Intraventricular Hemorrhage Grade Research Articles

Antibiotic-impregnated external ventricular drainage for the management of post-hemorrhagic hydrocephalus in low birth weight premature infants following intraventricular hemorrhage.

This study aims to evaluate the infection rates and catheterization duration of applying antibiotic-impregnated external ventricular drain (EVD) for the treatment of post-hemorrhagic hydrocephalus (PHH) in low birth weight infants (LBWI). This retrospective cohort study included 13 preterm LBWI with PHH. Data were collected from the patient's medical charts and included gender, gestational age, birth weight, intraventricular hemorrhage grade, ventriculostomy-associated infection (VAI), and the duration of catheterization. All patients were followed up for at least 6months after EVD surgery. The mean gestational age at birth was 27 ± 2.5weeks, and the mean birth weight was 907 ± 220g. Among all patients with IVH, two (6.7%) had grade 2 IVH, five (38.5%) had grade 3 IVH, and six (46.2%) had grade 4 IVH. EVD surgery was conducted once for six patients, twice for five patients, and three times for two patients. One patient (7.7%) had VAI post-EVD surgery at 14days. Three patients (23%) expired due to sepsis, shock, and chylous ascites. Seven patients (53.8%) had hydrocephalus and needed a ventriculoperitoneal shunt over the following course. The longest EVD catheterization period was 57days without sustained VAI. Antibiotic-impregnated EVD has a similar infection rate with the ventricular access device and ventriculosubgaleal shunt. The risk of VAI was not increased even with the EVD catheterization day approaching 2months. Our study supports the evidence that antibiotic-impregnated EVD is safe and effective for the management of PHH in LBWI. However, this research has a small sample sized and a retrospective design.

Neonatal morbidity and mortality for preterm in breech presentation regarding the onset mode of labor.

To assess severe neonatal morbidity and mortality in induced labor in preterm breech deliveries, compared to spontaneous labor. This is a retrospective study conducted in a tertiary university center in France. Women with single live breech pregnancy between 28 + 0 and 36 + 6weeks gestation were included. We excluded situations with medical contraindication to vaginal delivery and fetal malformations. We compared women with an unfavorable cervix, who had an indication for deliver and could receive cervical ripening to induce labor, to women in spontaneous labor. The primary outcome was a composite criterion of severe neonatal morbidity and mortality including perinatal death, traumatic event during delivery, Apgar score at 5-min < 4, moderate or severe encephalopathy, seizures within the first 24h, Intra-Ventricular Hemorrhage grade 3 or 4, necrotizing enterocolitis grade 2 or 3. We included 212 patients: 64 in the induced labor group and 136 in the spontaneous labor group. In the induced labor group, 45.3% of patients delivered vaginally, and 86% in spontaneous labor group. The neonatal morbidity and mortality rate were similar in both groups: 4.7% in the induced labor group, and 5.2% in the spontaneous labor group, p = 0.889, aOR = 1.5 (0.28-8.28). Nearly half of the patient who received induction of labor delivered vaginally. The onset mode of labor does not appear to have an effect on severe neonatal morbidity and mortality in preterm breech fetuses. Induction of labor could be an option for patients in this setting.

Development of an integrated risk scale for prediction of shunt placement after neonatal intraventricular hemorrhage.

Neonatal intraventricular hemorrhage (IVH) is a major cause of mortality and morbidity, particularly following premature birth. Even after the acute phase, posthemorrhagic hydrocephalus is a long-term complication, frequently requiring permanent ventriculoperitoneal shunt (VPS) placement. Currently, there are no risk classification methods integrating the constellation of clinical data to predict short- and long-term prognosis in neonatal IVH. To address this need, the authors developed a two-part machine learning approach for predicting short- and long-term outcomes after diagnosis of neonatal IVH. Integrating both maternal and neonatal characteristics, they developed a binary classifier to predict short-term mortality risk and a clinical scale to predict the long-term risk of VPS placement. Neonates with IVH were identified from the Optum Clinformatics Data Mart administrative claims database. Matched maternal and childbirth characteristics were obtained for all patients. The primary endpoints of interest were short-term (30 day) mortality and long-term VPS placement. Classification of short-term mortality risk was evaluated using 5 different machine learning approaches and the best-performing method was validated using a withheld validation subset. Prediction of long-term shunt risk was performed using a multivariable Cox regression model with stepwise variable selection, which was subsequently converted to an easily applied integer risk scale. A total of 5926 neonates with IVH were identified. Most patients were born before 32 weeks' gestation (67.2%) and with low birth weight (81.2%). Empirical 30-day mortality risk was 10.9% across all IVH grades and highest among grade IV IVH (34.3%). Among the neonates who survived > 30 days, actuarial 12-month postdiagnosis risk of shunt placement was 5.4% across all IVH grades and 31.3% for grade IV IVH. The optimal short-term risk classifier was a random forest model achieving an area under the receiver operating characteristic curve of 0.882 with important predictors ranging from gestational age to diverse comorbid medical conditions. Selected features for long-term shunt risk stratification were IVH grade, respiratory distress syndrome, disseminated intravascular coagulation, and maternal preeclampsia or eclampsia. An integer risk scale, termed the Shunt Prediction After IVH in Neonates (SPAIN) scale, was developed from these 4 features, which, evaluated on withheld cases, demonstrated improved risk stratification compared with IVH grade alone (Harrell's concordance index 0.869 vs 0.852). In a large cohort of neonates with IVH, the authors developed a two-pronged, integrated, risk classification approach to anticipate short-term mortality and long-term shunt risk. The application of such approaches may improve the prognostication of outcomes and identification of higher-risk individuals who warrant careful surveillance and early intervention.

Latent class growth analysis identified different trajectories in cognitive development of extremely low birthweight children

BackgroundRecent longitudinal studies suggest stable cognitive development in preterm children, although with great individual variation. This prospective neurocognitive follow-up study of extremely low birthweight (ELBW, <1000 g) children aimed to...

Functional and Structural Findings in Infants Treated for Retinopathy of Prematurity Using Optical Coherence Tomography Angiography.

To assess the foveal microvascular structure of children with retinopathy of prematurity (ROP) treated with diode laser photocoagulation using optical coherence tomography angiography (OCTA). OCTA was performed at a tertiary medical center in 17 children (27 eyes) aged 4 to 16 years with a history of diode laser photocoagulation treated ROP. OCTA parameters were compared with those of 12 healthy age-matched controls (23 eyes) attending the orthoptics clinic and correlated with clinical factors. Compared with controls, the ROP group had a smaller foveal avascular zone area (P < .001), lower deep vascular plexus density (P < .001), lower flow density (P = .025), and greater central macular thickness (P < .001). High intraventricular hemorrhage grade correlated with smaller foveal avascular zone area (P = .008) and greater inner macular thickness (P = .047). There was no impact of gestational age, birth weight, or refractive status. OCTA can identify significant quantifiable long-term macular microvascular and structural changes in this patient population. [Ophthalmic Surg Lasers Imaging Retina. 2022;53(4):194-201.].

130 Development of an Integrated Risk Scale for Prediction of Shunt Placement After Neonatal Intraventricular Hemorrhage

INTRODUCTION: Neonatal intraventricular hemorrhage (IVH) is a major source of mortality and morbidity in infants, particularly following premature birth. Even after the acute phase, post-hemorrhagic hydrocephalus is a long-term complication, frequently requiring permanent ventriculoperitoneal shunt placement (VPS). Currently, there are no risk classification methods integrating the constellation of clinical data to predict short- and long-term prognosis in neonatal IVH. METHODS: Neonates with IVH were identified from the Optum Clinformatics DataMart administrative claims database using ICD-9/10 codes. Matched maternal-childbirth characteristics were obtained. Primary endpoints were short-term (30-day) mortality and long-term VPS placement. Classification of short-term mortality risk was evaluated using five different machine learning approaches and the best-performing method was validated using a withheld validation subset. Prediction of long-term shunt risk was performed using a multivariable Cox regression model with stepwise variable selection, which was subsequently converted to an easily applied integer risk scale. RESULTS: A total of 5,926 neonate-maternal pairs were included. Empiric 30-day neonatal mortality risk was 10.9% across all IVH grades and highest among grade IV IVH (34.3%). Among those surviving beyond 30 days, actuarial 12-month risk of shunt placement was 5.4% across all IVH grades and 31.3% for grade IV IVH. The optimal short-term risk classifier was a random forest model achieving an AUROC of 0.882 with important predictors ranging from gestational age to diverse comorbid medical conditions. The final multivariable Cox regression model for long-term shunt risk stratification following stepwise feature selection included IVH grade, respiratory distress syndrome, disseminated intravascular coagulation, and maternal preeclampsia/eclampsia. An integer risk scale termed the Shunt Prediction After IVH in Neonates (SPAIN) scale was developed from these four features which, evaluated on withheld validation cases, demonstrated improved risk stratification compared to IVH grade alone (Harrell’s concordance index 0.869 vs 0.852). CONCLUSION: We developed an integrated risk classification approach to anticipate short-term mortality and long-term shunt risk. Application of such approaches may improve outcome prognostication and identification of higher risk individuals warranting careful surveillance and early intervention.

416 Relationship between reduced fetal growth velocity and adverse perinatal outcome

Introduction: According to the Delphi consensus late FGR, is among other defined as reduced growth velocity over 2 quartiles combined with abnormal CPR and/or increased PI in umbilical artery. It has been hypothesized that AGA neonates with reduced growth velocity in utero may be at higher risk of adverse perinatal outcome. Aim of the study: Assessment of the incidence of reduced growth velocity (RGV) and its relationship with adverse perinatal outcome. Methods: This is a retrospective cohort study. An anonymized database of singleton deliveries was created by combining the Astraia ultrasound database and the hospital electronic medical records. The study included singleton deliveries with an ultrasound in 28-32 weeks of gestation and subsequently delivered at our maternity unit. Exclusion criteria were major congenital anomalies, abnormal karyotype, multiple deliveries, and LGA neonates. Retrospectively based on the biometric measurements the Intergrowth centile was calculated. FGR was defined as below the 3rd centile, SGA as between the 3-10 centile, AGA as between the 10-90th centile, LGA as above the 90th centile. The birthweight centile was calculated using the Intergrowth chart. RGV was defined as decrease by at least 50 centile between birthweight and estimated fetal weight on ultrasound at 28-32 scan. Composite neonatal outcome, intrauterine fetal death and neonatal death were assessed in the following groups: SGA, AGA+RGV, SGA+RGV and AGA. A subgroup of FGR (weight < 3 centile) was analyzed. Adverse neonatal outcomes were defined as CS for fetal distress, instrumental vaginal delivery for fetal distress, respiratory distress syndrome, intraventricular haemorrhage grade III or IV, neonatal sepsis, periventricular leukomalacia, confirmed seizures and Apgar Score < 8 at 5 minutes of observation. APO was defined as combination of IUFD, ND+CNO. Results: The final database of combined ultrasound and delivery records comprised of 1906 records (AGA n=1748, AGA+RGV n=25, SGA n=126, SGA+RGV n=7 and FGR n=36; 91.71%, 1,31%, 6.61%, 0.37%, 2.41% respectively). The highest risk of APO was in neonates with FGR, birthweight below 3rd centile and was 73.91%, followed by SGA 57.94%. SGA with RGV had lower risk of APO 14.29%. This may be a selection bias because these pregnancies were monitored at our outpatient clinic. There were no differences in APO between AGA and AGA with RGV. Conclusions: The role of RGV needs further assessment. We confirmed the high risk of APO in relation to birthweight below the 3rd centile. RGV prompts increased surveillance in pregnancies at risk of SGA. This may explain the reduced risk of adverse perinatal outcome in this group.

İleri derecede immatür bebeklerde trombosit lenfosit oranları (TLO) ile ağır intraventriküler hemoraji (IVH) ilişkisi

Aim: Intraventricular hemorrhage (IVH) is a serious complication of premature births, especially in newborns with very low birth weight. It's important to be able to predict IVH. In this study, the relationship between platelet lymphocyte rate (PLR) and intraventricular hemorrhage in premature infants born under 28 weeks was examined. Material and methods: In the last 5 years, the medical records of infants with less than 28 weeks of gestational age (n=78) born in our hospital have been retrospectively examined. Obtained parameters from the whole blood count, especially the relationship between TLO and IVH were examined. Results: White blood cell and lymphocyte counts were significantly higher in severe IVH (grade 3-4), while TLO was found to be significantly lower (16048±5265 &amp;amp; 11972±10915, p=0.043; 10705±4537 &amp;amp; 6329±8101, p=0.007; 36.9±22.7 &amp;amp; 56.7±37.9 p=0.012, respectively). When the white blood cell, lymphocyte count, and PLR's diagnostic performance in predicting severe IVH were evaluated by ROC curve analyses, it was observed that the strongest performance belonged to the PLR (Area under the curve, AUC for WBC: 0.644; ALS: 0.687; PLR:0,691, respectively). PLR can estimate severe IVH with 94% sensitivity and 43% specificity at a cut-off value below 55.84. Conclusion: PLR can be used as a valuable marker for predicting IVH in extremely premature infants.

Arabin pessary to prevent adverse perinatal outcomes in twin pregnancies with a short cervix: a multicenter randomized controlled trial (PESSARONE)

The number of twin pregnancies continues to increase worldwide as both the number of pregnancies obtained by medically assisted reproduction and age at first pregnancy keep rising. Preterm delivery is the major complication associated with twin pregnancies. The effectiveness of preventive treatments such as progesterone or cervical cerclage for women with a short cervix is doubtful in twin pregnancies. The effectivity of cervical pessaries in preventing preterm birth and its associated morbidity and mortality is also controversial. We sought to investigate if the Arabin pessary reduces adverse neonatal outcomes in twin pregnancies with a short cervix. This open-label, multicenter, randomized controlled trial on twin pregnancies with a cervical length of <35 mm compared pessary placement at 16+0 to 24+0 weeks' gestation with standard care alone. The primary endpoint was a composite of adverse neonatal outcomes, namely peripartum or neonatal death or significant neonatal morbidity before hospital discharge, defined as at least 1 of the following complications: bronchopulmonary dysplasia, intraventricular hemorrhage grade III to IV, periventricular leukomalacia, necrotizing enterocolitis grade II or higher, culture-proven sepsis, and retinopathy requiring treatment. A sample size of 308 pregnancies was planned to ensure 80% power to compare the proportions of women with at least 1 infant with an adverse neonatal outcome. The intention-to-treat analysis after multiple imputation of missing data, was supplemented with a secondary analysis that controlled for gestational age and cervical length, both at inclusion. The primary endpoint was also compared between randomization groups in the per-protocol population, which excluded patients with prespecified major protocol violations (mostly cervical cerclage and/or progesterone after inclusion). Secondary endpoints included preterm birth, spontaneous preterm birth, and pessary side effects. In total, 315 women were randomized to either receive a pessary (n=157) or standard management (n=158). Overall, 10.8% (34 women) of participants had a missing value for the primary endpoint, mostly (79%) because of the lack of paternal consent for neonatal data collection. In the intention-to-treat analysis, the adverse neonatal outcome occurred in 16.8% of the pessary group vs in 22.5% of the control group (risk ratio, 0.69; 95% confidence interval, 0.39-1.23; P=.210). The per-protocol analysis did not show any significant difference between groups (risk ratio, 0.78; 95% confidence interval, 0.47-1.28; P=.320). The occurrence of preterm birth or spontaneous preterm birth did not differ significantly between groups. No serious side effects were associated with pessary use. Pessary use in our study did not significantly reduce adverse neonatal outcomes in twin pregnancies with a short cervix.

Minimally or less invasive surfactant replacement therapy in neonates: A narrative review

Surfactant replacement therapy is a major cornerstone in the successful management of neonates with respiratory distress syndrome. Until recently, the INtubate, SURfactant, Extubate protocol was the best a trade-off achieved to deliver the surfactant to the air exchanging respiratory epithelium against the barotrauma of prolonged intubation and ventilation. Minimal or Less Invasive Surfactant Therapy (MIST or LISA) was adapted in clinical practice as a gentler and a gentler way of delivering surfactant. LISA or MIST is associated with a significant reduction in the oxygen days and chronic lung disease, intraventricular hemorrhage of grade 2 or above, retinopathy of prematurity and other key neonatal outcomes. This translates into shortened neonatal intensive care unit stay and a significant reduction in the stress levels of neonatal nurses, parents, and caregivers. This procedure needs to be performed by skilled professionals with appropriate training to achieve the desired results.

Determination of Predictors of Brain Injury in Very Preterm Infants - A Retrospective Cohort Study.

Despite decades of research, there is inadequate evidence on the etiological factors of brain injury in preterm infants. To study the perinatal risk factors for preterm brain injury and to assess their strength of association. In this retrospective cohort study, we included infants born at <32 weeks' gestation and had either magnetic resonance imaging (MRI) or cranial ultrasound (CUS) performed at term equivalent age. Significant brain injury was diagnosed based on Kidokoro global brain injury score was ≥4 in MRI or cystic periventricular leukomalacia in CUS. Among the 698 infants, 48 had significant brain injury and 650 were taken as controls. In multiple logistic regression, intraventricular hemorrhage (IVH) grade 3-4 [adjusted odds ratio, 92.892 (19.495-442.619)], culture-positive sepsis [4.162 (1.729-10.021)], prolonged ventilation [3.688 (1.087-12.510)], and small for gestational age (SGA) [2.645 (1.181-5.924] were associated with greater risk of preterm brain injury. Severe IVH, culture-positive sepsis, prolonged ventilation and SGA were significant risk factors for preterm brain injury with severe IVH being the most significant contributing factor.

Serial Short-Term Outcomes of Very-Low-Birth-Weight Infants in the Korean Neonatal Network From 2013 to 2020.

BackgroundWe aimed to determine the current survival rate and short-term outcomes of very-low-birth-weight infants (VLBWIs) in Korea, as well as whether the survival rate and short-term outcomes have improved over time since 2013, which was when the Korean Neonatal Network (KNN) was launched.MethodsThis study used data from the annual reports of the KNN from 2013 to 2020. A total of 16,351 VLBWIs born at gestational age (GA) ≥ 22 weeks between January 1, 2013, and December 31, 2020, and who were registered in the KNN were enrolled. Serial outcomes were analyzed according to era (2013–14, 2015–16, 2017–18, and 2019–20).ResultsMore mothers delivered by cesarean section, had diabetes or hypertension during their pregnancy, and received antenatal steroids when analyzed by era. Fewer infants were intubated at birth and had air leaks when analyzed by era. The overall survival rate of VLBWIs between 2013 and 2020 was 87%. The rate of respiratory distress syndrome was 77% and that of bronchopulmonary dysplasia was 32% between 2013 and 2020. The rates of intraventricular hemorrhage (grade ≥ 3), periventricular leukomalacia, and sepsis decreased over time. The survival rate of infants with a GA of 26 weeks has improved serially according to era.ConclusionSince the launch of the KNN in 2013, the survival rates of infants with GA 26 weeks and short-term outcomes have improved, which implies a quality improvement in antenatal and delivery room care. Further studies on the long-term neurodevelopmental outcomes of these KNN registrants are warranted.

Decreasing Trend in Incidence of Late Onset Culture Positive Bloodstream Infections but Not Late Onset Meningitis in Preterm Infants

Introduction: Recent studies reported decreased incidence of late onset sepsis in the neonatal intensive care unit (NICU), but it is unclear whether this is also true for late onset meningitis. Recent reports that both meningitis and intraventricular hemorrhage (IVH) are associated with systemic inflammation also raise questions about an association between the 2. Methods: All preterm infants <33 weeks gestational age admitted to CNN NICUs from 2010 to 2018 were included. We compared incidence trends of late onset culture positive bloodstream infection (CPBSI) and late onset meningitis, and examined the association of meningitis and IVH (exposure), after adjustment for potential confounders. Results: Of 36,573 infants included, 32,198 had no infection, 3,977 had only late onset CPBSI and 398 had late onset meningitis. There was significant decrease in incidence of late onset CPBSI (14%–10%; adjusted odds ratio (AOR) = 0.93; 95% confidence interval [CI] 0.92, 0.95) but not late onset meningitis (1.6%–1.2%; AOR = 0.98; 95% CI 0.94, 1.01). Compared to infants with no IVH grade 3 or above, infants with IVH grade 3, or above had higher odds of late onset meningitis versus no infection (AOR 4.16; 95% CI 3.17, 5.44), and higher odds of late onset meningitis versus late onset CPBSI (AOR 4.11; 95% CI 3.08, 5.50). Conclusions: There was a decreasing trend of late onset CPBSI but not late onset meningitis. An association between late onset meningitis and IVH grade 3 or above was observed. Late onset CPBSI and meningitis may have different risk factors and require different prevention strategies.

93 Timing and frequency of head ultrasound screening to identify severe neurological injury among very preterm infants

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Universal head ultrasound (HUS) screening for severe neurological injury (SNI) injury is recommended for infants born &amp;lt; 32 weeks’ gestational age (GA). However, the risk of SNI varies inversely with GA at birth and other known risk factors; therefore targeted screening may be more appropriate. Objectives The objective of the study is to develop a risk-stratified HUS screening protocol for infants born &amp;lt; 32 weeks’ to identify SNI accurately while minimizing resource use. Design/Methods Retrospective cohort study of infants born 23-31 weeks’ admitted to a tertiary NICU between 2011-2017. Patient characteristics were extracted from the Canadian Neonatal Network database. All HUS were individually reviewed by a trained abstractor and grouped based on date of exam relative to birth: ≤ 3 days, 4-7 days, 8-14 days, 28-42 days and 35-42 weeks’ corrected GA. Severe neurological injury was defined as intraventricular hemorrhage grade ≥ 3 and/or periventricular leukomalacia on HUS. Logistic regression models were used to identify perinatal risk factors for SNI and determine the number and timing of HUS with highest diagnostic accuracy. Results Of 651 infants included, 72 (11%) developed SNI. Independent risk factors for SNI were GA &amp;lt;29 weeks (AOR 3.09, 95% CI 1.65-6.08), vasopressors (AOR 2.95, 95% CI 1.24-6.80) and mechanical ventilation on day of admission (AOR 2.22, 95% CI 1.23-4.11). Infants were grouped into three screening groups based on their exposure to these risk factors (Table 1). Diagnostic accuracy of 63 models of combinations of HUS time points were assessed, and a screening protocol was developed based on the specific time points of HUS that maximized diagnostic accuracy (area under the ROC curve &amp;gt;0.9) while minimizing number of HUS for each screening group (Table 2). Using this protocol could reduce the total number of HUS performed by 920 (40%) and median number of HUS per infant from three (IQR 2-4) to 2 (IQR 1-2; p &amp;lt; 0 .001). Conclusion Implementation of a risk factor-based HUS screening protocol may reduce resource use while maintaining high diagnostic accuracy for SNI, and reflects choosing wisely in the NICU.

Prophylactic or very early initiation of continuous positive airway pressure (CPAP) for preterm infants.

Prophylactic or very early initiation of continuous positive airway pressure (CPAP) for preterm infants.

Outcomes in Twins Compared With Singletons Subsequent to Preterm Prelabor Rupture of Membranes.

To compare maternal and neonatal outcomes after preterm prelabor rupture of membranes (PROM) from 23 to 34 weeks of gestation in twin compared with singleton gestations. We conducted a secondary analysis of an obstetric cohort of 115,502 individuals and their singleton or twin neonates born in 25 hospitals nationwide (2008-2011). Those with preterm PROM from 23 0/7 through 33 6/7 weeks of gestation were included; neonates with major fetal anomalies were excluded. The coprimary outcomes for this analysis were composite maternal morbidity (chorioamnionitis, blood transfusion, postpartum endometritis, wound infection, sepsis, venous thromboembolism, intensive care unit admission, or death) and composite major neonatal morbidity (persistent pulmonary hypertension, intraventricular hemorrhage grade III or IV, seizures, hypoxic-ischemic encephalopathy, necrotizing enterocolitis stage II or III, bronchopulmonary dysplasia, stillbirth subsequent to admission, or neonatal death before discharge). Logistic regression was used to estimate unadjusted and adjusted odds ratios (ORs) with 95% CIs for twin compared with singleton gestations. Of 1,531 (1.3%) individuals who met eligibility criteria for this analysis, 218 (14.2%) had twin gestations. The median gestational age at preterm PROM was similar between those with twins and singletons (31.2 weeks [interquartile range 27.4-32.9] vs 30.6 weeks [interquartile range 26.9-32.7], P=.23); however, those with twin gestations had a shorter median latency period (2.0 days [interquartile range 1.0-5.0] vs 3.0 days [interquartile range 2.0-8.0], P<.001). After adjustment for potential confounders, odds of experiencing composite maternal morbidity (17.9% vs 19.3%, adjusted OR 0.97, 95% CI 0.66-1.42) or composite neonatal morbidity (20.4% vs 20.5%, OR 0.97, 95% CI 0.72-1.31) did not differ between groups. In a large, diverse cohort, the likelihood of composite maternal or neonatal morbidity per fetus after preterm PROM was similar for twin and singleton gestations.

Effect of Preventive Care Bundle Guidelines for Nurses on Incidence of Intraventricular Hemorrhage among Mechanically Ventilated Preterm Neonates

Background: Intraventricular hemorrhage (IVH) is a major neurological complication responsible for preterm neonates' morbidity and mortality. In the first 72 hours of life, nurses have a critical role in maintaining bundled practices for intraventricular hemorrhage prevention. The study aimed to assess preventive care bundle guidelines for nurses on the incidence of intraventricular hemorrhage among preterm neonates who were mechanically ventilated. This study was carried out at Neonatal Intensive Care Unit of Specialized Pediatric Hospital at Benha city. Sample of the study was convenient sample for nurses and purposive sample for preterm neonates who consisted of 60 preterm neonates on mechanical ventilation and 60 nurses who cared for them at previous setting. Tools of data collection included four tools, (1) A structured Interviewing Questionnaire Sheet, (2) Medical record of preterm neonates, (3) Intraventricular hemorrhage grading scale, (4) preventive care bundle checklist. The main results of this study revealed high statistical significant improvement in the studied nursesʹ total level of knowledge and total practice post- preventive care bundle guidelines implementation. Additionally, there was a negative correlation between total nurses' knowledge, their practice and IVH incidence pre and post-neonatal care bundle guidelines implementation. The main recommendation is Conducting an orientation programs for nurses in NICU with regular updates of knowledge and practice regarding preventing intraventricular hemorrhage for enhancing the quality of care and reducing in the incidence of all grades of IVH.

Mortality and Major Neonatal Morbidity in Preterm Infants with Serious Congenital Heart Disease

To investigate the trends of 1-year mortality and neonatal morbidities in preterm infants with serious congenital heart disease (CHD). This cohort study used a population-based administrative dataset of all liveborn infants of 26-36weeks gestational age with serious CHD born in California between 2011 and 2017. We assessed 1-year mortality and major neonatal morbidities (ie, retinopathy of prematurity, bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular hemorrhage grade >2, and periventricular leukomalacia) across the study period and compared these outcomes with those in infants without CHD. We identified 1921 preterm infants with serious CHD. The relative risk (RR) of death decreased by 10.6% for each year of the study period (RR, 0.89; 95% CI, 0.84-0.95), and the RR of major neonatal morbidity increased by 8.3% for each year (RR, 1.08; 95% CI, 1.02-1.15). Compared with preterm neonates without any CHD (n=234 522), the adjusted risk difference (ARD) for mortality was highest at 32weeks of gestational age (9.7%; 95% CI, 8.3%-11.2%), that for major neonatal morbidity was highest at 28weeks (21.9%; 95% CI, 17.0%-26.9%), and that for the combined outcome was highest at 30weeks (26.7%; 95% CI, 23.3%-30.1%). Mortality in preterm neonates with serious CHD decreased over the last decade, whereas major neonatal morbidities increased. Preterm infants with a gestational age of 28-32weeks have the highest mortality or morbidity compared with their peers without CHD. These results support the need for specialized and focused medical neonatal care in preterm neonates with serious CHD.

Assessment of Neonatal Intensive Care Unit Practices, Morbidity, and Mortality Among Very Preterm Infants in China

The Chinese Neonatal Network was established in 2018 and maintains a standardized national clinical database of very preterm or very low-birth-weight infants in tertiary neonatal intensive care units (NICUs) throughout China. National-level data on outcomes and care practices of very preterm infants (VPIs) in China are lacking. To assess the care practices in NICUs and outcomes among VPIs in China. A cohort study was conducted comprising 57 tertiary hospitals from 25 provinces throughout China. All infants with gestational age (GA) less than 32 weeks who were admitted to the 57 NICUs between January 1 and December 31, 2019, were included. Care practices, morbidities, and survival were the primary outcomes of the study. Major morbidities included bronchopulmonary dysplasia, severe intraventricular hemorrhage (grade ≥3) and/or periventricular leukomalacia, necrotizing enterocolitis (stage ≥2), sepsis, and severe retinopathy of prematurity (stage ≥3). A total of 9552 VPIs were included, with mean (SD) GA of 29.5 (1.7) weeks and mean (SD) birth weight of 1321 (321) g; 5404 infants (56.6%) were male. Antenatal corticosteroids were used in 75.6% (6505 of 8601) of VPIs, and 54.8% (5211 of 9503)were born through cesarean delivery. In the delivery room, 12.1% of VPIs received continuous positive airway pressure and 26.7% (2378 or 8923) were intubated. Surfactant was prescribed for 52.7% of the infants, and postnatal dexamethasone was prescribed to 9.5% (636 of 6675) of the infants. A total of 85.5% (8171) of the infants received complete care, and 14.5% (1381) were discharged against medical advice. The incidences of the major morbidities were bronchopulmonary dysplasia, 29.2% (2379 of 8148); severe intraventricular hemorrhage and/or periventricular leukomalacia, 10.4% (745 of 7189); necrotizing enterocolitis, 4.9% (403 of 8171 ); sepsis, 9.4% (764 of 8171); and severe retinopathy of prematurity, 4.3% (296 of 6851) among infants who received complete care. Among VPIs with complete care, 95.4% (7792 of 8171) survived: 65.6% (155 of 236) at 25 weeks' or less GA, 89.0% (880 of 988) at 26 to 27 weeks' GA, 94.9% (2635 of 2755)at 28 to 29 weeks' GA, and 98.3% (4122 of 4192) at 30 to 31 weeks' GA. Only 57.2% (4677 of 8171) of infants survived without major morbidity: 10.5% (25 of 236) at 25 weeks' or less GA, 26.8% (48 of 179) at 26 to 27 weeks' GA, 51.1% (1409 of 2755) at 28 to 29 weeks' GA, and 69.3% (2904 of 4192) at 30 to 31 weeks' GA. Among all infants admitted, the survival rate was 87.6% (8370 of 9552)and survival without major morbidities was 51.8% (4947 of 9552). The findings of this study suggest that survival and survival without major morbidity of VPIs in Chinese NICUs have improved but remain lower than in high-income countries. Comprehensive and targeted quality improvement efforts are needed to provide complete care for all VPIs, optimize obstetrical and neonatal care practices, and improve outcomes.

Outcomes of very preterm infants with neonatal hyperglycaemia: a systematic review and meta-analysis

ObjectiveTo explore the association between hyperglycaemia and adverse outcomes in very preterm infants.DesignSystematic review and meta-analysis. Data were pooled separately for adjusted and unadjusted odds ratios (ORs) using random-effects model....