Developmental Outcome In Preterm Infants Research Articles

Developmental Outcomes of Preterm Infants Enrolled in a Randomized Clinical Trial of a Parent-Administered Sensorimotor Intervention in the NICU

Abstract Date Presented 03/22/24 This study revealed that a parent-administered sensorimotor intervention can enhance motor function in preterm infants, supporting the importance of OT’s advocacy for early parent-delivered interventions in the neonatal intensive care unit. Primary Author and Speaker: Sandra Fucile Contributing Authors: Laurie Snider, Kimberly Dow

Extrauterine Growth Restriction and Catch-up Growth Following NICU Discharge: A Tale of two Standards

Aim: Extrauterine growth restriction (EUGR) is common in premature infants, but the progression after neonatal intensive care unit (NICU) discharge is not well described. We aimed to assess EUGR after NICU discharge and to identify factors associated with catch-up growth (CUG) and neurodevelopmental outcomes at 2 years of age. Methods: Growth parameters at birth, 36 weeks postmenstrual age (PMA), and two neurodevelopmental follow-up visits for preterm graduates of our NICU were reviewed. EUGR was assessed using Fenton and Intergrowth-21 standards. Factors associated with outpatient growth and neurodevelopmental outcomes at 2 years of age were evaluated using logistic and linear regression. Results: 369 infants born at 24–32 weeks gestation comprised the cohort. EUGR prevalence was 14.9% for Intergrowth-21 versus 56.4% for Fenton ( p < .001). Although there was a significant decrease in weight z-score from birth to 36 weeks PMA, weight z-scores returned to their birth weight values at the second clinic visit (86 weeks PMA). Infants who received formula as opposed to human milk (HM) showed faster CUG. Higher scores in the Bayley-III scale at 2 years of age were associated with HM feeding. Discussion/Conclusion: Fewer infants were identified as EUGR when Intergrowth-21 versus Fenton growth standards were used, which categorizes infants with adverse clinical courses and poorer neurodevelopmental outcomes more distinctly. While growth failure during the birth hospitalization is common in preterm infants, outpatient CUG was demonstrated, with return to birth weight z-score. Our findings suggest that HM feeding may have a positive impact on cognitive, language, and motor developmental outcomes for preterm infants despite less rapid CUG.

The relationship between neonatal stress in preterm infants and developmental outcomes at the corrected age of 24-30 months.

The aim of research was to study the relationship between the stress experienced by preterm infants in the neonatal intensive care unit (NICU) and developmental status in the follow up, and to establish factors, associated with their neurodevelopment. The first stage of research involved measuring stress markers (cortisol, melatonin) in infants (n = 56) during their NICU stay; the second phase assessed the developmental status at the corrected age of 24-30 months. The total ASQ-3 score, communication, problem solving, and personal-social skills scores at the corrected age of 24-30 months were positively correlated with melatonin level determined in the neonatal period (r = 0.31, p = 0.026; r = 0.36, p = 0.009; r = 0.30, p = 0.033, and r = 0.32; p = 0.022 respectively). In the same time, ASQ-3 communication and personal-social scores were negatively correlated with cortisol level (r = -0.31, p = 0.043; r = -0.35, p = 0.022). The ROC-curve analysis revealed that a decrease of melatonin below 3.44 ng/mL and 3.71 ng/mL during the neonatal period could predict communication and problem-solving delay, respectively. An increase in cortisol above 0.64 mcg/dl is predictive in personal-social delay. Negative correlation was identified between the NICU and total hospital stay duration and ASQ-3 communication scores in the follow-up (r = -0.27; p = 0.049 and r = -0.41; p = 0.002, respectively). The duration of mechanical ventilation was negatively correlated with gross motor scores (r = -0.46; p = 0.043). Apgar score was positively correlated with ASQ-3 communication (r = 0.29; p = 0.032) and personal-social scores (r = 0.28; p = 0.034); maternal age-with ASQ-3 total (r = 0.29; p = 0.034), communication (r = 0.37; p = 0.006), and personal-social scores (r = 0.29; p = 0.041). Positive correlations were observed between gestational age and communication scores (r = 0.28; p = 0.033). Infants who suffered neonatal sepsis had significantly often delay of communication (p = 0.014) and gross motor skills (p = 0.016). Children who required mechanical ventilation were more likely to have communication delay (p = 0.034). Developmental outcomes in preterm infants at the corrected age of 24-30 months were associated with neonatal stress. Correlations between the communication, problem-solving and personal-social development in the follow up and cortisol and melatonin levels determined in the neonatal period supported this evidence. Factors as low gestational age, duration of hospital and NICU stay, mechanical ventilation, and sepsis were associated with more frequent delays in communication, gross motor and problems-solving skills.

Deep learning-based quantitative analyses of spontaneous movements and their association with early neurological development in preterm infants

This study aimed to develop quantitative assessments of spontaneous movements in high-risk preterm infants based on a deep learning algorithm. Video images of spontaneous movements were recorded in very preterm infants at the term-equivalent age. The Hammersmith Infant Neurological Examination (HINE) was performed in infants at 4 months of corrected age. Joint positional data were extracted using a pretrained pose-estimation model. Complexity and similarity indices of joint angle and angular velocity in terms of sample entropy and Pearson correlation coefficient were compared between the infants with HINE < 60 and ≥ 60. Video images of spontaneous movements were recorded in 65 preterm infants at term-equivalent age. Complexity indices of joint angles and angular velocities differed between the infants with HINE < 60 and ≥ 60 and correlated positively with HINE scores in most of the joints at the upper and lower extremities (p < 0.05). Similarity indices between each joint angle or joint angular velocity did not differ between the two groups in most of the joints at the upper and lower extremities. Quantitative assessments of spontaneous movements in preterm infants are feasible using a deep learning algorithm and sample entropy. The results indicated that complexity indices of joint movements at both the upper and lower extremities can be potential candidates for detecting developmental outcomes in preterm infants.

Maternal Singing but Not Speech Enhances Vagal Activity in Preterm Infants during Hospitalization: Preliminary Results.

Background: Early parental interventions in the Neonatal Intensive Care Units (NICUs) have beneficial effects on preterm infants’ short and long-term outcomes. The aim of this study was to investigate the effects of Early Vocal Contact (EVC)—singing and speaking—on preterm infants’ vagal activity and autonomic nervous system (ANS) maturation. Methods: In this multi-center randomized clinical trial, twenty-four stable preterm infants, born at 25–32 weeks gestational age, were randomized to either the EVC group or control group, where mothers did not interact with the babies but observed their behavior. Heart Rate Variability (HRV) was acquired before intervention (pre-condition), during vocal contact, and after it (post condition). Results: No significant effect of the vocal contact, singing and speaking, was found in HRV when the intervention group was compared to the control group. However, a significant difference between the singing and the pre and post conditions, respectively, preceding and following the singing intervention, was found in the Low and High Frequency power nu, and in the low/high frequency features (p = 0.037). By contrast, no significant effect of the speaking was found. Conclusions: Maternal singing, but not speaking, enhances preterm infants’ vagal activity in the short-term, thus improving the ANS stability. Future analyses will investigate the effect of enhanced vagal activity on short and long-term developmental outcomes of preterm infants in the NICU.

Pediatric Hypothermia: An Ambiguous Issue.

Hypothermia in pediatrics is mainly about small body size. The key thermal factor here is the large surface-to-volume ratio. Although small mammals, including human infants and children, are adapted to higher heat losses through their elevated metabolic rate and thermogenic capacity, they are still at risk of hypothermia because of a small regulatory range and an impending metabolic exhaustion. However, some small mammalian species (hibernators) use reduced metabolic rates and lowered body temperatures as adaptations to impaired energy supply. Similar to nature, hypothermia has contradictory effects in clinical pediatrics as well: In neonates, it is a serious risk factor affecting respiratory adaptation in term and developmental outcome in preterm infants. On the other hand, it is an important self-protective response to neonatal hypoxia and an evidence-based treatment option for asphyxiated babies. In children, hypothermia first enabled the surgical repair of congenital heart defects and promotes favorable outcome after ice water drowning. Yet, it is also a major threat in various prehospital and clinical settings and has no proven therapeutic benefit in pediatric critical care. All in all, pediatric hypothermia is an ambiguous issue whose harmful or beneficial effects strongly depend on the particular circumstances.

Autonomic Nervous System Maturation and Emotional Coordination in Interactions of Preterm and Full-Term Infants With Their Parents: Protocol for a Multimethod Study

BackgroundThere is limited knowledge on the physiological and behavioral pathways that may affect the developmental outcomes of preterm infants and particularly on the link between autonomic nervous system maturation and early social human behavior. Thus, this study attempts to investigate the way heart rate variability (HRV) parameters are related to emotional coordination in interactions of preterm and full-term infants with their parents in the first year of life and the possible correlation with the developmental outcomes of infants at 18 months.ObjectiveThe first objective is to investigate the relationship between emotional coordination and HRV in dyadic full-term infant–parent (group 1) and preterm infant–parent (group 2) interactions during the first postpartum year. The second objective is to examine the relationship of emotional coordination and HRV in groups 1 and 2 in the first postpartum year with the developmental outcomes of infants at 18 months. The third objective is to investigate the effect of maternal and paternal postnatal depression on the relation between emotional coordination and HRV in the two groups and on developmental outcomes at 18 months. The fourth objective is to examine the effect of family cohesion and coping on the relation between emotional coordination and HRV in the two groups and on developmental outcomes at 18 months.MethodsThis is an observational, naturalistic, and longitudinal study applying a mixed method design that includes the following: (1) video recordings of mother-infant and father-infant interactions at the hospital, in the neonatal period, and at home at 2, 4, 6, 9, and 12 months of the infants’ life; (2) self-report questionnaires of parents on depressive symptoms, family cohesion, and dyadic coping of stress; (3) infants’ HRV parameters in the neonatal period and at each of the above age points during and after infant-parent video recordings; and (4) assessment of toddlers’ social and cognitive development at 18 months through an observational instrument.ResultsThe study protocol has been approved by the Research Ethics Committee of the University of Crete (number/date: 170/September 18, 2020). This work is supported by the Special Account for Research Funds of the University of Crete (grant number: 10792-668/08.02.2021). All mothers (with their partners) of full-term and preterm infants who give birth between March 2021 and January 2022 at the General University Hospital of Crete (northern Crete, Greece) will be invited to participate. The researcher will invite the parents of infants to participate in the study 1 to 2 days after birth. Data collection is expected to be completed by March 2023, and the first results will be published by the end of 2023.ConclusionsInvestigating the regulatory role of HRV and social reciprocity in preterm infants may have implications for both medicine and psychology.International Registered Report Identifier (IRRID)PRR1-10.2196/28089

Maturation of the cardiac autonomic regulation system, as function of gestational age in a cohort of low risk preterm infants born between 28 and 32weeks of gestation.

The maturation of the sympathetic nervous system (SNS) occurs steadily throughout gestation while the myelinated vagus has accelerated maturation periods, between 25 and 32weeks of gestation and a further increase around 37-38weeks of gestation. The aim was to quantify the cardiac autonomic regulation maturation, as a function of gestational age (GA) in a cohort of low risk preterm infants born between 28 and 32weeks of gestation by assessing heart rate variability (HRV) at week 32, and at week 35 postmenstrual age (PMA). Forty preterm infants were recruited, 24h recordings of breathing rate and RR intervals were obtained at week 32 and week 35 PMA. A significant difference was noted between preterm infants born before 32weeks GA and preterm infants born at week 32; the latter present higher HRV values throughout the follow-up period. No significant change over time was noted for the parasympathetic HRV measures while a significant increase was found in the sympathetic system. Moreover, a significant interaction effect of time and system was found, the increase in values of the sympathetic system over time was significantly larger than the change noted in the vagal HRV measures. Given the beneficial influence of vagal tone on health and developmental outcomes in preterm infants, the findings of the current study highlight the need for further studies on the impact of specifics gestational age on vagal development and later assessing interventions associate with its continue development and maturation at these specific periods.

Brain White Matter Maturation and Early Developmental Outcomes in Preterm Infants With Retinopathy of Prematurity.

PurposeTo investigate brain white matter pathways using magnetic resonance diffusion tensor imaging (DTI) and correlate the findings with developmental outcomes at 18 months of corrected age in preterm infants with and without retinopathy of prematurity (ROP).MethodsIn this prospective cohort study, probabilistic maps of the 26 white matter pathways associated with motor, cognitive, visual, and limbic/language functions were generated in 84 preterm infants using DTI obtained at term-equivalent age. The mean fractional anisotropy (FA) and mean diffusivity (MD) values were compared between those with and without ROP. Developmental outcomes were assessed using the third edition of Bayley Scales of Infant and Toddler Development (BSID-III) at 18 months of corrected age. Multiple regression analyses were performed to confirm the association among developmental outcomes, white matter pathways, and ROP or severe ROP after adjusting for potential confounders.ResultsThe white matter pathways were insignificantly associated with ROP or severe ROP. There were no significant differences in the FA and MD values of the pathways between ROP infants treated with and without bevacizumab therapy. Furthermore, there were no significant differences in BSID-III scores between infants with and without ROP or severe ROP. The BSID-III scores at 18 months of age showed a significant association with FA or MD values in several pathways.ConclusionsROP or severe ROP was insignificantly associated with maturation delay of the white matter pathways. Developmental outcomes were similar between preterm infants with and without ROP or severe ROP or between ROP infants with and without intravitreal bevacizumab therapy.

Effect of individualized home-based intervention program in preterm infants at 35-36 weeks gestational age using prechtl’s general movement assessment: a pre-post experimental study

Background: Preterm birth associated with various abnormalities can have a detrimental impact on an infant’s developmental outcome which marks the need of a landmark tool to detect an abnormality at an early age and incorporate specific intervention strategies. Positive effects of intervention on developmental outcomes have been noted, however tailored home-based intervention programs on developmental enhancements are essential. Purpose: To evaluate the impact of Individualized Home Based Developmental Program on the neurodevelopmental outcome of preterm infants using Prechtl’s General Movement Assessment. Methodology: Ninety preterm infants admitted to the NICU (Neonatal Intensive Care Unit)of a tertiary care hospital in Tertiary care hospital at Belagavi, Karnataka, India. The study was carried out for a duration of 12 months. Participants were conveniently selected from a population-based sample from May 2018 to March 2019. Based on the inclusion criteria of the study, these infants were screened for the movement trajectories on Prechtl’s GMA at 3-36- and 38-40-weeksGA(Gestational Age) respectively. Out of the 90 infants, 19 infants showing abnormal movement trajectories were recruited for individualized home-based developmental program for a duration of 12 weeks followed by re-evaluation at 3 months post term age. Results: The results were statistically significant (p&lt;0.001) with 14 out of 19 infants exhibiting 70% improvement with normal Fidgety movements at 3 months post term age. Conclusion: IHBP delivered for 12 weeks was found to be effective in promoting developmental outcome in preterm infants. KEY WORDS: Preterm infants, Prechtl’s General Movement Assessment, home-based early intervention.

Longitudinal changes in attachment patterns of preterm infants born in a non-Western country.

Unexpected early birth of an infant may affect the attachment formation of mother-child dyads. This longitudinal study aimed to explore mother-infant attachment patterns of very preterm (VPT) and preterm (PT) infants compared to their term-born peers in a non-Western country. Neurodevelopmental outcomes of infants, maternal anxiety and depressive symptoms, and sociodemographic features were evaluated to explore their effects on attachment. Eighteen VPT, 11 PT, 11 term infants and their mothers participated. Observations of attachment patterns and neurodevelopmental assessments were performed at 18 and 24 months of corrected age. This study identified a change in attachment patterns of VPT infants over time such that VPT infants tended to have less insecure attachment patterns with their mothers at the end of the infancy period. While motor and language development scores were associated with attachment patterns at 18 months, models predicting attachment patterns were no longer significant at 24 months. Therefore, change in VPT infants' developmental outcomes and attachment patterns over time suggests that preterm birth itself is not necessarily a risk factor for developing insecure attachment patterns; yet, developmental delays may account for insecure attachment patterns. It is suggested that efforts to promote developmental outcomes of preterm infants may improve mother-child attachment.

Factors related to enrolment in early therapy services following neonatal intensive care unit discharge.

Early therapy can improve developmental outcomes for preterm infants. However, preterm infants who are referred have low enrolment in early therapy services following neonatal intensive care unit (NICU) discharge. This manuscript aims to investigate the relationship between infant medical and sociodemographic factors and enrolment in early therapy services post-NICU discharge, when system-related barriers to access are minimised. This was a retrospective investigation of 89 families with infants born ≤32weeks of gestation. Families were approached for enrolment into early therapy services following NICU discharge through Baby Bridge programming, which aims to improve access to therapy services following NICU discharge. Seventy-three (82%) families enrolled in early therapy services, and 16 (18%) families declined. Parents were more likely to enrol in early therapy if they had public insurance (P=0.01), a maternal psychiatric diagnosis (P=0.02) or additional children under 18years in the home (P=0.01). No infant medical factors were related to enrolment. Although enrolment rates were high, 18% of families refused therapy services, despite removing system-related barriers to access. Targeted interventions can be developed to increase enrolment in early therapy services among populations who are most likely to refuse therapy services after NICU discharge.

Can Use of Cerebral Oxygenation Predict Developmental Outcomes in Preterm Infants With NEC?

* Abbreviations: NEC — : necrotizing enterocolitis NIRS — : near-infrared spectroscopy In this issue of Pediatrics, Howarth et al1 report on a completed longitudinal study of 46 preterm infants born at <30 weeks’ gestational age in which they recorded cerebral oxygenation using near-infrared spectroscopy (NIRS) for 1 hour per week until hospital discharge or transfer. The 6 infants who developed necrotizing enterocolitis (NEC) had consistently lower levels of cerebral oxygenation (mean −6.6%) and small increases in cerebral fractional tissue oxygen extraction (mean 0.08) throughout the study. Using multilevel mixed-effects linear models nested within each infant, the authors adjusted for a large number of confounding variables, including patent ductus arteriosus, sex, ethnicity, volume of enteral feeding, hemoglobin, and gestational age. Although the small number of infants who developed NEC limited the study, the study provides preliminary evidence that lowered cerebral oxygenation may underpin the worse neurodevelopmental outcomes that have been reported in preterm infants with NEC.2–4 Worldwide, >15 million infants are born preterm (<37 weeks’ gestation) each year, and these rates are increasing. Improvements in the care of these infants have dramatically improved survival. However, contrary to expectations, recent data, in which outcomes in … Address correspondence to Rosemary S.C. Horne, PhD, DSc, Department of Paediatrics, Level 5, Monash Children’s Hospital, 246 Clayton Rd, Melbourne, VIC 3168, Australia. E-mail: rosemary.horne{at}monash.edu

Is sensory processing associated with prematurity, motor and cognitive development at 12 months of age?

BackgroundPrematurity may be a risk factor for sensory processing difficulties. Limited research has investigated sensory processing in preterm infants in their first year of life, when sensory processing dysfunctions are more subtle and difficult to detect. AimsThe aims of this study were to investigate the association between prematurity and sensory processing and the associations between sensory processing and motor and cognitive development in infants at 12 months of age. Study designCross-sectional study. Subjects45 infants allocated in two groups: control (37–41 weeks' gestation) and preterm (<34 weeks' gestation). Outcome measuresSensory processing was assessed with the Test of Sensory Functions in Infants (TSFI). Motor and cognitive development was assessed with the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). ResultsPreterm group was associated with significant decrease in TSFI's total (p < 0.01), reactivity to deep tactile pressure (p = 0.02) and vestibular stimulation reactivity (p = 0.03) scores. Bayley-III motor score was positive associated with TFSI score on ocular-motor control domain (p = 0.03). Bayley-III cognitive score and TSFI scores were not significantly associated. ConclusionsPrematurity negatively interferes with sensory processing, especially in tactile and vestibular domains, and better sensory processing in ocular-motor control contributes to better motor performance at 12 months of age. It is important to consider sensory processing in early developmental evaluation and interventions to promote better developmental outcomes in preterm infants.

Predicting developmental outcomes in preterm infants: A simple white matter injury imaging rule.

To develop a simple imaging rule to predict neurodevelopmental outcomes at 4.5 years in a cohort of preterm neonates with white matter injury (WMI) based on lesion location and examine whether clinical variables enhance prediction. Sixty-eight preterm neonates born 24-32 weeks' gestation (median 27.7 weeks) were diagnosed with WMI on early brain MRI scans (median 32.3 weeks). 3D T1-weighted images of 60 neonates with 4.5-year outcomes were reformatted and aligned to the posterior commissure-eye plane and WMI was classified by location: anterior or posterior-only to the midventricle line on the reformatted axial plane. Adverse outcomes at 4.5 years were defined as Wechsler Preschool and Primary Scale of Intelligence full-scale IQ <85, cerebral palsy, or Movement Assessment Battery for Children, second edition percentile <5. The prediction of adverse outcome by WMI location, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP) was assessed using multivariable logistic regression. Six children had adverse cognitive outcomes and 17 had adverse motor outcomes. WMI location predicted cognitive outcomes in 90% (area under receiver operating characteristic curve [AUC] 0.80) and motor outcomes in 85% (AUC 0.75). Adding IVH, BPD, and ROP to the model enhances the predictive strength for cognitive and motor outcomes (AUC 0.83 and 0.88, respectively). Rule performance was confirmed in an independent cohort of children with WMI. WMI on early MRI can be classified by location to predict preschool age outcomes in children born preterm. The predictive value of this WMI classification is enhanced by considering clinical factors apparent by term-equivalent age.

Developmental outcomes of preterm infants with bronchopulmonary dysplasia-associated pulmonary hypertension at 18\u201324\u2009months of corrected age

BackgroundOwing to advances in the critical care of premature infants with bronchopulmonary dysplasia (BPD), BPD-associated pulmonary hypertension (PH) is becoming a growing concern. However, only few investigations were available on neurodevelopmental outcomes in preterm infants with PH. Therefore, this study aimed to identify the impact of PH on growth and neurodevelopment at 18–24 months of corrected age (CA).MethodsWe retrospectively analyzed the medical records of 394 infants (aged < 28 weeks of gestation) admitted to the neonatal intensive care unit between 2005 and 2014. Among the surviving infants, 123 returned for follow-up evaluations including the Bayley Scales of Infant and Toddler Development, third Edition (Bayley-III) screening tests and growth assessment at 18–24 months of CA. Among the 81 infants with moderate or severe BPD, 20 met the criteria for PH. Baseline characteristics and outcomes were compared in infants who developed BPD-associated PH (PH group, n = 20) and moderate or severe BPD infants who did not develop PH (non-PH group, n = 61).ResultsCompared to the non-PH group, the PH group showed significantly lower cognitive (85 vs. 95, p = 0.004), language (81 vs. 89, p = 0.040), and motor (88 vs. 94, p = 0.010) scores of the Bayley-III at 18–24 months of CA. Cognitive delay was found in 45.0% (9/20) of PH infants. In addition, z-scores of weight (− 1.4 ± 1.3 vs. -0.6 ± 1.1%, p = 0.011) and HC (− 1.2 ± 1.8 vs. 0.53 ± 1.0%, p = 0.035) were significantly lower in the BPD with PH group. With the subgroup analysis in infants with severe BPD only, the cognitive score was consistently lower and poorer and weight gain after discharge was identified in infants with PH and severe BPD.ConclusionPH was a worsening factor of non-optimal growth and poor neurodevelopmental outcome in preterm infants with BPD at 18–24 months of CA. Our findings suggest the importance of close developmental follow-up and recognition of that risk to help optimize the outcome of preterm infants with PH.

Prediction of short term developmental outcomes in preterm infants utilizing cranial ultrasound examination

Background: Premature birth is associated with brain lesions mostly resulting from hypoxia-ischaemia and haemorrhage. Clinicians routinely need to provide parents and carers with prognostic information for their vulnerable infants, and most do this with the aid of some forms of neuroimaging. Studies of the relationship between ultrasound images from preterm newborns and developmental delay at 6 months’ corrected age. Methods: We evaluated associations between ultrasound-defined lesions of the brain and developmental delays at 6 months’ corrected age in 79 children born before the 37th postmenstrual week. Brain ultrasound scans were read for concordance on 4 lesions: Intraventricular haemorrhage; Periventricular leukomalacia; Ventricular dilatation; Other lesion (congenital anomaly, cystic lesion). Developmental assessment at 6 months by using Denver II developmental screening test and a neurologic examination. Results: Fully 24.1% of all of the children had delayed mental and/or psychomotor development. Ultrasound abnormalities were more strongly associated with developmental delays. They were intraventricular haemorrhage (RR 9.6) had periventricular leukomalacia (RR 10.3), ventricular dilatation (RR 18), congenital anomaly (RR 18) and cystic lesion (RR 18). Several peninatal variables including afgar score at 5 mins <7, hyaline membrane disease and mechanical ventilation are each associated with an elevated risk of developmental delays. Conclusion: Cranial ultrasound provides a good screening tool for detection of brain injury in preterm infants during hospitalisation. Future studies are necessary to evaluate whether MRI of preterm infants can lead to a more accurate prediction of the neurodevelopmental impairment.

Health, Physical Growth, and Neurodevelopmental Outcomes in Preterm Infants of Women With Hypertensive Disorders of Pregnancy

ObjectiveTo compare the health, physical growth, and developmental outcomes in preterm infants of women with and without hypertensive disorders of pregnancy (HDP). DesignCross-sectional analysis of health outcomes; physical growth (head circumference, height, and weight) collected at birth and 2 months, corrected for prematurity; and cognitive, language, and motor skills of preterm infants of women with and without HDP. SettingFour NICUs in the United States. ParticipantsWomen (n = 221) and their preterm infants who weighed less than 1,750 g were enrolled in a multicenter, randomized trial of two interventions administered by each infant’s mother when the infant was no longer critically ill. MethodsWomen and their preterm infants were categorized into groups with (n = 80) and without (control, n = 141) HDP. Data were extracted from infants’ medical records, and the women completed questionnaires. ResultsThe infants of women with HDP were more likely to be small for gestational age than the infants of women without HDP (31.7% vs. 10.6%, p < .002). The proportion of infants with greater neurologic risk, patent ductus arteriosus, intraventricular hemorrhage, and days on a ventilator did not differ between the groups. Although mean infant height at 2 months was less in the HDP group than the control group, other growth and neurodevelopmental outcomes did not differ between the groups. ConclusionAmong preterm infants admitted to NICUs, those born to women with HDP were more likely to be small for gestational age than those born to normotensive women. Additional research is needed to optimize care for infants born to women with HDP.

Population Characteristics, Clinical Course and Developmental Outcomes of Preterm Infants with Cerebellar Hemorrhage

Population Characteristics, Clinical Course and Developmental Outcomes of Preterm Infants with Cerebellar Hemorrhage

Carnitine deficiency in preterm infants: A national survey of knowledge and practices.

Lipid supplementation improves developmental outcomes in preterm infants. Carnitine is essential for lipid metabolism; however, despite high risk for carnitine deficiency, there are no standards for carnitine supplementation in preterm infants receiving total parenteral nutrition (TPN). Our objective was to assess knowledge, beliefs and practices regarding preterm carnitine deficiency and supplementation among neonatal practitioners. Cross-sectional electronic survey administered via a nationally representative listserv of neonatal practitioners. 492 respondents participated in the survey. Only 21% of respondents were aware that carnitine is secreted by the placenta. 72% believed that carnitine deficiency was common, and 60% believed deficiency could have serious consequences. Five percent routinely screened for deficiency, and 40% routinely provided carnitine supplementation. Respondents with >5 years' experience were more likely to report using carnitine supplementation (50% vs. 38%). Although most respondents believed that carnitine deficiency is common and could have serious consequences, few screened for deficiency and fewer than half routinely supplemented. Thus, many preterm infants remain at risk for carnitine deficiency. Further research is needed to elucidate the risks of carnitine deficiency in these vulnerable infants.