Extremely Low Birth Weight Preterm Infants Research Articles

The Association of Neonatal Gut Microbiota Community State Types with Birth Weight.

while most gut microbiota research has focused on term infants, the health outcomes of preterm infants are equally important. Very-low-birth-weight (VLBW) or extremely-low-birth-weight (ELBW) preterm infants have a unique gut microbiota structure, and probiotics have been reported to somewhat accelerate the maturation of the gut microbiota and reduce intestinal inflammation in very-low preterm infants, thereby improving their long-term outcomes. The aim of this study was to investigate the structure of gut microbiota in ELBW neonates to facilitate the early identification of different types of low-birth-weight (LBW) preterm infants. a total of 98 fecal samples from 39 low-birth-weight preterm infants were included in this study. Three groups were categorized according to different birth weights: ELBW (n = 39), VLBW (n = 39), and LBW (n = 20). The gut microbiota structure of neonates was obtained by 16S rRNA gene sequencing, and microbiome analysis was conducted. The community state type (CST) of the microbiota was predicted, and correlation analysis was conducted with clinical indicators. Differences in the gut microbiota composition among ELBW, VLBW, and LBW were compared. The value of gut microbiota composition in the diagnosis of extremely low birth weight was assessed via a random forest-machine learning approach. we briefly analyzed the structure of the gut microbiota of preterm infants with low birth weight and found that the ELBW, VLBW, and LBW groups exhibited gut microbiota with heterogeneous compositions. Low-birth-weight preterm infants showed five CSTs dominated by Enterococcus, Staphylococcus, Klebsiella, Streptococcus, Pseudescherichia, and Acinetobacter. The birth weight and clinical indicators related to prematurity were associated with the CST. We found the composition of the gut microbiota was specific to the different types of low-birth-weight premature infants, namely, ELBW, VLBW, and LBW. The ELBW group exhibited significantly more of the potentially harmful intestinal bacteria Acinetobacter relative to the VLBW and LBW groups, as well as a significantly lower abundance of the intestinal probiotic Bifidobacterium. Based on the gut microbiota's composition and its correlation with low weight, we constructed random forest model classifiers to distinguish ELBW and VLBW/LBW infants. The area under the curve of the classifiers constructed with Enterococcus, Klebsiella, and Acinetobacter was found to reach 0.836 by machine learning evaluation, suggesting that gut microbiota composition may be a potential biomarker for ELBW preterm infants. the gut bacteria of preterm infants showed a CST with Enterococcus, Klebsiella, and Acinetobacter as the dominant genera. ELBW preterm infants exhibit an increase in the abundance of potentially harmful bacteria in the gut and a decrease in beneficial bacteria. These potentially harmful bacteria may be potential biomarkers for ELBW preterm infants.

Predictive factors for extubation success in very low and extremely low birth weight preterm infants.

Although invasive mechanical ventilation (IMV) has contributed to the survival of preterm infants with extremely low birth weight (ELBW), it is also associated with unsatisfactory clinical outcomes when used for prolonged periods. This study aimed to identify factors that may be decisive for extubation success in very low birth weight (VLBW) and extremely low birth weight (ELBW) preterm infants. The cohort study included preterm infants with gestational age (GA) <36 weeks, birth weight (BW) <1500 grams who underwent IMV, born between 2015 and 2018. The infants were allocated into two groups: extubation success (SG) or failure (FG). A stepwise logistic regression model was created to determine variables associated with successful extubation. Eighty-three preterm infants were included. GA and post-extubation arterial partial pressure of carbon dioxide (PaCO2) were predictive of extubation success. Infants from FG had lower GA and BW, while those from SG had higher weight at extubation and lower post-extubation PaCO2. Although we found post-extubation PaCO2 as an extubation success predictor, which is a variable representative of the moment after the primary outcome, this does not diminish its clinical relevance since extubation does not implicate in ET removal only; it also involves all the aspects that take place within a specified period (72 hours) after the planned event. GA and post-extubation PaCO2 were predictors for extubation success in VLBW and ELBW preterm infants. Infants who experienced extubation failure had lower birth weight and higher FiO2 prior to extubation.

Utility of umbilical cord blood 25-hydroxyvitamin D levels for predicting bronchopulmonary dysplasia in preterm infants with very low and extremely low birth weight.

Background and objectiveThere remains controversy regarding vitamin D deficiency and bronchopulmonary dysplasia (BPD) in very low birth weight (VLBW) and extremely low birth weight (ELBW) preterm infants. This study aimed to determine the prevalence of vitamin D deficiency assessed by umbilical cord blood 25-hydroxyvitamin D [25(OH)D] in preterm infants in northeast China and to evaluate the ability and optimal threshold of 25(OH)D for predicting BPD.MethodsThe clinical data of VLBW and ELBW preterm infants with known cord-blood 25(OH)D levels were analyzed retrospectively. Infants were divided into groups based on their cord-blood 25(OH)D levels and BPD diagnosis. Logistic regression was performed to assess the risk factors for BPD and a nomogram was established. Receiver operating characteristic (ROC) curve analysis was used to evaluate the optimal threshold of cord-blood 25(OH)D concentration for predicting BPD.ResultsA total of 267 preterm infants were included, of which 225 (84.3%) exhibited vitamin D deficiency and 134 (50.2%) were diagnosed with BPD. The incidence of BPD was lower in the group with a 25(OH)D level of >20 ng/ml than in the other groups (P = 0.024). Infants with BPD had lower cord-blood 25(OH)D levels than those without BPD (11.6 vs. 13.6 ng/ml, P = 0.016). The multivariate logistic regression model revealed that 25(OH)D levels (odds ratio [OR] = 0.933, 95% confidence interval [95% CI]: 0.891–0.977), gestational age (OR = 0.561, 95% CI: 0.425–0.740), respiratory distress syndrome (OR = 2.989, 95% CI: 1.455–6.142), and pneumonia (OR = 2.546, 95% CI: 1.398–4.639) were independent risk factors for BPD. A predictive nomogram containing these four risk factors was established, which had a C-index of 0.814. ROC curve analysis revealed that the optimal cutoff value of 25(OH)D for predicting BPD was 15.7 ng/ml (area under the curve = 0.585, 95% CI: 0.523–0.645, P = 0.016), with a sensitivity of 75.4% and a specificity of 42.9%.ConclusionsA cord-blood 25(OH)D level of <15.7 ng/ml was predictively valuable for the development of BPD. The nomogram established in this study can help pediatricians predict the risk of BPD more effectively and easily.

The NICU Antibiotics and Outcomes (NANO) trial: a randomized multicenter clinical trial assessing empiric antibiotics and clinical outcomes in newborn preterm infants

BackgroundEarly-onset sepsis is an important cause of neonatal morbidity and mortality in the preterm population. Infants perceived to be at increased risk for early-onset sepsis are often treated empirically with broad-spectrum antibiotics while awaiting confirmatory blood cultures, despite an overall incidence of early-onset sepsis of 2–3% among extremely-low-birthweight (ELBW) infants. Recent observational studies associate perinatal antibiotic use with an increased incidence of necrotizing enterocolitis, late-onset sepsis, and mortality among ELBW infants. Given currently available data and variability in clinical practice, we designed a prospective multi-institutional randomized controlled trial to determine the safety of early antibiotic use in ELBW infants.MethodsThe NICU Antibiotics and Outcomes (NANO) trial is a multicenter, double-blinded, randomized controlled trial. A sample of 802 ELBW preterm infants will undergo web-based stratified block randomization to receive empiric antibiotics (EA; ampicillin and gentamicin) or placebo during routine evaluation for early-onset sepsis. Participating sites will use preexisting institutional protocols for antibiotic dosage and duration. Infants born at participating sites with a gestational age of 29 weeks or less are eligible for enrollment. Exclusion criteria include maternal intrauterine infection, hemodynamic or respiratory instability, delivery by caesarean section for maternal indications without labor or prolonged rupture of membranes, and prior administration of antibiotics. The primary outcome is the composite incidence of necrotizing enterocolitis, late-onset sepsis, or death during participants’ index hospitalization. Maternal and infant samples will be collected longitudinally and assessed for differences in microbiome composition and diversity.DiscussionThe NANO trial is designed to compare the rate of adverse outcomes of EA use at birth versus placebo in ELBW preterm infants. If EA at birth worsens clinical outcomes, then the results of the trial may help providers decrease antibiotic utilization in the NICU and subsequently decrease the incidence of complications associated with early antibiotic use in ELBW infants. If we instead find that EA improve outcomes, then the trial will validate a longstanding clinical practice that has not previously been supported by high-quality data. Future studies will assess long-term clinical and microbial outcomes in infants who received empiric antibiotics following delivery.Trial registrationTrial registration data: June 25, 2019 NCT03997266.

Developmental enamel defects of primary incisors in preterm infants with very low and extremely low birthweight. A case- control study.

To determine the prevalence of developmental defects of enamel (DDE) in primary incisors of preterm very low birthweight (VLBW) and extremely low birthweight (ELBW) one-year-old infants and to compare the findings with fullterm one-year-old normal birthweight (NBW) infants. All infants were enrolled in the case-control study at birth. Personal information and medical histories were obtained through interviews with parents and from medical hospital records. The presence of DDE in primary incisors was evaluated in 82 one-year old preterm infants delivered with VLBW, in 50 ELBW and in 58 fullterm NBW infants. The data were statistically analysed by ANOVA and chi-square tests, and a statistical significance level p<0.05 was established. Results DDE were diagnosed in 19 (23.2 %) preterm VLBW infants, in 27 (54%) ELBW infants and in 4 (6.9%) infants of the control group. The most frequent DDE found in the case group was hypoplasia in 10 (12.2%) VLBW infants and in 14 (28%) ELBW infants. The opacities were found in 6 (7.3%) VLBW infants and in 8 (16%) ELBW infants. The results of the study confirmed a significantly higher prevalence of DDE in the primary incisors in preterm ELBW infants than in VLBW infants and than in full term NBW infants.

Heated humidified high flow nasal cannula versus nasal continuous positive airway pressure for respiratory support in extremely low birth weight preterm infants after extubation: a single centre randomized controlled trial

Background: The objective of the study was to assess the indications, frequency of usage, clinical efficacy, and safety of heated humidified high-flow nasal cannula (HHHFNC) and nasal continuous positive airway pressure (NCPAP) in extremely low birth weight preterm infants (ELBWI) after extubation.Methods: Hospital based prospective randomized control study involving ELBWI with respiratory distress admitted in NICU. In this study, all selected preterm infants were placed on one of the non-invasive respiratory supports (HHHFNC or NCPAP), after a period of positive pressure ventilation (post-extubation). Reintubation rate within 72 hours after initial extubation, duration of invasive ventilation, duration of non-invasive respiratory support, duration of supplemental oxygen, and time to reach full feeds were the primary outcome measures. Duration of total enteral feeding, average weight gain rate, duration of hospitalization, and complications including nasal injury, IVH, BPD, NEC, ROP, and PDA, were the secondary outcomes.Results: A sample size of 46 ELBWI were included. HHHFNC effectively reduced the incidence of nasal injury and NEC (p&lt;0.05) along with the decreased duration of supplementary oxygen. Additionally, HHHFNC achieved a significant advance in time to reach full enteral feeding; increased the average weight gain before discharge; reduced the duration of hospitalization (p&lt;0.05).Conclusions: HHHFNC was effective in preventing extubation failure in mechanically ventilated preterm ELBWI compared to NCPAP. HHHFNC shortens the duration of supplemental oxygen and significantly reduces the incidence of nasal injury and necrotizing enterocolitis; moreover, it can also reduce the duration of hospitalization and its cost.

The Comparison of HHHFNC and NCPAP in Extremely Low-Birth-Weight Preterm Infants After Extubation: A Single-Center Randomized Controlled Trial.

Objectives: To compare the clinical efficacy of heated, humidified high-flow nasal cannula (HHHFNC) and nasal continuous positive airway pressure (NCPAP) in extremely low-birth-weight preterm infants (ELBWI) after extubation.Methods: This trial included 94 extremely low-birth-weight infants (ELBWI), within 7 days after birth, and prepared for tracheal extubation and a change to non-invasive ventilation in the neonatal intensive care unit (NICU) admitted to our hospital from January 2015 to December 2018, with 48 infants in the HHHFNC group and 46 infants in the NCPAP group. Reintubation rate within 72 h after initial extubation, total ventilation time, non-invasive ventilation time, total oxygen inhalation time, and the time to reach full enteral feeding were the primary outcome measures. Total intestinal feeding time, average weight gain rate, days of hospitalization, costs of hospitalization, and complication rates, including nasal injury, IVH, BPD, NEC, ROP, and PDA, were used as secondary outcomes. Data were analyzed using Student's t-test or the Mann-Whitney U-test with a Chi-square test or Fisher's exact test, as appropriate, in SPSS (25.0).Results: HHHFNC not only shortened the oxygen exposure time but also effectively reduced the incidence of nasal injury (6.25 vs. 36.96%) and NEC (10.42 vs. 28.26%) (P < 0.05). Additionally, HHHFNC achieved a significant advance in the time to reach full enteral feeding (31.24 ± 11.35 vs. 34.21 ± 14.09 days); increased the average weight gain rate (16.07 ± 3.10 vs. 13.74 ± 4.21) and reduced the days of hospitalization (73.45 ± 18.84 vs. 79.24 ± 19.75), with a lower cost of hospitalization (16.04 ± 3.64 vs.18.79 ± 4.13) thousand dollars (all P < 0.05).Conclusions: Compared with NCPAP, HHHFNC was effective in preventing extubation failure in mechanically ventilated preterm ELBWI. HHHFNC shortens oxygen consumption time and significantly reduces the incidence of nasal injury and necrotizing enterocolitis; moreover, it can also reduce the length of stay and the hospitalization costs.

Impact of inhaled corticosteroids on the neurodevelopmental outcomes in chronically ventilated extremely low birth weight preterm infants

Few studies have assessed the long-term impact of inhaled corticosteroids (ICS) in preterm infants. This study evaluated the neurodevelopmental outcomes of chronically ventilated extremely low birth weight (ELBW) preterm infants exposed to ICS. The medical records of ELBW preterm infants admitted to two tertiary-level neonatal intensive care units from 2008 to 2014 were reviewed. Infants intubated for more than 28 days were included. The neurodevelopmental outcomes were compared at 24 months corrected age, between those with ICS exposure (inhaled group, IH) and those without it (non-inhaled group, NIH), by using the Bayley-Scale-of-Infant-and-Toddler Development-III (BSID-III). Out of the 115 infants included, 64 had an ICS exposure. The incidence of the morbidities at the time of discharge, was comparable between the two groups, except for the duration of oxygen and mechanical ventilation dependence (IH 124.8±40.3 days vs. NIH: 101.0±28.6 days, p<0.001 and IH 60.0±25.8 days vs. NIH: 42.3±14.2 days, p<0.001, respectively). Multiple logistic regression analysis at 24 months corrected age revealed no significant differences in the BSID-III scores and in the incidence of cerebral palsy and neurodevelopmental impairment. The late ICS exposure was not associated with neurodevelopmental impairment at 24 months corrected age in chronically ventilated ELBW infants; however, it did not reduce the duration of their dependence on oxygen and mechanical ventilation.

Nutritional intake and growth velocity in preterm extremely low-birthweight infants in Asia: Are we doing enough?

To describe nutritional practices among preterm extremely low-birthweight (ELBW) infants and their impact on growth and to compare differences in nutritional intervention and comorbidities between those with limited growth velocity (GV < 25th percentile) and those with GV > 25th percentile. A prospective cohort study was conducted to assess total protein and energy intake for week 1, days 14, 21 and 28 of life. Post-natal growth was calculated by measuring GV using an exponential model. Univariable analysis was applied to identify the potential risk factors associated with poor GV at day 28 and at discharge from hospital. The median GV from birth to day 28 was 9.84 g/kg/day and 11.87 g/kg/day for GV from birth to discharge. Increased protein and energy intake was associated with higher GV at discharge. Hypotension needing inotropes, necrotising enterocolitis (NEC), patent ductus arteriosus and chronic lung disease were significantly associated with reduced GV at discharge. Infants with NEC, hypotension needing inotropes and sepsis took a significantly longer time to achieve full enteral nutrition. A longer time to attain full enteral feeds was associated with slower GV at discharge. Small-for-gestational-age babies increased from 22% at birth to 66.6% at discharge. GV at discharge was positively correlated with increasing protein and energy intake in the first 28 days and adversely affected by the presence of neonatal morbidities. There was strong evidence of extra-uterine growth restriction, with the majority of preterm ELBW infants having lower z scores at discharge compared to at birth.

Rates of survival and complications among extremely preterm infants and extremely low birth weight infants

Objective To review the trends of the rates of survival and complications in extremely preterm infants and extremely low birth weight infants (ELBWI). Methods The clinical data of 259 extremely preterm infants (gestational age <28 weeks) and 239 ELBWI (birth weight <1 000 g) (163 cases with gestational age <28 weeks and birth weight <1 000 g), who were discharged between January 1, 2009 and December 31, 2015, from Neonatal Intensive Care Unit of Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, were collected and studied retrospectively. Grouped by gestational age and birth weight, the number of inpatients, and the rates of survival and complications were compared in pairs by trend Chi-square test. Results The median gestational age of extremely preterm infants was 27 weeks (22+6 to 27+6 weeks), and the median birth weight of ELBWI was 880 g (450-998 g). The survival rate of extremely preterm infants and ELBWI was 42.9% (9/21) in 2009, which increased to 85.3% (58/68) in 2015, with an ascending trend (χ2trend=21.643, P=0.001). The cure and survival rates of 259 extremely preterm infants were 64.1% (166/259) and 71.0% (184/259); the cure and survival rates of 239 ELBWI were 64.4% (154/239) and 70.7% (169/239); and the cure and survival rates of 163 extremely preterm ELBWI were 62.6% (102/163) and 69.9% (114/163), respectively. The survival rate in extremely preterm infants with gestational age <24 weeks was 1/7, increased to 81.4% (118/145) in those with gestational age≥27 to <28 weeks, showing an ascending trend with increased gestational age (χ2trend=36.037, P=0.000). The survival rate in ELBWI with birth weight <500 g was 0/2, increased to 80.7% (88/109) when birth weight was ≥900 to <1 000 g, with an ascending trend with increased birth weight (χ2trend=26.505, P=0.000). The major complications were neonatal respiratory distress syndrome [85.1%(285/335)], intraventricular hemorrhage [48.1%(161/335)], bronchopulmonary dysplasia [45.1%(151/335)], patent ductus arteriosus [40.9%(137/335)], retinopathy of prematurity [30.1%(101/335)], periventricular leukomalacia [4.2%(14/335)], hospital-acquired infection [3.0%(10/335)] and necrotizing enterocolitis ≥Ⅱa stage [2.1%(7/335)]. The incidence of complications, such as neonatal respiratory distress syndrome, patent ductus arteriosus,Ⅲ and Ⅳstages of intraventricular hemorrhage, moderate and severe bronchopulmonary dysplasia and hospital-acquired infection, decreased with increased gestational age in extremely preterm infants, while the incidence of neonatal respiratory distress syndrome, patent ductus arteriosus,Ⅲ andⅣstages of intraventricular hemorrhage decreased with the increase of birth weight in ELBWI (all P<0.05). Conclusions In recent years, the number of extremely preterm infants and ELBWI has increased obviously. The survival and cure rates have shown an increasing trend. With the increase of gestational age and birth weight, the survival rate has increased, and the rate of complications has decreased. Key words: Infant, extremely premature; Infant, extremely low birth weight; Survival rate; Mortality; Intensive care units, neonatal

Red Blood Cell Transfusion and Clinical Outcomes in Extremely Low Birth Weight Preterm Infants

Red blood cell (RBC) transfusion is often considered a life-saving measure in critically ill neonates. The smallest and least mature infants tend to receive the largest amount of transfusions. RBC transfusion itself has also been suggested as an independent risk factor of poor clinical outcome in critical patients. Our aim is to study if there are associations between RBC transfusion and in-hospital mortality, short-term morbidities, and late neurodevelopmental outcome in extremely low birth weight (ELBW) preterm infants. A cohort of ELBW preterm infants admitted to our neonatal intensive care unit from January 2009 to December 2010 were recruited. The number of RBC transfusions within 7 days, 30 days, and 60 days of life were recorded. Clinical outcomes including in-hospital mortality, development of retinopathy of prematurity (ROP), necrotizing enterocolitis, chronic lung disease, and later neurodevelopmental outcome were assessed with follow-up of up to 2 years of age. Multivariable logistic regression was used to estimate the associations between RBC transfusion and clinical outcomes. A total of 98 ELBW preterm infants survived at the time of discharge. Of these survivors, the mean numbers of RBC transfusions were 2.5 ± 1.7, 7.4 ± 3.1, and 11.3 ± 4.5 times within 7 days, 30 days, and 60 days after birth, respectively. The number of transfusions within 7 days of life was correlated with risk of death before 1 month of age (odds ratio: 1.54, 95% confidence interval: 1.04-2.27, p = 0.03) and the number of transfusions within 30 days was correlated with risk of developing threshold ROP (odds ratio: 1.27, 95% confidence interval: 1.04-1.55, p = 0.02). The number of transfusions within 7 days of life was positively correlated with cognitive performance (Mental Developmental Index score) at 18-24 months of corrected age. RBC transfusion has a negative impact on survival in ELBW infants. It increases the risk of developing ROP and affects late neurodevelopment. Decisions of blood transfusion in these very immature infants should be made cautiously taking these deleterious results into consideration.

Risk Factors for Extubation Failure in Extremely Low Birth Weight Infants

Although antenatal steroids and early use nasal continuous positive airway pressure (NCPAP) have significantly improved outcomes of neonatal respiratory distress syndrome, intubation with ventilator support is still commonly required in extremely low birth weight (ELBW) infants. The optimal timing of extubation in ELBW infants remains unclear. We retrospectively analyzed all ELBW preterm infants who were admitted to our neonatal intensive care unit (NICU) from January 2009 to December 2013. Demographic, ventilation, and arterial blood gas analysis results prior to and 2hours after extubation were collected. Extubation failure was defined as reintubation due to deterioration of respiratory condition within 7days after extubation. Risk factors for extubation failure were analyzed. In total, 173 ELBW infants were born and admitted to our NICU during these 5years. Among these 173 infants, 77 (44.5%) used NCPAP only during their hospitalization (20 diagnosed with chronic lung disease (CLD), 25.9%). Among the 95 patients that required intubation, 27 patients expired so extubation was not attempted. Sixteen of 68 (23.5%) survival cases required reintubation within 7days after extubation. We found that gestational age, birth body weight, and sex ratio did not differ between the successful extubation group and the failed extubation group. Univariate analysis showed that the failed extubation group had a lower arterial pH right before and 2hours after extubation, with a lower bicarbonate level after extubation. Further multivariate logistic regression analysis revealed an association between poor acid-base homeostasis 2hours after extubation (pH<7.3 and HCO3<18mM/L) and extubation failure (odds ratio 4.56 and 6.187 and 95% confidence interval: 1.263∼16.462 and 1.68∼22.791, respectively). This study shows that nearly half of ELBW infants do not require intubation. Among ELBW infants who require invasive ventilator support, those who have lower postextubation arterial pH and bicarbonate levels are at high risk of extubation failure.

Chorioamnionitis and neonatal outcome: early vs late preterm infants

Chorioamnionitis (CA) describes an intrauterine status of inflammation and/or infection of placental membranes, refering to both histological and clinical CA [1]. It is considered the major risk of spontaneous preterm delivery, especially at earlier gestational age. The intrauterine exposure to infection/inflammation leads to the fetal inflammatory syndrome (FIRS) that together with CA is responsible for multiple organ injury, neonatal morbidity and mortality [2]. Strong evidences support that neonates exposed to CA are sicker at birth, have a higher rates of early-onset sepsis, respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), patent ductus arteriousus (PDA) and surgical necrotizing enterocolitis (NEC) as compared with unexposed neonates [3-6]. Neonates with ≤ 28 weeks of gestational age (GA) have a significantly higher mortality than neonates with a longer gestation period [7]. Recently Pappas et al reported an increased odds of cognitive impairment and death/neurodevelopmental impairment in extremely low birth weight (ELBW) exposed to CA [8]. In infants born at 36 weeks or later in gestation CA has been indentified as an independent risk factor of CP [9]. Lee et al highlighted that acute histologic CA is a risk factor for adverse neonatal outcome in late preterm birth after preterm premature rupture of membranes (PPROM) [10]. Neverthless, the effects of CA on the neonatal outcome remain under debate, because gestation-independent effects of CA on neonatal outcomes are difficult to assess. Thus in some studies at adjusted analyses for GA, the adverse impact of CA on neonatal outcome is not confirmed [11]. Additionally in many study groups discrimination between ELBW and late preterm infants is not considered. In the future, sufficiently powered cohort studies and well-matched case-control studies will be able to provide useful informations regarding the different outcome between extremely and late preterms infants. An dequate antenatal screening and treatment for CA will improve the prognosis for infants at risk of multiple organ disease as a result of exposure to infection/inflammation before birth [12-14].

Early optimal nutrition improves neurodevelopmental outcomes for very preterm infants.

Recent advances in perinatal and neonatal intensive care have resulted in significant improvements in the survival of preterm extremely low-birthweight (PELBW) infants; however, extrauterine growth restriction (EUGR) and undernutrition occur frequently during hospitalization and are associated with adverse outcomes, including bronchopulmonary dysplasia, sepsis, and neurodevelopmental impairment. Early optimal parenteral nutrition with adequate amino acids and lipids, especially long-chain polyunsaturated fatty acids, has been shown to decrease the incidence of EUGR, bronchopulmonary dysplasia, necrotizing enterocolitis, sepsis, and retinopathy of prematurity in animal models and clinical trials. In PELBW infants, breast milk and probiotics have been shown to reduce the incidence of necrotizing enterocolitis, and lactoferrin has been demonstrated to prevent late-onset sepsis. Thus, early administration of optimal postnatal parenteral and enteral nutrients can help prevent neurodevelopmental impairment caused by EUGR, necrotizing enterocolitis, sepsis, bronchopulmonary dysplasia, and retinopathy of prematurity, and recent evidence indicates such treatment is feasible.

Daily physical activity in low-risk extremely low birth weight preterm infants: positive impact on bone mineral density and anthropometric measurements.

The aim of this study was to evaluate the changes in bone mineral density and anthropometric indices of extremely low birth weight (ELBW) preterm infants undergoing daily physical activity. Twenty-eight low-risk ELBW preterm infants (intervention group = 14, control group = 14) with a birth weight of under 1000 g and gestational age of 26-32 weeks were recruited. Preterm infants in the control group were provided with standard nursing care, whereas those in the intervention group received a daily physical activity programme in addition to standard nursing care during the study. Before and after the study, anthropometric indices and tibial speed of sound (SOS) values were measured. In this study, the tibial SOS values were found to be increased in the intervention group (+111.14 m/s) (p = 0.001) and decreased in the control group (-58.21 m/s) (p = 0.030). The increase in percentage of body weight, height, and tibial length of infants in the intervention group was significantly higher than in the control group (respectively; p = 0.002, p = 0,015, p < 0.001). A daily physical activity programme increased body weight, height, tibial length, and SOS values of the tibia in ELBW preterm infants.

Feasibility of Peritoneal Dialysis in Extremely Low Birth Weight Infants

Acute renal injury is common in extremely low birth weight (ELBW) infants with a frequency ranging from 8% to 24%. Peritoneal dialysis (PD) has been used only occasionally in ELBW. We report our experience and share the solutions used to tackle the difficulties rising from the small size of this type of patients. PD was successfully performed in three ELBW infants with acute renal failure. A neonatal, single-cuff, straight Tenckhoff catheter was placed in 2 patients, while a Broviac single cuff vascular catheter was used in another. PD was feasible and effective in all children. Leakage was observed with Tenckhoff catheters, but this didn’t impair the PD efficacy. The technical difficulties were related to the size and shape of the peritoneal catheters, not easily fitting with the very thin abdominal wall of the preterm in­fants. We conclude that PD is feasible and effective, can be considered as the rescue ther­apy in preterm ELBW infants with acute renal failure.

Risk prediction using a neonatal therapeutic intervention scoring system in VLBW and ELBW preterm infants

The Neonatal Therapeutic Intervention Scoring System (NTISS) is a therapy-based severity-of-illness index, The aim of the present study was to evaluate whether: (i) NTISS can predict the severity of illness with the same accuracy both in very low-birthweight (VLBW) and extremely low-birthweight (ELBW) infants, using all parameters; and (ii) the performance of NTISS can be increased by using only the significant variables. All inborns <1500 g, and all outborns <1500 g transferred in the first 12 h of postnatal life, were included. NTISS using 63 variables was assessed for all infants at the 24th hour. Predictive performance for the overall variables was assessed using area under the curve (AUC) for group 1 (500-1499 g), 2 (1000-1499 g) and 3 (500-999 g). Variables with good prediction were identified for each group and a second AUC was assessed using only sensitive variables. Receiver operating characteristic (ROC) curve area for all variables was compared with the ROC area for sensitive variables. A total of 364 preterm infants fulfilled the eligibility criteria. The AUC of groups 1, 2 and 3 with all variables were 0.851; 0.834 and 0.749, respectively. The number of parameters with good prediction was 33 in group 1, 30 in group 2 and 18 in group 3. The AUC for sensitive variables was 0.848 in group 1; 0.821 in group 2 and 0.823 in group 3. When compared, increase in the description of outcome was significant only for group 3 patients (P = 0.02). NTISS using all parameters seems to be less predictive in ELBW infants. It is probably related to the use of some interventions, done as a routine procedure in almost all ELBW preterm infants, therefore NTISS may be modified according to birthweight in order to obtain a more sensitive prediction.

Early vocalization of preterm infants with extremely low birth weight (ELBW), part I: from birth to expansion stage

The vocalization of preterm infants with extremely low birth weight (ELBW) up to the expansion stage was systematically described and compared with those of healthy full-term infants. The sample consisted of 18 preterm ELBW infants and the control group of 11 full-term infants. The follow-up was performed intensively using video-recordings. The vocalization of the preterm and full-term infants was analyzed quantitatively according to the categorical stages created by Oller. A descriptive analysis of all the vocalizations produced by the infants was performed. The preterm infants entered the primitive articulation stage later than the full-term infants and failed to produce more skills during that stage. According to this sample, there was no difference in entering the expansion stage, but the preterm infants failed to produce more skills than the full-term infants. The number of vocalization acts varied differently by age between the groups.

Oral versus intravenous ibuprofen for patent ductus arteriosus closure: a randomised controlled trial in extremely low birthweight infants

ObjectiveTo compare the efficacy and safety of oral versus intravenous ibuprofen for the pharmacological closure of patent ductus arteriosus (PDA) in less mature preterm infants.DesignProspective, randomised controlled study.SettingTertiary neonatal intensive...

Mode of delivery and threshold retinopathy of prematurity in pre‐term ELBW neonates

Retinopathy of prematurity (ROP) is a multifactorial disease, but little is known about its relationship with perinatal risk factors. We tested the hypothesis that the mode of delivery may be associated with threshold ROP as defined by CRYO-ROP. We conducted a prospective, cohort analysis of a database of all extremely low birth weight (ELBW) neonates (= birth weight < 1000 g) admitted over a 8-year period from 1997 to 2004 to a large tertiary neonatal intensive care unit in a urban area of northern Italy and screened for ROP. Incidence of threshold ROP was calculated for the whole studied population. The definition of threshold ROP was as defined by the CRYO-ROP study. Univariate analysis was performed to look for significant associations between threshold ROP and several possible associated factors, and among them, the mode of delivery (vaginal delivery or caesarean section). When an association was indicated by p < 0.05, multiple logistic regression was used to determine the factors significantly associated with ROP. Enrolled ELBW neonates were 174, and 46 of them (26.4%) displayed threshold ROP. Threshold ROP occurred in 40.9% (27 of 66) of the neonates vaginally delivered and in 17.5% (19 of 108) of those born via caesarean section (R.R. 3.35; 95% CI 1.230-4.855; p = 0.008 at univariate analysis, and = 0.04 at multivariate logistic regression after controlling for birth weight, gestational age, intraventricular haemorrhage grade 2 or more, days on supplemental oxygen, systemic fungal infection). Birth by vaginal delivery was not significantly associated with other major sequelae of prematurity (intraventricular haemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis). In our Institution birth by vaginal delivery is a significant and independent predictor of threshold ROP in ELBW infants. We suggest to consider closely ophthalmological surveillance for pre-term ELBW infants born this mode.