Peri-intraventricular Hemorrhage Research Articles

Early-onset neonatal sepsis as a risk factor for peri-intraventricular hemorrhage in premature infants.

To assess early-onset sepsis as a risk factor of peri-intraventricular hemorrhage in premature infants born at less than or equal to 34 weeks' gestation and admitted to a neonatal intensive care unit (NICU). This retrospective cohort study included premature patients born at less than or equal to 34 weeks' gestation who were admitted to the NICU of a tertiary hospital in southern Brazil, and born from January 2017 to July 2021. Data were collected from patients' medical records. Early-onset sepsis was measured according to the presence or absence of diagnosis within the first 72 hours of life, whereas the outcome, peri-intraventricular hemorrhage, was described as the presence or absence of hemorrhage, regardless of its grade. Hazard ratios were calculated using Cox regression models. A total of 487 patients were included in the study, of which 169 (34.7%) had some degree of peri-intraventricular hemorrhage. Early-onset sepsis was present in 41.6% of the cases of peri-intraventricular hemorrhage, which revealed a significant association between these variables, with increased risk of the outcome in the presence of sepsis. In the final multivariate model, the hazard ratio for early-onset sepsis was 1.52 (95% confidence interval 1.01-2.27). Early-onset sepsis and the use of surfactants showed to increase the occurrence of the outcome in premature children born at less than or equal to 34 weeks' gestation. Meanwhile, factors such as antenatal corticosteroids and gestational age closer to 34 weeks' gestations were found to reduce the risk of peri-intraventricular hemorrhage.

Characterization and neuroprotective care for preterm newborns in an Intensive Care Unit

Objective: To characterize the clinical-epidemiological profile of premature infants admitted to the intensive unit of a public hospital in Paraná. Methods: This is a retrospective observational study based on 170 medical records of newborns <32 weeks, born and staying at the study institution and without associated pathologies, hospitalized between 2017 and 2021. Data were collected between June and August 2022, after approval of the Ethics Committee, and, subsequently, a descriptive analysis was carried out, with simple and relative frequencies, mean, median, standard deviation and interquartile range, and inferential, using the chi-square test and the Mann-Whitney test. Results: The majority were male, delivered by cesarean section, very premature, with very low birth weight, Apgar ≥7 at the fifth minute, needing immediate assistance at birth. There were 31 (18.2%) deaths and there was a higher frequency of peri-intraventricular hemorrhage in males preterm newborns, with lower gestational ages, birth weight and Apgar. Minimum care measures were recorded in 43 (25.3%) medical records, which guided neuroprotective care and reduced the risk of brain injury and subsequent problems. Conclusion: Identifying the profile and factors that can be intervened can prevent premature dbirths and reduce the number of newborns affected by peri-intraventricular hemorrhage. The importance of developing public policies and effective programs aimed at maternal and child health is highlighted, in order to improve quality of care and reduce negative outcomes.

Bubble CPAP as first ventilatory choice in extremely premature infants: Relation to outcomes and bronchopulmonary dysplasia

PurposePropose an admission strategy of very PTNB, for quality improvement and prevent adverse events, and risk of developing bronchopulmonary dysplasia-BPD, vascular, and neurological outcomes. Methodsobservational prospective cohort study, from 2020 to 2021. All preterms younger than 32 weeks of gestational age were admitted to bCPAP, recorded failure and main outcomes. Results26 very PTNB (30 weeks+2 days), 6 presented bCPAP failure and intubated. Outcomes: 1 nasal bleeding, 2 septal hyperemia, 1 septal lesion and 1 pneumomediastinum, 5 peri-intraventricular hemorrhages, negative retinopathy of prematurity in those who underwent the examination, 1 death and 2 had a diagnosis of BPD. A positive association was identified with the need for FIO2 greater than 21% and BPD. Conclusionsvery PTNB can be safely admitted to bCPAP with the implementation of the proposed protocol, provided that the multidisciplinary team is prepared with periodic training. Attention should be given to the proper positioning of the interface and the baby in the bed, in addition to constant monitoring of ventilatory parameters and air temperature. Supplemental oxygen is associated with an increased risk of developing BPD.

Perfil epidemiológico da prematuridade e comorbidades associadas em recém-nascidos prematuros de muito baixo peso

Objective: To describe the major epidemiological features of prematurity, risk factors, prevalence of comorbidities, death and survival rates in very low birth weight newborns. Methods: Transversal study with rectrospective data collection from medical charts of 616 premature and very low birth weight newborns admitted to Complexo Hospital de Clínicas da UFPR (CHC-UFPR) between August 2008 and August 2018. It was studied comorbidities prevalence, survival rate and factors related to mortality. For all statistical tests, it was considered a 5% level of significance. Results: The average gestational age (GA) was 28.2 ± 2.9 weeks and the average birth weight (BW) was 997.4 ± 279.9 grams. The population with GA < 28 weeks (42.5%) had a greater need for neonatal resuscitation and ventilatory support and a higher prevalence of the following diseases: respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), pulmonary hypertension, pulmonary hemorrhage, peri-intraventricular hemorrhage (PIVH), retinopathy of prematurity (ROP), patent ductus arteriosus (PDA) and early-onset neonatal sepsis. The main comorbidities associated with an increased risk of death were (p <0.05): RDS (OR: 4,04), pulmonary hemorrhage (OR: 5,21) and PIVH (OR: 3,32). The reduction in survival rate was associated with lower values ??of GA and BW, as well as the presence of respiratory and neurological comorbidities. Conclusions: Extremely premature newborns have a higher prevalence of comorbidities and neonatal complications. Low birth weight, morbidities of the respiratory and neurological systems were the main factors associated with increased mortality.

Perfil epidemiológico da prematuridade e comorbidades associadas em recém-nascidos prematuros de muito baixo peso

OBJECTIVE: To describe the major epidemiological features of prematurity, risk factors, prevalence of comorbidities, death and survival rates in very low birth weight newborns. METHODS: Transversal study with rectrospective data collection from medical charts of 616 premature and very low birth weight newborns admitted to Complexo Hospital de Clínicas da UFPR (CHC-UFPR) between August 2008 and August 2018. It was studied comorbidities prevalence, survival rate and factors related to mortality. For all statistical tests, it was considered a 5% level of significance. RESULTS: The average gestational age (GA) was 28.2 ± 2.9 weeks and the average birth weight (BW) was 997.4 ± 279.9 grams. The population with GA < 28 weeks (42.5%) had a greater need for neonatal resuscitation and ventilatory support and a higher prevalence of the following diseases: respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), pulmonary hypertension, pulmonary hemorrhage, peri-intraventricular hemorrhage (PIVH), retinopathy of prematurity (ROP), patent ductus arteriosus (PDA) and early-onset neonatal sepsis. The main comorbidities associated with an increased risk of death were (p <0.05): RDS (OR: 4,04), pulmonary hemorrhage (OR: 5,21) and PIVH (OR: 3,32). The reduction in survival rate was associated with lower values ??of GA and BW, as well as the presence of respiratory and neurological comorbidities. CONCLUSIONS: Extremely premature newborns have a higher prevalence of comorbidities and neonatal complications. Low birth weight, morbidities of the respiratory and neurological systems were the main factors associated with increased mortality.

Problemática da persistência do canal arterial: um vilão ou uma alteração presente ao acaso?

OBJECTIVE: To analyze newborns weighing less than 1500g at birth who developed complications like bronchopulmonary dysplasia, retinopathy of prematurity, peri-intraventricular hemorrhage, pulmo-nary hemorrhage and necrotizing enterocolitis with or without patent ductus arteriosus (PDA). The aim was to establish a causal relationship between them. METHOD: Search in the database of the Bra-zilian Network of Neonatal Research of newborns from the Hilda Brandão Maternity Hospital at Santa Casa de Belo Horizonte - MG, between 2014-2019. It included babies who were born or were admitted to the maternity ward with birth weight between 401 and 1500g or gestational age of 22 weeks and 0 days to 29 weeks and 6 days. RESULTS: It was observed that for all complications, the absolute num-ber of cases was considerably higher in the presence of PDA. However, in our sample, after the statis-tical analises, there was no causal relationship between the events studied (patent ductus arteriosus X complications). CONCLUSION: The presence of some association between patent ductus arteriosus and diseases and complications inherent to prematurity is indisputable. However, as suggested in other case series, in this study, a causal relationship between PDA and the studied comorbidities was not established. It suggests that maybe all the conditions (including the patency of the canal) are just mo-re common in a group of severe preterm infants. The absence of a causal association leads us to re-flect on the PDA closure treatment, opting for less interventionist and more selective approaches.

Seis meses de aleitamento materno exclusivo no pré-termo de muito baixo peso submetido ao método canguru

OBJECTIVE: To know the rate and factors associated with exclusive breastfeeding in the follow-up of the preterm submitted to the kangaroo method. METHODS: Cross-sectional study performed with pre-terms smaller than 33 weeks and/or birth weight <1,500 grams, born in 2019, submitted to the kangaroo method and followed up to six months. Descriptive analysis and association and comparison tests were carried out for the maternal and neonatal factors for the outcome of exclusive breastfeeding yes (G1) and not (G2) by the IBM-SPSS/Statistics program 22. RESULTS: Of the 111 patients who were discharged, 82 (100%) were followed up to the corrected ages 3.8/4.2 and chronological 5.9/6.3 months, respectively, in the G1/G2. Exclusive breastfeeding was present in G1 at 22 (26.8%) patients and 60 (73.2%) in the G2 had already introduced formula. Maternal age averages 28/29 years, gestational age 30.3/30.4 weeks, birth weight 1295/1434g, mechanical ventilation time 5.0/5.8 and total hospitalization 56/49 days in groups G1 and G2, respectively. Cesarian section frequencies 68/61%, necrotizing enterocolitis 4.5/8.3%, severe peri-intraventricular hemorrhage 4,5/8.3%, late sepsis 19/16.9%, and rehospitalization after discharge 4.5/6,8% in G1 and G2 patients. There was no statistical significance of the variables analyzed for the outcome of exclusive breastfeeding. CONCLUSION: Compared to other cohorts and at the service itself in 2010 analysis, the breastfeeding rate was high and, especially the exclusive breastfeeding, condition associated with the best development of the preterm. The perinatal variables were not determinants of the success of exclusive breastfeeding in these patients treated by the kangaroo method.

Clinical factors associated with abnormal general movements of preterm newborns during hospitalization in a neonatal intensive care unit

IntroductionThere is no clarity about which clinical variables during hospitalization in the Neonatal Intensive Care Unit (NICU) are associated with abnormal General Movements (GMs). ObjectiveTo describe the trajectory of GMs of preterm newborns and explore the association between clinical variables and the presence of abnormal GMs during the NICU stay. MethodsFifty-eight preterm newborns (33 males), with a mean gestational age at birth of 31,93 week's postmenstrual age, were evaluated using the GMs assessment by Hadders-Algra method. Clinical variables recorded weekly throughout the hospitalization period. The weekly association between clinical variables and the presence of abnormal GMs was tested using the Generalized Estimating Equations (GEE) model. ResultsPreterm infants were recorded for up to sixteen weeks and more than half of the infants (56.9 %) had abnormal movements in at least one week during hospitalization. The absence of peri-intraventricular hemorrhage (PIVH) grades I-II and non-invasive ventilatory support and/or oxygen therapy on the day of the evaluation reduced, respectively, by 77.3 % (OR = 0.23; p > 0.0001) and 64.3 % (OR = 0.36; p > 0.0001) the chance of having an abnormal classification. In addition, each day of increased invasive mechanical ventilation increased the chance of having an abnormal classification by 1.11 times (OR = 0.025; p > 0.0001). ConclusionPIVH grades I-II, longer durations of mechanical ventilation and the presence of non-invasive ventilatory support and/or oxygen therapy are associated with abnormal movements during stay in the neonatal period. The data suggest that development outcome of infants having these conditions should be closely monitored.

In-hospital outcomes in preterm and small-for-gestational-age newborns: a cohort study.

ABSTRACTObjective To compare in-hospital outcomes between small-for-gestational-age and appropriate-for-gestational-age preterm neonates who needed intensive care.Methods A retrospective cohort study with preterm newborns, from January to December 2017. The results are presented as median, frequency, and odds ratio. Numerical variables were compared using the Wilcoxon test. Categorical variables were compared using the χ2 test. We considered p<0.05 as significant.Results Out of 129 preterm newborns included, 20.9% were small-for-gestational-age. Median gestational age was 31 2/7 weeks, birthweight was 1,450g, and length of hospital stay was 39 days. Preterm small-for-gestational-age newborns presented a higher chance of peri-intraventricular hemorrhage (odds ratio of 3.23; p=0.02), retinopathy of prematurity (odds ratio of 2.78 p=0.02), patent ductus arteriosus (odds ratio of 2.50; p=0.04) and a lower chance of presumptive early-onset sepsis (odds ratio of 0.37; p=0.03).Conclusion Preterm small-for-gestational-age neonates were associated with peri-intraventricular hemorrhage, retinopathy of prematurity and patent ductus arteriosus. This emphasizes the need of special care for these neonates.

Pharmacological neuroprotection and clinical trials of novel therapies for neonatal peri-intraventricular hemorrhage: a comprehensive review.

Peri-intraventricular hemorrhage (PIVH) is a serious condition for preterm infants, caused by traumatic or spontaneous rupture of the germinal matrix (GM) capillary network in the cerebral ventricles. It is a common source of morbidity and mortality in neonates, and risk correlates with earlier delivery, low birth weight, maternal-fetal infection, and vital sign derangements, among others. PIVH typically occurs in the first 72h of life, and symptoms, when present, manifest most commonly within the first week of life. Prevention remains the primary goal in management, predominantly via prolonging of gestation. Current therapy protocols are center-dependent without consistent consensus guidelines, but infant positioning, homeostatic stabilization, and neuroprotection offer potential options. In this update of pharmacologic neuroprotective therapies for PIVH, we highlight commonly utilized therapies and review the investigative literature. Further multi-institutional clinical trials and basic research studies are required.

Survival and Neurodevelopmental Outcomes of Premature Infants with Severe Peri-Intraventricular Hemorrhage at 24 Months of Age

Severe peri-intraventricular haemorrhage has been associated with higher mortality and neurodevelopmental impairment. The impact of peri-intraventricular haemorrhage alone (without white matter injury) remains controversial. The aim of this study was to evaluate the influence of severe peri-intraventricular haemorrhage, associated or not with cystic peri-ventricular leukomalacia, on mortality and neurodevelopment at 24 months. Retrospective cohort study, that included newborns with severe peri-intraventricular haemorrhage admitted to a maternity hospital with differentiated perinatal support between 2006 and 2015, and two controls with the same gestational age, without peri-intraventricular haemorrhage, who were admitted immediately after the case. Neurodevelopmental assessment, at 24 months, was performed in 99 children, using the Schedule of Growing Skills II scale in 52 and the Ruth Griffiths mental development scale in 47 children. Severe neurodevelopmental deficit was diagnosed in the following conditions: cerebral palsy, delayed psychomotor development, deafness requiring hearing aids and blindness. The study included 41 cases and 82 controls. Out of these, 23 died, 16 (39.0%) in the group of severe peri-intraventricular haemorrhage and seven (8.5%) in the control group (OR 7.6, 95% CI 2.6 - 20.4, p < 0.001). Severe neurodevelopmental deficit was diagnosed in seven (30.4%) in the severe peri-intraventricular haemorrhage group and one (1.3%) in the control group (OR 32; 95% CI 3.7 - 281, p < 0.001). Individualized analysis showed that mortality was higher in peri-intraventricular haemorrhage grade III with associated cystic peri-ventricular leukomalacia (OR 4.4 95% CI 1.3 - 14.2, p = 0.015) and in peri-intraventricular haemorrhage IV (OR 12; 95% CI 3.5 - 41.2, p < 0.001), when compared to controls. Differences were also noticed regarding severe neurodevelopmental deficit when compared with controls (1.3%) in grade III peri-intraventricular haemorrhage with associated cystic peri-ventricular leukomalacia, (75.0%, p < 0.001) and grade IV peri-intraventricular haemorrhage (50.0%, p < 0.001 ). This work showed a higher mortality rate and neurodevelopment impairment in preterm newborns with severe peri-ventricular haemorrhage. Analysis by groups stratified according to gestational age and different grades of peri-ventricular haemorrhage displayed the complications associated with peri-ventricular haemorrhage grade IV or grade III, with or without cystic peri-ventricular leukomalacia. Preterm newborns with peri-intraventricular haemorrhage grade IV or grade III with cystic peri-ventricular leukomalacia, had a higher risk of mortality and severe neurodevelopmental impairment.

Adesão ao seguimento ambulatorial e reinternação hospitalar após alta da segunda etapa do método canguru

Objectives: To assess compliance to outpatient follow-up after discharge from the second stage of the kangaroo method, and a rate of hospital readmission up to 30 days of corrected age. Methods: We ran a cross-sectional study with very low birth weight infants and/or children under 33 weeks of age born from January to December/2019 at the Januário Cicco Maternity School / Natal / RN. For data analysis we used the Shapiro-Wilk, Mann-Whitney and the Fishers Exact tests. Results: Of the 100 newborns included in the study, 13 did not return for outpatient follow-up. Among the 87 (100%) newborns in a row, 6 (6.9%) were readmitted for anemia requiring transfusion; 2 (33.3%) for urinary tract infection; 1 had regurgitation (16,5%); and 1 (16.5%) was undetermined. Newborns with follow-up had higher birth weight, fewer days in mechanical conditions and frequency of grade 3 and 4 peri-intraventricular hemorrhage compared with the no follow-up group. Conclusion: An important number of high-risk newborns did not return for outpatient follow-up, thus being an alert for the team that organized patient discharge. The low rate of readmission, in the first month of corrected age suggests a good condition of the patients at discharge. However, a longer period of observation should be used since the studies showed higher rates of readmission in those assessed up to 12 months of the corrected age.

Evaluation of the effectiveness of antenatal corticoid in preterm twin and single pregnancies: a multicenter cohort study

Background The effects of antenatal corticosteroids (ANSs) on twins are not well established. Objective To determine the impact of ANS use according to the number of fetuses. Methods Retrospective cohort study of newborns between 23 and 33 weeks of gestational age, birth weight from 400 to 1499 g, without malformations, delivered at 20 public university hospitals from 2010 to 2014. Exposed group: Received ANS (any time, any dose) and no exposed group: no received ANS. Analysis of birth conditions and clinical outcomes. Association of variables, relative risks, and 95% confidence intervals estimated from the adjustment of log-binomial regression models. Results About 7165 premature infants were analyzed: 5167 singleton, 937 twins, and 104 triplets. Characteristics of gestations with one, two, or three fetuses not receiving ANS were similar. Reduced hemodynamic instability in single and twins gestations in the first 72 h were observed (Adj R 2 Twins = 0.78; 95% CI = 0.69–0.86) (Adj R 2 Singles = 0.79; 95% CI = 0.62–0.99). Reduced peri-intraventricular hemorrhage (Adj R 2 Twins = 0.54; 95% CI = 0.36–0.78) (Adj R 2 singles = 0.54; 95% CI = 0.36–0.78); and early sepsis reduction on single and triplex gestations (Adj R 2 triplex = 0.51; 95% CI = 0.27–0.94) (Adj single R 2 = 0.51; 95% CI = 0.27–0.94) were observed. Conclusions This study demonstrates ANS produces an important protective factor for severe intraventricular hemorrhage and hemodynamic instability in single and multiple pregnancies. ANS had a protective effect on death and birth conditions improvement just in single gestations. Regarding respiratory aspects was not observed the protective effect in the single or multiple gestations.

Impact of bundle implementation on the incidence of peri/intraventricular hemorrhage among preterm infants: a pre-post interventional study.

Peri/intraventricular hemorrhage (PIVH) is a frequent cause of death and morbidity among preterm infants. Few studies have addressed the use of bundles for preventing PIVH. To evaluate the efficacy of a bundle of interventions designed to decrease the incidence of intraventricular hemorrhage at hospital discharge among preterm infants. Pre-post interventional study with retrospective and prospective data collection performed before and after bundle implementation in the neonatal intensive care unit of a university hospital. Infants with gestational age < 32 weeks without malformations, who survived > 6 days were included. The bundle consisted of the following actions during the first 72 hours of life: maintenance of head in neutral position with the body in supine position, minimal handling, including delay of lumbar puncture until after 72 hours and absence of respiratory therapy maneuvers. Cranial ultrasound was performed on days 3, 7 and 28, or later if needed. The effect of the bundle was analyzed through logistic regression and results were adjusted for confounding variables. 167 infants met the inclusion criteria; 146 (87%) were analyzed. Bundle implementation was associated with decreased chances of PIVH at hospital discharge (odds ratio 0.29; 95% confidence interval 0.13-0.65). Cerebrospinal fluid collection within the first 72 hours increased the odds of PIVH of any grade during the hospital stay fourfold, after adjustment for all variables included in the model. Implementation of a bundle of interventions to avoid intraventricular hemorrhage was effective for decreasing the incidence of all grades of PIVH in preterm infants.

Neuroprotection of the Perinatal Brain by Early Information of Cerebral Oxygenation and Perfusion Patterns.

Abnormal patterns of cerebral perfusion/oxygenation are associated with neuronal damage. In preterm neonates, hypoxemia, hypo-/hypercapnia and lack of cerebral autoregulation are related to peri-intraventricular hemorrhages and white matter injury. Reperfusion damage after perinatal hypoxic ischemia in term neonates seems related with cerebral hyperoxygenation. Since biological tissue is transparent for near infrared (NIR) light, NIR-spectroscopy (NIRS) is a noninvasive bedside tool to monitor brain oxygenation and perfusion. This review focuses on early assessment and guiding abnormal cerebral oxygenation/perfusion patterns to possibly reduce brain injury. In term infants, early patterns of brain oxygenation helps to decide whether or not therapy (hypothermia) and add-on therapies should be considered. Further NIRS-related technical advances such as the use of (functional) NIRS allowing simultaneous estimation and integrating of heart rate, respiration rate and monitoring cerebral autoregulation will be discussed.

Early life serum neurofilament dynamics predict neurodevelopmental outcome of preterm infants

Background and purposeTo determine whether neurofilament light chain (NfL), a promising serum and cerebrospinal fluid (CSF) biomarker of neuroaxonal damage, predicts functional outcome in preterm infants with neonatal brain injury.MethodsOur prospective observational study used a sensitive single-molecule array assay to measure serum and CSF NfL concentrations in preterm infants with moderate to severe peri/intraventricular hemorrhage (PIVH). We determined temporal serum and CSF NfL profiles from the initial diagnosis of PIVH until term-equivalent age and their association with clinical and neurodevelopmental outcome until 2 years of age assessed by Bayley Scales of Infant Development (3rd edition). We fitted univariate and multivariate logistic regression models to determine risk factors for poor motor and cognitive development.ResultsThe study included 48 infants born at < 32 weeks of gestation. Median serum NfL (sNfL) at PIVH diagnosis was 251 pg/mL [interquartile range (IQR) 139–379], decreasing markedly until term-equivalent age to 15.7 pg/mL (IQR 11.1–33.5). CSF NfL was on average 113-fold higher (IQR 40–211) than corresponding sNfL values. Additional cerebral infarction (n = 25)-but not post-hemorrhagic hydrocephalus requiring external ventricular drainage (n = 29) nor any other impairment-was independently associated with sNfL. Multivariate logistic regression models identified sNfL as an independent predictor of poor motor outcome or death at 1 and 2 years.ConclusionsSerum neurofilament light chain dynamics in the first weeks of life predict motor outcome in preterm infants with PIVH.

Description of a Nutrition Screening and Assessment Tool and Associations with Clinical Outcomes in Preterm Newborns.

Preterm newborns have higher nutrition risk and mortality. Nutrition risk screening enables early intervention. This article evaluates a nutrition screening tool in a neonatal intensive care unit (NICU). Retrospective longitudinal study of preterm newborns (aged <37 weeks) in a NICU in Brazil from May 2018 to January 2019. Weight, length, and head circumference (HC) were analyzed. Nutrition screening was defined by care levels (CLs). Outcomes analyzed were bronchopulmonary dysplasia (BPD), peri-intraventricular hemorrhage (PIVH), retinopathy of prematurity (ROP), late sepsis, length of stay, mortality, and time receiving enteral and parenteral nutrition. Data on 110 newborns were studied, with median gestational age 34 (31-35) weeks, mean weight 1914.92 g (±657.7), length 42.2 cm (±4.45), and HC 29.9 cm (±2.97). Most (82.7%) of them were adequate for gestational age. Screening classifications were 41.8% (n = 46) at CL 2, 41.8% (n = 46) at CL 3, and 16.4% (n = 18) at CL 4. CL 3 and CL 4 patients had higher frequencies of BPD (P = .003), ROP (P = .027), and PIVH (P = .006) and longer enteral time (P < .001) and length of stay (P < .001). All mortality occurred in CL 4 patients (P < .001). CL 3 and CL 4 patients had more BPD, ROP, PIVH, and mortality and longer enteral nutrition. Hospital stay was longer for CL ≥3 than CL 2 patients. Patients classified as CL 3 and CL 4 by the nutrition screening tool may have higher nutrition risk.

Prevalence, Risk Factors and Intra-Hospital Outcomes Relating to Peri-Intraventricular Hemorrhage in Premature Newborns of Gestational Age Less than 34 Weeks

Peri-intraventricular hemorrhage is one of the main causes of neurological impairment in premature newborns. To control their risk factors is necessary in view of the increasing survival of extreme preterm infants. Objective: To evaluate the prevalence of peri-intraventricular hemorrhage in premature newborns, identify the risk factors and observe the frequencies of intra-hospital outcomes of interests. Methods: This study was done in Brazil. This was an observational, analytical longitudinal and prospective study. The subjects included were newborns of gestational age less than 34 weeks who were admitted to two public hospitals between May and November 2015. To assess possible associated factors, obstetric, perinatal and neonatal data were analyzed (chorioamnionitis, antenatal corticosteroids, gestational age, newborn weight, Apgar score at 1 and 5 minutes, resuscitation in the delivery room, surfactant in the delivery room, newborn transferred from another hospital, respiratory distress syndrome: RDS, sepsis, umbilical vein catheterization, assisted ventilation, exogenous surfactant in the Neonatal ICU, use of sodium bicarbonate, inotropic agents, adrenaline, volume expanders and blood products). The hospital outcomes studied were assisted ventilation time, hospital stay and death. The data analysis was performed by chi-square test or Fisher’s test, with a significance level of 5%. Results: Out of 156 newborns, 46 (29.9%) presented peri-intraventricular hemorrhage and 28.2% of these had a severe form of the disease. There were significant associations (p 0.05) with the following risk factors: gestational age, birth weight, low Apgar score, delivery room resuscitation, RDS, surfactant use, sepsis, packed red blood cell transfusion, mechanical ventilation and umbilical vein catheterization. The newborns with peri-intraventricular hemorrhage presented longer times on assisted ventilation, longer hospital stays and higher risk of death. Conclusion: The prevalence of peri-intraventricular hemorrhage was high in the population studied, especially the severe form. Perinatal and neonatal risk factors were associated with a higher risk of developing the disease and the outcomes studied were more evident in these newborns.

Neuroprotective effect of ACTH on collagenase-induced peri-intraventricular hemorrhage in newborn male rats

Peri-intraventricular hemorrhage (PIVH) is a common and serious prematurity-related complication in neonates. Adrenocorticotropic hormone (ACTH) has neuroprotective actions and is a candidate to ameliorate brain damage following PIVH. Here, we tested the efficacy of ACTH1-24 on a collagenase-induced lesion of the germinal matrix (GM) in newborn male rats. Animals received microinjection of the vehicle (PBS, 2 µl) or collagenase type VII (0.3 IU) into the GM/periventricular tissue on postnatal day (PN) 2. Twelve hours later pups received microinjection of either the agonist ACTH1-24 (0.048 mg/kg), or the antagonist SHU9119 (antagonist of MCR3/MCR4 receptors, 0.01 mg/kg), or their combination. Morphological outcomes included striatal injury extension, neuronal and glial cells counting, and immunohistochemical expression of brain lesion biomarkers ipsilateral and contralateral to the hemorrhagic site. Data were evaluated on PN 8. Collagenase induced PIVH and severe ipsilateral striatal lesion. ACTH1-24 dampened the deleterious effects of collagenase-induced hemorrhage in significantly reducing the extension of the damaged area, the striatal neuronal and glial losses, and the immunoreactive expression of the GFAP, S100β, and NG2-glia biomarkers in the affected periventricular area. SHU9119 blocked the glial density rescuing effect of ACTH1-24. ACTH1-24 could be further evaluated to determine its suitability for preclinical models of PVH in premature infants.

Low cardiac output measured by bioreactance and adverse outcome in preterm infants with birth weight less than 1250 g

BackgroundRecently a new continuous non-invasive cardiac output measurement, bioreactance, has become available. Bioreactance measurement of cardiac output has been shown to correlate with left ventricular output detected by echocardiography in healthy term and preterm neonates. AimsOur aim was to correlate cardiac output measurements by bioreactance in the first 48 h of life with adverse outcomes attributable to hypoperfusion (peri/intraventricular haemorrhage (PIVH) and/or necrotising enterocolitis (NEC)) in the cohort of extremely preterm infants. Study designA prospective observational cohort study. SubjectsPreterm infants with birth weight less than 1250 g. Outcome measuresCardiac output was measured between six and 48 h of age by bioreactance. Our primary outcome was a difference in cardiac output between infants with an adverse outcome attributable to hypoperfusion (Group 1), and infants without the predefined adverse outcome (Group 2). ResultsThere were 39 infants enrolled in the study. There were six infants in Group 1. These infants had a significantly lower minimal cardiac output measurement compared to Group 2 (mean 36.7 ml/kg/min vs 64.5 ml/kg/min, p = .0006). The mean cardiac output in Group 1 was significantly lower on day one of life, followed by a significant increase in cardiac output on day two of life compared to Group 2. ConclusionsInfants with birth weight less than 1250 g and PIVH and/or NEC had significantly lower cardiac output compared to infants without these complications on day one of life. This low cardiac output was then followed by a significant increase on day two of life.