Outcomes In Very Low Birth Weight Infants Research Articles

Neuroprem 2: An Italian Study of Neurodevelopmental Outcomes of Very Low Birth Weight Infants.

Background: Despite the increased survival of preterm newborns worldwide, the risk of neurodevelopmental disabilities remains high. Analyzing the outcomes of the preterm population can identify risk factors and enable specific early interventions.Aims: Neuroprem is a prospective cohort study of very low birth weight (VLBW) infants that aims to evaluate the neurodevelopmental outcomes and risk factors for severe functional disability at 2 years of corrected age.Methods: Nine Italian neonatal intensive care units participated in the network. The Griffiths Mental Developmental Scales (GMDS-R) or the Bayley Scales of Infant and Toddler Development (BSDI III) and a neuro-functional evaluation (according to the International Classification of Disability and Health and Neuro-Functional Assessment, or NFA ICF-CY) were administered to VLBW infants at 24 months of corrected age. The primary outcome measure was severe functional disability, defined as cerebral palsy, bilateral blindness, deafness, an NFA ICF-CY of >2, a BSDI III cognitive composite score of <2 SD, or a GMDS-R global quotient score of <2 SD. Perinatal risk factors for severe functional disability were assessed through multivariate logistic regression analysis.Results: Among 502 VLBW survivors who completed the 24-month follow-up, 48 (9.6%) presented severe functional disability, of whom 27 had cerebral palsy (5.4%). Rates of severe functional disability and cerebral palsy were higher in neonates with a lower gestational age (p < 0.001). Overall, 147 infants (29.3%) were referred to neuromotor intervention. In the multivariate regression model, gestational age at birth OR 0.79; 95% CI 0.67–0.90; p = 0.001) and periventricular-intraventricular hemorrhage (OR 2.51; 95% CI 1.19–5.26; p = 0.015) were significantly associated with severe functional disability.Conclusion: Neuroprem 2 provides updated information on the neurodevelopmental outcomes of VLBW infants in a large Italian cohort. The overall rate of neurodevelopmental disabilities was quite lower than reported in the previous literature. These data indicate the need for structured follow-up programs from a national neonatal network perspective.

The Test of Infant Motor Performance (TIMP) in very low birth weight infants and outcome at two years of age.

To evaluate TIMP in preterm very low birth weight (VLBW) infants, analyze risk factors, for atypical TIMP (aTIMP) scores, and explore TIMP's predictive relationship with Bayley-III at 2 years. A prospective study of 288 VLBW infants, with TIMP assessment between 34 weeks postmenstrual age and 16 weeks age, corrected for prematurity. aTIMP scores were observed in 58/288(20%) infants, whose mean birth weight (BW) and gestational age were 1122 ± 257 g and 29.2 ± 2.12 weeks respectively. Risk factors included BW < 750 g (OR 4.8, 95% CI 1.3-17.7) and 750-1000 g (OR 2.9, 95% CI 1.2-6.9), presence of necrotizing enterocolitis ≥ stage 2; or focal intestinal perforation (OR 4.6, 95% CI 1.4-14.4), periventricular leukomalacia (OR 22.4,95% CI 2.0-246.2), and need for intensive resuscitation at birth (OR 2.7, 95% CI 1.3-5.5). aTIMP scores correlated with Bayley-III Score <85 in motor and cognitive domains with high specificity (80-82%) and negative predictive value (85-94%). Identification of the risk factors for aTIMP scores will enable targeted intervention to optimize resources and outcomes in VLBW infants.

Patent ductus arteriosus treatment trends and associated morbidities in neonates

To evaluate national epidemiologic data on infants treated for patent ductus arteriosus (PDA) in Korea and analyze outcomes associated with different PDA treatments. We retrospectively evaluated data on 12,336 patients diagnosed with PDA (International Classification of Diseases-10 code: Q250) between 2015 and 2018 from the Health Insurance Review and Assessment database. Among them, 1623 patients underwent surgical ligation (code: O1671). We used birth certificate data from Statistics Korea to estimate the prevalence, diagnosis, and treatment of PDA. The prevalence of infants with PDA was 81 infants per 10,000 live births and 45.2% in very low birth weight (VLBW) infants, which increased from 2015 to 2018. PDA ligation was performed in 2571 infants and 22% VLBW infants. Medical treatment was administered to 4202 infants, which decreased significantly, especially in VLBW infants (62% to 53%). The proportion of treatment was as follows: conservative treatment (53.1%), intravenous ibuprofen (24.4%), surgery (20.4%), and oral ibuprofen (10.7%); that among 4854 VLBW infants was as follows: intravenous ibuprofen (46.3%), conservative treatment (33.2%), surgery (22.2%), and oral ibuprofen (14.2%). Surgical treatment had a significantly higher risk (odds ratio 1.36) of mortality than conservative treatment. Surgical and/or medical treatments were associated with a higher risk of morbidity. Recently, increased use of conservative management of PDA has contributed to improved neonatal outcomes in VLBW infants. Select patients may still benefit from surgical ligation following careful consideration.

Analysis of clinical outcomes of oropharyngeal colostrum administration in very low-birth-weight preterm newborns

ObjectivesColostrum is the first secretion produced by the mammary glands and is present through the seventh day after birth. Colostrum has important immunomodulatory components and protective factors that contribute to the protection and development of newborns. The oropharyngeal administration of colostrum (OAC) has been proposed as a potential nutritional option for very low-birth-weight (VLBW) newborns (<1500 g). This study aimed to analyze the clinical outcomes of VLBW infants receiving OAC. MethodsThis is a retrospective longitudinal study with nonprobability sampling of VLBW infants on the OAC protocol. VLBW infants for whom no OAC data were available, who received no dose, or who died within the first 7 d of life were excluded. The Mann–Whitney test was used to compare quantitative variables and the Wilcoxon test to assess the evolution of anthropometric values with a significance level of 5% (P < 0.05). ResultsEnteral nutritional therapy was commenced after 1 d (median: 1 d; interquartile range [IQR], 1–1 d). Full enteral feeding was achieved after 11 d (median: 11.0 d; IQR, 9.0–16.0 d). Birth weight was recovered after 11 d (median: 11 d; IQR, 7.0–14.0 d). OAC was commenced at 3 d of life, and 32.5 doses (IQR, 21.0–44.0 d) were given in total. There were significant differences in the evolution of anthropometric characteristics during hospitalization, with a tendency to recover birth weight more quickly the higher the number of doses administered (P = 0.07). Time to full enteral feeding was significantly longer and time to recovery of birth weight significantly shorter when OAC was commenced ≤3 d after birth (P = 0.023). ConclusionsOAC was associated with a shorter time to recover birth weight and time to full enteral feeding.

Impact of Different Types of Nosocomial Infection on the Neurodevelopmental Outcome of Very Low Birth Weight Infants.

Nosocomial infections (NIs) are important conditions associated with mortality and morbidity in very low birth weight infants (VLBWIs). The aim of this study was to investigate the impact of NIs and the different subtypes on neurodevelopmental outcomes in a cohort of VLBWIs. VLBWIs born with a gestational age between 23 0/7 and 31 6/7 weeks in a level III neonatal center were enrolled. Neonatal morbidities as well as the neurodevelopmental outcome at 2 years of corrected age were analyzed. Six-hundred infants completed the study successfully. Of these, 38% experienced an NI episode. NIs were associated with an increased risk of neonatal complications, such as brain injury, bronchopulmonary dysplasia (BPD) and death, and were a significant risk factor for adverse motor development at 2 years of corrected age in our cohort of VLBWIs. The negative impact of NIs on neurodevelopmental outcomes was particularly associated with necrotizing enterocolitis (NEC), suspected NIs and Gram-positive NIs. This study demonstrated that NIs are a significant risk factor for both morbidity and mortality as well as adverse neurodevelopmental outcomes in VLBWIs.

Effects of early intake of amino acid on the neurodevelopmental outcomes in very low birth weight infants at correct age of 20months and school age.

Inadequate nutrition leads to poor neurodevelopmental outcomes in very low-birth weight infants (VLBWIs). This study aimed to investigate the beneficial effects of early amino acid intake on the neurodevelopmental outcomes in VLBWIs at 20months of correct age and school age. The information of VLBWIs that received amino acid intake were retrospectively analyzed in this study. The cases in early group (EAA) received amino acid within 24h, but the cases in standard group (SAA) after 48h post-natal. The body weight, height, and Bayley score of the infants at correct age of 20months were compared between groups. And the cognitive outcomes at school age were evaluated using Wechsler Intelligence Scale and Das-Naglieri cognitive assessment system. There were no differences at baseline characteristics of the VLBWIs between EAA and SAA groups. Compared with the SAA group, the infants in EAA group had shorter time to regain birth weight (P < 0.05). The head circumference, MDI, and PDI in EAA group at 20months of correct age were significantly higher than that in SAA group (both P < 0.05). According to the Wechsler scale and Das-Naglieri scores, the infants in EAA group had markedly improved cognitive outcomes compared with those in SAA group (all P < 0.05). The results of this study revealed that early amino acid intake within 24h could significantly improve the neurodevelopmental and cognitive outcomes in VLBWIs at 20months of correct age and school age.

Delayed Maturation of the Middle Cerebellar Peduncles at Near-Term Age Predicts Abnormal Neurodevelopment in Preterm Infants

Background: The infant brain grows quickly with elaborate microstructural development during the neonatal period. The white matter, during critical periods of development, is selectively vulnerable to altered maturation and impaired growth in very-low-birth-weight (VLBW) infants. Objective: To evaluate whether abnormal white matter maturation in VLBW infants is associated with poor neurodevelopmental outcomes at 18 months of corrected age. Methods: Between 2015 and 2017, we recruited 60 VLBW infants at 24–32 weeks of gestational age and 15 full-term controls. All participants underwent magnetic resonance imaging at near-term age and were assessed at 18 months of corrected age with the Bayley Scales of Infant and Toddler Development, Third Edition. The associations between regional white matter fractional anisotropy (FA) and mean diffusivity on diffusion tensor imaging (DTI) and developmental outcomes were explored using multivariable linear regression after correcting for gestational age, postmenstrual age at DTI scan, and maternal education level. Results: The FA values of the splenium of the corpus callosum (p = 0.032), corticospinal tract (p = 0.025), middle cerebellar peduncle (MCP) (p < 0.001), and cingulum (p = 0.043) were significantly related to cognitive scores; however, only the association corresponding to the MCP remained significant after correcting for multiple comparisons. The MCP FA (p = 0.008) was associated with motor scores after correction for multiple comparisons (p = 0.008). Cognitive impairment (area under the curve [AUC] = 0.823, 95% confidence interval [CI] = 0.722–0.911) and motor impairment (AUC = 0.776, 95% CI = 0.656–0.899) were predicted by MCP FA. Conclusions: The FA of MCP at near-term age may predict developmental outcomes of VLBW infants at 18 months of corrected age.

Clinical Characteristics and Outcome of Very Low Birth Weight Infants with Surgical Meconium Related Ileus

Objective: Meconium related ileus (MRI) was defined as functional ileus in neonates characterized by impaired meconium excretion with preferential occurrence in very low birth weight (VLBW) infants. The aim of this study was to investigate the clinical characteristics and outcome of VLBW infants who underwent surgical treatement, especially exploratory laparotomy and ileostomy, due to MRI. Methods: This retrospective study included VLBW infants born in our hospital between January 2010 and December 2018. Infants were included if they were diagnosed with MRI and underwent exploratory laparotomy. In order to compare the clinical characteristics, matched controls for each subject were chosen. Results: Among the 178 VLBW infants delivered during the study period, total 19 cases and 19 controls were identified. The mean GA and birth weight in the MRI group were 27.6±1.9 weeks and 966±233 g, respectively, and 28.7±2.2 weeks and 1,005±198 g, respectively, in the control group. There was no significant difference between the both groups in perinatal, maternal and neonatal characteristics such as respiratory distress syndrome (RDS). Day of full enteral feeding and hospitalization were significantly longer in MRI group compared to control group). The proportion of less than 3 percentile for postmenstrual age at discharge were significantly higher in MRI group (73% vs. 21%, P=0.001). Conclusion: The results of our study showed that delayed treatment of MRI lead to longer hospital stay and lower weight at discharge. Early treatment including exploratory laparotomy should be considered to improve outcome when the baby was suspected MRI with risk factors.

Evidence-Based Practices Reduce Necrotizing Enterocolitis and Improve Nutrition Outcomes in Very Low-Birth-Weight Infants.

Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in preterm infants. Survivors may suffer both short- and long-term morbidities. Current evidence suggests that the incidence of NEC can be reduced by standardizing the care delivery in addressing key risk factors including an altered gut microbiome, use of formula milk, hyperosmolar feeds, and unrestricted use of high-risk medications METHODS: Since 2014, the department has a workgroup who analyzed all cases of NEC within a month of diagnosis to identify preventable risk factors. Existing evidence-based quality improvement strategies were revised and new ones were implemented sequentially over the next 4 years. These strategies include (1) a standardized feeding protocol, (2) early initiation of enteral feeding using human milk, (3) optimization of the osmolality of preterm milk feeds using standardized dilution guidelines for additives, and (4) promotion of healthy microbiome by use of probiotics, early oral care with colostrum and by restricting high-risk medications and prolonged use of empirical antibiotics RESULTS: Baseline characteristics of the patients including sex, gestational age, and birth weight were similar during the study period. After implementing the evidence-based practices successively over 4 years, the incidence of NEC in very- low birth-weight (VLBW) infants dropped from 7% in 2014 to 0% (P < .001) in 2018. The duration of parenteral nutrition, use of central line, and days to full feeds were also reduced significantly (P < .05) CONCLUSION: Adopting evidence-based best practices resulted in a significant decrease in the incidence of NEC and improved the nutrition outcomes in VLBW infants.

Interleukin 8 may predict surgical necrotizing enterocolitis in infants born less than 1500 g

Necrotizing enterocolitis (NEC) often leads to gastrointestinal emergency resulting high mortality in very low birth weight infants (VLBWIs) requiring surgery. To date, few studies have explored the role of serum cytokines in the development of feeding intolerance (FI) or NEC outcomes in VLBWIs. Infants born weighing <1500 g or of 32 weeks of gestational age were prospectively enrolled from May 2018 to Dec 2019. We measured several cytokines routinely within 72 h of life, even before NEC-like symptoms developed. NEC or FI group comprised 17 (27.4%) infants, and 6 (9.7%) infants had surgical NEC. The gestational age and birth weight were significantly lower in the NEC or FI group with more prematurity-related complications. The surgical NEC group also demonstrated significantly lower gestational age and birth weight along with more infants experiencing refractory hypotension within a 1 week of life, pulmonary hypertension, and patent ductus arteriosus. IL-10 levels were significantly higher in the NEC or FI group, whereas IL-8 levels were significantly higher in the infants with surgical NEC. Our findings indicated to IL-8 can predict surgical NEC while increased IL-10 can predict NEC development in VLBWIs.

Impact of breast milk-acquired cytomegalovirus infection in premature infants: Pathogenesis, prevention, and clinical consequences?

Maternal-fetal transmission of cytomegalovirus (CMV) represents the most common infectious cause of long-term neurodevelopmental disability in children. Congenital CMV (cCMV) infection is associated with microcephaly, seizure disorders, cognitive disability, developmental delay, and sensorineural hearing loss (SNHL). Of these disabilities, SNHL is the most common, affecting approximately 10% of infants with cCMV. Although the sequelae of cCMV are well recognized, it is much less clear what long-term morbidities may occur in neonates that acquire post-natal CMV infection. Post-natal CMV (pCMV) infection is most commonly transmitted by breast-feeding, and in full-term infants is of little consequence. However, in preterm, very-low birthweight (VLBW) infants (<1500 g), pCMV can result in a severe sepsis-like syndrome, with wide-ranging end-organ disease manifestations. Although such short-term complications are well recognized among clinicians caring for premature infants, the long-term risks with respect to adverse neurodevelopmental outcomes remain controversial. In this review, we provide an overview of the clinical manifestations of breast milk-acquired pCMV infection. In particular, we summarize studies that have examined-sometimes with conflicting conclusions-the risks of long-term adverse neurodevelopmental outcome in VLBW infants that acquire pCMV from breast milk. We highlight proposed preventive strategies and antiviral interventions, and offer recommendations for high-priority areas for future basic science and clinical research.

Survival rate of very low birth weight infants over a quarter century (1994-2019): A single-institution experience.

Newborn infants with birth weight less than 1500 grams defining very low birth weight (VLBW) constitute 1.2-1.5% of total live births and 15-20% of all admissions to neonatal units. Advances in antenatal care, care at delivery, and neonatal practice over the past few decades, have substantially improved outcomes in VLBW infants, and reduced neonatal mortality. A retrospective single tertiary care center cohort study of VLBW infants with gestational age between 23-33 weeks admitted to the neonatal intensive care unit (NICU) in King Abdulaziz Medical City, Jeddah (KAMC-J) between January 1, 1994, and December 31, 2019 (26 years). The trends of survival of VLBW infants and major changes in clinical practice of premature care over a period of 26 years were evaluated. Over a period of 26 years, 1,247 VLBW infants were admitted to the NICU that represents 1.43% (1.25-1.83%) of total live births. 50.80% (n = 634) were male, whereas the 49.2% (n = 613) were female. Among them, 1013 (81.2%) were discharged home alive. There was a significant and progressive improvement in the survival rate of VLBW infants over a 26-year period from 66.83% in period 1 (1994 -1998) to 90.0 % in period 5 (2014 -2019), which represents a 34.67% total improvement rate. The improvement in survival rates was observed in all gestational ages between 23-33 weeks, particularly in infants weighing ≤750 grams and ≤1000 grams, and with gestational age between 23-27 weeks. Infants with a gestational age of ≤26 weeks and birth weight ≤750 grams delivered by cesarean section had a higher survival rate. Moreover, female infants with a gestational age of ≤26 weeks and birth weight ≤750 grams had a higher survival rate compared to males but not statistically significant. The survival rate of VLBW infants had improved significantly over the past 26 years (1994 -2019). This is attributed mainly to the improved survival of ELBW infants (<1000 grams) and gestational age of ≤26 weeks.

Influence of the level of maternal education on the long-term neurodevelopmental outcome of Saudi infants with birth weight of 1000-1500 grams at the age of 21-24 months

Background: Advancements in perinatal-neonatal care in the last decades has led to improved survival rates of very-low birth weight (VLBW) infants. An association between the level of maternal education and neurodevelopmental outcome has been demonstrated in many European studies. This study evaluates the influence of maternal education level and socio-demographic status on the long-term development of Saudi VLBW infants with birth weight of 1000-1500 grams at a corrected gestational age of 21-24 months. Method: This retrospective cohort study examined prospectively collected data from the period of 2005 to 2016 from the Neonatal Follow-up Program (NFP) at King Khalid University Hospital in Riyadh, Saudi Arabia. Results: A total of 122 VLBW infants with a mean gestational age of 29.57 weeks and mean birth weight 1265 grams were enrolled. There was no statistically significant association between the level of maternal education and neurodevelopmental screening outcome at the age of 21-24 months according to the Bayley Infant Neurodevelopmental Screener (BINS) (p=0.149). Bronchopulmonary dysplasia (BPD) was highly associated with cerebral palsy (p=0.001) and an abnormal BINS score (p=0.010). Conclusion: There was no significant influence of the level of maternal education on the neurodevelopmental screening outcome of VLBW infants at the corrected age of 21-24 months. BPD was the strongest predictor of adverse neurodevelopmental outcome. Keywords: Bayley Infant Neurodevelopmental Screener (BINS), Neurodevelopmental Outcome, Maternal educational level, Neonatal follow-up program (NFP), Very Low Birth Weight (VLBW) infant.

Human Milk and Clinical Outcomes in Preterm Infants.

The LOVE MOM cohort (Longitudinal Outcomes of VLBW Infants Exposed to Mothers' Own Milk; NIH: R010009; Meier PI) enrolled 430 infants with very low birth weight (VLBW) between 2008 and 2012 to study the impact of the dose and exposure period of MOM during hospitalization in the neonatal intensive care unit (NICU) on potentially preventable complications of prematurity and their associated costs. In this prospective study, MOM and formula feedings were calculated daily (mL), medical diagnoses for NICU morbidities (necrotizing enterocolitis [NEC], late-onset sepsis [sepsis], and bronchopulmonary dysplasia [BPD]) were confirmed independently by 2 neonatologists, and propensity scoring was used to analyze covariates. Neurodevelopmental outcome was measured for a subset of 251 LOVE MOM infants at 20 months of age, corrected for prematurity (CA). Data revealed a dose-response relationship between higher amounts of MOM received during critical NICU exposure periods and a reduction in the risk of NEC, sepsis, BPD, and their costs, as well as higher cognitive index scores at 20 months CA. MOM appears to function via different mechanisms during NICU exposure periods to reduce the risk of potentially preventable complications and their costs in VLBW infants. Institutions should prioritize the economic investments needed to acquire, store, and feed high-dose MOM in this population.

Early Pulse Oximetry Data Improves Prediction of Death and Adverse Outcomes in a Two-Center Cohort of Very Low Birth Weight Infants.

We previously showed, in a single-center study, that early heart rate (HR) characteristics predicted later adverse outcomes in very low birth weight (VLBW) infants. We sought to improve predictive models by adding oxygenation data and testing in a second neonatal intensive care unit (NICU). HR and oxygen saturation (SpO2) from the first 12 hours and first 7 days after birth were analyzed for 778 VLBW infants at two NICUs. Using multivariate logistic regression, clinical predictive scores were developed for death, severe intraventricular hemorrhage (sIVH), bronchopulmonary dysplasia (BPD), treated retinopathy of prematurity (tROP), late-onset septicemia (LOS), and necrotizing enterocolitis (NEC). Ten HR-SpO2 measures were analyzed, with first 12 hours data used for predicting death or sIVH and first 7 days for the other outcomes. HR-SpO2 models were combined with clinical models to develop a pulse oximetry predictive score (POPS). Net reclassification improvement (NRI) compared performance of POPS with the clinical predictive score. Models using clinical or pulse oximetry variables alone performed well for each outcome. POPS performed better than clinical variables for predicting death, sIVH, and BPD (NRI > 0.5, p < 0.01), but not tROP, LOS, or NEC. Analysis of early HR-SpO2 characteristics adds to clinical risk factors to predict later adverse outcomes in VLBW infants.

Two-Year Follow-up of a Randomized Controlled Nutrition Intervention Trial in Very Low-Birth-Weight Infants.

Very low-birth-weight (VLBW) infants are at risk for neurodevelopment impairment. This study assessed the effect of early aggressive parenteral nutrition (PN) on long-term outcome in VLBW infants. Directly after birth, VLBW infants (birth weight <1500 g, n = 142) were randomized to 5 different PN regimes. Controls (n = 46) received glucose and standard-dose amino acids (AAs; 2.4 g/[kg·d]) from birth onward and pure soybean oil fat emulsion (SOY) on the second day of life. Two intervention groups received glucose, standard-dose AAs, and lipids from birth onward: SOY (n = 24) or mixed fat emulsion (MIX, n = 25). The 2 other intervention groups received glucose, high-dose AAs (3.6 g/[kg·d]), and lipids from birth onward: SOY (n = 24) or MIX (n = 23). The primary outcome of this follow-up study was the composite outcome of "death or major disability" at 2 years corrected age. Secondary outcomes were death, major disabilities, neurodevelopmental scores, and anthropometry. Follow-up rate was 92% (n = 134). Thirty-five (26%) infants had died or had a major disability, with no differences between intervention groups and controls. Increased odds for death were observed in the standard-dose AA-MIX group (odds ratio, 5.4; 95% confidence interval [CI], 1.1-27.0). Neurodevelopmental scores and incidence of major disabilities did not differ between groups. Growth in the high-dose AA-MIX group was enhanced compared with growth in controls at 2 years corrected age (+0.51 [0.01-1.02] weight SDS). This randomized controlled hypothesis-generating study demonstrated no beneficial effect of early high-dose AA administration and mixed fat emulsions on survival and neurodevelopmental outcome in VLBW infants, although growth was enhanced.

Survival and morbidities in very low birth weight (VLBW) infants in a tertiary care teaching hospital

Background: Very low birth weight (VLBW) infants often need institutional advanced neonatal care. There is paucity of literature about the survival and morbidities of this very vulnerable group of preterm very low birth weight infants in tertiary care teaching hospitals. The aim of the study was to measure the outcome of VLBW infants in terms of survival and various short-term morbidities in a tertiary care teaching hospital.Methods: This was a retrospective data analysis of all VLBW infants born in a tertiary care teaching hospital of eastern India, between 01 July 2014 and 31 December 2016. 35 VLBW infants were studied for the outcomes in terms of survival and morbidities like respiratory distress, apnoea of prematurity, intra ventricular haemorrhage, necrotizing enterocolitis, patent ductus arteriosus, retinopathy of prematurity and broncho pulmonary dysplasia.Results: The overall survival rate of VLBW infants weighing &gt;750 g (n=30) was 96.6% and &lt;750 gm (n=5), was 40%. The commonest complications were respiratory distress (65.7%), neonatal hyperbilirubinemia (74.3%) and suspect early onset sepsis (51.4%) based on maternal risk factors.Conclusions: The majority of VLBW infants above 750 g at birth or ≥ 26 weeks POG, survived in a tertiary care teaching hospital.

Mortality and morbidity profile of preterm very low birth weight infants: A prospective longitudinal observational study

Objective: To study the survival to discharge and immediate outcome of preterm very low birth weight (VLBW) infants. Materials and Methods: Design: Prospective observational longitudinal study. Setting: Level II neonatal intensive care unit in a tertiary care center. Subjects: All live born inborn babies with birth weight 401-1499 g or gestational age between 22 weeks 0 day and 31 weeks 9 days. Outcome: Key outcome was survival to discharge for preterm VLBW infants. Incidence of major morbidities was assessed. Results: Of 183 neonates enrolled in the study, 73.2% babies were alive at initial disposition. Respiratory distress syndrome was the most common morbidity, and infection was the most common cause of death. Lower gestational age and low APGAR score at 1 min were the most significant predictors of poor outcome. Conclusion: This study provides a baseline database for evaluating the efficiency of perinatal services in a tertiary care center. Further large-scale trials are needed to substantiate our findings and to study neurodevelopmental outcome of VLBW infants.

Early extubation failure in very low birth weight infants: Clinical outcomes and predictive factors

To identify the clinical outcomes and the potential predictive factors of early extubation failure (EEF) in very low birth weight (VLBW) infants. A retrospective study of VLBW infants admitted to the neonatal intensive care unit (NICU) over fifteen years. Neonates were intubated and mechanically ventilated on the first day of life, and early extubated within the first 3 days. EEF was defined as the need for re-intubation within 3 days of the first extubation. A composite outcome of mortality or any major morbidity (grade 3-4 intraventricular hemorrhage or periventricular leukomalacia; stage 3-4 retinopathy of prematurity, moderate-severe bronchopulmonary dysplasia or stage 2-3 necrotizing enterocolitis) was assessed. In total, 394 infants were extubated early. Of those, 347 (88%) had early extubation success (EES), whereas 47 (12%) had EEF. Incidence of the composite outcome was significantly higher in the EEF group than the EES group, even after adjusting for confounding factors. Logistic regression indicated that birth weight < 1000 g (p < 0.01), administration of≥2 doses of surfactant (p < 0.01) and administration of≥2 inotropic agents (p < 0.01) were all significantly associated with EEF. The area under the curve (AUC) for the combination of these three factors (AUC = 0.77) indicated significantly higher predictive value (p < 0.01) for EEF in VLBW infants, compared with individual factors (AUC = 0.59 for≥2 inotropic agents, AUC = 0.64 for birth weight≤1000 g and AUC = 0.66 for≥2 doses of surfactant). EEF is associated with poor clinical outcomes in VLBW infants. The combination of birth weight and the requirement for surfactants and inotropic agents can predict EEF.

Parental perception of child vulnerability among mothers of very low birth weight infants: psychological predictors and neurodevelopmental sequelae at 2 years.

ObjectiveTo examine the impact of maternal psychological distress on the development of parental perception of child vulnerability (PPCV) in mothers of VLBW infants; and to examine the impact of PPCV on neurodevelopmental outcome in VLBW infants in the 2nd year of life.Study DesignProspective study of 69 mothers and their VLBW infants recruited in 2011-2012 for whom maternal psychological data was collected during the NICU hospitalization. Maternal PPCV was assessed at 4 months corrected age (CA). Neurodevelopmental outcome was assessed at 20 months CA. Regression analyses modeled the development of PPCV and the impact of PPCV on neurodevelopmental outcome.ResultsPPCV at 4 months CA was predicted by maternal anxiety and history of previous fetal loss reported during the NICU stay. Higher PPCV at 4 months CA was associated with lower language scores at 20 months CA.ConclusionsTargeted interventions aimed reducing PPCV in the NICU are supported.