Extremely Low Birth Weight Preterm Infants Research Articles

Population Cohort Associating Chorioamnionitis, Cord Inflammatory Cytokines and Neurologic Outcome in Very Preterm, Extremely Low Birth Weight Infants

Intrauterine inflammation may relate to neurologic disability among preterm children. We investigated the relationship between chorioamnionitis, cord serum cytokines, and neurologic outcome. Sixty-one consecutively born very preterm extremely low birth weight (ELBW) infants were prospectively enrolled. Histologic inflammation in placenta and umbilical cord and vascular pathology were evaluated. Cord sera were analyzed for five proinflammatory cytokines. Serial brain ultrasound and magnetic resonance imaging were performed for evaluation of intraventricular hemorrhage (IVH grade I-III) and white matter damage (WMD: cystic periventricular leukomalacia or IVH grade IV). Neurologic and neurocognitive outcomes were assessed at the corrected age of 2 y. The incidences of HCA, WMD, and abnormal neurologic outcome were 48%, 13% and 19%, respectively. HCA or high IL-6 in cord serum predicted spontaneous preterm labor with high accuracy. HCA increased the risk of IVH grade II-III. In HCA, without either clinical chorioamnionitis or histologic placental perfusion defect, the children had a low risk of WMD (0%) and a low risk of abnormal neurologic outcome (6%). In HCA, the concentration of IL-6 in cord serum was lower in children with abnormal neurologic outcome than in children with normal neurologic outcome. In HCA and placental perfusion defect (compound defect) the risk of abnormal neurologic outcome was high. Compound placental defect and WMD additively predicted abnormal neurologic outcome. We propose that HCA together with other insults (placental perfusion defect or maternal systemic infection) increases the risk of poor neurologic outcome in very preterm ELBW infants.

Neurobehavioral Assessment Predicts Differential Outcome Between VLBW and ELBW Preterm Infants

To evaluate the impact of birth weight on development of very low birth weight (VLBW) infants using the Neurobehavioral Assessment of the Preterm Infant (NAPI) before hospital discharge, and to show the relation to follow-up outcomes at 12, 18 and 30 months of age. In total, 113 preterm infants were assessed with the NAPI at 36 weeks postmenstrual age. Later, neurodevelopment was examined using the Bayley Infant Neurodevelopmental Screener (BINS) at 12 months and the Bayley Scales of Infant Development, at 18 and 30 months. The cohort was divided into two groups, based on birth weight, extremely low birth weight (ELBW) (<1000 g) and VLBW (1000 to 1500 g). ELBW infants showed significantly lower NAPI scores compared with VLBW infants at 36 weeks. The predischarge NAPI scores correlated with the 12, 18 and 30 months scores when the ELBW infants continue to have lower performance than the VLBW infants. In all, 14 infants developed cerebral palsy. These infants had significantly lower NAPI, BINS and Bayley scores compared with all other preterm infants. NAPI before discharge provides clinically meaningful information related to later neurodevelopmental outcome.

124 Hyperkalaemia in The Extremely Low Birth Weight Preterm Infant

Top of pageAbstract Background: The purpose of the study was to investigate factors that affect potassium(K) homeostasis over the first 6 days of life in extremely low birth weight (ELBW) preterm infants. Methods: Clinical and laboratory data was collected retrospectively on infants >23 and < 27 weeks admitted to NICU from January '01 to December '02. Infants were excluded if they had a congenital abnormality or died at < 24 hours. Haemolysed samples were excluded. Correlation of variables was analysed using Mann Whitney, Fisher Exact, one way ANOVA and multiple linear regression. Results: 80 infants were eligible with a median birth weight and gestational age of 722g(IQR 220g) and 25.0 wks(IQR 1.8 wks). 48(60.0%) had at least 1 episode of hyperkalaemia(K 6.5mmmol/L). Lowest mean K levels(4.8mmol/L SD 1.1) occurred on D1 rising to a peak mean (5.9 mmol/L SD 1.3) on D2 of life. Absolute [K] did not correlate with survival. There was a significant increase in [K] levels on D2–D3 in infants who died vs survivors (0.6mmol/L v–1.0mmol/L p= 0.0087). 16 of 45 infants died in the hyperkalaemic group (35.5%).15 of 31died in the normokalaemic group (48.4%). This was not significant. There was no correlation between [K] and [Na] concentration;mean arterial pressure;urine output;gestation;sex or pH. There was a negative correlation between glucose levels and [K] on days 2, 6 (p- values 0.02, 0.007). Mean [K] were significantly higher in infants who were hypoglycaemic (glucose< 2.8). This was noted on D2 of life(6.8mmol/L vs 5.6mmol/L p= 0.003). The mean [K] were significantly lower in infants who had received 2 doses of antenatal steroids(ANS) (n = 41) vs those who received none (n= 21) on D1(5.(1.1) vs 4.6 (0.9) mmol/L p-value= 0.02) and D2(6.5 (1.5) vs 5.(1.1) p= 0.009). There was no significant difference in [K] noted with 1 dose ANS compared with infants who were given no ANS; this was a small group. Conclusion: Hyperkalaemia affects almost¾ of ELBW preterm infants. [K] tend to rise from D1 to peak on D2. A rise on D3 is associated with a poorer chance of survival. The negative correlation between glucose and [K] may be due to lower substrate source of energy and a decrease in NA-K ATP-ase activity. ANS appear to have a protective effect on [K] levels in the first 48 hours of life in pregnancies of < 27 weeks possibly due to steroid induced maturation of Na-K ATP-ase2. 2.Omar S et al Effect of prenatal steroids on potassium balance in extremely low birth weight neonates.Pediatrics 2000;106(3):561–7

Assessing the effect of disease on nutrition of the preterm infant

Objective: To review existing data on nutritional requirements of extremely low birth weight (ELBW) and very low birth weight (VLBW) preterm infants (those who weigh < 1000 g and 1000–1500 g at birth, respectively), and the effects of diseases on these nutritional requirements. Data sources: A literature search was conducted on applicable articles related to nutritional requirements of preterm ELBW and VLBW infants and the effects of diseases in these infants on their nutritional and metabolic requirements. Data synthesis: The literature was analyzed to determine nutritional requirements of preterm ELBW and VLBW infants, to select the most common diseases that have significant and important effects on nutrition and metabolism in these infants, and to make recommendations about diagnostic and therapeutic approaches to nutritional problems as affected by diseases in ELBW and VLBW infants. Conclusions: Many diseases unique to preterm infants, either directly or by enhancing the effects of stress on the metabolism of such infants, provide important changes in the nutrient requirements. The overriding observation from all studies, however, is that ELBW and VLBW preterm infants are underfed during the early postnatal period and that this condition, combined with additional stresses from various diseases, increases the risk of long-term neurological sequelae. The value of achieving a specific body composition and growth weight is less certain. There remains a critical need for determining the right quality as well as quantity of nutrients for these infants.