalities but remained unchanged (16% to 18%) in the normal group. Early neurologic abnormalities that are transient did not predict cognitive delays at 4 years of age in preterm infants.

Relations between neonatal states and 8-month developmental outcome in preterm infants

This study investigated longitudinal relations between measures of neonatal state behavior and developmental outcome in a sample of preterm infants ( N = 16). Results indicate that irritability/reactivity in the neonatal period is positively associated with Bayley scores and exploratory play at 8 months. Conversely, neonatal alertness was not associated with these developmental measures. These preliminary findings, based on a small sample, are discussed in the context of preterm function.

Preoperative evaluation of serum CA 125 levels in premenopausal and postmenopausal patients with pelvic masses: Discrimination of benign from malignant disease

antimicrobial agents during pregnancy. Rev Infect Dis 1985;7:287-313. 12. Garite TJ, Keegan KA, Freeman RK, Nageotte MP. A randomized trial of ritodrine tocolysis versus expectant management in patients with premature rupture of membranes at 25 to 30 weeks of gestation. AM J OBSTET GYNECOL 1987; 157:388-93. 14. Quinn PA, Bauty J, Taylor J, Hannah W. Chorioamnionitis: Its association with pregnancy outcome and microbial infection. AM j 0BSTET GYNECOL 1987;156:37987. 15. Yeast JD, Garite TR. The role of cervical cerclage in the management of preterm premature rupture of the membranes. AM j 0BSTET GYNECOL 1988; 158:106-10. 13. Morales WJ. The effect of chorioamnionitis on the developmental outcome of preterm infants at one year. Obstet Gynecol 1987;70:183-6.

The Developmental Profile and Outcome of 325 Unselected Preterm Infants Up to Two Years of Age

A regional birth cohort of 351 preterm infants born between the 1st June, 1981 and the 31st May, 1982 was followed-up during the first two years of life. The follow-up data were obtained from 325 preterm infants. The term, appropriate-for-gestational age low-risk infants born in the region during the same period served as a control population. The follow-up examinations took place at the well-baby clinics run by public health nurses and health centre physicians at 3, 6, 12, 18 and 24 months of conceptional age. A modification of the Denver Developmental Screening Test was applied in the follow-up. In 15 (5%) preterm infants the developmental outcome at two years was doubtful or abnormal. The developmental outcome at two years was doubtful or abnormal. The developmental outcome in preterm infants was associated with gestational age, birthweight, severity of respiratory distress and five-minute Apgar score when analyzed separately. After stepwise logistic regression analysis only five-minute Apgar score significantly predicted the gross motor and fine motor outcomes while the psychosocial outcome was associated with five-minute Apgar score and birthweight. The developmental profiles of the preterm infants differed from those of the control infants by showing higher percentages of unoptimal scores especially in fine motor development at three months and psychosocial development at two years. The prognosis for preterm infants without complications was, however, near that of their term peers.

Developmental Outcome of Preterm Infants with Intraventricular Hemorrhage at One and Two Years of Age

Developmental Outcome of Preterm Infants with Intraventricular Hemorrhage at One and Two Years of Age