Outcome Of Low Birth Weight Infants Research Articles

The Association of Missed Nursing Care With Very Low Birthweight Infant Outcomes.

The health outcomes of very low birthweight (VLBW) infants in neonatal intensive care units (NICUs) may be jeopardized when required nursing care is missed. This correlational study is the first to look at the association between missed nursing care and mortality, morbidity, and length of stay (LOS) for VLBW infants in a U.S. NICU sample. We used 2016 hospital administrative discharge abstracts for VLBW newborns (n = 7,595) and NICU registered nurse survey responses (n = 6,963) from the National Database of Nursing Quality Indicators. The 190 sample hospitals were from 19 states in all regions. Missed clinical nursing care was significantly associated with higher odds of bloodstream infection and longer LOS, but not mortality or severe intraventricular hemorrhage. With further research, these results may motivate the development of interventions to reduce missed clinical nursing care in the NICU.

Associations between maternal residential rurality and maternal health, access to care, and very low birthweight infant outcomes.

Infant mortality is increased in isolated rural areas. This study compares prenatal factors, access to care, and health outcomes for very-low birthweight (VLBW) infants by degree of maternal residential rurality. This descriptive population-based retrospective cohort study used the California Perinatal Quality Care Collaborative registry to study VLBW infants. Rurality was assigned as urban, large rural, and small rural/isolated using the Rural Urban Commuting Area codes. We used hierarchical random effect models to test the association of rurality with survival without major morbidity. The study included 38 614 dyads. VLBW survival without major morbidity decreased with increasing rurality and the relationship remained significant for small rural/isolated areas (OR 0.79, p = 0.03) after adjustment. Birth weight, gestational age, and infant sex were similar across geographic groups. A rural urban disparity exists for VLBW survival without major morbidity. Our findings generate hypotheses about factors that may be driving these disparities.

Executive Functions and Academic Outcomes of Low Birthweight Infants: A Prospective Longitudinal U.S. Cohort.

Executive functions such as working memory and cognitive flexibility are key to lifelong learning. Our hypothesis was that children born low birthweight (LBW), defined as weight < 2,500 g, would have lower cognitive outcomes than those born normal weight, and children with poor executive functioning would be at risk for poor academic outcomes. We evaluated data from 12,656 children followed prospectively in the Early Childhood Longitudinal Study, Kindergarten Class 2010-2011, assessing outcomes from kindergarten, first grade, and second grade. Multivariable linear and logistic regressions were run evaluating the relationship between birthweight and cognitive outcomes, and the odds of infants with poor executive functioning having poor academic outcomes. Compared with children with normal birthweight, those born LBW had lower mean z-scores for academic and directly assessed executive functions from kindergarten through second grade. LBW children were at an increased risk of scoring in the bottom 20% of children at all time points: second-grade reading odds ratio (OR) = 1.60 (95% confidence interval [CI:] 1.23-2.09), math OR = 1.49 (95% CI: 1.21-1.84), science OR = 1.41 (95% CI: 1.11-1.81), cognitive flexibility OR = 1.61 (95% CI: 1.27-2.02), and working memory OR = 1.40 (95% CI: 1.10-1.77). LBW infants remain at risk of poor cognitive outcomes in second grade. Early difficulties with executive functioning can increase the risk of a child's academic performance years later.

Small for gestational age and extremely low birth weight infant outcomes.

Background Small for gestational age (SGA) infants are less likely to develop respiratory distress syndrome (RDS), but more likely to develop bronchopulmonary dysplasia (BPD) and have a higher mortality. Our aim was to focus on outcomes of those with a birth weight less than or equal to 750 g. Methods The mortality, BPD severity, necrotising enterocolitis (NEC), home oxygen requirement and length of hospital stay were determined according to SGA status of all eligible infants in a 5-year period admitted within the first 24 h after birth. Results The outcomes of 84 infants were assessed, and 35 (42%) were SGA. The SGA infants were more mature (P<0.001), had a lower birth weight centile (P<0.001) and a greater proportion exposed to antenatal corticosteroids (P=0.022). Adjusted for gestational age (GA), there was no significant difference in mortality between the two groups (P=0.242), but a greater proportion of the SGA infants developed severe BPD (P=0.025). The SGA infants had a lower weight z-score at discharge (-3.64 vs. -1.66) (P=0.001), but a decrease in z-score from birth to discharge was observed in both groups (median -1.53 vs. -1.07, P=0.256). Conclusion Despite being more mature, the SGA infants had a similar mortality rate and a greater proportion developed severe BPD.

Growth and Neurodevelopmental Outcome in Preterm LBW Infants with Sepsis in India: A Prospective Cohort.

Objective Neonatal sepsis is associated with abnormal neurodevelopmental outcomes but not with poor growth at 9 to 15 months of corrected age in LBW infants. Design, Setting, and Participants This is a prospective cohort study involving 128 eligible preterm low-birth-weight (LBW) infants admitted during the period of 2013-2014 to the Durgabai Deshmukh Hospital and Research Center. All patients were followed up in the outpatient Department of Pediatrics. They were divided into the sepsis and nonsepsis group. Results A total of 94 infants were evaluated (40 in sepsis and 54 in nonsepsis group). At the age of 9–15 months, low-birth-weight infants with neonatal sepsis had an increased risk of neurodevelopmental disorders (67.5 versus 20.3%; RR: 3.31 (1.87–5.85)). There is no statistically significant difference in the growth outcomes. Conclusion Neonatal infections are associated with the abnormal neurodevelopmental outcomes in LBW infants but there was no significant difference at growth outcome at 9 to 15 months of corrected age between both groups.

Low Birth Weight Prevalence, Risk Factors, Outcomes in Primary Health Care Setting: A Cross-Sectional Study

Background: Low birth weight (LBW) is defined by WHO as birth weight less than 2500 g. it is the single most important factor affecting neonatal mortality and morbidity. Furthermore, LBW babies are at an increased risk for serious health problems, ranging from neuro-developmental disabilities to respiratory disorders and cardiovascular disease at adulthood. Early comprehensive care for LBW infants in primary care setting is vital. Well-baby clinic offers a comprehensive and multidisciplinary care to children including LBW children. This study aimsto determine the prevalence, risk factors and outcome of LBW infants registered in well-baby clinic at primary health care setting. Methods: This is a Cross sectional retrospective epidemiological study has been conducted in accredited primary health care centers in Saudi Arabia. Target population is registered children in the Well-baby clinic of high risk category, born during 2014. Pre-term infants and infants with congenital anomalies were excluded. For data collection, a constructed data sheet for the variables included in the study adopted from the formal records of both: LBW infants and their mothers was used. Necessary permission to conduct the study obtained from research and ethical committee of the joint committee of family and community medicine. Confidentiality of information has been strictly adhered by assuring that no names or ID number will be recorded. Results: Babies with birth weight less than 2500 gram were taken as cases. A total number of 124 (4.39%) were included, 55 (44.4%) of them were male babies and 69 (55.6%) were female babies. The mean maternal age was 28.82 years. 10 (8.1%) of LBW babies were delivered to mothers suffering from chronic illness (mainly diabetes and hypertension). 5 (4%) of LBW babies were born to smoker mothers. 76 (61.3%) of the LBW were born to anemic mothers. 9 (7.3%) of babies were born to mothers never had regular ANC follow-up. 28 (22.6%) of LBW babies were admitted to the NICU and 111 (89.5%) cases were improved after one-year follow-up in well-baby clinic. Conclusion: The study findings suggest that four factors increase the incidence of LBW, namely smoking, anemia, mothers never had regular ANC and mother's chronic disease. It also leads to conclude that breast feeding and NICU admission are significant independent variables that have been assumed to affect the outcome of LBW during follow up at the well-baby clinic.

A free parking trial to increase visitation and improve extremely low birth weight infant outcomes.

ObjectiveFrequent parental visits are likely to benefit infants in a neonatal ICU (NICU), particularly extremely low birth weight (ELBW; ≤1000g) survivors. Parking costs (≥$10/visit in our center) may deter visitation, especially for low-income parents. We assessed whether free parking (FP) decreased survivors’ length-of-stay (LOS).Study DesignParents (N=138) of ELBW infants (7–14 days old) were randomized to usual care (UC; n=66) or FP (n=72). The primary outcome was LOS.ResultsAmong survivors (n=116), LOS was not significantly less with FP than UC (Means: FP=89, UC=102 days; p=0.22; Medians: FP=82, UC=84 days; p=0.30). Groups did not differ significantly on proportion of visit days (FP=0.69, UC=0.72, p=0.47), parental involvement, knowledge/skills, and satisfaction. Post-hoc analyses found that parents with a greater income, a car, and fewer children visited more.ConclusionMore potent interventions than FP are needed to increase parental visits and reduce LOS for ELBW infants in disadvantaged urban populations.

OC08.02: The significance of chorionicity on long‐term outcome of low birthweight infants of less than 1,500 grams in twin pregnancies

OC08.02: The significance of chorionicity on long‐term outcome of low birthweight infants of less than 1,500 grams in twin pregnancies

Significance of chorionicity on long‐term outcome of low birthweight infants of &lt;1500g in twin pregnancies

The aim of this study was to evaluate the long-term outcomes of very low birthweight twins by chorionicity and to identify the perinatal predictors for outcomes in the era of laser surgery for twin-twin transfusion syndrome. This was a retrospective single-center cohort study of twin pregnancy infants <1500 g from 2003 through 2010. During the study period, laser surgery was performed on cases of twin-twin transfusion syndrome. The composite of adverse outcomes at 3 years of age was defined, including death, cerebral palsy, and developmental delay. The association between perinatal factors and adverse outcomes was evaluated by multiple logistic regression analysis. A total of 162 infants (79 dichorionic diamniotic twins [DCDA] and 83 monochorionic diamniotic twins [MCDA]) were included in this study. Laser surgery was performed on 11 cases. The rate of adverse outcomes was 13.9% for DCDA and 26.5% for MCDA. The incidence of each outcome for DCDA and MCDA was: cerebral palsy, 1.3% and 4.8%; developmental delay, 8.9% and 9.6%; and death, 3.8% and 14.5%. Gestational age at birth (adjusted odds ratio: 0.69; 95% confidence interval, 0.57-0.84); and anemia at birth (adjusted odds ratio, 10.64; 95% confidence interval, 1.69-66.9) were independent risk factors, whereas chorionicity did not have significance for outcomes. The long-term outcome of very low birthweight MCDA was almost identical to that of DCDA. Gestational age and anemia at birth were independent risk factors for adverse outcomes.

Congenital heart disease in low-birth-weight infants: effects of small for gestational age (SGA) status and maturity on postoperative outcomes.

Few studies have examined the role that small for gestational age (SGA) status plays in postoperative outcomes for low-birth-weight (LBW) infants with congenital heart disease (CHD). This study aimed to examine the effect of SGA status, gestational and chronologic age, and weight on differences in morbidities and mortalities during the immediate postoperative hospitalization period. The charts of infants with CHD weighing less than 2.5 kg who underwent operative repair during the neonatal period between 2004 and 2011 were reviewed. Infants with an isolated patent ductus arteriosus were excluded from the study. Data on hospital morbidities and mortality before discharge were collected. The study identified 136 LBW infants with a diagnosis of CHD. Among the 74 infants who underwent surgery and had complete chart records, the SGA infants had a higher gestational age at birth (36.8 vs. 32.3 weeks; p < 0.0001). The SGA and non-SGA infants did not differ in terms of survival to discharge or immediate postoperative outcomes. A lower weight at surgery was significantly associated with an increased risk of postoperative infection. In contradistinction, an older postnatal age at surgery was associated with an increased risk of preoperative infection (p < 0.0001). Additionally, lower gestational age at birth was associated with home oxygen use, higher tracheostomy rates, and discharge with a gastrostomy tube. Small for gestational age status played no protective role in the outcome for LBW infants after primary surgery for CHD. A weight of 2.4 kg or greater at the time of surgery was associated with lower rates of postoperative infections. Greater duration of time between birth and surgery was associated with a greater risk of preoperative infection. A gestational age of 32 weeks or more at birth was associated with decreased morbidities, which could influence obstetric management.

Trend and Seasonality in Admission and Outcome of Low Birthweight Infants in Gwagwalada-Abuja, Nigeria

Background : Low birthweight is an important contributor to neonatal morbidity and mortality. Various interventions have been instituted toward the reduction in the incidence of low birthweight deliveries and a dmissions. Knowledge of the current trend and seasonality in low birthweight admission is required in the control of the condition. Objectives: To determine the trend and seasonality in admission and outcome of low birthweight deliveries. Methods : Retrospective review of records of babies admitted into the Special Care Baby Unit of University of Abuja Teaching Hospital, with birthweights below 2500 grams over a 5-year period, from January 2006 through December, 2010, was undertaken and the data obtained were analyzed using Epi Info version 3.5.2 software. A pvalue of <0.05 was set as point of statistical significance. Results: A total of 4358 babies were admitted into the Special Care Baby Unit during the

Neonatal stomach volume and physiology suggest feeding at 1‐h intervals

There is insufficient evidence on optimal neonatal feeding intervals, with a wide range of practices. The stomach capacity could determine feeding frequency. A literature search was conducted for studies reporting volumes or dimensions of stomach capacity before or after birth. Six articles were found, suggesting a stomach capacity of 20mL at birth. A stomach capacity of 20mL translates to a feeding interval of approximately 1h for a term neonate. This corresponds to the gastric emptying time for human milk, as well as the normal neonatal sleep cycle. Larger feeding volumes at longer intervals may therefore be stressful and the cause of spitting up, reflux and hypoglycaemia. Outcomes for low birthweight infants could possibly be improved if stress from overfeeding was avoided while supporting the development of normal gastrointestinal physiology. Cycles between feeding and sleeping at 1-h intervals likely meet the evolutionary expectations of human neonates.

Improved perinatal and very low birth weight infant outcomes following neonatal and perinatal regionalization in a rural setting

Objective: To evaluate the changes in outcome that occurred during implementation of a comprehensive outreach program to five level I newborn care facilities, by one level III neonatal intensive care unit in rural WA State. Study design: Standardized outreach educational programs were provided. Outcome measures were assessed by collecting monthly perinatal and postnatal data on 61,551 births. Three six-year periods were defined. Period I (1988-1994) was compared with period II (1994-2000) and period III (2000-2006). Results: Comparing the averages for the three periods, there was a statistically significant increase in maternal transports from level I hospitals, and significant decreases in early-onset sepsis, meconium aspiration syndrome, low Apgar scores, major congenital malformations, neonatal and perinatal mortality rates, very low birth weight (VLBW) infant mortality, chronic lung disease and duration of hospital stay (all p< 0.001). Conclusion: A successful regionalization of perinatal service in rural areas can be accomplished by establishing extensive outreach programs. This model can be utilized to improve perinatal, neonatal and VLBW infant outcomes.

237 Reducing The CMV Infectivity of Mother's Own Breast Milk

Background: Infants can acquire primary postnatal CMV infection from the breast milk of their CMV infected mothers(1). About 60% of Australian mothers are CMV positive. Most of these will eventually excrete CMV into their breast milk(1). CMV transmission has been documented in 37% of preterm infants of CMV infected mothers(1) -symptomatic infection such as neutropenia, thrombocytopenia, hepatopathy, sepsis-like deterioration occurred in about half of these (1). The infants most at risk of symptomatic infection are the extremely low birth weight infants and those who acquire CMV early(2). An increased risk of adverse neurodevelopmental outcome in low-birth weight infants who acquired CMV early has been suggested (3). Preventing CMV transmission in extremely preterm infants from maternal milk is a clinical problem. Methods that reliably remove CMV such as heating also remove beneficial properties of breast milk. Freezing is not harmful to the protective effects of breast milk. Previous small studies of freezing (to −20°C) breast milk with naturally acquired CMV showed a reduction in CMV titres, or elimination of CMV. These studies used a culture method with a low sensitivity.

Relationship of prenatal care and perinatal morbidity in low-birth-weight infants

Objective Lack of or no prenatal care (NPC) is associated with preterm birth (PTB) and low birth weight (LBW). Our purpose was to determine whether LBW infants delivered after NPC have worse outcomes than LBW infants with prenatal care (PC). Study design Eight thousand sixty-five consecutive women delivered at six hospitals in Shelby County, Tenn, were evaluated regarding clinical characteristics and perinatal outcomes depending on the occurrence of PC. Infant and LBW infant outcomes were evaluated on the basis of the occurrence of PC. Multivariate analysis was performed for neonatal outcomes adjusting for race, plurality, antenatal steroids, amnionitis, and ponderal index. A P value less than .05 was considered significant. Results NPC women were more likely multiparous (80% vs 65%), African American (70% vs 61%), and uninsured (25% vs 4%), P<.0001 for each. PTB (36% vs 15%) and LBW (22% vs 12%) were more common with NPC, P<.0001 for each. Women with NPC had more advanced cervical dilation (ACD) greater than 4 cm (ACD: 63% vs 39%) and more amnionitis on admission (2% vs 1%), P≤.001 for each, and had more fetal distress in labor, P = .02. NPC infants had increased mortality, respiratory distress syndrome, intraventricular hemorrhage, retinopathy, and bronchopulmonary dysplasia. Among LBW infants, NPC was associated with premature rupture of membranes, antepartum hemorrhage, amnionitis, and ACD. Controlling for other factors, NPC LBW infants had increased mortality (17% vs 9%), respiratory distress syndrome (31% vs 24%), intraventricular hemorrhage (10% vs 5%), retinopathy (13% vs 9%), and bronchopulmonary dysplasia (11% vs 7%), P≤.04 for each. Conclusion In addition to increasing PTB and LBW, NPC is associated with increased perinatal morbidity and mortality among LBW infants after controlling for confounding factors.

Editorial

The Annual Research Review is intended to provide the readership with updates in selected areas of current research. In this, the 13th Annual Research Review, I have again been pleased to work with an outstanding group of contributors to whom I extend my thanks. The comments of an outstanding set of referees have served to enrich both the papers and the authors and I extend our thanks to them as well. The charge to authors is to provide selective coverage of their topic area. By encouraging these selective reviews our hope is to provide a more interesting and readable set of papers for issues as the authors identify those findings which they feel have been of greatest importance for research over the past decade. In the first paper in this issue Caspi and Shiner have focused on personality differences in children and adolescents. This excellent review brings together a body of current and emerging work. In the next paper Grossman and colleagues discuss the effects of experience on brain development and its possible contributions to psychopathology. This review builds on the growing body of work on the effects of experience on the brain and its potential for providing new perspectives on understanding developmental and behavioral disorders. In their article Bachevalier and Machado discuss the uses and limitations of nonhuman primate models of psychopathology; this work may have particular implications for autism and similar disorders as we understand more about the role of specific brain mechanisms in mental disorders. In his paper Willoughby discuses the developmental course of symptoms of attention deficit hyperactivity disorder during the transition from childhood to adolescence and highlights areas important for future research. McMahon and colleagues have undertaken a review of the role of specificity of stress and psychopathology in children and adolescents; this review has particular importance as we attempt to understand how specific the role of stress is in producing specific symptomatology. Finally Woods and colleagues discuss potential parental contributions to children's experience of anxiety. For the 14th edition of the Annual Research Review we anticipate coverage of the following topics: autism and related disorders, assessment in infancy and early childhood, peer relations, outcome of low birthweight infants, learning disabilities, and cross-cultural perspectives on psychopathological disorders. Fred R. VolkmarAssociate Editor

Neurodevelopmental outcome of low birthweight infants using corrected and uncorrected scores on the Vineland Adaptive Behavior Scales and Bayley Scales of Infant Development-Second edition

Neurodevelopmental outcome of low birthweight infants using corrected and uncorrected scores on the Vineland Adaptive Behavior Scales and Bayley Scales of Infant Development-Second edition

Acetazolamide plus furosemide for periventricular dilatation: lessons for drug therapy in children

Despite significant decreases in mortality for preterm infants attributable to technological and pharmacological advances in perinatal care, the rates of neuro-developmental impairment have been static. 1 Hack M Klein N Taylor HG Long term developmental outcome of low birthweight infants. Palo Alto, California: Packard Foundation. The Future of Children. 1995; 5: 176-196 Crossref PubMed Scopus (504) Google Scholar The major determinants of brain injury among preterm infants are severe periventricular haemorrhage with its associated complications, periventricular infarction and post-haemorrhagic hydrocephalus, and periventricular leucomalacia. Risk of congenital anomalies near hazardous-waste landfill sites in Europe: the EUROHAZCON studyThis study shows a raised risk of congenital anomaly in babies whose mothers live close to landfill sites that handle hazardous chemical wastes, although there is a need for further investigation of whether the association of raised risk of congenital anomaly and residence near landfill sites is a causal one. Apparent differences between malformation subgroups should be interpreted cautiously. Full-Text PDF

Vagal regulation in the prediction of outcome in low birthweight infants

Vagal regulation in the prediction of outcome in low birthweight infants

Early identification of cerebral palsy using a profile of abnormal motor patterns

Physical growth of preterm infants relates to many medical factors, such as birthweight, severity of medical illnesses, and nutritional status. We previously reported that maternal behaviors influence developmental outcomes in low birthweight infants (birthweight < 1600 g); we now hypothesize that maternal behaviors also influence physical somatic growth in low birthweight (LBW) infants. We serially followed 218 mother-infant pairs from birth through 12 months of age. One-hundred thirteen LBW infants were categorized based on severity of early medical complications. Low Risk infants (LR, n = 71) had acute respiratory distress and/or grade 1–2 intraventricular hemorrhage (IVH), or grade 3 IVH without hydrocephalus. High Risk infants (HR, n = 42) had chronic lung disease, grade 3 IVH with hydrocephalus or grade 4 IVH, and/or periventricular leukomalacia. We also studied 105 socioeconomic (SES) matched Full Term (FT) controls. Maternal behaviors were assessed during home visits with global ratings of Warm Sensitivity and Punitiveness. Infant weight was measured at birth and at 38 weeks, 6 months and 12 months corrected gestational age. We examined alternative expressions of weight growth across the three groups by developing the Weight Quotient (WQ), which is the ratio of actual measured weight to the median weight for age. For each infant the regression of the WQ ratio against correct gestational age was analyzed. We used a General Linear Model to compare the relation of the maternal variables to the weight quotients for the three groups. We determined the catch up growth as the slope of each regression. Results indicated that higher levels of maternal Punitiveness were related to slower rates of growth for High Risk (R2 = 0.36), but not Low Risk or Full Term. For maternal Warm Sensitivity (R2 = 0.36), there were significant (P < 0.05) inverse relations with weight gain growth for the Full Term infants. These data suggest that some maternal behaviors are related to the growth of term and premature infants, although the mechanisms through which this occurs is unclear.