Morbidity In Very Low Birth Weight Infants Research Articles

Çok düşük doğum ağırlıklı bebeklerde Erken Neonatal Sepsisin Bronkopulmoner Displazi Üzerine Etkisi

Objective
 Bronchopulmonary dysplasia (BPD) remains critical morbidity in very low birth weight (VLBW) infants. The etiology is multifactorial, and inflammation plays an essential role in the pathogenesis. We aimed to investigate the effect of early neonatal sepsis (ENS) on BPD and other preterm morbidities in VLBW infants.
 
 Materials and Methods
 Preterm infants of

Cesarean delivery was associated with low morbidity in very low birth weight infants: A retrospective cohort study.

To estimate the relationship among the cesarean delivery (CD), mortality and morbidity in very low birth weight (VLBW) infants weighing less than 1500 g. This retrospective cohort study enrolled 242 VLBW infants delivered between the 24 to 31week of gestation from 2015 to 2021. We compared CD with vaginal delivery (VD). The primary outcome was a composite neonatal morbidity including bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, late-onset sepsis and retinopathy of prematurity. The secondary outcome included mortality within 28 days. A multivariate logistic regression was used and adjusted for birthweight, twin pregnancy and antenatal steroids intake. The overall CD rate was 80.6%. Compared with VD, a significantly lower composite neonatal morbidity was associated with CD (adjusted odds ratio, 0.33, 95% confidence interval, 0.12-0.90, P = .031). The relationship between CD and neonatal morbidity disappeared when the VLBW infants were stratified according to the gestational age. No significant difference was observed between the VD and CD cohorts regarding mortality. Compared with VD, CD was associated with a lower morbidity in VLBW infants. Further studies are required to clarify how this association is influenced by gestational age.

Survival and Survival without Major Morbidity Seem to Be Consistently Better throughout Gestational Age in 24- to 30-Week Gestational Age Very-Low-Birth-Weight Female Infants Compared to Males

Introduction: Several studies showed advantages in outcomes for very-low-birth-weight (VLBW) female infants. It has been suggested that recent advances in perinatal care might have benefited boys relatively more than girls, making differences disappear. Objectives: The aims of the study were (1) to determine if sex differences in survival and survival without morbidity in VLBW infants are still present in the context of more advanced perinatal care and (2) to know whether these differences are consistent throughout gestational age (GA). Methods: Retrospective cohort study in seven countries participating in the Spanish SEN1500 and the South American NEOCOSUR neonatal networks. We included VLBW infants 24–30 weeks’ GA, born alive without major congenital anomalies (2013–2016). Major morbidity, survival, and survival without morbidity were compared between male and female infants overall and stratified by GA. Results: 10,565 patients were included: 5,620 (53.2%) males and 4,945 (46.8%) females. Female infants exhibited a lower incidence rate ratio (95% CI) of respiratory distress syndrome: 0.91 (0.88, 0.94), necrotizing enterocolitis: 0.83 (0.74, 0.93), major brain damage: 0.79 (0.72, 0.86), moderate-severe bronchopulmonary dysplasia (BPD): 0.77 (0.72, 0.83), higher survival: 1.03 (1.01, 1.05), survival without BPD: 1.11 (1.07, 1.16), survival without major brain damage: 1.05 (1.02, 1.08), and survival without major morbidity: 1.14 (1.07, 1.21). Survival and survival without morbidity were almost consistently favourable to females throughout GA. Conclusions: Our findings suggest that perinatal results continue to be favourable for VLBW female infants in the context of current perinatology, and that they are almost consistent throughout GA.

Mortality and morbidity of infants with trisomy 21, weighing 1500 grams or less, in Japan.

Although very low birth weight (VLBW) is well studied in neonatology and the perinatal prognosis of VLBW infants has improved over time, little is known about the prognosis of VLBW infants with trisomy 21 (T21). We aimed to investigate the mortality and morbidity of VLBW infants with T21 during NICU admission in Japan, in comparison to those of infants without birth defects (BD-). Maternal and neonatal data of infants weighing 1500 grams or less admitted to the centers of the Neonatal Research Network of Japan from 2003 to 2016 were collected prospectively. Of 60,136 infants, 328 (0.55%) had T21. Although maternal age in the case of T21 infants was higher, maternal complications tended to be less frequent than in those with BD-. Multivariable analysis revealed that morbidities were higher in infants with T21 than in those with BD- but respiratory distress syndrome and retinopathy of prematurity were less frequent in those with T21 (p < 0.001, and p = 0.014, respectively), and no significant difference was observed between the two groups in the proportion of late-onset circulatory collapse of prematurity as well as cystic periventricular leukomalacia (p = 0.739 and p = 0.733, respectively). The survival rate at discharge from the NICU was 77% and 94% for T21 and BD-, respectively. This was the first nationwide survey of VLBW infants with T21 in Japan. Although there were no data regarding the timing of diagnosis, these data will aid prenatal genetic counseling and perinatal management of T21 infants.

Association of Blood Donor Sex and Age With Outcomes in Very Low-Birth-Weight Infants Receiving Blood Transfusion

There are conflicting data on the association between blood donor characteristics and outcomes among patients receiving transfusions. To evaluate the association of blood donor sex and age with mortality or serious morbidity in very low-birth-weight (VLBW) infants receiving blood transfusions. This is a cohort study using data collected from 3 hospitals in Atlanta, Georgia. VLBW infants (≤1500 g) who received red blood cell (RBC) transfusion from exclusively male or female donors were enrolled from January 2010 to February 2014. Infants received follow-up until 90 days, hospital discharge, transfer to a non-study-affiliated hospital, or death. Data analysis was performed from July 2019 to December 2020. Donor sex and mean donor age. The primary outcome was a composite outcome of death, necrotizing enterocolitis (Bell stage II or higher), retinopathy of prematurity (stage III or higher), or moderate-to-severe bronchopulmonary dysplasia. Modified Poisson regression, with consideration of covariate interactions, was used to estimate the association between donor sex and age with the primary outcome, with adjustment for the total number of transfusions and birth weight. In total, 181 infants were evaluated, with a mean (SD) birth weight of 919 (253) g and mean (SD) gestational age of 27.0 (2.2) weeks; 56 infants (31%) received RBC transfusion from exclusively female donors. The mean (SD) donor age was 46.6 (13.7) years. The primary outcome incidence was 21% (12 of 56 infants) among infants receiving RBCs from exclusively female donors, compared with 45% (56 of 125 infants) among those receiving RBCs from exclusively male donors. Significant interactions were detected between female donor and donor age (P for interaction = .005) and between female donor and number of transfusions (P for interaction < .001). For the typical infant, who received a median (interquartile range) of 2 (1-3) transfusions, RBC transfusion from exclusively female donors, compared with male donors, was associated with a lower risk of the primary outcome (relative risk, 0.29; 95% CI, 0.16-0.54). The protective association between RBC transfusions from female donors, compared with male donors, and the primary outcome increased as the donor age increased, but decreased as the number of transfusions increased. These findings suggest that RBC transfusion from female donors, particularly older female donors, is associated with a lower risk of death or serious morbidity in VLBW infants receiving transfusion. Larger studies confirming these findings and examining potential mechanisms are warranted.

Factors Associated with Survival and Survival without Major Morbidity in Very Preterm Infants in Two Neonatal Networks: SEN1500 and NEOCOSUR

Introduction: Very low-birth weight (VLBW) infants represent a high-risk population for morbidity and mortality in the neonatal period. Variability in practices and outcomes between centers has been acknowledged. Multicenter benchmarking studies are useful to detect areas of improvement and constitute an interesting research tool. Objectives: The aim of the study was to determine the perinatal variables and interventions associated with survival and survival without major morbidity in VLBW infants and compare the performance of 2 large networks. Methods: This is a prospective study analyzing data collected in 2 databases, the Spanish SEN1500 and the South American NEOCOSUR networks, from January 2013 to December 2016. Inborn patients, from 24⁰ to 30⁶ weeks of gestational age (GA) were included. Hazard ratios for survival and survival without major morbidity until the first hospital discharge or transfer to another facility were studied by using Cox proportional hazards regression. Results: A total of 10,565 patients, 6,120 (57.9%) from SEN1500 and 4,445 (42.1%) from NEOCOSUR, respectively, were included. In addition to GA, birth weight, small for gestational age (SGA), female sex, and multiple gestation, less invasive resuscitation, and the network of origin were significant independent factors influencing survival (aHR [SEN1500 vs. NEOCOSUR]: 1.20 [95% CI: 1.15–1.26] and survival without major morbidity: 1.34 [95% CI: 1.26–1.43]). Great variability in outcomes between centers was also found within each network. Conclusions: After adjusting for covariates, GA, birth weight, SGA, female sex, multiple gestation, less invasive resuscitation, and the network of origin showed an independent effect on outcomes. Determining the causes of these differences deserves further study.

Improved survival and survival without bronchopulmonary dysplasia in very low birth weight infants after active perinatal care.

Perinatal and neonatal care for very low birth weight (VLBW) infants have changed significantly during the past two decades. However, it is unclear how these changes have affected neonatal mortality and morbidity in developing countries. The aim of this study was to investigate the impact of the advanced neonatal care on short-term outcomes of VLBW infants. A retrospective study was performed to compare the mortality and morbidity of VLBW infants between period I (2007-2011) and period II (2012-2016) in our unit. A total of 188 infants in period I and 214 infants in period II were evaluated. The overall in-hospital mortality for VLBW infants dropped from 26.1% in period I to 13.1% in period II. The incidence of birth asphyxia decreased significantly during period II (10.1% [period I] vs 3.7% [period II]). The rate of nasal continuous positive airway pressure (NCPAP) use (69.8% vs 87.1%) and the duration of NCPAP therapy (median: 3 days [period I] vs 5 days [period II]) increased significantly, while the proportion of infants treated with mechanical ventilation and the duration of mechanical ventilation significantly decreased. There was a significant increase in the proportion of survivors without major neonatal morbidity, mainly due to a significant increase in the incidence of survival without bronchopulmonary dysplasia (BPD) (72.7% vs 82.8%). In contrast, the incidence of late-onset sepsis increased significantly during period II (7.9% vs 19.4%). Active perinatal care is associated with improvements in survival and survival free of BPD for VLBW infants. However, late-onset sepsis is still a major concern.

Oxygen desaturations in the early neonatal period predict development of bronchopulmonary dysplasia.

Background:Bradycardia and oxygen desaturation episodes are common among preterm very low birthweight (VLBW) infants in the Neonatal Intensive Care Unit (NICU), and their association with adverse outcomes such as bronchopulmonary dysplasia (BPD) is unclear.Methods:For 502 VLBW infants we quantified bradycardias (HR <100 for ≥ 4 seconds) and desaturations (SpO2 <80% for ≥ 10 seconds), combined bradycardia and desaturation (BD) events, and percent time in events in the first 4 weeks after birth (32 infant-years of data). We tested logistic regression models of clinical risks (including a respiratory acuity score incorporating FiO2 and level of respiratory support) to estimate the risks of BPD or death and secondary outcomes. We then tested the additive value of the bradycardia and desaturation metrics for outcomes prediction.Results:BPD occurred in 187 infants (37%). The clinical risk model had ROC area for BPD of 0.874. Measures of desaturation, but not bradycardia, significantly added to the predictive model. Desaturation metrics also added to clinical risks for prediction of severe intraventricular hemorrhage, retinopathy of prematurity and prolonged length of stay in the NICU.Conclusions:Oxygen desaturations in the first month of the NICU course are associated with risk of BPD and other morbidities in VLBW infants.

Patent ductus arteriosus in premature infants: to treat or not to treat?

Closing patent ductus arteriosus (PDA) is a widely accepted approach in the management of very low birth weight (VLBW) infants. Our objective is to test the hypothesis that conservative management (no treatment) of PDA will not affect survival without chronic lung diseases (CLD). This retrospective study utilizes a prospectively collected database to compare two cohorts of VLBW infants. Infants in the first group (2001 to 2009) had their PDA treated with pharmacological and if necessary with surgical ligation. PDA in the second group (2010 to 2014) was not treated with medical or surgical intervention. The primary outcome was survival without oxygen requirement at 36 weeks. Pulmonary and non-pulmonary morbidities were also compared. Logistic regression analyses were performed to control for confounders. This study included 643 VLBW infants, of them 415 infants in the Treat group and 228 in the No-Treat group. The rate of survival without CLD did not differ between Treat and No-Treat groups (78.4% vs 83.9%, respectively; adjusted odds ratio (aOR)=1.72, confidence interval (CI): 0.92 to 3.23, P=0.09). Mortality declined in No-Treat group (15.2% vs 10.5%, aOR=0.51, CI: 0.25 to 0.99, P=0.049), but the two groups did not differ in the incidence of CLD among survivors (5.8% vs 5.0%,=P0.47). Pulmonary complications and non-pulmonary morbidities did not differ between groups. Conservative management (no treatment) of PDA may not compromise survival without CLD and is not associated with increased morbidities in VLBW infants. Prospective physiological studies are needed to determine the sector of VLBW infants, if any, who could benefit from PDA treatment.

Maternal human immunodeficiency virus status and morbidity and mortality in very low birthweight infants

Background: Human immunodeficiency virus (HIV) remains a common cause of infection in pregnant women. The effect of HIV exposure on growth, morbidity and mortality in very low-birthweight infants (VLBWI) is under-reported.Aim: To determine anthropometry at birth, morbidity during hospital stay and mortality at hospital discharge of VLBWI stratified according to HIV-exposure in a tertiary public government hospital in Johannesburg, South Africa.Methods: Retrospective descriptive study. Records of VLBWI were reviewed for maternal HIV status, infant characteristics, diagnosis and outcome to hospital discharge. Anthropometry, morbidity and mortality were compared according to HIV-exposure.Results: Of 302 VLBWI,103 (34.1%)were HIV-exposed. Among the 103mothers, 38 (36.9%)were on combined anti-retroviral therapy (cART), 41 (39.8%) were on zidovudine (AZT) and 24 (23%) were not on either. More HIV-exposed VLBWI weighed v1000 g (41.2 vs 23.1%, Pv0.01). There were no differences in incidence or number of episodes of sepsis between HIV-exposed and -unexposed. More HIV-exposed VLBWI had severe intraventricular haemorrhage (IVH) (57.1 vs 11.4%, Pv0.01). The overall mortality rate was 27%, with HIV-exposed VLBWI having a mortality rate of 38.6% compared with 21% of the HIV-unexposed (Pv0.01). On multivariate analysis, the predictor of mortality was birthweight (Pv0.01).Conclusion: HIV-exposed VLBWI are more likely to have extremely low birthweights. Morbidity in VLBWI is not affected by HIV-exposure, except for severe IVH. Birthweight is a predictor of mortality in VLBWI, irrespective of maternal HIV status.

A risk-adjusted, composite outcomes score and resource utilization metrics for very low-birth-weight infants.

It is difficult for neonatal intensive care units (NICUs) to determine the overall efficacy of multiple continuous quality improvement (CQI) projects aimed at reducing very low-birth-weight (VLBW) infant morbidities. It is challenging to know whether a NICU is becoming more proficient, and it is not usually apparent whether concurrent resource use is changing. To develop a risk-adjusted composite score of the major morbidities in VLBW infants and a companion metric that accounts for resource use to enhance the ability to measure overall progress in CQI and to identify proficient NICUs. This retrospective investigation used individual patient-level demographic and outcomes data from 8 NICUs who were long term CQI collaborators within the Vermont Oxford Network, a large international quality improvement organization dedicated to improving the care of premature infants. Study participants were infants who weighed 401 to 1500 g born from January 1, 2000, through December 31, 2011, at each of the 8 participating NICUs. Risk-adjusted, composite VLBW infant morbidity and resource utilization score. A total of 15,961 infants (mean [SD] gestational age, 28.2 [3.0] weeks; mean [SD] birth weight, 1020 [306] g) were analyzed. Concurrent with multiple shared CQI projects over 12 years, the group benefit metric improved 38% from 80 in 2000 to 110 in 2011 (P < .001). The entire member VON benefit metric improved 28% from 72 in 2000 to 92 in 2011 (P < .001). The group value metric improved 25% from 1.2 in 2000 to 1.5 in 2011 (P < .001). The entire member VON value metric improved 18% from 1.1 in 2000 to 1.3 in 2011 (P < .001). Significant inter-NICU variation in both composite scores was noted in the 8 member CQI group. Hospital length of stay increased in the 8 NICUs 64 to 71 days (P <.001), and a similar increase was noted in the entire member VON, 65 to 68 days (P < .001). We have created the first, to our knowledge, web-based tool for NICUs to calculate their own composite morbidity and resource utilization scores that estimate NICU CQI proficiency. In our structured group CQI over 12 years, both metrics revealed significant improvement, but increases in length of stay (resource use) blunted value improvement. Why some NICUs improve their scores more successfully than others remains a crucial challenge. Future CQI efforts should explore strategies that cost-efficiently reduce intertwined VLBW infant morbidities, emphasizing whole cultures of proficient care rather than the traditional emphasis on single-morbidity reduction.

Neonatal Morbidities Associated with Histologic Chorioamnionitis Defined Based on the Site and Extent of Inflammation in Very Low Birth Weight Infants.

Conflicting results on the influences of histologic chorioamnionitis (HC) on neonatal morbidities might be partly originated from using different definition of HC. The aim of this study was to determine the relationship between HC and neonatal morbidities using definition of HC that reflects the site and extent of inflammation. This was a retrospective cohort study of 261 very low birth weight (VLBW) infants admitted at a tertiary academic center. Based on the site of inflammation, HC was categorized: any HC; amnionitis; funisitis; amnionitis+funisitis. The extent of inflammation in each site was reflected by sub-defining high grade (HG). The incidences of morbidities in infants with and without HC were compared. The bronchopulmonary dysplasia (BPD) rate was significantly higher in infants with amnionitis and the severe retinopathy of prematurity (ROP) rate was significantly higher in infants with any HC and funisitis. After adjustment for both gestational age and birth weight, the respiratory distress syndrome (RDS) rate was significantly lower in infants with all categories of HC except for HG amnionitis and HG funisitis, which are not associated with lower RDS rate. HG amnionitis was significantly associated with increased BPD rate but the association of HC with severe ROP disappeared. In conclusion, HC is significantly associated with decreased RDS and HG amnionitis with increased BPD while lacking association with other neonatal morbidities in VLBW infants. The association with HC and neonatal morbidities differs by the site and extent of chorioamnionitis.

Association of Antenatal Corticosteroids and the Mode of Delivery with the Mortality and Morbidity of Infants Weighing Less than 1,500 g at Birth in Japan

Objective: This study aimed to re-evaluate the effectiveness of antenatal corticosteroids (ACS) and to analyze the association between ACS and the mode of delivery in the context of perinatal morbidity and mortality in very-low-birth-weight (VLBW) infants. Study Design: This retrospective cohort study involved 15,765 VLBW infants born between 2003 and 2008 at less than 34 weeks of gestation and weighing less than 1,500 g at birth. Data were obtained from the Japanese neonatal research network database. Univariate and multivariate logistic regression analyses were performed to evaluate the impact of ACS and mode of delivery on the risk of infant mortality and morbidity. Results: Administration of ACS was associated with decreases in mortality rate, intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP), and was not associated with the incidence of respiratory distress syndrome (RDS), periventricular leukomalacia or necrotizing enterocolitis (NEC). When the administration of ACS was analyzed in the context of different modes of delivery, the incidence of IVH and ROP tended to decrease with cesarean section deliveries, whereas the incidence of RDS tended to decrease and the incidence of NEC tended to increase for infants delivered vaginally. The incidence of chronic lung disease tended to increase in association with both delivery methods. Conclusions: This large cohort study reconfirms that ACS treatment is associated with decreases in infant mortality and severe morbidity. Furthermore, the delivery method may be associated with severe morbidity in VLBW infants exposed to ACS.

Mortality and Morbidity of VLBW Infants With Trisomy 13 or Trisomy 18

Little is known about how very low birth weight (VLBW) affects survival and morbidities among infants with trisomy 13 (T13) or trisomy 18 (T18). We examined the care plans for VLBW infants with T13 or T18 and compared their risks of mortality and neonatal morbidities with VLBW infants with trisomy 21 and VLBW infants without birth defects. Infants with birth weight 401 to 1500 g born or cared for at a participating center of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network during the period 1994-2009 were studied. Poisson regression models were used to examine risk of death and neonatal morbidities among infants with T13 or T18. Of 52,262 VLBW infants, 38 (0.07%) had T13 and 128 (0.24%) had T18. Intensity of care in the delivery room varied depending on whether the trisomy was diagnosed before or after birth. The plan for subsequent care for the majority of the infants was to withdraw care or to provide comfort care. Eleven percent of infants with T13 and 9% of infants with T18 survived to hospital discharge. Survivors with T13 or T18 had significantly increased risk of patent ductus arteriosus and respiratory distress syndrome compared with infants without birth defects. No infant with T13 or T18 developed necrotizing enterocolitis. In this cohort of liveborn VLBW infants with T13 or T18, the timing of trisomy diagnosis affected the plan for care, survival was poor, and death usually occurred early.

1634 The Effects of Synbiotic use on Morbidity and Mortality in Premature Infants: A Prospective Randomized Controlled Trial

Background and AimIt is previously claimed that probiotic and prebiotic use in premature infants prevents pathogenic bacterial colonization in the intestine and reduces morbidity and mortality. In this study, the...

Cost of Morbidities in Very Low Birth Weight Infants

To determine the association between direct costs for the initial neonatal intensive care unit hospitalization and 4 potentially preventable morbidities in a retrospective cohort of very low birth weight (VLBW) infants (birth weight <1500 g). The sample included 425 VLBW infants born alive between July 2005 and June 2009 at Rush University Medical Center. Morbidities included brain injury, necrotizing enterocolitis, bronchopulmonary dysplasia, and late-onset sepsis. Clinical and economic data were retrieved from the institution's system-wide data and cost accounting system. A general linear regression model was fit to determine incremental direct costs associated with each morbidity. After controlling for birth weight, gestational age, and sociodemographic characteristics, the presence of brain injury was associated with a $12048 (P = .005) increase in direct costs; necrotizing enterocolitis, with a $15 440 (P = .005) increase; bronchopulmonary dysplasia, with a $31565 (P < .001) increase; and late-onset sepsis, with a $10055 (P < .001) increase. The absolute number of morbidities was also associated with significantly higher costs. This study provides collective estimates of the direct costs incurred during neonatal intensive care unit hospitalization for these 4 morbidities in VLBW infants. The incremental costs associated with these morbidities are high, and these data can inform future studies evaluating interventions aimed at preventing or reducing these costly morbidities.

Parenteral lipid administration to very-low-birth-weight infants—early introduction of lipids and use of new lipid emulsions: a systematic review and meta-analysis

The use of intravenous lipid emulsions in preterm infants has been limited by concerns regarding impaired lipid tolerance. As a result, the time of initiation of parenteral lipid infusion to very-low-birth-weight (VLBW) infants varies widely among different neonatal intensive care units. However, lipids provide energy for protein synthesis and supply essential fatty acids that are necessary for central nervous system development. The objective was to summarize the effects of initiation of lipids within the first 2 d of life and the effects of different lipid compositions on growth and morbidities in VLBW infants. A systematic review and meta-analysis of publications identified in a search of PubMed, EMBASE, and Cochrane databases was undertaken. Randomized controlled studies were eligible if information on growth was available. The search yielded 14 studies. No differences were observed in growth or morbidity with early lipid initiation. We found a weak favorable association of non-purely soybean-based emulsions with the incidence of sepsis (RR: 0.75; 95% CI: 0.56, 1.00). The initiation of lipids within the first 2 d of life in VLBW infants appears to be safe and well tolerated; however, beneficial effects on growth could not be shown for this treatment nor for the type of lipid emulsion. Emulsions that are not purely soybean oil-based might be associated with a lower incidence of sepsis. Large-scale randomized controlled trials in preterm infants are warranted to determine whether early initiation of lipids and lipid emulsions that are not purely soybean oil-based results in improved long-term outcomes.

Effect of persistent patent ductus arteriosus on mortality and morbidity in very low‐birthweight infants

Because New Caledonia is geographically isolated from the nearest cardiac surgical centre, surgical closure of ductus arteriosus is not performed in very low-birthweight (VLBW) infants who have a persistent patent ductus in spite of having undergone treatment with ibuprofen. This study aimed at investigating the possible effect of persistent patent ductus in VLBW infants. The study included 177 VLBW infants born at 25-31 weeks of gestation from January 2006 to May 2011. Mortality and major morbidities were compared between infants with a persistent patent ductus (n = 33) and those without it (n = 104). Statistical associations between potential neonatal risk factors and significant morbidities were identified using multivariate regression analyses. Rates of mortality and major morbidities, including the rate of bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular haemorrhage grades I-II and III-IV, periventricular leucomalacia, late-onset infections and failure of hearing screening, were insignificantly higher in VLBW infants with a persistent patent ductus than in those without it. This study adds further evidence that persistent patent ductus arteriosus has no significant effect on mortality and morbidity in VLBW infants born at ≥25 weeks' gestational age.

Effect of maternal clinical chorioamnionitis on neonatal morbidity in very-low birthweight infants: a case-control study

To assess the relationship between maternal clinical chorioamnionitis and neonatal outcome in preterm very-low birthweight (VLBW) infants. An observational case-control study was conducted in the Neonatology Services of 12 acute-care teaching hospitals in Spain. Between January 2004 and December 2006, all consecutive VLBW (< or =1500 g) infants born to a mother with clinical chorioamnionitis were enrolled. Controls were infants without chorioamnionitis matched by gestational age who were born immediately after each index case. There were 165 cases and 163 controls. A significantly higher percentage of cases than controls required intubation (53% vs. 35.8%), had normal intrauterine growth (98.1% vs. 84.7%), were born in a tertiary center (inborn) (95.1% vs. 89.1%), from single gestations (76.4% vs. 65.6%) and vaginal delivery (47.3% vs. 33.3%), showed a lower Apgar score at 5 min, and presented a higher rate of early-onset sepsis (10.4% vs. 1.2%). Older maternal age (32.5 vs. 30.8 years), premature labor (67.3% vs. 25.8%), premature rupture of membranes (61.3% vs. 25.8%), and antibiotic treatment (88.5% vs. 52.3%) were significantly more frequent among cases than controls. After controlling by gestational age, maternal chorioamnionitis was associated with neonatal depression and early sepsis but not with other prematurity-related complications.

The effect of glutamine-enriched enteral nutrition on intestinal microflora in very low birth weight infants: A randomized controlled trial

In a previous study, we have found that glutamine supplementation decreased the infection rate in very low birth weight (VLBW) infants. In this study, we investigated whether this beneficial effect originated from increased number of bifidobacteria and lactobacilli in the intestinal microflora of these infants. In a randomized controlled trial, VLBW infants (gestational age <32 weeks and/or birth weight <1500g) received enteral glutamine supplementation (0.3g/kg/day) or isonitrogenous placebo supplementation between d3 and d30 of life. Faecal microflora was determined by fluorescent in situ hybridization <48h, at d7, d14 and d30 of life. In 43/52 (glutamine group) and 43/50 (control group) infants, > or = 2 samples were analyzed. Baseline characteristics were not different between groups. The prevalence of bifidobacteria, lactobacilli, Escheria coIi, streptococci and clostridia was not different between groups (p>0.05). In both groups, colonization with bifidobacteria was delayed, whereas potentially pathogenic bacteria such as E. coli, appeared rapidly after birth. Antibiotic treatment decreased the prevalence of all faecal bacteria (p<0.05). Decreased infectious morbidity in VLBW infants that received glutamine supplementation was not associated with alterations in the prevalence of bifidobacteria, lactobacilli, E. coIi, streptococci and clostridia. In general, colonization with health-promoting bacteria was delayed, whereas potentially pathogenic bacteria appeared rapidly after birth. Antibiotic treatment delayed the bacterial colonization.