Impairment In Preterm Infants Research Articles

TNF-\u03b1 antagonist attenuates systemic lipopolysaccharide-induced brain white matter injury in neonatal rats

BackgroundSystemic inflammation is an important risk factor for neurodevelopmental impairments in preterm infants. Premyelinating oligodendrocytes are main building blocks of white matter in preterm infants and vulnerable to oxidative stress and excitotoxic stress. Tumour necrosis factor-α (TNF-α) plays important roles in systemic inflammation and local inflammation leading to apoptosis of premyelinating oligodendrocytes and white matter injury (WMI) in brain tissue. This study was conducted to investigate whether etanercept, a TNF-α antagonist, could attenuate systemic lipopolysaccharide (LPS)-induced WMI in the immature brain.ResultsWe found that intraperitoneal LPS administration caused systemic and local inflammation in brain tissue. Subsequent etanercept treatment significantly attenuated LPS-induced inflammation in brain tissue as well as in systemic circulation. Intraperitoneal LPS also induced microgliosis and astrocytosis in the cingulum and etanercept treatment reduced LPS-induced microgliosis and astrocytosis. Additionally, systemic LPS-induced apoptosis of oligodendrocyte precursor cells was observed, which was lessened by etanercept treatment. The concentration of etanercept in the CSF was higher when it was administrated with LPS than when administrated with a vehicle.ConclusionsIt appears that etanercept reduce WMI in the neonatal rat brain via attenuation of systemic and local inflammation. This study provides preclinical data suggesting etanercept-mediated modulation of inflammation as a promising approach to reduce WMI caused by sepsis or necrotizing enterocolitis in preterm infants.

Automated movement analysis to predict motor impairment in preterm infants: a retrospective study.

To apply automated movement analysis to the general movements assessment (GMA) to build a predictive model for motor impairment (MI). A retrospective cohort study including infants ≤306/7 weeks GA or BW ≤1500 g seen at 3-5 months was conducted. Automated video analysis was used to develop a multivariable model to identify MI, defined as Bayley motor composite score <85 or cerebral palsy (CP). One hundred and fifty two videos were analyzed. Median GA and BW were 275/7 weeks and 955 g, respectively. MI and CP rates were 22% (N = 33) and 14% (N = 22). Minimum, mean, and mean vertical velocity of the infant's silhouette correlated significantly with MI. Sensitivity, specificity, positive and negative predictive values, and accuracy of automated GMA were 79%, 63%, 37%, 91%, and 66%, respectively. C-statistic indicated good fit (C = 0.77). Automated movement analysis predicts MI in preterm infants. Further refinement of this technology is required for clinical application.

Assessing therapeutic response non-invasively in a neonatal rat model of acute inflammatory white matter injury using high-field MRI

Perinatal infection and inflammatory episodes in preterm infants are associated with diffuse white matter injury (WMI) and adverse neurological outcomes. Inflammation-induced WMI was previously shown to be linked with later hippocampal atrophy as well as learning and memory impairments in preterm infants. Early evaluation of injury load and therapeutic response with non-invasive tools such as multimodal magnetic resonance imaging (MRI) would greatly improve the search of new therapeutic approaches in preterm infants. Our aim was to evaluate the potential of multimodal MRI to detect the response of interleukin-1 receptor antagonist (IL-1Ra) treatment, known for its neuroprotective properties, during the acute phase of injury on a model of neonatal WMI.Rat pups at postnatal day 3 (P3) received intracerebral injection of lipopolysaccharide with systemic IL-1Ra therapy. 24 h later (P4), rats were imaged with multimodal MRI to assess microstructure by diffusion tensor imaging (DTI) and neurochemical profile of the hippocampus with 1H-magnetic resonance spectroscopy. Astrocyte and microglial activation, apoptosis and the mRNA expression of pro-inflammatory and necroptotic markers were assessed.During the acute phase of injury, neonatal LPS exposure altered the concentration of hippocampus metabolites related to neuronal integrity, neurotransmission and membrane integrity and induced diffusivity restriction. Just 24 h after initiation of therapy, early indication of IL-1Ra neuroprotective effect could be detected in vivo by non-invasive spectroscopy and DTI, and confirmed with immunohistochemical evaluation and mRNA expression of inflammatory markers and cell death.In conclusion, multimodal MRI, particularly DTI, can detect not only injury but also the acute therapeutic effect of IL-1Ra suggesting that MRI could be a useful non-invasive tool to follow, at early time points, the therapeutic response in preterm infants.

Dysmaturation of Somatostatin Interneurons Following Umbilical Cord Occlusion in Preterm Fetal Sheep.

IntroductionCerebral white matter injury is the most common neuropathology observed in preterm infants. However, there is increasing evidence that gray matter development also contributes to neurodevelopmental abnormalities. Fetal cerebral ischemia can lead to both neuronal and non-neuronal structural-functional abnormalities, but less is known about the specific effects on interneurons.ObjectiveIn this study we used a well-established animal model of fetal asphyxia in preterm fetal sheep to study neuropathological outcome. We used comprehensive stereological methods to investigate the total number of oligodendrocytes, neurons and somatostatin (STT) positive interneurons as well as 3D morphological analysis of STT cells 14 days following umbilical cord occlusion (UCO) in fetal sheep.Materials and MethodsInduction of asphyxia was performed by 25 min of complete UCO in five preterm fetal sheep (98–100 days gestational age). Seven, non-occluded twins served as controls. Quantification of the number of neurons (NeuN), STT interneurons and oligodendrocytes (Olig2, CNPase) was performed on fetal brain regions by applying optical fractionator method. A 3D morphological analysis of STT interneurons was performed using IMARIS software.ResultsThe number of Olig2, NeuN, and STT positive cells were reduced in IGWM, caudate and putamen in UCO animals compared to controls. There were also fewer STT interneurons in the ventral part of the hippocampus, the subiculum and the entorhinal cortex in UCO group, while other parts of cortex were virtually unaffected (p > 0.05). Morphologically, STT positive interneurons showed a markedly immature structure, with shorter dendritic length and fewer dendritic branches in cortex, caudate, putamen, and subiculum in the UCO group compared with control group (p < 0.05).ConclusionThe significant reduction in the total number of neurons and oligodendrocytes in several brain regions confirm previous studies showing susceptibility of both neuronal and non-neuronal cells following fetal asphyxia. However, in the cerebral cortex significant dysmaturation of STT positive neurons occurred in the absence of cell loss. This suggests an abnormal maturation pattern of GABAergic interneurons in the cerebral cortex, which might contribute to neurodevelopmental impairment in preterm infants and could implicate a novel target for neuroprotective therapies.

Aluminium release by coated and uncoated fluid-warming devices.

The use of fluid-warming systems is recommended for infusion rates >500ml.h-1 to avoid peri-operative hypothermia. Some fluid-warming devices use disposable aluminium-heated plates for heat transfer, but there is no protective coating to separate the fluid from the heated aluminium surface. It is unknown if this could promote release of aluminium into infusion fluids. We investigated a coated (Fluido compact) and an uncoated (enFlow) fluid-warming device using normal saline or balanced electrolyte solution as infusion fluids, pumped through the heated disposables at flow rates of 2, 4 and 8ml.min-1 for 60min each. Aluminium concentrations in the fluid samples were analysed using graphite furnace atomic absorption spectrometry. With saline the coated and uncoated devices yielded aluminium concentrations below the level of quantification (<128μg.l-1 ). Similarly, balanced electrolyte solution in the coated device yielded aluminium concentrations <128μg.l-1 . However, balanced electrolyte solution in the uncoated device yielded aluminium concentrations of up to 6794 (3465-8002 [1868-7421]) μg.l-1 . Repeating this last study at a flow rate of 2ml.min-1 resulted in quite high aluminium concentrations when the uncoated device was not heated (~1000μg.l-1 ) and higher concentrations after the device was heated. We conclude that using uncoated aluminium plates in fluid-warming systems can lead to a risk of administering potentially harmful concentrations of aluminium when balanced crystalloid solutions are used. The mechanism is unclear, but heat is in part involved. Coating for aluminium within medical devices in direct contact with infusion fluids should be recommended.

No Increased Risks Associated with Propranolol Treatment for Infantile Hemangioma in Preterm Infants were Identified at 3 Years of Age.

Concerns have been raised that propranolol treatment of infantile hemangioma (IH) may be associated with increased risks of adverse effects and growth impairment in preterm infants due to their immature development. This study aimed to find out whether treatment of IH with propranolol in preterm infants is associated with higher incidences of long-term adverse effects and growth impairment in comparison with term infants. The clinical data of 55 preterm infants and 180 term infants with IH treated with oral propranolol for 6months were retrospectively collected and analyzed. The preterm and term patients did not differ significantly in terms of the general characteristics and adverse effect incidence (all p > 0.05). Height, weight, and head circumference of the preterm infants at ages 1, 2, and 3years did not differ significantly from the normal references (all p > 0.05). In the term patients, only 1-year-old female weight and head circumference were significantly higher than the normal references (both p < 0.05). Treatment of IH with propranolol for 6months did not increase the risks for adverse effects or growth impairment up to age 3years in preterm versus term patients in our study.

Safety of Conservative Approach for Persistent Patent Ductus Arteriosus in Preterm Infants: Neurodevelopmental Outcomes at 5 Years of Age.

Patent ductus arteriosus (PDA) is a common problem among preterm infants. The standard of care for PDA has been to attempt to close the PDA by pharmacological treatment or surgical ligation. Recently, conservative approach for PDA (i.e., infants receive no treatment for PDA unless it is necessary for rescue) is gaining interest. However, when PDA is persisted under the conservative approach, there is a concern about the neurodevelopmental problems caused by decreased cerebral oxygenation. Our objective was to examine the risk of neurodevelopmental impairment in preterm infants, when PDA remained persistently open under conservative approach for PDA. We retrospectively analyzed data from the medical charts in 72 included infants (gestational age < 29 weeks, birth weight < 1,250 g). Under our conservative approach for PDA, we divided infants by their ductal patency: a closed ductus group (ductus closure within 14 days after birth, n = 52) and a persistent patent ductus arteriosus group (ductus closure after 14 days, n = 20). We compared the clinical parameters and neurodevelopmental outcomes assessed with the Kaufman Assessment Battery for Children (K-ABC) at 5 years of corrected age in two groups. Among the children who completed the K-ABC test, there were no significant differences in neurodevelopmental scores between a closed ductus group (n = 44) and a persistent patent ductus arteriosus group (n = 17). A conservative approach for PDA, even in the case of prolonged PDA, does not increase the risk of neurodevelopmental impairment at 5 years of corrected age in preterm infants.

The biological embedding of neonatal stress exposure: A conceptual model describing the mechanisms of stress-induced neurodevelopmental impairment in preterm infants.

The biological embedding of early life stress exposure may result in life-long neurodevelopmental impairment in preterm infants. Infants hospitalized in the neonatal intensive care unit are exposed to significant experiential, environmental, and physiologic stressors over the course of their extended hospitalization. Stress exposure during the sensitive period of brain development may alter biological processes, including functioning of the immune system, the autonomic nervous system, and the hypothalamic-pituitary-adrenal axis as well as gene expression. These alterations may subsequently affect brain structure and function. Changes to these processes may mediate the relationship between neonatal stress exposure and neurodevelopment in preterm infants and represent potential therapeutic targets to improve long-term outcomes. The purpose of this paper is to introduce a conceptual model, based on published research, that describes the mechanisms mediating stress exposure and neurodevelopment impairment in preterm infants and to provide the theoretical foundation on which to base future descriptive research, intervention studies, and clinical care.

A Web-Based Calculator for the Prediction of Severe Neurodevelopmental Impairment in Preterm Infants Using Clinical and Imaging Characteristics.

Although the most common forms of brain injury in preterm infants have been associated with adverse neurodevelopmental outcomes, existing MRI scoring systems lack specificity, do not incorporate clinical factors, and are technically challenging to perform. The objective of this study was to develop a web-based, clinically-focused prediction system which differentiates severe neurodevelopmental outcomes from normal-moderate outcomes at two years. Infants were retrospectively identified as those who were born ≤30 weeks gestation and who had MRI imaging at term-equivalent age and neurodevelopmental testing at 18–24 months. Each MRI was scored on injury in three domains (intraventricular hemorrhage, white matter injury, and cerebellar hemorrhage) and clinical factors that were strongly predictive of an outcome were investigated. A binary logistic regression model was then generated from the composite of clinical and imaging components. A total of 154 infants were included (mean gestational age = 26.1 ± 1.8 weeks, birth weight = 889.1 ± 226.2 g). The final model (imaging score + ventilator days + delivery mode + antenatal steroids + retinopathy of prematurity requiring surgery) had strong discriminatory power for severe disability (AUC = 0.850), with a PPV (positive predictive value) of 76% and an NPV (negative predictive value) of 90%. Available as a web-based tool, it can be useful for prognostication and targeting early intervention services to infants who may benefit the most from such services.

Cerebellar peduncle injury predicts motor impairments in preterm infants: A quantitative tractography study at term-equivalent age

PurposeCerebellar injury is well established as an important finding in preterm infants with cerebral palsy (CP). In this study, we investigated associations between injury to the cerebellar peduncles and motor impairments in preterm infants using quantitative tractography at term-equivalent age, which represents an early phase before the onset of motor impairments. MethodsWe studied 64 preterm infants who were born at <33 weeks gestational age. These infants were divided into three groups: CP, Non-CP (defined as infants with periventricular leukomalacia but having normal motor function), and a Normal group. Diffusion tensor imaging was performed at term-equivalent age and motor function was assessed no earlier than a corrected age of 2 years. Using tractography, we measured fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of the superior cerebellar peduncles (SCP) and middle cerebellar peduncles (MCP), as well as the motor/sensory tracts. ResultsThe infants in the CP group had significantly lower FA of the SCP and sensory tract than those in the other groups. There was no significant difference in FA and ADC of the motor tract among the three groups. Severity of CP had a significant correlation with FA of the MCP, but not with the FA of other white matter tracts. ConclusionOur results suggested that the infants with CP had injuries of the ascending tracts (e.g. the SCP and sensory tract), and that additional MCP injury might increase the severity of CP. Quantitative tractography assessment at term-equivalent age may be useful for screening preterm infants for prediction of future motor impairments.

Lack of Association of Intraventricular Hemorrhage with Retinopathy of Prematurity

Objective Retinopathy of prematurity (ROP) is the primary cause of visual impairment in premature infants. Our objective was to study the relationship between ROP and intraventricular hemorrhage (IVH) in the premature infant. Methods This study was a retrospective chart review of very low birthweight infants of 1,500 g or less admitted to Kings County Hospital Center's neonatal intensive care unit who were screened for ROP over a 6-year period. Results Of 335 infants screened for ROP, 85 infants were identified to have ROP. Of these, 50 (56%) infants had stage 1 ROP, 25 (29%) had stage 2 ROP, 7 (8%) had stage 3 ROP, and 3 (4%) had stage 4 ROP. The incidence of IVH in our population was 14%. Multiple logistic regression demonstrated a significant association between ROP and gestational age (p = 0.001). There was no significant association between ROP stage and IVH grade. There was also no significant association between birthweight, ethnicity, or 5-minute Apgar score. Conclusions Our data demonstrated no association between IVH and severity of ROP. There was a statistically significant association between ROP and gestational age. We speculate that these data may be a reflection of improvement in neonatal care, with a declining incidence of IVH as well as increased ROP screening efforts.

HIGH SYSTEMIC BLOOD PRESSURE IN PRETERM INFANTS WITH BRONCHOPULMONARY DYSPLASIA AND LONG-TERM OUTCOMES

Abstract BACKGROUND Bronchopulmonary dysplasia (BPD) is a known risk factor for neurodevelopmental impairment in preterm infants. BPD is also associated with an increased incidence of high systemic blood pressure (HBP). However, it is not known if a diagnosis of HBP in BPD patients relates to later neurodevelopmental outcomes. OBJECTIVES We aimed to determine the incidence of neonatal HBP diagnosis in a cohort of preterm infants born &lt;29 weeks of gestational age (GA) with BPD. The secondary objective was to assess if a concomitant diagnosis of BPD and HBP influences neurodevelopmental outcomes at 18 months. DESIGN/METHODS We performed a single center retrospective study using data from medical charts. All infants born &lt;29 weeks GA admitted to our level-IV neonatal intensive care unit between January 2010 and December 2012 diagnosed with BPD at 36 weeks of corrected GA were included. Patients transferred before 36 weeks of corrected GA, that died before 18 months or had congenital anomalies were excluded. Patients were classified in the HBP group if HBP was a documented diagnosis in the chart. The control group was the remaining patients with BPD at 36 weeks corrected GA but without HBP. Severe neurodevelopmental impairment at 18 months was defined as either any Bailey-III score &lt;70, cerebral palsy or severe hearing or visual impairment. Descriptive statistics for prenatal and postnatal patients’ characteristics were analyzed. Logistic regression was performed for factors associated with long-term disability. Level of significance was determined as a p value &lt;0.05. RESULTS During the study period, 337 preterm infants &lt;29 weeks of GA were identified and after exclusions, 98 newborns met the criteria of BPD at 36 weeks corrected GA. Mean GA and mean birth weight were 26.7 ± 1.7 weeks and 882 ± 199 g respectively. The majority were males (57%) and received antenatal steroids (87.8%). We identified twenty-five newborns (25.5%) with a diagnosis of HBP. Demographic data was similar between the 2 groups. 56% of the HBP group received a post-natal course of steroids, compared to 36% for the control group (p 0.07). The neurodevelopmental outcome at 18 months was similar between the two groups (p 0.54) and was not influenced by the presence of a HBP diagnosis after regression analysis (p 0.8). CONCLUSION The diagnosis of HBP was frequent in our cohort of preterm infants born &lt;29 weeks GA with BPD but did not seem to be related to long-term neurodevelopmental outcomes.

Identifying Risk Factors Shared by Bronchopulmonary Dysplasia, Severe Retinopathy, and Cystic Periventricular Leukomalacia in Very Preterm Infants for Targeted Intervention

Background: Bronchopulmonary dysplasia (BPD), severe retinopathy of prematurity (sROP), and cystic periventricular leukomalacia (cPVL) are 3 major morbidities with long-term neurodevelopmental impairments in preterm infants. Objective: To investigate the strength of associations and identify key risk factors shared by BPD, sROP, and cPVL for targeted intervention. Methods: We studied the Taiwanese very-preterm-infant registry data on 3,507 infants admitted to neonatal intensive care units and discharged at postmenstrual age ≥36 weeks between 2008 and 2013. Results: Of 3,507 infants, 1,497 presented with at least 1 morbidity (26 [1.7%], 386 [25.8%], and 1,085 [72.5%] exhibited 3, 2, and 1 morbidities, respectively). BPD was strongly associated with sROP (odds ratio 5.93; 95% confidence interval 5.02–7.03), followed by cPVL (2.08; 1.63–2.64), but sROP and cPVL were weakly associated (1.59; 1.17–2.13). Most risk factors contributed to BPD, which shared risk factors with sROP and cPVL. A birth weight of < 1,000 g, male sex, and prolonged mechanical ventilation (MV) were shared by BPD and sROP, and chorioamnionitis, severe respiratory distress syndrome, and prolonged MV specifically contributed to BPD and cPVL. Prolonged MV was the single risk factor common to BPD, sROP, and cPVL. Avoiding prolonged MV reduced the risk of having at least 1 of the 3 morbidities by 37%. Conclusions: BPD and sROP were most strongly associated. Most risk factors contributed to BPD, with differentially shared effects on sROP and cPVL. Prolonged MV was the only risk factor shared by all 3 morbidities, and avoiding it potentially reduced the risk of having at least 1 of them.

Late-onset Sepsis in Extremely Premature Infants: 2000-2011.

Late-onset sepsis (LOS) is an important cause of death and neurodevelopmental impairment in premature infants. The purpose of this study was to assess overall incidence of LOS, distribution of LOS-causative organisms and center variation in incidence of LOS for extremely premature infants over time. In a retrospective analysis of infants 401-1000 g birth weight and 22-28 6/7 weeks of gestational age born at 12 National Institute of Child Health and Human Development Neonatal Research Network centers in the years 2000-2005 (era 1) or 2006-2011 (era 2) who survived >72 hours, we compared the incidence of LOS and pathogen distribution in the 2 eras using the χ test. We also examined the effect of birth year on the incidence of LOS using multivariable regression to adjust for nonmodifiable risk factors and for center. To assess whether the incidence of LOS was different among centers in era 2, we used a multivariable regression model to adjust for nonmodifiable risk factors. Ten-thousand one-hundred thirty-one infants were studied. LOS occurred in 2083 of 5031 (41%) infants in era 1 and 1728 of 5100 (34%) infants in era 2 (P < 0.001). Birth year was a significant predictor of LOS on adjusted analysis, with birth years 2000-2009 having a significantly higher odds of LOS than the reference year 2011. Pathogens did not differ, with the exception of decreased fungal infection (P < 0.001). In era 2, 9 centers had significantly higher odds of LOS compared with the center with the lowest incidence. The incidence of LOS decreased over time. Further investigation is warranted to determine which interventions have the greatest impact on infection rates.

Restricted Ventilation Associated with Reduced Neurodevelopmental Impairment in Preterm Infants

Background and Objective: Restrictive use of invasive mechanical ventilation (IMV) in preterm infants reduces the risk of bronchopulmonary dysplasia (BPD). Our objective was to determine its effect on neurodevelopmental impairment (NDI) at 24 months' corrected age (CA). Methods: This retrospective single-center cohort study included all patients with a gestational age <30 weeks born in 2004/2005 (epoch 1) and 2010/2011 (epoch 2). In epoch 2, we introduced a policy of restriction on IMV and liberalized the use of respiratory stimulants in the delivery room and neonatal intensive care. Data on patient characteristics, respiratory management, short-term outcomes, mortality, BPD, and NDI at 24 months' CA were collected. Results: Four hundred and four preterm infants were included. Compared to those in epoch 1, infants in epoch 2 were less likely to be intubated and the duration of IMV was shorter. Other noninvasive adjuvant therapies such as caffeine, doxapram, and nasal ventilation were more often used during epoch 2. There was a trend to less BPD in epoch 2 compared to epoch 1 (17 vs. 23%, adjusted OR = 0.75, 95% CI: 0.48, 1.16). Mortality did not change over time. The combined outcome death or NDI at 24 months' CA was significantly lower in epoch 2 compared to epoch 1 (24.7 vs. 33.9%, adjusted OR = 0.71, 95% CI: 0.53, 0.97). Conclusions: Restricted use of IMV is feasible in preterm infants and might be associated with a reduced risk of the combined outcome death or NDI at 24 months' CA. Larger studies are needed to confirm these findings.

Prevalence, Risk Factors and Diagnostics of Hearing Impairment in Preterm Infants

Introduction: The preterm birth is clearly associated with increased risk of developing congenital hearing impairment. Therefore, special attention must be paid to the postnatal control of auditory function in all preterm infants. The present work investigates if the latest scientific findings regarding prevalence, clinical diagnostics, therapy and risk factors of hearing impairment in premature infants are regularly implemented in daily practice. Methods: At the department of phoniatrics and pediatric audiology of the University Hospital of Magdeburg, the treatment data of 126 preterm children born between 2006 and 2011 were evaluated retrospectively. The additional analysis of all records available at the screening center (n=67 640) covering this period enables drawing conclusions on the total number and prevalence of hearing impairment in preterm infants in Saxony-Anhalt. Results: Almost all premature babies, like mature newborns, underwent postnatal hearing screening of both ears. The data analysis shows that the practical implementation often does not comply with the guideline of the G-BA (Gemeinsamer Bundesausschuss) in all details. For example, the recommended screening method for preterm infants (AABR) or the screening and treatment timing are not always applied in accordance with the guidelines of the G-BA. Discussion: Assessment of the practical implementation of universal newborn hearing screening was planned at the time of the introduction of the hearing screening program by the G-BA. As a part of this investigation, the practical care of vulnerable groups such as preterm infants must be given special attention. Based on the collected data, the diagnostics and therapy should be unified. Regardless of the maternity clinic where the infants were born, there should be the same opportunity for early diagnosis and thus for prognostically better treatment of congenital hearing impairment. Rapid postnatal fitting with hearing aid can stimulate the maturation of the central auditory system and potentially help to avoid problems of hearing and speech development.

Amplitude-integrated electroencephalography in preterm infants

Objective In recent years, amplitude-integrated electroencephalography(aEEG)has been widely used in cerebral function monitor in NICU.It is a simplified form of electroencephalogram.Many study on term infants have shown that aEEG can help identify brain injury and predict nurodevelopment outcome.However, the aEEG in preterm infants relates to gestational age and can be influenced by many factors.Its prognostic value of neurodevelopmental impairment in preterm infants is still unclear and need to be determined. Key words: Infant; Preterm infant; Amplitude-integrated electroencephalography

Risk predictors for the development of retinopathy of prematurity in very low birth weight neonates

Background: Retinopathy of prematurity (ROP) is an important cause of visual and neurological impairment in premature infants. Identification of risk factors and effective management of the same will help in better outcomes. Information on ROP and its risk factors are limited especially from South India and interventions directed at prevention and treatments have produced only modest results. Methods: The study was of a prospective, unmatched case–control design and was conducted in premature, very low birth weight infants (&lt;34 weeks; &lt;1500 g) admitted to Neonatal Intensive Care Unit in a tertiary care center in South India during an18-month period. The neonates were screened for ROP and subjects who developed ROP were classified as cases and those who did not were categorized as controls. The maternal risk factors studied were the type of delivery, maternal fever, pregnancy-induced hypertension (PIH), gestational diabetes mellitus, cardiac disease, premature rupture of membrane, antepartum hemorrhage, chorioamnionitis, multiple pregnancy, infertility treatment, urinary tract infections, polyhydramnios, and oligohydramnios. The neonatal factors studied were gestational age, birth weight, septicemia, apnea, anemia, hypotension, need for inotropic support, typeand duration of oxygen therapy, patent ductus arteriosus, necrotizing enterocolitis, intraventricular hemorrhage, and phototherapy. Both univariate and multivariate analyses were carried out. Results: A total of 54 cases and 54 controls (1:1) were enrolled into the study. Males dominated the study (63% of cases). Univariate analysis showed gestational age, PIH, birth weight, sepsis, oxygen administration, hypotension and packed cell transfusion as important risk factors for ROP. On binary logistic regression analysis,birth weight (odds ratio: 6.00; p: 0.014), oxygen exposure (odds ratio: 11.05; p: 0.003), and hypotension (odds ratio: 6.85; p: 0.009) were identified as important risk predictors of ROP. Conclusions: The study adds important information to the understanding of risk factors of ROP.

Neurodevelopmental Assessment in Preterm Neonates at Early Ages: Screening of at-risk Infants for Long Term Sequlae

Background: Preterm infants are at risk for long term neurodevelopmental impairements. Neurodevelopmental assessment at early months of infancy has been proposed as a valuable tool for prediction of neurodevelopmental outcomes in this population.Objective: The present study attempted to find the neurodevelopmental impairments in preterm infants and thus to identify the at risk infants for follow up and subsequent therapeutic intervention.Methodology: This prospective cross-sectional observational study was conducted in Dhaka Shishu (Children) Hospital from October 2011 to March, 2012. A total 103 preterm neonates who met the inclusion criteria underwent rapid neurodevelopmental assessment (RNDA) at neonatal period and again at their 3 months of age to find the at risk infants for long term neurodevelopmental impairments.Results: Among the enrolled 103 preterm infants during RNDA at neonatal period, abnormal domains found in primitive reflexes 41(39.7%), gross motor 42(40.7%), fine motor 32(31%), vision 40(38.7%), hearing 32 (31%), speech 40(38.7%), cognition 3(2.8%), behavior 3 (2.8%) and 3(2.8%) had seizure. Again in RNDA at 3 months of age, the no. of preterm infants having abnormal developmental domains are: gross motor 49(47.5%), fine motor 19(18.3), vision 9(8.6%), hearing 16(15.4%), speech 15 (14.5%), cognition 6(5.7%), speech 15 (14.5%), cognition 6(5.7%), behavior 11(10.6%) and 3 (2.9%) had seizure.Conclusion: The identification of neurodevelopmental impairments in early months of preterm infants should offer a valuable complement to tools for identification of at risk infants for long term sequlae (in neurodevelopmental impairment).Bangladesh J Child Health 2016; VOL 40 (1) :5-11

Lenticulostriate Vasculopathy and Neurodevelopmental Outcomes in Preterm Infants: A Systematic Review.

Objective The objective of this study was to perform a systematic review of all studies that report neurodevelopmental outcomes at 12 months' corrected age or later for preterm infants (< 32 weeks) who are diagnosed with lenticulostriate vasculopathy (LSV) on cranial ultrasound. Study Design This is a systematic review. Results We identified 501 unique publications of which 3 met all prespecified eligibility criteria. Neurodevelopmental outcome data were available for 44 preterm infants with LSV. There were mixed results from the studies: the first reported impairments of mental development; the second reported impairments of motor development only; and finally, the third reported that three of three preterm infants with LSV had mild or moderate developmental delay. Conclusion The available results raise some concern for future impairments in preterm infants with LSV, but they are conflicting and inconclusive. There is insufficient evidence about the neurodevelopmental implications of LSV in preterm infants to inform counseling of parents.