Low Birth Weight Preterm Infants Research Articles

Home Visiting for NICU Graduates: Impacts of Following Baby Back Home.

The Following Baby Back Home (FBBH) home visiting program supports families of high-risk low birth weight preterm infants after discharge from a hospital NICU. This study compares the health care use, immunization, and infant mortality rate of low birth weight preterm infants enrolled in FBBH with similar infants not in the program. From January 2013 to December 2017, 498 children enrolled in FBBH were identified in Arkansas vital statistics records and the Arkansas All-Payer Claims Database. Infants in FBBH were matched with children in a control group on the basis of demographics and medical conditions of the infant. Generalized linear mixed models with double propensity-score adjustment were used to estimate program effects. In the first year after discharge and compared with a propensity-score matched cohort of control infants, those enrolled in FBBH were significantly more likely to have higher numbers of medical appointments and more compliant immunization history. The odds of dying in the first year of life for control infants was 4.4 times (95% confidence interval: 1.2-20.7) higher than those managed in the program. A goal of the FBBH home visiting program is to work with parents to educate and support them as they care for their medically fragile infants. We conclude that education and support was instrumental in the infant health care use and outcome differences we observed during the first year of life.

Temporal association of maternal weight gain with early-term and preterm birth and low birth weight babies.

Low birth weight and preterm or early-term babies may have a higher risk of poor health. One of the main factors is the weight gain of a pregnant woman during gestational weeks in the second and third trimesters. Changes in weight over a month in a pregnant woman might also have an impact on infant outcomes. This study aimed to investigate the association between maternal weight at different time points and low birth weight and preterm or early-term babies (premature babies). A total of 156 pregnant women were recruited. Maternal weight was collected at different gestational weeks. Maternal age, body mass index, delivery mode, delivery week, and infant weight were also recorded. Maternal data were restructured into a person-period format before mixed-effects multiple logistic regression was used. Various weight variables with either a fixed effect or time-varying effects were tested in the model. Thirty (19.23%) women had delivered low birth weight or premature babies. Multiple logistic regression model demonstrated that mothers with higher increases in weight at 32 weeks of gestation than that in the predelivery stage had a lower probability of having a low birth weight or premature baby (odds ratio [OR] = 0.64; 95% CI, 0.49-0.85; p < 0.001). Women with a weight increase of more than 2 kg in a 4-week gestation period had a higher probability of having a low birth weight or premature baby than those with an increment of <1 kg (OR = 8.43; 95% CI, 2.90-24.54; p < 0.001). An increase in weight gain after 32 weeks was shown to reduce the risk of low birth weight and premature babies. Maternal weight monitoring was suggested to be conducted every 4 weeks to minimize the chance of having a low birth weight and premature baby.

German S3-Guideline on the treatment of Psoriasis vulgaris, adapted from EuroGuiDerm - Part 2: Treatment monitoring and specific clinical or comorbid situations.

German S3-Guideline on the treatment of Psoriasis vulgaris, adapted from EuroGuiDerm - Part 2: Treatment monitoring and specific clinical or comorbid situations.

Effects of Intermittent Kangaroo Mother Care in Preterm Low Birth Weight Babies: A Randomized Controlled Trial

Background: Prematurity is the largest cause of neonatal mortality. They need incubators or radiant warmers which are expensive and very difficult to arrange in a resource constraint country. Kangaroo mother care (KMC) had been proposed as an alternative to conventional neonatal care for low birthweight (LBW) babies.&#x0D; Objectives: To observe the benefits of Kangaroo mother care in preterm low birth weight babies.&#x0D; Methods: This randomized controlled trial was conducted over 6 months in Dhaka Shishu Hospital. Neonates who were &lt;1800 gm and hemodynamically stable were enrolled. Total 80 neonates were enrolled and divided into 2 groups: Kangaroo mother care group and conventional method care group (incubator/warmer). The mother or caregiver were taught for KMC, supervised by trained nurses round the clock. KMC was given at least 2 hours at a time and at least 12 hours in a day. When the baby was not in KMC at that time the baby was placed in cot with adequate coverings. During hospital stay both the groups were monitored.&#x0D; Results: In KMC group 25% and conventional care group 40% neonates became hypothermic. Among the study population 35% neonates in KMC and 65% neonates in conventional care groups developed sepsis (p= 0.007). More KMC babies were exclusively breastfed at the end of the study (95% vs 60%). The KMC babies had shown better growth: weight gain per day (18.35±7.81 grams vs 13.55±4.89 p&lt;0.001) and length (0.99±0.70 vs 0.71±0.44 cm, p = 0.03). KMC babies were discharged earlier than conventional care baby.&#x0D; Conclusion: KMC provides significant improvement in exclusive breast feeding, reduction of infection, decrease hospital stay and gaining weight of the babies. It also helps in maintaining temperature better than conventional care.&#x0D; DS (Child) H J 2020; 36(2): 107-113

A Systematic Review and Meta-Analysis of Human Milk Feeding and Short-Term Growth in Preterm and Very Low Birth Weight Infants.

Human milk (HM) is the gold standard for feeding infants but has been associated with slower growth in preterm infants compared with preterm formula. This systematic review and meta-analysis summarises the post-1990 literature to examine the effect of HM feeding on growth during the neonatal admission of preterm infants with birth weight ≤1500 g and/or born ≤28 weeks’ gestation. Medline, PubMed, CINAHL, and Scopus were searched, and comparisons were grouped as exclusive human milk (EHM) vs. exclusive preterm formula (EPTF), any HM vs. EPTF, and higher vs. lower doses of HM. We selected studies that used fortified HM and compared that with a PTF; studies comparing unfortified HM and term formula were excluded. Experimental and observational studies were pooled separately. The GRADE system was used to evaluate risk of bias and certainty of evidence. Forty-four studies were included with 37 (n = 9963 infants) included in the meta-analyses. In general, due to poor quality studies, evidence of the effect of any HM feeds or higher versus lower doses of HM was inconclusive. There was a possible effect that lower doses of HM compared with higher doses of HM improved weight gain during the hospital admission, and separately, a possible effect of increased head circumference growth in infants fed EPTF vs. any HM. The clinical significance of this is unclear. There was insufficient evidence to determine the effects of an exclusive HM diet on any outcomes.

Impact of Early Empiric Antibiotic Regimens on the Gut Microbiota in Very Low Birth Weight Preterm Infants: An Observational Study.

Frequent use of antibiotics in preterm infants disturbs their gut microbial balance. In this preliminary observational study, we investigated the effect of different antibiotic regimens, administered during the first week of life, on microbial composition and diversity in very low birth weight (VLBW) preterm infants. We performed fecal sampling of breastfed VLBW infants on days 7, 14, and 30. After excluding stool samples from infants who received probiotics or who were administered antibiotics beyond the age of 7 days, we compared gut microbiota profiles between infants receiving a combination of ampicillin and gentamicin for 3 days (AG group, n = 10) and those receiving a combination of ampicillin and cefotaxime for 7 days (AC group, n = 14) using 16S ribosomal DNA community profiling. We also assessed the changes over time in each group. Compared to the AG group, Enterococcus species were significantly more abundant in the AC group (P = 0.002), especially in 7-day samples (12.3 vs. 0.6%, respectively, P = 0.032). No difference was observed at phylum and genus level over time within each group. Species richness in the AC group decreased significantly in the 14-day (P = 0.038) and 30-day (P = 0.03) samples compared to that in the 7-day sample. The same was observed for microbial evenness; in contrast, no significant difference in Shannon index and beta-diversity was detected between the two groups. Controlling for relevant confounding variables did not change the results. In conclusion, different antibiotic regimens affect the early development of gut microbiota in VLBW preterm infants. Prolonged use of ampicillin and cefotaxime might result in overabundance of Enterococcus. However, given that no significant differences were observed in 1-month samples, bacterial genera appear to continue colonizing the gastrointestinal tract despite previous exposure to antibiotics. The clinical relevance of these findings should be elucidated by further studies.

Late-onset sepsis in very low birth weight preterm infants: 7 years' experience at a tertiary hospital in China

Studies about the epidemiology and risk factors of late onset of sepsis (LOS) in preterm very low birth weight (PVLBW) infants of developing countries are limited and variable. The objective of this study was to explore the epidemiology, risk factors and pathogens of LOS in VLBW infants in a Chinese tertiary hospital. Data concerning demographies, pathogens, risk factors and outcomes of LOS were collected in a cohort of 710 VLBW infants discharged from January 2012 to December 2018. Chi-square, t-test and multivariable logistic regression analysis were used to identify risk factors. The overall incidence of LOS was 24.08% and blood culture-proven sepsis was 19.58%. Gram-negative bacteria accounted for 57.93%, and 32.41% of the isolates were Klebsiella pneumoniae. LOS led to a longer hospital stay, higher hospitalization cost and higher mortality compared to infants without LOS. Mortality in Gram-negative or fungi LOS was higher than in Gram-positive LOS. The factor of PVLBW infants with registered permanent residence (PR) was associated with 80% lower likelihood of LOS compared to those without registered PR (P=0.000, 95% CI 0.096-0.420). Infants with thrombocytopenia had 2.5 times LOS of control (P=0.014, CI 1.210-5.132). Duration of parenteral nutrition was a risk of LOS (P=0.009, CI 1.010-1.069). Gram-negative bacteria, especially Klebsiella pneumonia, were the dominant pathogens in this study. Social factors might be a risk of LOS in PVLBW infants in developing countries. Taking measures to reduce the duration of parenteral nutrition may be helpful in decreasing the incidence of LOS. Awareness of thrombocytopenia may help to recognized diagnosis of LOS.

Heat Shock Protein-70 Levels Are Associated With a State of Oxidative Damage in the Development of Bronchopulmonary Dysplasia.

Background: Heat shock protein-70 (Hsp-70) exhibits cytoprotective effects against oxidative stress-induced airway injury. This study aimed to examine Hsp-70 and 8-hydroxy-2′-deoxyguanosine (8-OHdG) from tracheal aspirates (TA) in very low-birth weight (VLBW) preterm infants to predict the development of bronchopulmonary dysplasia (BPD).Methods: This birth cohort study enrolled 109 VLBW preterm infants, including 32 infants who developed BPD. Hsp-70 and 8-OHdG concentrations from TA were measured by immunoassay. The apoptosis of TA epithelial cells obtained on Day 28 after birth was measured using annexin-V staining assay.Results: Hsp-70 and 8-OHdG levels in TA fluid were persistently increased from Day 1 to Day 28 of life in the BPD group. Multiple linear regression analysis demonstrated that BPD was significantly associated with gestational age, respiratory distress syndrome, and TA Hsp-70 and 8-OHdG levels on post-natal Day 28. The TA Hsp-70 level positively correlated with TA 8-OHdG level on the Day 1 (r = 0.47) and Day 28 of life (r = 0.68). Incubation of recombinant Hsp-70 with primary epithelial cells derived from TA of patients decreased hydrogen peroxide-induced epithelial cell death.Conclusions: Hsp-70 levels are associated with a state of oxidative injury in the development of BPD.

Parents of Preterm and Very Low Birthweight Infants and Their Childrearing Practices.

Emerging research supports that early intervention leads to better health and higher functional status for infants with very low birthweight and/or low gestational age. Optimizing the transition from neonatal intensive care to early intervention programs relies heavily on parent engagement. The purpose of this descriptive correlational study was to investigate the relationship between parental characteristics, childrearing behaviors, and participation in early intervention. We used convenience sampling of 49 parents who participated in early intervention and the Parent Behavior Checklist to assess parent characteristics. Correlation coefficients between parenting behaviors, birthweight, and participation in early intervention were low. An important finding was that most parents in this study were within the "average" range for childrearing practices, despite the documented challenges associated with very low birthweight or gestational age. Despite documented challenges, parents of preterm infants with very low birthweight and parents of typical birthweight infants have similar parenting beliefs and behavior.

Follow-Up of Low Birth Weight Preterm Infants After Hospital Discharge: Incidence and Reasons for Rehospitalization

The rehospitalization frequency/indications of low birth weight (LBW) preterms and the effect of rehospitalization on growth and neurodevelopment were investigated. LBW preterms discharged from NICU were prospectively followed until the corrected age of 1 year. Infants rehospitalized after discharge were defined as the study group and those not rehospitalized as the control group. The frequency, duration and etiology of rehospitalization were investigated and the effects of neonatal complications, surgery and socio-demographic status on rehospitalization were assessed. The study and the control group included 113 and 217 infants, respectively. Infants in the study group were rehospitalized 247 times in total. Rehospitalization was significantly higher in the male gender (39.7% vs. 28.9%, p < 0.05). Hyperbilirubinemia-anemia, anemia-surgery and pulmonary-other infections were the most common indications for rehospitalization in the 0-14 days, 15 days to 2 months and 2-12 months, respectively. Intrauterine growth had no impact on rehospitalization. Somatic growth and neurodevelopment were significantly delayed in the study group (p < 0.05). Birth weight and gestational week are the most important determinants of rehospitalization. Rehospitalized preterm infants have significant deficits in both somatic growth and neurodevelopment despite high-quality follow-up care.

Hepatic Lesions of Total Parenteral Nutrition (Tpn) Secondary to Umbilical Venous Catheter (Uvc) Malposition in A Very Low-Birth Weight Infant in China

Umbilical vein catheterization (UVC) is a common operation for vascular access in preterm infants. However, there are complications associated with their use. We here a case of extravasation of the fluids due to misplacement of the catheter causing hepatic collection of TPN in a very low-birth weight preterm (VLBW) infant.

Hepatic Lesions of Total Parenteral Nutrition (Tpn) Secondary to Umbilical Venous Catheter (Uvc) Malposition in A Very Low-Birth Weight Infant in China

Umbilical vein catheterization (UVC) is a common operation for vascular access in preterm infants. However, there are complications associated with their use. We here a case of extravasation of the fluids due to misplacement of the catheter causing hepatic collection of TPN in a very low-birth weight preterm (VLBW) infant.

Effect of kangaroo mother care on the weight gain of the low birth weight preterm infants

A premature birth is one that occurs before the start of the 37th week of pregnancy. Preterm birth is commonly associated with Low birth weight (LBW), often have complicated medical problems. They may need extra care. Kangaroo mother care (KMC), care with skin to skin contact with mother or care giver has now become the standard of care either as an alternative to or an adjunct to technology based care. Objective of the study was to Effect of Kangaroo Mother Care on the weight gain of the Low birth Preterm Infants. 51 infants were included for the study; KMC was given for special neonatal care. LBW infants between 1000-1500 grams of birth weight & of gestational age 27-35.6 weeks were included in the study. Initial weight of the child as well as the KMC hours for the day were recorded for seven consecutive days. The Infants showed significant difference in weight gain between baseline & final assessment, with a P value of 0.00481. Thus, the study resulted with a positive outcome with a significant weight gain as well as with development of a strong mother-child bond through long hours of protective skin to skin contact.

Parenteral nutrition with fish oil-based lipid emulsion reduces the risk of cholestasis in preterm infants.

ObjectivePreterm infants receive long-term parenteral nutrition (PN) for gastrointestinal immaturity. This study aimed to determine if mixed lipid emulsions containing fish oil decrease the incidence of PN-associated cholestasis by reducing oxidative stress and providing an anti-inflammatory effect.MethodsThis retrospective cohort study enrolled 399 very low birth weight premature infants (gestational age ≤32 weeks) between January 2009 and November 2017 at a single neonatal intensive care unit. Preterm infants received total PN with either mixed lipid emulsion including fish oil (SMOFlipid®, n = 195) or soybean oil-based lipid emulsion (Lipovenoes®, n = 204) for at least 7 days. We compared the outcomes of PN-associated cholestasis, comorbidities, and mortality between the groups.ResultsThe incidence of PN-associated cholestasis was significantly lower in the SMOFlipid group than in the Lipovenoes group. The duration to full feeding days was significantly shorter in the SMOFlipid group compared with the Lipovenoes group. Relevant complications, such as severe retinopathy of prematurity and bronchopulmonary dysplasia, were also significantly reduced in the SMOFlipid group compared with the Lipovenoes group.ConclusionIn premature infants, PN with fish oil-based lipid emulsions is associated with a lower incidence of PN-associated cholestasis compared with soybean oil-based lipid emulsions.

I Wouldn't Let it Get to Me: Pregnant Black Women's Experiences of Discrimination.

Non-Hispanic Black women in the United States experience disproportionately higher rates of adverse birth outcomes including preterm birth and low birth weight infants compared with White women. Racial discrimination has been associated with these adverse outcomes. However, not all Black women experience discrimination in the same way. The majority of studies that report on the relationship between racial discrimination and maternal health have used quantitative methods that may present a monolithic understanding of this relationship. Qualitative methods, specifically those that incorporate intersectionality, may illuminate the nuances in pregnant Black women's experiences of discrimination. We present a qualitative analysis of Black women's experiences of racial discrimination and pregnancy to shed light on some of these complexities. Qualitative interviews that addressed racial discrimination and pregnancy were conducted as part of a larger study of pregnant Black women that examined social support, neighborhood disorder, and racial discrimination. Interviews were coded for descriptions of racial discrimination and within and across case analysis was conducted. Women described varying experiences of racial discrimination in different contexts. Shielding emerged as a recurring theme in women's accounts of dealing with racial discrimination during pregnancy. Nurses engaged in maternity care need an understanding of how pregnant Black women experience racial discrimination in different ways. Black women may be likely to take personal responsibility for managing discrimination-related stress in pregnancy as a consequence of direct experiences of discrimination. Nurses can support pregnant Black women by recognizing varied experiences of racial discrimination, and by not blaming them for experiences or potential resultant outcomes.

An experimental animal model of bronchopulmonary dysplasia: Secondary publication.

Bronchopulmonary dysplasia (BPD) is a serious complication of preterm delivery and low birthweight infants. The incidence of BPD has not decreased, and there is no effective treatment for the disease. Since the survival rate of premature infants has increased, it has become difficult to obtain pathological tissue samples from BPD death cases. There is also no in vitro experimental system for complex three-dimensional structures, such as alveolarization and pulmonary angiogenesis; thus, the use of animal models is necessary to elucidate the pathology of BPD and develop new treatments. To date, BPD animal models were being developed by exposing immature animal lungs to various stimuli. In the present review, I summarize BPD animal models that use (i) highly concentrated oxygen, (ii) mechanical ventilation, and (iii) infection/inflammation. In addition, with mesenchymal stromal cell (MSC) therapy for BPD as an example, I will discuss the expectations for new treatments that would be applied from animal models to humans.

The challenge of accurately describing the epidemiology of bronchopulmonary dysplasia (BPD) based on the various current definitions of BPD.

Despite marked improvements in the survival of extremely low birth weight preterm infants, bronchopulmonary dysplasia (BPD) remains a prevalent morbidity. BPD has evolved pathologically and epidemiologically but the definition has failed to keep up. The majority of the definitions of BPD still use the respiratory support provided to the infants at a single timepoint. The lack of a uniform definition of BPD presently reflects the changing BPD pathogenesis and phenotype and limits defining the epidemiology. To address the epidemiology of BPD, the definition should be clarified; even the newer definitions have not been validated entirely. The definition needs to be meaningful clinically and be predictive of long-term respiratory outcomes. We believe the definition should have a composite assessment like a score (quantitative measurement) and include the different phenotypes (qualitative measurements) so that optimally they can be applied to the different phases of BPD and at different timepoints. Furthermore, the definitions need to be easy to measure and assess so that generalizability is enhanced.

Thyroid function and dysfunction in preterm infants-Challenges in evaluation, diagnosis and therapy.

Thyroid hormone levels have a crucial role for optimal brain development from gestation through the first 2 postnatal years. However, thyroid hormones vary with gestational age, and their levels vary between term and preterm infants. Preterm newborns are prone to thyroid dysfunction which is now more frequently observed with the advances of neonatal care and improved survival of extremely premature infants. Thus, hypothyroxinaemia of prematurity associated with delayed TSH elevation is very common in low birth weight premature infants most likely due to the immaturity of the hypothalamic-pituitary thyroid axis. Furthermore, postnatal illness, medications and iodine status may contribute to the thyroid dysfunction or affect the interpretation of the thyroid function tests. Despite available guidelines, timing of screening and optimal treatment of thyroid dysfunction in premature infants remains controversial. Furthermore, it is unknown whether untreated thyroid dysfunction in premature babies affects neurodevelopmental outcome. In the vast majority of preterm infants, hypothyroxinaemia is transient; however, permanent hypothyroidism due to thyroid dysgenesis or enzyme defects might also occur. Therefore, careful monitoring of thyroid function and long-term follow-up is needed to assess an appropriate therapeutic approach. This article reviews thyroid physiology in preterm infants, the influences of gestation and other neonatal conditions on thyroid function tests, optimal timing of screening and possible predictors to differentiate transient hypothyroxinaemia from permanent hypothyroidism.

Protective factors against preterm infants to develop significant patent ductus arteriosus

Identifying preterm infants with a higher likelihood of spontaneous patent ductus arteriosus (PDA) closure would be desirable. This study aimed to examine daily PDA status during the first week of life for very low birthweight (VLBW, <1500g) preterm infants and to develop a scoring system to predict spontaneous PDA closure. We enrolled VLBW infants admitted between January 2016 and January 2017 and performed daily echocardiographic screening for PDA existence. Oxygen index (OI, mean airway pressure×fraction of inspired oxygen/partial pressure of arterial oxygen) was applied to represent the respiratory condition. A total of 215 VLBW infants were enrolled, and the accumulative incidence of spontaneous PDA closure by age 1 week was 80%, 70%, and 34% for infants born of gestational age (GA) ≥30, 28-29, and ≤27 weeks, respectively. Of these 215 infants, 184 infants entered the second phase to establish the scoring system. Infants with spontaneous PDA closure were more mature (GA 29.2±2.3 vs. 26.9±2.3 weeks, p<0.001), had lower OI (2.8±2.2 vs. 5.6±5.3, p<0.001) and were less likely to need endotracheal intubation (23% vs. 68%, p<0.001). Using the receiver operating characteristics curve, OI <2.5 was determined favoring higher PDA closure incidence. The score was calculated based on the odds ratio generated in multiple regression: 4, 3 and 1 points for GA ≥30, 28-29 and≤27 weeks, 2 and 1 points for OI <2.5 and≥2.5, and 3 and 1 points for without and with endotracheal intubation. Using score ≥6 to predict PDA closure, the sensitivity and specificity were 0.77 and 0.72. A score made up of GA, OI and need for intubation was proposed to predict spontaneous PDA closure by age 1 week, which could be helpful to clinicians in the management of PDA in preterm infants.

Very Low Birthweight Preterm Infants: A 2020 Evidence Analysis Center Evidence-Based Nutrition Practice Guideline.

The National Institutes for Health and the Academy of Nutrition and Dietetics initiated the “Pre-B Project” to address the lack of very low birth weight (VLBW) preterm infant evidence-based nutrition practice guidelines. A scoping review and nine systematic reviews on enteral nutrition interventions were conducted by a multidisciplinary Preterm Panel. Recommendations were developed using the Academy’s Evidence Analysis Center Process and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence-to-Decision framework.