Low Birth Weight Premature Neonates Research Articles

Association of Very Low Birth Weight Infants With Parental and Sibling Mental Health Care Usage.

Parents and siblings of very low birth weight, premature infants are at risk for poor mental health outcomes with increased mental health care usage. Knowledge regarding mental health care use patterns could guide interventions. This retrospective cohort study included US families with commercial insurance coverage from a single carrier. Neonates born at ≤30 weeks' gestational age or with a birth weight <1500 g were identified by insurance claim data between July 1, 2015, and June 30, 2016. Each case neonate family was matched with up to 4 control families. The study included 1209 case and 1884 control neonates (with 134 deaths among only the case neonates [11.1% of cases]); 2003 case and 3336 control parents (mean [SD] age, 34.6 [5.4] years; 2858 [53.5%] female); and 884 case and 1878 control siblings (mean [SD] age, 6.8 [5.5] years; 1375 [49.8%] female). Compared with controls, more case parents used mental health care over the first year after birth hospitalization discharge. Higher usage was observed for bereaved case parents soon after their child's death. A smaller proportion of bereaved case siblings received mental health care compared with controls. Although nonbereaved case parents returned toward the proportion of use observed in controls, nonbereaved case female siblings, bereaved case female and male siblings, and bereaved male parents experienced continued differences. Understanding and meeting the mental health care needs of parents and siblings of very low birth weight premature neonates can be guided by these findings, including elevated and prolonged needs of bereaved parents and siblings.

Right ventricular myocardial performance index (Tei) in premature infants

The objective of this study was to evaluate the right ventricular myocardial performance index) based on echocardiography in very low birth weight premature neonates, close to hospital discharge. This was a prospective cross-sectional study that included premature neonates with birth weight <1,500 g and gestational age <37 weeks at the Intermediate Neonatal Unit of Bonsucesso Federal Hospital from July 2005 to July 2006. The infants underwent two-dimensional color Doppler echocardiography, being the right ventricular myocardial performance index evaluated close to hospital discharge. We compared the neonatal and echocardiographic variables in neonates with and without bronchopulmonary dysplasia. A total of 81 exams were analyzed. The mean birth (standard deviation) weight and gestational age were 1,140 (235) g and 30 (2.2) weeks, respectively. The incidence of bronchopulmonary dysplasia was 32%. The mean right ventricle myocardial performance index (standard deviation) of the sample was 0.13 (0.06). We found a significant difference in aortic diameter [non-bronchopulmonary dysplasia 0.79 (0.07) vs. bronchopulmonary dysplasia 0.87 (0.11) cm, p=0.003], left ventricle in diastole [non-bronchopulmonary dysplasia 1.4 (0.19) vs. bronchopulmonary dysplasia 1.59 (0.21) cm, p=0.0006], ventricular septal thickness [non-bronchopulmonary dysplasia 0.23 (0.03) vs. bronchopulmonary dysplasia 0.26 (0.05) cm, p=0.032], and "a" measurement [(= sum of the isovolumetric contraction time, ejection time, and isovolumetric relaxation time) when calculating the myocardial performance index (p=0.01)]. Higher "a" interval in neonates with bronchopulmonary dysplasia suggests right ventricle diastolic dysfunction. We conclude that the right ventricle myocardial performance index is an important indicator both of ventricular function and for serial follow-up testing of very low birth weight premature neonates, especially those with bronchopulmonary dysplasia.

Source of human milk (mother or donor) is more important than fortifier type (human or bovine) in shaping the preterm infant microbiome

SummaryMilk fortifiers help meet the nutritional needs of preterm infants receiving their mother’s own milk (MOM) or donor human milk. We conducted a randomized clinical trial (NCT03214822) in 30 very low birth weight premature neonates comparing bovine-derived human milk fortifier (BHMF) versus human-derived fortifier (H2MF). We found that fortifier type does not affect the overall microbiome, although H2MF infants were less often colonized by an unclassified member of Clostridiales Family XI. Secondary analyses show that MOM intake is strongly associated with weight gain and microbiota composition, including Bifidobacterium, Veillonella, and Propionibacterium enrichment. Finally, we show that while oxidative stress (urinary F2-isoprostanes) is not affected by fortifier type or MOM intake, fecal calprotectin is higher in H2MF infants and lower in those consuming more MOM. Overall, the source of human milk (mother versus donor) appears more important than the type of milk fortifier (human versus bovine) in shaping preterm infant gut microbiota.

Predictors of survival among preterm neonates admitted to Debre Tabor Comprehensive Specialized Hospital, Northwest Ethiopia; Implication for the maternal and neonatal health care-services

IntroductionPreterm neonatal death is one of the world's most pressing problems, especially in Ethiopia, despite the implementation of extensive prevention initiatives. As a result, the goal of the study was to determine the incidence of neonatal mortality among preterm neonatal admissions in the hospital setting. MethodsThe study was conducted among preterm neonatal admissions at Debre Tabor Comprehensive Specialized Hospital from January 1, 2014, to December 30, 2017. Cox regression model was used for analysis. Variables with a p-value of 0.2 in the log-rank test were taken to multivariable cox regression analysis and level of statistical significance was declared at P- value ≤ 0.05. ResultsAccording to current study, the overall rate of premature death was 31.2 per 100 live births (95% CI: 27.3, 35.1). Males ((Adjusted Hazard Ratio (AHR) = 1.38; 95% CI: 1.01, 1.90), neonates under 32 weeks of gestational age (AHR = 1.74; 95% CI: 1.24, 2.46), neonate born from preeclampsia mothers (AHR = 1.95; 95% CI: 1.13, 3.36), neonate with extremely very low birth weight (AHR = 2.94; 95%CI: 1.05, 8.24), and neonate having respiratory distress syndrome (AHR = 1.70; 95% CI: 1.20, 2.41) were significantly associated with preterm mortality. ConclusionThe burden of preterm mortality at hospital setting was high. As a result, reducing and treating preeclampsia is critical in lowering neonatal mortality. In addition, very low birth weight newborns and premature neonates with respiratory distress syndrome should be given special attention. Considering of every premature neonates as a danger of death, essential care such as; kangaroo mother care, feeding, infection prevention, oxygen therapy, thermal care, close follow-up, and medication administration should be considered.

Early iron supplementation and iron sufficiency at one month of age in NICU patients at-risk for iron deficiency

In order to reduce iron deficiency in neonates at-risk for iron deficiency, we implemented a guideline to increase the consistency of early iron supplementation in infants of diabetic mothers, small for gestational age neonates and very low birthweight premature neonates. Three years following implementation we performed a retrospective analysis in order to assess adherence to the guideline and to compare timing of early iron supplementation and reticulocyte-hemoglobin (RET-He) values at one month of life in at-risk infants. Adherence with early iron supplementation guidelines was 73.4% (399/543) with 51% (275/543) having RET-He values obtained at one month. Despite good adherence, 16% (44/275) had RET-He <25 pg (5th percentile for gestational age). No infants receiving red blood cell transfusion (0/20) had RET-He <25 pg vs. 26.1% (40/153) of those treated with darbepoetin (p < 0.001). There was no evidence of increased feeding intolerance (episodes of emesis/day) with early iron supplementation.

Apgar score was a prognostic predictor of outcome in very low birthweight premature neonates.

The reliability of Apgar scores and umbilical cord pH for predicting outcomes in very low birth weight (VLBW) neonates is controversial. A few studies have tried to identify the prognostic value of these measurements among VLBW and preterm infants. Forsblad et al. showed that the Apgar score had a prognostic value in preterm infants born at 25 weeks and that a high Apgar score was associated with survival, without neurological morbidity, in the first 180 days of life (1). Locatelli et al reported that the umbilical cord pH can be normal even if the Apgar score is low five minutes after birth (2).

Non-invasive Respiratory Support of the Premature Neonate: From Physics to Bench to Practice.

Premature births continue to rise globally with a corresponding increase in various morbidities among this population. Rates of respiratory distress syndrome and the consequent development of Bronchopulmonary Dysplasia (BPD) are highest among the extremely preterm infants. The majority of extremely low birth weight premature neonates need some form of respiratory support during their early days of life. Invasive modes of respiratory assistance have been popular amongst care providers for many years. However, the practice of prolonged invasive mechanical ventilation is associated with an increased likelihood of developing BPD along with other comorbidities. Due to the improved understanding of the pathophysiology of BPD, and technological advances, non-invasive respiratory support is gaining popularity; whether as an initial mode of support, or for post-extubation of extremely preterm infants with respiratory insufficiency. Due to availability of a wide range of modalities, wide variations in practice exist among care providers. This review article aims to address the physical and biological basis for providing non-invasive respiratory support, the current clinical evidence, and the most recent developments in this field of Neonatology.

Hyperthyrotropinemia is common in preterm infants who are born small for gestational age.

Background To determine the incidence of congenital hypothyroidism (CH) with a delayed increase in thyroid-stimulating hormone (TSH) levels in preterm infants and to describe the associated factors. Methods A prospective newborn screening (NBS) was conducted in 122 very low birth weight (VLBW) premature neonates born between June 2016 and September 2017. A dried blood spot thyroid stimulating hormone (TSH) level ≥15 mIU/L at 7 and 15 days of life, ≥10 in serum at the second screen or ≥5 at the third screen was defined as positive for CH. A concomitant increase in the TSH level and normal free thyroxine (T4) level was classified as hyperthyrotropinemia (HT). Results Before the first month of life, no cases of CH were identified. However, the second and third NBS identified 10 and six subjects with HT, respectively, but no cases of CH. The overall cumulative incidence of HT was 1:8. Small for gestational age (SGA) was a variable that was significantly associated with HT, even after the exclusion of patients with Down syndrome. Conclusions A high incidence of HT, but not CH, was found after the first month of life in preterm infants. Being SGA was strongly associated with having higher TSH. The need for repeating TSH screening after the first month of life in this population remains to be established.

Surgical Closure of Patent Ductus Arteriosus in Premature Neonates Weighing Less Than 1,000 grams: Contemporary Outcomes.

The safety of surgical closure of patent ductus arteriosus (PDA) in very low birth weight premature neonates has been questioned because of associated morbidities. However, these studies are vulnerable to significant bias as surgical ligation has historically been utilized as "rescue" therapy. The objective of this study was to review our institutions' outcomes of surgical PDA ligation. All neonates with operative weight of ≤1.00 kg undergoing surgical PDA ligation from 2003 to 2015 were analyzed. Records were queried to identify surgical complications, perioperative morbidity, and mortality. Outcomes included pre- and postoperative ventilator requirements, pre- and postoperative inotropic support, acute kidney injury, surgical complications, and 30-day mortality. One hundred sixty-six preterm neonates underwent surgical ligation. One hundred twenty-one (70.3%) had failed indomethacin closure. One hundred sixty-four (98.8%) patients required mechanical ventilation prior to surgery. At 17 postoperative days, freedom from the ventilator reached 50%. Of 109 (66.4%) patients requiring prolonged preoperative inotropic support, 59 (54.1%) were liberated from inotropes by postoperative day 1. Surgical morbidity was encountered in four neonates (2.4%): two (1.2%) patients had a postoperative pneumothorax requiring tube thoracostomy, one (0.6%) patient had a recurrent laryngeal nerve injury, and one (0.6%) patient had significant intraoperative bleeding. The 30-day all-cause mortality was 1.8% (n = 3); no deaths occurred intraoperatively. In this retrospective investigation, surgical PDA closure was associated with low 30-day mortality and minimal morbidity and resulted in rapid discontinuation of inotropic support and weaning from mechanical ventilation. Given the safety of this intervention, surgical PDA ligation merits consideration in the management strategy of the preterm neonate with a PDA.

Treatment of metabolic abnormalities with rasburicase in a premature neonate

Transient leukemoid reactions are well-documented in the neonatal intensive care unit, however, hyperleukocytosis greater than 100 x 10 9 /L remains a rare entity in premature neonates. We report the development of extreme hyperleukocytosis in an extremely low birth weight premature neonate born at 24-2/7 weeks of gestational age due to premature rupture of membranes in a mother who had received antenatal corticosteroids. The patient subsequently developed gross dyselectrolytemia similar to tumor lysis syndrome. Infectious workup remained unrevealing, flow cytometry of the peripheral blood showed no immunophenotypic evidence of acute leukemia, and a normal female XX karyotype was confirmed. A single dose of rasburicase was administered, with rapid and safe resolution of hyperuricemia, allowing for maintenance of kidney function. The patient was treated for presumed sepsis, although cultures remained negative. The white blood cell count gradually normalized over the first two weeks of life. The patient required treatment for a patent ductus arteriosus and was severely ventilator dependent for 33 days post-partum. To our knowledge, this is the first documented case wherein electrolyte abnormalities similar to those seen in tumor lysis syndrome had complicated the course of a leukemoid reaction in an extremely premature neonate necessitating the use of rasburicase

Scrotal enteric fistula in an extremely low birth weight premature neonate

Abstract Congenital inguinal hernia is a common condition in the pediatric population. Incarceration of inguinal hernias is known to result in significant morbidity such as necrotic bowel, and if not recognized promptly, has the potential to present as a scrotal fecal fistula. We present an extremely low birth weight premature male infant who developed spontaneous fecal drainage from his right scrotum.

Candida parapsilosis Secreted Lipase as an Important Virulence Factor.

The prevalence of Candida parapsilosis, an opportunistic human pathogenic fungal species, is increasing at an alarming rate in the hospital environment. Patients at risk for C. parapsilosis infection include those with immunosuppression, such as individuals with cancer, AIDS, and low birth weight premature neonates as well as patients that had undergone abdominal surgery. Neonatal candidiasis caused by C. parapsilosis has been widely reported across the globe. Various reports have shown that, compared to other Candida species, certain C. parapsilosis clinical isolates were less susceptible to antifungals such as amphotericin B, fluconazole, and caspofungin. In addition, some studies have even reported multi-echinocandin or multi-azole resistant strains of C. parapsilosis. C. parapsilosis has several virulence factors that contribute to its capacity for host invasion and among these factors extracellular lipases have a major role in pathogenesis. In this review we have collected all the recent relevant studies that confirm the involvement of secreted lipases in C. parapsilosis pathogenesis, using both in vitro and in vivo models of infection. Of particular note, an available lipase deficient C. parapsilosis strain has been utilized to demonstrate that the lack of secreted lipases decreased virulence, reduced tissue damage, and was less able to survive within phagocytes or mice compared to the wild type. Since fungal secreted lipases have different characteristics than lipolytic enzymes present in humans, C. parapsilosis extracellular lipases may be potential targets for the development of novel antifungal drugs.

Cardiopulmonary Bypass (CPB) in Low-birth Weight Premature Neonate with Double Aortic Arch, Congenital Heart Disease and Tracheal Stenosis

Introduction: Prenatal diagnosis of aortic arch anomalies associated with critical tracheal stenosis is challenging and management is related to high morbidity and mortality. We present successful surgical treatment of low-birth weight premature neonate with vascular ring, congenital heart disease and tracheal stenosis.

Isolated gastric pneumatosis in a premature infant following steroid exposure

Isolated gastric pneumatosis in neonates is extremely rare and usually associated with necrotizing enterocolitis (NEC) or obstruction of the proximal gastrointestinal tract. Although similar radiographically, gastric pneumatosis secondary to NEC is typically a marker of fulminant disease that carries a poor prognosis while gastric pneumatosis from proximal obstruction follows a more benign course after relief of the obstruction. This case describes an extremely low birth weight premature neonate treated with postnatal steroids who developed isolated gastric pneumatosis without evidence of intestinal obstruction.

Standardised Parenteral Nutrition

Parenteral nutrition (PN) has become an integral part of clinical management of very low birth weight premature neonates. Traditionally different components of PN are prescribed individually considering requirements of an individual neonate (IPN). More recently, standardised PN formulations (SPN) for preterm neonates have been assessed and may have advantages including better provision of nutrients, less prescription and administration errors, decreased risk of infection, and cost savings. The recent introduction of triple-chamber bag that provides total nutrient admixture for neonates may have additional advantage of decreased risk of contamination and ease of administration.

Surgical Placement of Permanent Epicardial Pacing Systems in Very Low-Birth Weight Premature Neonates

Few studies have characterized the surgical outcomes following epicardial pacemaker placement in very low-birth weight infants with congenital complete heart block. This study was undertaken to review the surgical experience with this patient population based on data from a large multi-institutional registry. The Pediatric Cardiac Care Consortium (PCCC) multi-institutional database was retrospectively reviewed to identify premature, low-birth weight neonates that underwent surgical placement of an epicardial pacing system for heart block. We reviewed 179 patients with birth weights less than 1.5 kg that underwent a major operative procedure. Of these, 10 patients underwent surgical placement of an epicardial pacing system for heart block. Patients had heart block in otherwise structurally normal hearts (n = 6) or heart block associated with complex structural congenital cardiac anomalies (n = 4). There were no deaths directly related to the surgical placement of the epicardial pacing system. There were no immediate complications with either lead or generator placement. One generator pocket was revised three months following placement. Survival to discharge was 60%. The four deaths occurred at a mean of 11 days (range 1-45 days) following the procedure. Neonates born with prematurity and congenital heart block represent a challenging subset of patients with significant mortality. Generator pocket breakdown and infection have been considered barriers to optimal short- and long-term outcomes. Among cases in the PCCC, there were no deaths or major complications that could be attributed to permanent epicardial pacemaker placement. These data suggest that an aggressive surgical strategy may be justified.

Experience with Early Enteral Feeding in a Patient with Venoarterial Extracorporeal Membrane Oxygenation

The study deals with the pathogenesis and early diagnosis of renal dysfunction in low and extremely low birth weight (ELBW) premature neonates. Objective: to study the specific features of the mechanisms responsible for the development of acute renal failure (ARF) in low and ELBW neonates and to use an analysis of oxygen status parameters as a method for early diagnosis of neonatal ARF. Subjects and methods. The study included 172 neonatal infants with a birth body weight of 800 to 1500 g. The values of blood gas composition and base-acid balance, and oxygen status were daily studied in all the children, by analyzing all the indices reflecting tissue hypoxia. Results. Analysis of oxygen status parameters in relation to a baby&#8217;s body weight revealed no considerable differences. The development of renal dysfunction and ARF in low and ELBW neonates was demonstrated to be most frequently caused by the progression of respiratory failure and tissue hypoxia, which suggests secondary renal lesion in the pattern of multiple organ dysfunction. It was ascertained that edema had a direct correlation with a physiological shunt fraction and oxygenation index and a moderate inverse correlation with blood oxygen tension and respiration index. In addition, an inverse correlation was found between the serum concentration of lactate and the daily volume of diuresis. The rate of hourly diuresis had a direct correlation with respiratory index and an inverse correlation with oxygenation index. Conclusion. Dysfunction of the kidneys and acute renal failure in neonatal infants in the pattern of multiple organ syndrome are secondary and closely related to the progres&#8211; sion of respiratory failure, as suggested by the oxygen status parameters that may be used for the prediction and early diagnosis or Key words: acute renal failure, renal dysfunction, neonaQtal infants, low and extremely low birth weight, hypoxia, oxygen status, multiple organ dysfunction. neonates. Key words: acute renal failure, renal dysfunction, neonatal infants, low and extremely low birth weight, hypoxia, oxygen status, multiple organ dysfunction.

H-type tracheoesophageal fistula in an extremely low birth weight premature neonate: appearance on magnetic resonance imaging

Many diagnostic methods have been used to establish the diagnosis for a suspected H-type tracheoesophageal fistula (TEF). In case of a strong assumption of an H-type fistula, besides all standard diagnostic work-up tools a more aggressive combined approach is advisable. However, in a critically ill premature infant, conventional invasive investigations could not be performed as being potentially hazardous and not always easy to achieve. We describe the unique imaging features of an H-type TEF on magnetic resonance imaging (MRI). Our case demonstrates that MR images could be used for diagnosis, and localization of an H-type TEF could be detected safely and accurately in a sick preterm infant.

Linezolid treatment of glycopeptide-resistant Enterococcus faecium in very low birth weight premature neonates

Glycopeptide-resistant Enterococcus faecium has emerged as an important nosocomial pathogen with limited therapeutic options. Here we report the successful treatment of glycopeptide-resistant E. faecium infection in two very low birth weight premature infants with the new oxazolidinone linezolid. Treatment with linezolid at a dosage of 10 mg/kg every 8 h intravenously for a duration of 16 days and 14 days, respectively, was well tolerated and led to complete clinical recovery and clearance of the organism from all body sites. The two cases support the clinical efficacy and safety of linezolid in very low birth weight premature neonates with glycopeptide-resistant E. faecium infections.

Retard de croissance postnatal du grand prématuré (27-33 SA) : fréquence et facteurs de risque: Étude rétrospective à propos de 161 cas

The optimization of the nutrition of very low birth weight premature neonates has become a major concern given the improvement in survival for these children. The goal of the recommended nutritional intakes is to reach a quantitative and qualitative growth similar to the in utero growth. The objectives of this study were to analyze the anthropometric data at birth and near term in a cohort of premature neonates with birth weight appropriate for gestational age and to try to determine risk factors of postnatal hypotrophy. Population and methods. – We conducted a retrospective study over three years (1998-2001) in the neonatology unit of the Armand Trousseau Children’s Hospital, Paris, France. The inclusion criteria was a gestational age under 33 weeks with birth weight appropriate for gestational age. Data were collected at admission, during hospitalisation and at discharge and a standardised form was filled for each child. We defined postnatal hypotrophy (PNH) as an hypotrophy at discharge (weight < 10 th centile according to the Audipog reference curve) in neonates with birth weight appropriate for gestational age. Results. – One hundred and sixty one neonates were included. Eighty two had PNH. In univariate analysis, factors significantly associated with PNH were: birth weight, gestational age, length of hospitalisation, the occurrence of nosocomial infection, of enteropathy, preeclampsia, neonatal asphyxia and antenatal corticoid treatment. In multivariate analysis, risk factors of PNH were: low birth weight, low gestational age and the occurrence of nosocomial infection. Conclusion. – Our study shows that half of the appropriate for gestational age premature neonates were hypotrophic near term. The causes may be various: nutrition is not optimal and intercurrent factors may play a major role such as nosocomial infection.