Low Birth Weight Preterm Infants Research Articles

Optimization of antenatal monitoring approaches of women with chronic inflammatory bowel diseases

Chronic inflammatory bowel diseases (CIBD) affect patients at their peak of reproductive age. Clinical presentation of CIBD in pregnancy is associated with an increased risk of adverse effects in mother and fetus, including prematurity, low birth weight, increased indications for caesarean section. Thus optimizing of the CIBD diagnosis and treatment before and during pregnancy is essential to improve maternal and fetal outcomes.Research aim: to analyze the effectiveness of the CIBD clinical management at the stage of preconception and during pregnancy.Materials and methods. It was searched the Cochrane Library, WHO platform, clinical guidelines, and research reference database Medline. All potential studies have evaluated the clinical practice guidelines in women with CIBD for conception, pregnancy and breastfeeding. Recommendations related to the necessary laboratory and instrumental examination methods, therapeutic strategy, the safety of drugs for mother and fetus, the features of multidisciplinary antenatal observation, the timing and method of delivery of pregnant women with CIBD. Results. Treatment in the planning phase and pregnancy should be multidisciplinary, involving a gastroenterologist, obstetrician-gynecologist, primary care physician, pediatrician and a colorectal surgeon if necessary, as well as stakeholders from the association of patients with CIBD. Communication between these professionals is critical to avoid ambivalent or even conflicting counseling, which is an additional source of anxiety for patients, and also potentially dangerous for suboptimal prevention of clinical CIBD manifestation. Obtained results of the analysis will prevent laboratory and therapeutic polypharmacy and significantly improve the pregnancy outcome.Conclusions. Most women with CIBD had a physiological pregnancy and healthy children. However, some studies have linked CIBD to an increased risk of preterm birth and low birth weight infants. The development of national clinical guidelines will optimize and improve the quality of perinatal care to women with CIBD in the Ukraine, and will lead to a decrease in obstetric, fetal and neonatal complications.

Is intravenous fish oil associated with the neurodevelopment of extremely low birth weight preterm infants on parenteral nutrition?

Preterm infants are at increased risk of long-term neurodevelopmental disabilities (NDD). Long chain n-3 fatty acids play a key role during the development of the central nervous system and some studies in preterm infants showed benefits of docosahexaenoic acid and arachidonic acid supplementation for visual and cognitive development. In recent years fish oil has been added to the fat blend of intravenous (IV) lipid emulsions (LE) but to date scanty data are available on neurodevelopmental outcome of preterm infants that received fish oil containing LE. We studied the effect of fish oil containing IV LE vs standard IV LE on neurodevelopment in a large cohort of preterm infants who received routine parenteral nutrition (PN) from birth. We retrospectively reviewed the neurodevelopmental outcome of 477 preterm infants (birth weight (BW): 400-1249g and gestational age (GA) at birth: 24+0 - 35+6 weeks (W)) admitted to our NICU between Oct-2008 and June-2017, who received routine PN with different LE, with and without fish oil (IV-FO vs CNTR). We compared neurodevelopment at 2 years corrected age by the Bayley III development scale and the incidence of NDD. Demographics, birth data and the incidence of the main clinical short-term outcomes of prematurity were similar in the two groups (IV-FO: n=178, GA 197±14 days, BW 931±182g; CNTR: n=192, GA 198±15 days, BW 944±194g). No differences were found in maternal demographics nor in parental education between the two groups. Cognitive score was not significantly different between IV-FO and CNTR (92±15 vs 93±13, p=0.5). No differences were found in motor and language scores, and in the incidence of NDD in the two groups. Contrary to our hypothesis, the use of fish oil containing LE in a large cohort of preterm infants on routine PN did not result in better neurodevelopment. Large randomized controlled trials powered for neurodevelopment are needed to clarify the impact of the widely used fish oil containing LE on neurodevelopment of preterm infants.

Long-term Outcomes after Postnatal Cytomegalovirus Infection in Low Birthweight Preterm Infants: A Systematic Review.

Cytomegalovirus (CMV) is the most common viral infection seen in newborns. Although postnatally acquired CMV (pCMV) infection rarely results in serious manifestations in term infants, preterm infants can develop severe clinical illness. However, the long-term implications of pCMV infection of preterm infants are unknown. Few robust studies on long-term outcomes of pCMV infection have been performed, and those reported often present conflicting results. Our objective was to assess the long-term outcomes for low birthweight (LBW) preterm infants after pCMV infection. A systematic review of English and non-English articles using MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science was conducted. Search strategies included a mix of keywords and database-specific subject headings for CMV and LBW infants. Editorials, comments, reviews and animal-only studies were excluded. Case reports, observational, experimental and randomized controlled trials that examined pCMV in preterm or VLBW infants and long-term (>1 month) impact of pCMV were included. pCMV infection in preterm infants is associated with increased risk for pulmonary and neurologic complications and increases length of stay. There is less evidence to suggest that pCMV is associated with necrotizing enterocolitis, ophthalmologic, audiologic and anthropomorphic complications in preterm infants. Preterm infants with pCMV, especially those with symptomatic infection, may have long-term pulmonary and neurodevelopmental morbidity compared with their pCMV negative counterparts. Our results highlight the importance of pCMV detection and prevention in preterm infants in the neonatal intensive care unit. Large prospective studies are needed to fully define outcomes and determine if treatment improves outcomes.

Feeding Strategies in Preterm Very Low Birth-Weight Infants: State-of-the-Science Review.

Providing enteral feeds to preterm very low birth-weight (VLBW) infants is critical to optimize nutrition, enhance growth, and reduce complications. Protocols guiding feeding practices can improve outcomes, but significant variation exists between institutions, which may limit their utility. To be most effective, protocols should be based on the best available evidence. To examine the state of the science on several key components of feeding protocols for VLBW infants. The authors searched PubMed, CINAHL, and EMBASE databases for terms related to feeding VLBW infants less than 32 weeks' gestational age, including initiation of feedings, rate of feeding advancement, timing of human milk (HM) fortification, and feeding during blood transfusions, when diagnosed with a patent ductus arteriosus (PDA) and during medical treatment of PDA closure. Initiation of feeds within the first 3 days of life and advancement by 30 mL/kg/d may decrease time to attain full feeds without increasing complications. Insufficient evidence guides optimal timing of HM fortification, as well as feeding infants undergoing blood transfusions, infants diagnosed with a PDA, and infants receiving medical treatment of PDA closure. Integration of existing research regarding feeding initiation and advancement into feeding protocols may improve outcomes. Infants at highest risk of feeding-related complications may benefit from a personalized feeding approach. Additional research is needed to provide evidence concerning the optimal timing of HM fortification and feeding strategies for infants undergoing blood transfusions and those diagnosed with a PDA or receiving medical treatment of PDA closure to incorporate into evidence-based feeding protocols.

Fortification of Human Milk With Infant Formula for Very Low Birth Weight Preterm Infants: A Systematic Review

Off-label fortification of expressed human milk (HM) with infant milk formula (IMF) is common in developing countries, though its benefits and safety are unclear. To study the effects of IMF fortification of HM on growth of very low birth weight (VLBW) preterm infants. Systematic review and meta-analysis of randomized and quasi-randomized controlled trials (RCTs). MEDLINE, EMBASE, CINAHL, CENTRAL and other databases were searched for articles published in English language from inception to December 2019, evaluating the effects of HM fortified with IMF as intervention, compared to unfortified HM or HM fortified with human milk fortifier (HMF). Five RCTs including 423 VLBW preterm infants. Feeding with HM fortified with IMF compared to unfortified or HMF-fortified HM. Primary outcome measure was assessment of growth as weight, length and head circumference (HC) gain velocity. Secondary outcome measures were incidences of feed intolerance (FI), necrotizing enterocolitis (NEC), time to reach full feeds, concentration of nutritional biomarkers, duration of hospital-stay and cost of intervention. Of the five studies included in the review, pooled effects regarding weight gain velocity (SMD 0.27 g/day; 95% CI 0.08 to 0.62), length gain (MD 0.07cm/week; 95% CI 0.02 to 0.16) and HC gain (MD 0.05 cm/wk; 95% CI 0.01 to 0.11), were not statistically significant. Sensitivity analysis by pooling studies using unfortified milk as comparator yielded a statistically significant result for all growth parameters. Risk of FI or NEC was comparable. Length of hospitalstay was reduced in the intervention group. A very-low quality evidence suggested that IMF fortification of HM is superior to unfortified milk and may be a safe alternative for HMF for short term growth of VLBW preterm infants.

Antenatal Thymosin β4: a New Tool for Accelerating Fetal Development in Preterms? Thymosin Beta-4: a Breakthrough in the “Physiological” Regenerative Medicine in Preterm Newborns

To prevent the health risks related to prematurity, multiple drugs have been introduced in clinical practice in recent years. This paper focuses on a new "physiological" regenerative approach to be started in the perinatal period, particularly on very low birth weight preterm infants. This new preventive approach underlined the necessity to start regenerative medicine very early after birth, a period in which kidney, brain, pancreas, and lung stem cells maintain their proliferative and differentiating abilities. Among the multiple factors proposed in the literature as potential growth promoters for preterm neonates, thymosin beta-4 (Tβ4) has been indicated as one of the most important candidates for regenerative medicine.

Study to Assess the Maternal and Perinatal Outcome in Teenage Pregnancy

Background: A pregnant teenager ‘’A child in child”as to meet the growing demands of fetus in additionto her own growing needs, thus putting her in a stressful situation. Teenage pregnancy is dangerous forthe mother, child and the community. Medical complications such as preterm labor, pregnancy-inducedhypertension, anemia and low birth weight babies are strongly associated with adolescent pregnancy. Suchpregnancies are seen mostly amongst the poorer and less educated sections of the society.Aim: To evaluate the maternal and perinatal outcome in teenage pregnancy in a tertiary care center.Objectives: To compare the maternal and perinatal outcome in teenage and adult pregnanciesDesign: A prospective studySetting: Department of Obstetrics and Gynecology, Sri Siddhartha medical college, Tumkur.Materials and Method: This study was undertaken at Sri Siddhartha medical college and hospital researchcentre tumakuru between October 2018 to October 2020, among the married pregnant women visiting toantenatal OPD and inpatients in the department of the OBG between 18 to 19 yrs as per the inclusion andexclusion criteria.Results: Teenage pregnancy may cause a significant obstetric complication Anaemia, preterm delivery,prom, pph, low birth weight babies, NICU admissions, respiratory distress syndrome were found to behigher among teenage mothers when compared to adult mothers.Conclusion: Teenage pregnancy was associated with increased incidence of anaemia and contract ed pelvis.Consequently there were higher incidence of lscs and PPH. There was in creased incidence of low birthweight babies, RDS, NICU admissions among the ba bies born to teenage mothers. Teenage pregnancy isassociated with increased mater nal and perinatal morbidity

Effects of two modalities of noninvasive ventilation on breathing pattern of very low birth weight preterm infants immediately after extubation: a quasi-experimental study

Aim The primary objective of this study was to investigate the effects of two modalities of noninvasive ventilation, continuous positive airway pressure-CPAP and non-synchronized nasal intermittent positive pressure ventilation-nsNIPPV, on breathing pattern of very low birth weight preterm infants immediately after extubation. Methods It was conducted a quasi-experimental study at a public university hospital. Infants with gestacional age ≤32 weeks and birth weight ≤1,500 g were randomized into the sequences, prior extubation: CPAP – nsNIPPV (1) or nsNIPPV – CPAP (2). Each preterm infant was studied for a period of 60 min in each ventilatory mode. Respiratory inductive plethysmography was used to assess breathing pattern. Inferential analysis was performed by repeated measures ANOVA or Friedman test. Results Eleven preterm infants were studied and a total of 7,564 respiratory cycles were analyzed. No significant differences were observed in any of the comparisons made for any of the breathing pattern variables (p > .05). Conclusions There was no significant difference on breathing pattern between CPAP and nsNIPPV of preterm infants after extubation.

Cerebral oxygenation is stable in preterm infants transitioning to heated humidified high-flow nasal cannula therapy.

To assess cerebral oxygenation in premature infants who are transitioning from nasal continuous positive airway pressure (nCPAP) to heated humidified high-flow nasal cannula therapy (HFNC). A prospective observational study done in a single-centre neonatal intensive care unit (NICU). Regional cerebral oxygen saturations (RcSO2 ) were measured using frequency-domain near-infrared spectroscopy (FD-NIRS) in very low birthweight (VLBW) premature infants born at <32weeks transitioning from nCPAP to HFNC. Median gestational age was 27weeks and median birthweight was 924g. Recordings were performed at a median gestational age of 30weeks and a median postnatal age of 10days. Median weight at study entry was 1111g. Cerebral oxygenation was not significantly different in infants transitioning from nCPAP to HFNC (66% vs 66%). No difference in cerebral oxygenation in premature infants transitioning from nCPAP to HFNC was observed. This finding is reassuring and further supports the use of HFNC in preterm infants.

Kalkulierter Pflegebedarf für Frühgeborene mit sehr geringem Geburtsgewicht aus Routinedaten: Eine 5-Jahresanalyse

The quality assurance directive for very low birthweight preterm infants (QFR-RL) by the German Federal Joint Committee calls for fixed nurse-to-patient ratios (NPRs) in neonatal intensive care, leading to considerable difficulties for staff planners, especially in smaller hospitals, as an extensive pool of nursing staff is required to ensure compliance with guidelines. Reliable parameters are therefore needed to provide a valid basis for staff planning. To calculate the number of nurse full-time equivalents (FTE) required to meet the demands of the QFR-RL for individual diagnosis-related groups (FTE-debit) and in relation to relative caseweight (FTE-debit / RW); to compare the calculated estimates with real hospital expenses (FTE-real) with nurse-relevant DRG proportions calculated by the Institute for the Hospital Remuneration System (FTE-norm). We included all very low birthweight infants (VLBW, <1,500g) treated between 08/2013 and 07/2018. FTE-debit was determined on the basis of shifts with 1:1, 1:2, and 1:4 NPR using the time infants underwent invasive or non-invasive mechanical ventilation, had a birthweight below 1,000g, or with imminent death. FTE-real was extracted from hospital cost accounting, and FTE-norm was determined as nurse-relevant DRG proportions calculated by the Institute for the Hospital Remuneration System. 856 (50.1% female) VLBW preterm infants were analysed. Calculated FTEs varied from 0.02 (95% confidence interval (CI) 0.02-0.02) to 1.16 (95%-CI 0.96-1.37) between individual DRGs. Calculated estimates (FTE-debit) were consistent with real expenses (FTE-real) and calculated nurse-relevant DRG-proportions (FTE-norm). In relation to the relative caseweight, an average demand of nurse FTE of about 0.02 FTE / relative weight point (FTE-debit / RW) was identified. This approach facilitates prospective planning which is in line with the FTEs required by the QFR-RL and based on remunerated DRGs; however, it is not supposed to replace shift-specific documentation.

Management strategies of functional intestinal obstruction of prematurity

Functional intestinal obstruction of prematurity (FIOP) is characterised by a partial or complete failure of meconium evacuation due to hypomotility of the immature bowel and this presents with features of intestinal obstruction typically within the first 2 weeks of life. It contributes significantly to the morbidity and mortality of extremely and very low birth weight preterm infants. This disorder has been described using many terminologies and there is controversy amidst clinicians as to the optimal approach to its management. This review summarises the characteristic clinical and radiologic findings to aid timely diagnosis and initiation of prompt treatment. Available evidence on different treatment options and their limitations is reviewed and practical stepwise management is described. In most cases, FIOP can be successfully managed conservatively with proactive management and monitoring. Overall outcomes are favourable and normal long-term gastrointestinal function is commonly experienced. Evidence for investigations to exclude cystic fibrosis and Hirschsprung’s disease in preterm infants with FIOP is evaluated and a link with focal intestinal perforation is highlighted.

The U.S. National Trend for Retinopathy of Prematurity.

The use of supplemental oxygen in premature infants is essential for survival. However, its use has been associated with unintended complications. The restricted use of oxygen is associated with increased mortality and necrotizing enterocolitis (NEC), whereas its liberal use is associated with increased risk for retinopathy of prematurity (ROP). Although there is no clear consensus on the acceptable oxygen saturation range, clinicians have recently become more liberal with the use of oxygen. We aim to assess (1) the national trends for ROP in very low birth weight preterm infants, and (2) the associated trends in mortality, NEC, intraventricular hemorrhage (IVH), and length of hospital stay (LOS). We analyzed deidentified patient data from the National Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP) from 2002 to 2017. All infants with gestational age ≤32 weeks and birth weight <1,500 g were included. Trends in ROP, severe ROP, mortality, NEC, IVH, severe IVH, and LOS were analyzed using Jonckheere-Terpstra test. A total of 818,945 neonates were included in the study. The overall mortality was 16.2% and the prevalence of ROP was 17.5%. There was a significant trend for increased ROP over the years (p < 0.001). Severe ROP was also significantly increased (p < 0.001). This was associated with a significant trend for increased median LOS in survived infants (p < 0.001). Mortality was significantly decreased (p < 0.001), whereas NEC and severe NEC did not change over time (p = 0.222 and p = 0.412, respectively). There is a national trend for increased ROP and severe ROP over the 16 years of the study period. This trend was associated with a significant increase in the LOS in survived infants without change in NEC. · Prevalence of ROP and severe ROP has increased in VLBW infants over the 16-year study period.. · The prevalence of NEC did not change over the same time period.. · Increased ROP and severe ROP were consistent in all three GA and BW subgroups..

A Retrospective Cohort Study on Mortality and Neurodevelopmental Outcomes of Preterm Very Low Birth Weight Infants Born to Mothers with Hypertensive Disorders of Pregnancy

We examined the effects of maternal hypertensive disorders of pregnancy (HDP) on the mortality and neurodevelopmental outcomes in preterm very low birth weight (VLBW) infants (BW ≤1,500 g) based on their intrauterine growth status and gestational age (GA). We included singleton VLBW infants born at <32 weeks' gestation registered in the Neonatal Research Network Japan database. The composite outcomes including death, cerebral palsy (CP), and developmental delay (DD) at 3 years of age were retrospectively compared among three groups: appropriate for GA (AGA) infants of mothers with and without HDP (H-AGA and N-AGA) and small for GA (SGA) infants of mothers with HDP (H-SGA). The adjusted odds ratios (AOR) and 95% confidence intervals (CI) stratified by the groups of every two gestational weeks were calculated after adjusting for the center, year of birth, sex, maternal age, maternal diabetes, antenatal steroid use, clinical chorioamnionitis, premature rupture of membranes, non-life-threatening congenital anomalies, and GA. Of 19,323 eligible infants, outcomes were evaluated in 10,192 infants: 683 were H-AGA, 1,719 were H-SGA, and 7,790 were N-AGA. Between H-AGA and N-AGA, no significant difference was observed in the risk for death, CP, or DD in any GA groups. H-AGA had a lower risk for death, CP, or DD than H-SGA in the 24 to 25 weeks group (AOR: 0.434, 95% CI: 0.202-0.930). The odds for death, CP, or DD of H-SGA against N-AGA were found to be higher in the 24 to 25 weeks (AOR: 2.558, 95% CI: 1.558-3.272) and 26 to 27 weeks (AOR: 1.898, 95% CI: 1.427-2.526) groups, but lower in the 30 to 31 weeks group (AOR: 0.518, 95% CI: 0.335-0.800). There was a lack of follow-up data; however, the outcomes of liveborn preterm VLBW infants of mothers with HDP depended on their intrauterine growth status and GA at birth. · The effects of HDP on preterm low birth weight infants need to be further examined.. · The outcomes were not different between AGA infants with and without maternal HDP.. · The outcomes of SGA infants with maternal HDP were dependent on their GA..

The indirect calorimetry in very low birth weight preterm infants: An easier and reliable procedure

ObjectivesPreterm infants are at increased risk of developing extrauterine growth restriction, which is associated with worse health outcomes. The energy needs are not well known, as the measurement of resting energy expenditure (REE) using indirect calorimetry has critical issues when applied to infants. One of the main issues is the time required to obtain reliable data owing to the difficulty in keeping infants quiet during the entire examination. Thus, the aim of this study was to define the minimum duration of calorimetry to obtain reliable data. MethodsThe volume of oxygen consumption (VO2) and the volume of carbon dioxide production (VCO2) were recorded for a mean duration of 90 consecutive minutes. REE was calculated using a neonatal prototype calculator. We extracted data regarding VO2, VCO2, and REE at 10(T1), 20(T2), 30(T3), 40(T4), and 50(T5) minutes of steady state and compared these data to those of entire steady state period. ResultsTwenty-six very low birth weight preterm infants were evaluated at 36.58 ± 0.99 wk corrected age. Infants were appropriate for gestational age and clinically stable without comorbidities. There were no significant differences between mean VO2 and REE at T1 (8.26 ± 1.45 mL/kg to 57.80 ± 10.51 kcal/kg), T2 (8.15 ± 1.41 mL/kg to 56.87 ± 10.05 kcal/kg), T3 (8.04 ± 1.41 mL/kg to 56.32 ± 9.73 kcal/kg), T4 (8.05 ± 1.41 mL/kg to 56.07 ± 10.28 kcal/kg), and T5 (8.06 ± 1.55 mL/kg to 57.17 ± 11.62 kcal/kg), respectively, compared to steady state (8.13 ± 1.33 mL/kg to 56.77 ± 9.34 kcal/kg). The median values of VCO2 were significantly different only when T1 data were compared with other time slots (7.02 ± 1.02 mL/kg at steady state; 7.26 ± 1.23 mL/kg at T1; 7.13 ± 1.20 mL/kg at T2; 7.02 ± 1.19 mL/kg at T3; 6.85 ± 1.16 mL/kg at T4; 6.91 ± 1.24 mL/kg at T5). ConclusionTwenty consecutive minutes in steady state condition are sufficient to obtain reliable data on REE in stable, very low birth weight infants.

Correlation between clinical features and total maturation score by magnetic resonance imaging in very low birth weight premature infants with brain injury.

Brain injury in premature infants (BIPI) seriously affects the growth and development of preterm infants. Magnetic resonance imaging (MRI) has become an important method of assessing brain development. The aim of this study was to explore the correlation between clinical features and total maturation score (TMS) by MRI in very low birth weight (VLBW) preterm infants with brain injury at term postmenstrual age (PMA). A retrospective cohort of 65 cases of BIPI with VLBW and 40 normal control cases were included, and all cases underwent MRI examination. The 2 groups were assessed in terms of TMS and sub-parameters (myelination, cortical infolding, germinal matrix, bands of migrating glial cells), and the correlation between TMS and term PMA was also analyzed. The TMS of the BIPI group was lower than that of the control group (P<0.01). The differences in myelination and cortical infolding were statistically significant (P<0.01). No significant differences in the germinal matrix and bands of migrating glial cells were found. The linear regression equation showing a positive correlation between TMS and term PMA in normal preterm infants was y=1.164x-28.888 (t=9.478, P=0.000). TMS by conventional cranial MRI can objectively reflect the brain maturity and brain damage of premature infants, and is related to the term PMA.

Serum Ferritin Concentration in the Early Third Trimester of Pregnancy and Risk of Preterm Birth and Low Birth Weight Based on Gestational Age

Objective: Although serum ferritin is considered the best measure of total body iron, with low levels indicating iron deficiency, recent studies have shown that high levels are associated with gestational diabetes, premature birth, and low birth weight. This study aimed to analyze the association between serum ferritin levels in the third trimester of pregnancy and low birth weight and preterm birth.Methods: This study included pregnant women who delivered a single fetus at Kangwon National University Hospital between January 2009 and December 2013 and in whom serum ferritin levels were measured between 28 and 34 weeks of gestation. The association between serum ferritin levels measured in the early third trimester of pregnancy and preterm birth and low birth weight infants was analyzed.Results: A total of 1,079 women fulfilled the study criteria and had their serum ferritin level measured during the third trimester (28–33.9 weeks of gestation) and later delivered at Kangwon National University Hospital. Comparison of the group with serum ferritin levels above the 75th percentile and those below the 25th percentile at the beginning of the third trimester revealed that the incidence of preterm births (&lt;34 weeks of gestation, &lt;37 weeks of gestation) and low birth weight were significantly higher in the group with serum ferritin levels above the 75th percentile than those below the 25th percentile (p&lt;0.05). When variable factors were controlled through multiple regression analysis, the group whose serum ferritin levels were above the 75th percentile at 30–31.9 weeks of gestation had the highest risk of preterm birth before 34 weeks of gestation (adjusted odds ratio [OR], 7.85; 95% confidence interval [CI], 1.32–29.9) and low birth weight (adjusted OR, 6.49; 95% CI, 2.10–20.0).Conclusion: In this study, when serum ferritin was high in the third trimester of pregnancy, it was significantly increased with preterm birth (&lt;34 and 37 weeks) and low birth weight. In particular, when serum ferritin levels were high at 30–31.9 weeks of gestation, the risk of premature birth before 34 weeks and low birth weight was statistically highest.

Fresh Frozen Plasma Transfusion: An Independent Risk Factor for Hemodynamically Significant Patent Ductus Arteriosus in Premature Infants.

The incidence of patent ductus arteriosus (PDA), a major complication of prematurity, may be reduced by restricting fluid administration. Prophylactic fresh frozen plasma (FFP) transfusion may reduce the incidence of intraventricular hemorrhage in these infants, but risks transfusion-related volume overload. We conducted a retrospective study to investigate whether FFP transfusion is a risk factor for hemodynamically significant PDA (hsPDA) in very low birth weight (BW) premature infants. From January 2009 to December 2014, 102 premature infants with gestational age (GA) less than or equal to 30 weeks were admitted to a level III neonatal intensive care unit, and 88 patients were enrolled. Patients were further divided into non-hsPDA (n = 29) and hsPDA groups (n = 59). We retrospectively reviewed demographic characteristics and various perinatal and postnatal variables. Univariate and multivariable analyses were performed to identify risk factors for hsPDA. Compared with non-hsPDA patients, hsPDA patients had lower mean BW and GA, a higher incidence of severe respiratory distress symptoms, perinatal infection, use of surfactant, and need for FFP transfusion. However, multivariable logistic regression analysis showed that only FFP transfusion remained an independent risk factor for hsPDA (adjusted odds ratio = 3.880, 95% confidence interval: 1.214-12.402, p = 0.022) after adjusting for confounding factors. FFP transfusion is a significant risk factor for the subsequent development of hsPDA in our study population. FFP transfusion may complicate the fluid management of premature infants and increase the risk of hsPDA. · Hemodynamic significant PDA is an important complication of preterm infant.. · FFP transfusion may complicate the fluid management of premature infants.. · FFP transfusion is an independent risk factor for hsPDA in very low birth weight premature infants..

Predominance of Gram-negative infections a cause of neonatal sepsis among low birth weight preterm infants

Abstract Objectives Neonatal sepsis continues to be a leading and most important cause of mortality among low birth weight (LBW) preterm infants. Methods The study group included 226 LBW preterm infants with sepsis. A total of 100 normal birth weight infants with sepsis served as control. Blood and cerebrospinal fluid (CSF) samples collected for microbiological culture and processed according to standard protocol. Antibiotic resistance patterns were performed following standard guidelines. Results Out of 226 LBW preterm infants 106 (46.9%) showed positive blood culture, of which 52 (49%) Escherichia coli, 28 (26.4%) Klebsiella pneumoniae, 12 (11.32%) Enterobacter spp., 4 (3.7%) Pseudomonas aeruginosa, 2 (1.88%) Acinetobacter spp., 5 (4.7%) methicillin-resistant Staphylococcus aureus (MRSA), 3 (2.8%) Staphylococcus epidermidis were isolated. Out of 100 control group infants, 46 (46%) showed positive blood cultures, of which 18 (39.1%) E. coli, 12 (26.08%) Enterobacter spp., 8 (17.39%) K. pneumoniae, 1 (2.17%) P. aeruginosa, 2 (4.34%) MRSA, 3 (6.52%) S. epidermidis and 2 (4.34%) Candida spp. were isolated. Cephalosporin and Penicillin group showed highest resistance with 58 and 52%, respectively. Aminoglycosides showed 22% resistance. The control group showed highest resistance of 62% to the Penicillin group, 54% cephalosporin and 18% for aminoglycosides. Conclusions Our study highlights on the surveillance of resistant pathogens causing sepsis in LBW preterm infants emphasizing antimicrobial stewardship to control the mortality rate.

Neonatos críticos recebem a terapia nutricional parenteral em volume conforme suas necessidades prescritas? Estudo clínico observacional

Introduction: Monitoring of parenteral nutrition therapy (NPT) in critical neonates is essential for clinical outcome, and it is indispensable to quantify the infused NPT compared to the prescribed and prepared amount. The purpose of this study is to account for monetary losses due to unmanaged NPT disposal. Methods: Neonates were stratified into two groups. Group A (n = 6): low birth weight preterm infants; Group B (n = 6): preterm infants of very low weight and extreme low weight &lt;1,000 g, followed by 167 days of NPT, compared to the percentage differences in volumes, calories and average monetary losses of the despised volumes. Results: The percentage difference between volume prescribed and prepared for group A was 42.49 ± 18.27% and for group B it was 86.82 ± 63.52% (p = 0.003). Between volume prepared and infused, the difference was 63.15 ± 15.11% for group A and 47.98 ± 17.25% for group B (p = 0.003). Among prescribed and infused calories, the difference was 22.61 ± 8.69% for group A and 13.92 ± 3.45% for group B (p = 0.04). The average monetary losses of the despised volumes were R$ 992.68 and R$ 1,296.81 (p = 0.0129), respectively. Conclusion: Infused NPT was lower than prescribed, resulting in lower caloric intake for neonates and significant financial losses associated with NPT disposal.

English

BACKGROUND Retinopathy of prematurity (ROP) also known as retrolental fibroplasia is a vasoproliferative retinopathy which affects the retinal blood vessels in developing state. ROP is one of the major causes of preventable blindness in children. It usually occurs in very low birth weight premature infants. Its presentation varies from complete regression in some, to leaving long term sequelae in others. Our aim was to find the prevalence of ROP in Ganjam district, Odisha. METHODS A prospective study was undertaken in M.K.C.G. Medical College and Hospital along with Christian Hospital and City Hospital, Berhampur, from 01/10/2016 to 30/09/2018. Babies fulfilling the inclusion criteria were screened after 3rd week of life or post-conceptional age of 31 - 33 weeks whichever was at a later date, and followed till 45 weeks of gestation according to stage. The babies were screened by indirect ophthalmoscopy and 28 D lens with the help of infant speculum and scleral depressor after instilling topical anaesthetic 2 % proparacaine. The pupil was dilated with 0.4 % tropicamide and 2.5 % phenylephrine. Analysis of qualitative data was done by chi-square test. RESULTS Out of 123 babies examined, 26 were lost to follow up and 19 out of 97 babies (19.58 %) developed ROP (inclusive of all stages). Low birth weight, low gestational age, duration of oxygen exposure &gt; 2 days, exchange transfusion, septicaemia with positive CRP value were found to be significant risk factors in development of ROP. Hyperbilirubinemia, gender and multiple gestation were found to be insignificant in the development of ROP. CONCLUSIONS Timely screening, regular follow-up, early detection and intervention are the best ways to reduce the prevalence of ROP. Neonatal intensive care unit (NICU) should follow strict guidelines for screening of new-borns. Proper counselling and motivation of parents for regular screening of at-risk infants are the need of the hour. KEYWORDS Retinopathy of Prematurity, Low Birth Weight, Low Gestational Age, Oxygen Exposure, Exchange Transfusion