Discharge In Preterm Infants Research Articles

Impact of intrauterine growth restriction on preterm lung disease.

Intrauterine growth restriction (IUGR) is an important cause for prematurity and adversely influences prematurity-related morbidities. This study evaluates the impact of IUGR on respiratory outcomes in infants <32 weeks with IUGR and birthweight <10th centile (SGA) compared to matched appropriate for gestation (AGA) controls. The primary outcomes of this retrospective study are short-term pulmonary outcomes of chronic lung disease (CLD), CLD or death, and need for home oxygen at discharge. Subgroup analysis by gestation-based stratification (<28 and ≥28 <32 weeks) was decided a priori. Total of 153 IUGR and 306 non-IUGR infants were enrolled. The rate of CLD (45% vs. 17%, p = 0.0001), death (16% vs. 4.6%, p = 0.0001), CLD or death (46% vs. 21.5%, p = 0.0001), home oxygen rates (13.7% vs. 6.5%, p = 0.01) and duration of respiratory support was significantly higher in the IUGR group. IUGR emerged as the strongest predictor of CLD (adjusted OR, 95%CI: (8.4 [2, 35]) and CLD or death (12.7 [3, 54]) across all gestation. IUGR is a major risk factor for adverse short-term pulmonary outcomes as reflected by higher rates of CLD, CLD or death, and oxygen dependency at discharge in preterm infants.

Impact of Oral Sensory Motor Stimulation on Feeding Performance, Length of Hospital Stay, and Weight Gain of Preterm Infants in NICU

Background:One of the limiting factors for early hospital discharge in preterm infants is their inability to feed sufficiently to obtain consistent weight gain. Therefore, feeding difficulty is one of the most significant issues with which a preterm infant is faced.Objectives:The purpose of this study was to examine the effect of oral sensory motor stimulation on feeding performance, length of hospital stay, and weight gain in preterm infants at 30 - 32 weeks of gestational age.Patients and Methods:Premature infants (n = 20) were randomly assigned to experimental and control groups. The experimental group received oral sensory motor stimulation of the oral structures (15 minutes / day) for 10 successive days, while these stimulations were not offered to the control group. Days elapsed to achieve oral feeding, length of hospital stay, and weight gain in the two groups were assessed.Results:Transition to oral feeding was acquired significantly earlier in the infants in the experimental group than in the controls: 13 and 26 days, respectively (P < 0.001). Likewise, the length of hospitalization was significantly shorter in the experimental group than in the control group: 32 days and 38 days, correspondingly (P < 0.05). The two groups showed no significant difference in terms of weight gain in the first, second, third, and fourth weeks of birth: first week: 100 vs. 110; second week: 99 vs. 111; third week: 120 vs. 135; and fourth week: 129 vs. 140.Conclusions:The present research revealed that the number of days to reach oral feeding in our preterm babies was decreased by oral motor stimulation, which in turn conferred earlier hospital discharge.

Death or survival with major morbidity in VLBW infants born at Brazilian neonatal research network centers

Objective: To analyze unfavorable outcomes at hospital discharge of preterm infants born at Brazilian public university centers.Methods: Prospective cohort of 2646 inborn infants with gestational age 23–33 weeks and birth weight 400–1499 g, without malformations, born at 20 centers in 2012–2013. Unfavorable outcome was defined as in-hospital death or survival at hospital discharge with ≥1 major morbidities: bronchopulmonary dysplasia (BPD) at 36 corrected weeks, intraventricular hemorrhage (IVH) grades 3–4, periventricular leukomalacia (PVL) or surgically treated retinopathy of prematurity (ROP).Results: Among 2646 infants, 1390 (53%) either died or survived with major morbidities: 793 (30%) died; 497 (19%) had BPD; 358 (13%) had IVH 3–4 or PVL; and 84 (3%) had ROP. Logistic regression adjusted by center showed association of unfavorable outcome with: antenatal steroids (OR 0.70; 95%CI 0.55–0.88), C-section (0.72; 0.58–0.90), gestational age <30 (4.00; 3.16–5.07), being male (1.44; 1.19–1.75), small for gestational age (2.19; 1.72–2.78), 5th-min Apgar <7 (3.89; 2.88–5.26), temperature at NICU admission <36.0 °C (1.42; 1.15–1.76), respiratory distress syndrome (3.87; 2.99–5.01), proven late sepsis (1.33; 1.05–1.69), necrotizing enterocolitis (3.10; 2.09–4.60) and patent ductus arteriosus (1.69; 1.37–2.09).Conclusions: More than half of the VLBW infants born at public university level 3 Brazilian hospitals either die or survive with major morbidities.

A light/dark cycle in the NICU accelerates body weight gain and shortens time to discharge in preterm infants

BackgroundBright constant light levels in the NICU may have negative effects on the growth and development of preterm infants ObjectiveThe aim of this study is to evaluate the benefits of an alternating light/dark cycle in the NICU on weight gain and early discharge from the therapy in premature infants. Patients and methodsA randomized interventional study was designed comparing infants in the NICU of Hospital Juarez de México, exposed from birth either to an LD environment (LD, n=19) or to the traditional continuous light (LL, n=19). The LD condition was achieved by placing individual removable helmets over the infant's heads. Body weight gain was analyzed, as the main indicator of stability and the main criteria for discharge in preterm infants born at 31.73±0.31week gestational age. ResultsInfants maintained in an LD cycle gained weight faster than infants in LL and therefore attained a shorter hospital stay, (34.37±3.12 vs 51.11±5.29days; P>0.01). Also, LD infants exhibited improved oxygen saturation and developed a daily melatonin rhythm. ConclusionsThese findings provide a convenient alternative for establishing an LD environment for preterm healthy newborns in the NICU and confirm the beneficial effects of an alternating LD cycle for growth and weight gain and for earlier discharge time. Here we provide an easy and practical alternative to implement light/dark conditions in the NICU.

Effects of pre-feeding oral stimulation on oral feeding in preterm infants: A randomized clinical trial

ObjectiveTo evaluate the effect of early oral stimulation before the introduction of oral feeding, over the duration of concomitant tube feeding (“transition period”), the length of hospital stay and the breastfeeding rates upon discharge in preterm infants. Study designPreterm infants born between 26 and 33 weeks gestational age (n=86), were randomized into an intervention and control group. Infants in the intervention group received an oral stimulation program consisting in stimulation of the oral structures for 15 min at least for 10 days, before introduction of oral feeding. Oral feeding was introduced at 34 weeks GA in both groups. ResultsBreastfeeding rates upon discharge were significantly higher in the intervention than in the control group (70% versus 45.6%, p=0.02). There was no statistical difference between the two groups in terms of the length of the transition period or the length of the hospital stay.The need for prolonged CPAP support (HR=0.937, p=0.030) and small size for gestational age at birth (HR=0.338, p=0.016) were shown to be risk factors for a prolonged transition period. ConclusionA pre-feeding oral stimulation program improves breastfeeding rates in preterm infants. The study results suggest that oral stimulation, as used in our specific population, does not shorten the transition period to full oral feeding neither the length of hospital stay.

Peculiarities of physical growth and body composition of preterm infants, received different types of feeding, at the discharge from hospital

This article is devoted to a research and practice problem--optimization of feeding preterm infants. 80 preterm infants of different GA with perinatal pathology were included in the study group. Anthropometric figures of weight and length z-scores and also BMI of preterm infants, received different types of feedings, at the discharge are presented. All patients' body composition (Fat free mass and Fat mass) was estimated by air plethysmography. Less mass and length at the discharge in preterm infants, received breast feeding (including fortified milk), in comparison with the infants, received mixed and formula feeding, were found out. At the same time, preterm infants received breast feeding had more optimal body composition (less fat mass), than the infants received formula feeding. Personalised approach to human milk fortifiers prescription is explained. Important practical value of methodology for estimating body composition by air plethysmography is established.

Pulse-Oximetry Screening to Detect Critical Congenital Heart Disease in the Neonatal Intensive Care Unit

The current pulse-oximetry screening (POS) protocol for detection of critical congenital heart defects (CCHDs) is recommended only for newborns in well-infant and intermediate care nurseries, and there is no evidence-based protocol for infants discharged from the neonatal intensive care unit (NICU). The objectives of this study were to examine the efficacy of the current screening protocol in a NICU setting and to determine the impact of a unit protocol on the use of POS. Charts of 250 infants previous (group 1) and 250 infants after (group 2) the protocol implementation were reviewed. The results of screening test and preductal and postductal SpO₂ were recorded for screened infants. A predischarge SpO₂ value was recorded if screening was not performed. No infant in group 1 had POS. All eligible infants in group 2 received screening and passed. Preductal and postductal oxygen saturations in preterm infants at discharge were similar to saturations in late preterm and term infants. These results show that oxygen saturations at discharge in late preterm and term infants requiring admission to the NICU are similar to infants with no morbidities and that the current POS protocol can be safely used for these infants at discharge from the NICU. This study also confirms that preductal and postductal oxygen saturations at discharge in preterm infants are not different from those in late preterm and term infants. A unit protocol is likely to be more effective than relying on individual providers to ensure that all infants undergo POS for detection of CCHD.

Potential influence of total parenteral nutrition on body composition at discharge in preterm infants

Objective: This study was undertaken to assess the potential influence of total parenteral nutrition (TPN) on body composition (BC) in preterm infants.Study design: This prospective, observational study of infants born <35 weeks measured BC at discharge using air displacement plethysmography. The % body fat (BF) at discharge was correlated with variables gestational age (GA), severity of illness, days on oxygen, time to regain birth weight and duration of TPN.Result: The 61 patients enrolled had a %BF at discharge of 13.9%. GA and TPN days correlated with %BF for the entire group. Multiple regression analysis identified that the time to regain birth weight added to the effect of GA, but not TPN. Isolating the influence of TPN in a subgroup of similarly aged infants (30–35 weeks) did not reveal a difference in body composition at the time of discharge between infants who did or did not receive TPN.Conclusion: These findings fail to demonstrate a clear influence of TPN on the increased accrual of BF in premature infants and implicate gestational modification in nutrient/caloric utilization as a principle regulator of body composition in premature newborns.

Recém-nascido prematuro: suporte materno domiciliar para o cuidado

Este estudo descritivo, com abordagem qualitativa, teve como objetivo identificar o suporte materno, no domicílio, para o cuidado do recém-nascido prematuro egresso de Unidade Neonatal. O estudo, realizado em 2008, entrevistou doze mães residentes no município de Sumaré-SP. Os relatos, gravados, foram tratados pela técnica do Discurso do Sujeito Coletivo (DSC). Os resultados acrescem o conhecimento de enfermagem pela diversidade de recursos que emergiram, e que revelaram a importância da inserção materna na Unidade Neonatal; valorizaram a Cartilha de orientação oferecida pelo serviço; e destacaram a relevância do apoio social para o cuidado do bebê, no domicílio. Recomenda-se a inserção do familiar no plano de enfermagem para a alta do prematuro na Unidade Neonatal.

Urinary N-Terminal B-Type Natriuretic Peptide Predicts Severe Retinopathy of Prematurity

The goal of this study was to evaluate urinary N-terminal fragment of B-type natriuretic peptide concentrations, normalized to creatinine (UNBCR), to predict morbidities at discharge in preterm infants. UNBCR were determined in urine collected on day of life (DOL) 2, 7, 14, and 28 in 136 preterm infants <1500 g birth weight, 22 of whom developed bronchopulmonary dysplasia (BPD), defined as oxygen supplementation at 36 weeks' gestational age) and 11 infants developed severe retinopathy (ROP), defined as stage 3 or stage ≥ 2 requiring surgery). UNBCR on DOL 7, 14, and 28 was elevated in infants who developed BPD or ROP compared with controls (P ≤ .001). On multiple regression analysis including birth weight and gestational age, ROP but not BPD remained independently associated with UNBCR on DOL 14 and 28. Areas under receiver operating characteristic curves for UNBCR on DOL 14 and 28 to predict ROP were 0.938 (0.027) and 0.954 (0.021), respectively. UNBCR DOL 14 and 28 thresholds exceeded by all infants with severe ROP (100% sensitivity, 100% negative predictive value) had a specificity of 66% and 85%, respectively. UNBCR might hold promise to reduce unnecessary eye examinations by timely and accurate identification of infants at risk of severe ROP.

Early Weaning From Incubator and Early Discharge of Preterm Infants: Randomized Clinical Trial

Early Weaning From Incubator and Early Discharge of Preterm Infants: Randomized Clinical Trial

PP-28. Comparison of findings on cranial ultrasound and magnetic resonance imaging before discharge in preterm infants. Correlation with the neurological examination

PP-28. Comparison of findings on cranial ultrasound and magnetic resonance imaging before discharge in preterm infants. Correlation with the neurological examination

362 Leptin Levels and Body Composition During the First Year of Life in Premature Infants and Their Relationship with Nutrition

Aims: To analyze the changes in leptin serum levels (LSL), body mass index (BMI) and total body fat (TBF) during the first year in preterm infants (PI), comparing those who received an adapted standard formula (AF) after hospital discharge with those fed with a formula for premature infants (PF). Methods: Seventy-two PI were included in the study (32.1±1.9 weeks and 1,712±340 g). Thirtysix received AF (Energy: 67kcal/100ml; proteins: 1.2g/100ml) and 36 received PF (Energy: 81kcal/100ml, proteins: 2.3g/100 ml) from hospital discharge until corrected postnatal age (CA) of 4 months. The data were obtained at 36 weeks postconceptional age (PCA, baseline), and at 3, 6 and 12 months CA. Results: In all the PI studied, skinfold measurements and percentage TBF showed an important increase from baseline to 3 months CA, decreasing from 6 to 12 months CA. LSL showed a significant correlation with these variables at 3 and 6 months CA, and also with BMI at 6 months CA. Throughout the study period, the infants fed with PF showed significant higher values for BMI at 6 and 12 months CA, as well as for the increase in BMI and sum of 4 skinfolds from 36 weeks PCA to 6 months CA. There were no significant differences between the two groups in size or LSL. Conclusions: Nutrition with a formula of greater energy and protein content during the first four months after hospital discharge in PI was associated with higher BMI and body fat without affecting statural growth or LSL.

67 Early Weaning From Incubator and Early Discharge of Preterm Infants: A Randomized Clinical Trial

Objective: Early discharge is to be pursued in preterm infants. The aim of this study was to evaluate the feasibility of an earlier weaning from incubator in preterm infants, and its impact on an earlier discharge. Methods: This prospective randomized study included preterm infants with birth weight < 1600 grams admitted in our Neonatal Sub-Intensive Ward. 47 infants transferred from incubator to an open crib at > 1600 grams (ET Early Transition group) were compared with 47 infants transferred from incubator to an open crib at > 1800 grams (ST Standard Transition group). The primary outcome of the study was the length of stay (LOS). Secondary outcomes were the number of infants returned to incubator, growth velocity (GV) in open crib and during the first week at home, the proportion of breastfeeding at discharge and during the first week at home, and the hospital readmission rate. Results: LOS was significantly shorter in ET than in ST (26 ± 9 vs 35 ± 12 days; p = 0.0001). No infants required to be transferred back to the incubator. Only one infants from ST group was readmitted to the hospital during the first week after discharge. GV and breastfeeding rate were similar between the two groups. Conclusions: This randomized clinical study demonstrates that weaning preterm infants from incubators to an open crib at weight as low as 1600 g is associated with an early discharge home without apparent adverse effects.

Early Weaning From Incubator and Early Discharge of Preterm Infants: Randomized Clinical Trial

The goal was to assess the feasibility of earlier weaning from the incubator for preterm infants. This was a prospective, randomized study with preterm infants with birth weights of <1600 g who were admitted to a neonatal subintensive ward. Findings for 47 infants who were transferred from an incubator to an open crib at >1600 g (early transition group) were compared with those for 47 infants who were transferred from an incubator to an open crib at >1800 g (standard transition [ST] group). The primary outcome of the study was length of stay. Secondary outcomes were the number of infants returned to an incubator, the growth velocity in an open crib and during the first week at home, the proportions of breastfeeding at discharge and during the first week at home, and the hospital readmission rate. The length of stay was significantly shorter in the early transition group than in the standard transition group (23.5 vs 33 days; P=.0002). No infants required transfer back to the incubator. Only 1 infant in the standard transition group was readmitted to the hospital during the first week after discharge. Growth velocities and individual amounts of breastfeeding were similar between the 2 groups. In this study, weaning of moderately preterm infants from incubators to open cribs at 1600 g was safe and resulted in earlier discharge.

31 Oral Feeding Disorders at Hospital Discharge: A Unique Marker of Disability?

The purpose of this study was to determine the prevalence of oral feeding problems at hospital discharge for preterm infants and to assess if these could be markers of later disability. This was a retrospective review of patients enrolled in a follow-up clinic database. Infants included were ≤ 32 wk GA, seen for the initial clinic visit between January 1, 2002 to December 31, 2004. 71/328 (22%) infants had oral feeding disorders (OFD) as defined by having one or more of the following at hospital dismissal: use of tubes and/or feeding pump, feeding more frequently than every 3 hours secondary to poor volume tolerance, and/or less than 100% of feeding orally. A comparison group of infants was determined by matching each study infant with the next infant in the database without a feeding problem but with the same GA (± 1 wk) and BW (± 100g). Medical complications and limited outcome data were obtained by database review. Group differences were determined by chi-square and univariate analysis of variance with significance indicated by P<.05. There were no group differences in BW (1023 ± 370 and 1026 ± 345 g, OFD and control, respectively), GA (27.6 ± 2.5 wk, both), or gender. OFD infants were, on average, discharged from the hospital 5 weeks later and 880 g heavier than comparisons (P=.000). There were no group differences in rates of severe IVH or ROP. OFD infants were more likely to have CLD (52% and 35%, P=.04) and be discharged on a home apnea monitor (47% and 25%, P=.009). 39% of OFD infants had neither CLD or IVH. A subset of infants had 24-month developmental screening using the Bayley Infant Neurodevelopmental Screener (BINS). Controlling for CLD and maternal race, OFD infants (n=14) tended to have a lower mean BINS scores than comparisons (n=30), 6.9 ± 3.6 and 4.3 ± 3.2, P=.08. Preterm infants appear to frequently have oral feeding problems at hospital discharge. Additional study of this population is needed to determine possible etiologies and long-term implications of delayed oral feeding, which could be a unique marker of disability.

Short‐term outcome in infants with a birthweight less than 501 grams

To report survival and morbidity until discharge in preterm infants <501 g with life support started immediately after birth. Cohort study of all preterm infants with birthweights < 501 g born in three tertiary perinatal centres between 1 January 1998 and 31 December 2001 (gestational age (GA) 25.2 [21.0-30.7] wk; birthweight 435 [290-500] g; median [range]). A total of 107 infants with birthweights <501 g were born. Twenty-nine were stillborn. A prenatal decision to initiate life support immediately after birth was reached in 9/37 (24%) infants <24.0 wk GA and in 39/42 (93%) infants > or =24.0 wk GA. Survival was 3/37 (8%) and 26/41 (63%) in infants <24 wk GA and > or =24.0 wk GA, respectively. Twenty-nine of the 48 infants with immediate life support (60%) survived (95% CI: 46-75%). Forty-two of these 48 (88%) infants were small for gestational age. No infant without immediate life support survived (0/30). Twenty-three (79%) survivors developed chronic lung disease (CLD) and eight (28%) received photocoagulation for retinopathy of prematurity (ROP). In this population of extremely low birthweight infants, survival was higher than in previous studies when life support was provided immediately after birth. Short-term morbidity was similar to other studies. The presented data on survival support our concept to offer immediate life support after birth in preterm infants with birthweights <501 g. The long-term outcome of these infants needs to be assessed urgently.

Early discharge of preterm infants followed by domiciliary nursing care: parents' anxiety, assessment of infant health and breastfeeding

The aim of this study was to evaluate the effect of early discharge of preterm infants, followed by domiciliary nursing care, on the parents' anxiety, their assessment of infant health and breastfeeding. Seventy-five families including 88 preterm infants who were physiologically stable but in need of further special care, such as gavage feeding, were allocated to an early discharge group (EDG) that was offered home visits (n = 40), or to a control group offered standard neonatal care (CG) (n = 35). Seventy families (37 in the EDG and 33 in the CG) completed the study to the 1-y follow-up. Data were collected by means of questionnaires on three occasions: in the EDG, at hospital discharge, on completion of the domiciliary care programme and after 1 y, and in the CG at the corresponding points in time, which were during hospitalization, at hospital discharge and after 1 y. No statistical differences were observed between the groups in emotional well-being, except that mothers in the EDG had a lower level of situational anxiety at the time of hospital discharge compared with CG mothers whose infants remained in hospital. One year after the birth, the EDG mothers said they had felt better prepared to take responsibility for the care of their babies after completion of the domiciliary care programme, in contrast to CG mothers. However, no statistical differences were observed in the recollection of anxiety, confidence in handling the baby and periods of mental imbalance. No statistical difference was observed in breastfeeding rates between the groups. Fathers in the EDG group tended to perceive their babies as being healthier, compared with CG fathers. Early discharge of preterm infants followed by domiciliary nursing care did not seem to have any major effect on the parents' anxiety and their assessment of infant health.

Early discharge of preterm infants followed by domiciliary nursing care: parents' anxiety, assessment of infant health and breastfeeding

The aim of this study was to evaluate the effect of early discharge of preterm infants, followed by domiciliary nursing care, on the parents'anxiety, their assessment of infant health and breastfeeding. Seventy‐five families including 88 preterm infants who were physiologically stable but in need of further special care, such as gavage feeding, were allocated to an early discharge group (EDG) that was offered home visits (n= 40), or to a control group offered standard neonatal care (CG) (n= 35). Seventy families (37 in the EDG and 33 in the CG) completed the study to the 1‐y follow‐up. Data were collected by means of questionnaires on three occasions: in the EDG, at hospital discharge, on completion of the domiciliary care programme and after 1 y, and in the CG at the corresponding points in time, which were during hospitalization, at hospital discharge and after 1 y. No statistical differences were observed between the groups in emotional well‐being, except that mothers in the EDG had a lower level of situational anxiety at the time of hospital discharge compared with CG mothers whose infants remained in hospital. One year after the birth, the EDG mothers said they had felt better prepared to take responsibility for the care of their babies after completion of the domiciliary care programme, in contrast to CG mothers. However, no statistical differences were observed in the recollection of anxiety, confidence in handling the baby and periods of mental imbalance. No statistical difference was observed in breastfeeding rates between the groups. Fathers in the EDG group tended to perceive their babies as being healthier, compared with CG fathers. Conclusion: Early discharge of preterm infants followed by domiciliary nursing care did not seem to have any major effect on the parents' anxiety and their assessment of infant health.

Does early hospital discharge with home support of families with preterm infants affect breastfeeding success? A randomized trial

The aim of the present study was to determine if earlier discharge of preterm infants (&lt;37 wk) from hospital is safe and if it affects breastfeeding rates. In a pilot observational study, premature infants received full oral (sucking) feeds for a mean (SD) 7.7 ± 7.9 d before discharge. In the main study, 308 preterm infants were randomly assigned to either Early Discharge (148 infants) when fully orally fed but not yet gaining weight or Routine Discharge (160 infants) when fully orally fed and also gaining weight before discharge. A further 122 mothers declined randomization. The Early Discharge group was followed by Visiting Nurse Specialists who were available 24 h a day, while the Routine group was followed by the Home Care Nurses available on week days. There were no significant differences between the groups in birthweight or gestational age. The Early Discharge group were discharged 2.5 ± 2 d after full oral feeding compared to 4.4 ± 2.7 d for the Routine group (p &lt; 0.001) and 6.1 ± 5 d for those who declined. However, there was no significant difference between the Early and Routine groups for breastfeeding either at discharge (80 vs 83%), or 6 wk (55 vs 60%) or 6 mo after discharge (36 vs 36%), or for weight gain, or rates of re‐hospitalization (8.8% vs 11.9% at 6 wk, p = 0.37). Conclusion: Early discharge from hospital once a preterm infant can take full oral feeds does not alter later breastfeeding rates when adequate visiting nursing support is available.