Prognosis Of Preterm Infants Research Articles

Effects of the environment of Neonatal Intensive Care Unit on encephalopathy of prematurity

Encephalopathy of prematurity is still an important reason which affects the survival and quality of life of preterm infants.During hospitalized in neonatal intensive care unit (NICU), a variety of environmental factors such as noise, light, too much tactile stimuli, pain, and maternal-infant separation all will affect the development of preterm infants' brain, leading to encephalopathy of prematurity.Therefore, need to attach importance to the effects of NICU environment on the growth and development and the neurological function of preterm infants, try to optimize the environment of NICU, to reduce the incidence of brain injury of prematurity, improve the long-term prognosis of preterm infants. Key words: Encephalopathy of prematurity; Neonatal intensive care unit; Noise; Light; Tactile stimulus; Pain; Maternal-infant separation

PO-0734 Effect Of Volume-targeted Ventilation In Extremely Low Birthweight Infants Under High Frequency Oscillatory Ventilation

Background and aims Volume-targeted ventilation, or volume guarantee (VG) is known to improve neonatal prognosis in preterm infants, when added to conventional ventilation. Yet, VG effect is unclear when combined with pressure-controlled high frequency oscillatory ventilation (HFOV). The aim of this study is to investigate the effect of VG mode added to HFOV on respiratory parameters. Methods We conducted a prospective study in extremely low birthweight infants who were ventilated after 28 days of age with HFOV (Babylog VN500). VG was applied for 8 h and VG was removed for the following 8 h. Frequency (12 Hz) and mean airway pressure were fixed during study period in each case. Tidal volume, amplitude, minute volume (MV), heart rate (HR) and oxygen saturation (SpO2) data were analysed. Results Six neonates were included (gestational age 22 w 5 d-23 w 6 d, birthweight 424–584 g). Standard deviations of both SpO2 and MV with VG were significantly smaller than those without VG (Figure, pared t-test). HR fluctuation was not different. In total, desaturation episodes (SpO2). Conclusions This pilot study suggests VG added to HFOV would attenuate fluctuation of SpO2 and pCO2, which leads to prevent hypoxia and hypocapnia, possibly resulting in preferable neonatal prognosis.

Related factors and prognosis of periventricular hemorrhage-intraventricular hemorrhage in preterm infants

Objective To investigate the coagulation function, the related factors and prognosis of preterm infants with periventricular hemorrhage-intraventricular hemorrhage(PVH-IVH). Methods Eighty-one preterm infants with PVH-IVH and 81 infants with non-PVH-IVH as a control were enrolled in the study.The changes in activated thromboplastin time(PT), activated partial thromboplastin time(APTT), Fibrinogen and D-dimer were determined by enzyme-linked immunosorbent assay.Clinical factors which were related to PVH-IVH in infants were analyzed with statistical analysis and prognosis was assessed with neonatal behavioral neurological assessment (NBNA). Results The average of gestational age in PVH-IVH group was(30.9±1.79)weeks, in control group were(31.36±1.39)weeks, and there was significant difference between the 2 groups(F=6.52, P=0.012). There were significant differences in APTT, and D-dimer between PVH-IVH and non-PVH-IVH infants(all P<0.05). Multivariate Logistic regression analysis showed that the related factors included gestational age, neonatal respiratory distress syndrome(NRDS), hyperoxia, and mechanical ventilation(OR=3.98, 1.72, 2.99, 5.65, all P<0.05). The NBNA scores of the 2 groups were also significantly different(t=9.16, P<0.05). Conclusions The occurrence of PVH-IVH is very complex resulted from gestational age, NRDS, hyperoxia, mechanical ventilation and other factors.In order to avoid the occurrence of intracranial hemorrhage and improve the life quality of preterm infants, the NRDS was prevented as far as possible, coagulation abnormalities were managed positively and the mechanical ventilation was shortened. Key words: Periventricular hemorrhage-intraventricular hemorrhage; Coagulation function; Related factors; Neonatal behavioral neurological assessment scores

Macular Hard Exudates and Scar Formation After Laser Photocoagulation in Retinopathy of Prematurity

The authors report the formation of hard exudates and macular scarring after laser photocoagulation therapy in patients with retinopathy of prematurity (ROP). Two premature neonates, the first born at 24 weeks and the second at 25 weeks gestational age, were diagnosed as having ROP that necessitated laser photocoagulation treatment at 32 and 36 weeks, respectively. Subretinal fluid and macular hard exudation developed in both patients that eventually caused bilateral macular scarring. Subretinal macular fluid with hard exudation could lead to macular scar formation in neonates with ROP after laser photocoagulation that could significantly affect the visual prognosis in preterm infants.

Early radiological changes and effect on prognosis in preterm infants with cerebral white matter damage

Early radiological changes and effect on prognosis in preterm infants with cerebral white matter damage

Decisions and Dilemmas Related to Resuscitation of Infants Born on the Verge of Viability

Over the last several decades, advancements in neonatal care have improved the survival rate and prognosis of premature infants. It is now commonplace for infants born at gestational ages once considered nonviable to be discharged home and live normal healthy lives with few, if any, morbidities. Neonatology has now progressed to an era where infants born at 22 to 24 weeks gestation are being resuscitated, resulting in potentially lifelong consequences for both infants and their families. Decisions concerning resuscitation of infants on the verge of viability are complex and must take into consideration the ethics of resuscitating infants at risk for extremely high levels of mortality and morbidity as well as the impact on the infant, family, and society as a whole.

Magnetic Resonance Imaging Regional T1 Abnormalities at Term Accurately Predict Motor Outcome in Preterm Infants

The aim of this study was to assess whether periventricular leukomalacia findings are sufficiently sensitive for predicting the severity of motor prognosis by conventional MRI in the near term. Preterm infants with T1 hyperintensity or cysts in the periventricular regions on term MRI were selected, and their gross motor functions were evaluated at the age of 3 to 5 years. Sixty-two infants had findings of T1 hyperintensity or cysts, and except for infants with these findings, none were diagnosed later as periventricular leukomalacia. All 37 patients with cerebral palsy had periventricular lesions with T1 hyperintensity or cysts in the corona radiata above the posterior limb of the internal capsule on coronal sections. Small T1 hyperintensity lesions were seen on coronal slices and were often difficult to detect on axial slices. All of the 17 infants with T1 hyperintensity findings sparing the corona radiata above the posterior limb of the internal capsule showed normal motor development, irrespective of findings of ventriculomegaly. There was a tendency for the presence of widespread lesions in corona radiata above the posterior limb of the internal capsule to be correlated with the severity of motor handicap. Lesions in the corona radiata above the posterior limb of the internal capsule on a coronal view by term MRI were useful for predicting motor prognosis in preterm infants with periventricular leukomalacia.

Herpes Simplex Virus Infections in Preterm Infants

Neonatal herpes simplex virus infections cause significant neonatal mortality and morbidity, but the course and prognosis in preterm infants is not well documented. We performed a retrospective review of herpes simplex virus infections at out institution within the first 30 days after birth in infants who were born at <37 weeks to help better define the symptoms and signs of herpes simplex virus infections in preterm infants and to assist in prognosis. Hospital databases were reviewed to identify culture- or polymerase chain reaction-proven cases of herpes simplex virus-1 or herpes simplex virus-2 infections that occurred in preterm newborns between 1989 and 2003. Maternal and neonatal histories, clinical features, and laboratory results were reviewed systematically. Ten preterm singletons and a set of twins were infected with herpes simplex virus-2 during the first month after birth. No mother had herpes simplex virus lesions at delivery, but a history of genital herpes simplex or other sexually transmitted infections was prevalent among the mothers. Infants presented with either disseminated disease or encephalitis. All infants with disseminated disease (n = 9) died, whereas the 3 infants with encephalitis survived. All infants in the cohort developed respiratory distress, and consistent with the prominence of respiratory symptoms, viral cultures of the respiratory tract were consistently positive. Ten of 12 infants received acyclovir, but despite treatment within 48 hours of symptoms, infants with disseminated disease deteriorated rapidly and died. Two of 3 infants who received high-dosage (60 mg/kg per day) acyclovir survived. Herpes simplex virus infections in preterm infants usually present during the first 2 weeks of life with respiratory distress and a high incidence of disseminated disease. Viral respiratory cultures have a high yield for documentation of infection. The morbidity of herpes simplex virus in this population may be attributable to a relatively immature immune system in this population. Additional studies are necessary to delineate the evolution of herpes simplex virus disease in preterm infants and the role of antiviral therapy in mitigating the sequelae of herpes simplex virus infections in this population.

Different patterns of cortico-cardiac coupling in healthy and postasphyctic preterm infants – a marker for prognosis?

Electroencephalogram (EEG) combined with heart rate (HR) patterns can give information about the functioning of central nervous system structures and the integrity of the autonomic nervous system in preterm infants at risk on the Neonatal Intensive Care Unit. Maturational pattern and cerebral impairment play an important role. In healthy preterm infants with a conceptional age (CA) of 32 and 36 weeks the occurrence of slow wave EEG bursts is accompanied by a weak biphasic HR change always starting with a HR-acceleration in the order of about 2 beats per minute (bpm). In post-asphyctic preterm infants we found a different behaviour of HR patterns in form of a slow monophasic HR change with a magnitude of around 1 bpm and duration of several seconds. This finding might be a marker for estimation of prognosis in preterm infants at risk.

Pulmonary prognosis in preterm infants

Pulmonary prognosis in preterm infants

Pulmonary prognosis in preterm infants

The increased survival of preterm infants poses the challenge of dealing with a wide range of chronic pulmonary diseases, including bronchopulmonary dysplasia, Wilson-Mikity syndrome and recurrent wheezing. This article reviews the pulmonary clinical and functional prognosis of preterm newborns in infancy and adolescence. MEDLINE search for articles published between 1970 and 2004 that focused on lung growth and function of preterm infants, besides a clinical follow-up of this group. Prenatal and postnatal events, such as placental insufficiency, tobacco exposure, infections, oxygen and mechanical ventilation, have an important effect on lung development and can lead to chronic lung diseases, of which bronchopulmonary dysplasia is the most severe complication. However, significant loss of lung function occurs in preterm infants who do not fulfill the criteria for bronchopulmonary dysplasia, and even in those who did not have significant respiratory disease during the neonatal period. The impact of prematurity on the respiratory system of these patients is usually underestimated. Clinically, preterm infants have an increased incidence of pneumonia and bronchiolitis, hospital readmissions due to respiratory diseases, chronic cough and wheezing and bronchial hyperresponsiveness. In adolescence, there is a tendency for normalization of the lung function, but they persist with reduced flows, lower exercise tolerance and bronchial hyperresponsiveness. Prematurity, the events that cause it and the interventions that follow it permanently change the development of the respiratory system. Studies are necessary to clarify the effect of each of these perinatal insults on the development of the respiratory system.

‘They Have to Show That They Can Make It’: vitality as a criterion for the prognosis of premature infants

‘They Have to Show That They Can Make It’: vitality as a criterion for the prognosis of premature infants

Mortalité, morbidité et devenir neurologique à court terme des nouveau-nés d'âge gestationnel inférieur ou égal à 32 semaines au CHR de Fort-de-France

The mortality and neurodevelopmental outcome of premature infants born between 25 and 33 weeks of gestational age in Fort-de-France (Martinique, French West Indies) is reported. The preterm cohort included 214 infants born during the years 1992 to 1995. The mortality rate during the hospitalization was 20%, but was only 14% when the birth weight was more than 1,000 g. The main neonatal problems were: hyaline membrane disease (34%), bronchopulmonary dysplasia (6.5%), necrotizing enterocolitis (6%), intraventricular hemorrhage (9%) and periventricular leucomalacia (2%). Twenty infants (13.5%) showed abnormal neurodevelopmental outcome, with only three having major handicap. This study shows a notable improvement in the prognosis of premature infants in Fort-de-France. Nevertheless, a strong effort must be made in very low gestational ages and very low birth weight infants.

Prise en charge psychique de l'extrême prématurité

The ongoing progress in neonatal intensive care is modifying the psychic context of context of prematurity for all the partners, infants as well as parents and physicians. Comfort and prognosis of preterm infants have much improved. Since newborns under 24 weeks of gestational age are now surviving, they spend approximately half the duration of pregnancy out of the maternal uterus. All the psychological issues of such an early separation have to be considered, including the developmental outcome of a sensorial environment which is quite different from the intra-uterine one. Research has been developing in this field. The cooperation between neonatalogists and psychologists has been profitable to parents. Problems linked to the separation, such as difficulty in representing the infant, are no more frequent owing to the attention paid to the motherchild bond and subsequent early contacts. What is forward now is the impact of an hyper technical world of intensive care on the parents, and of the strange aspect of the tiny baby surrounded by engines and tubes. Such an overpresence of reality often results in a reaction of traumatic daziness among parents. The cooperation of the whole staff is necessary for the resumption of an imaginary process of psychic functioning. Finally, the survival of very-law-birth-weight infants confronts the neonatalogists with some delicate ethical questions. Psychiatrists and psychologists might have an important part to play in aiding the profession in its sorting out of these ethical issues.

The long-term prognosis of pre-term infants: conceptual, methodological, and ethical issues.

The dramatic increases in the survival rate of prematurely born, very low birth weight infants (<1500 g) have created concern about the possible sequelae experienced by these children, in terms of both severe problems and less severe learning and behavior problems. The methodological difficulties involved in answering questions about the outcomes of these children, including the choice of appropriate outcome measures, the analysis of individual variation, the problems associated with dropouts, the relevant comparison groups, the importance of survival rate, and the question of correcting for the degree of prematurity, are considered. In spite of the difficulties in interpreting the studies, the research indicates that many premature children have learning disabilities, particularly in the perceptual and visual motor functioning and some aspects of language and reading. In addition, ethical issues related to prematurity are discussed, including parents’ rights, decision-making, and cost and treatment. Finally, some solutions are proposed involving the use of risk indices for the early detection of developmental problems.

Clinical Evaluation of the Pathogenesis of Neonatal Asphyxia

AbstractThe perinatal mortality rate in Japan decreased from 16.8 per 1000 live‐births in 1964 to 4.5. in 1980, and the early neonatal mortality rate from 8.1 in 1964 to 1.1 in 1980. These decreases are mainly due to the improvement in prognosis of premature infants. The incidence of neonatal asphyxia in mature infants also decreased from 8.8% in 1967–68 to 5.1% in 1979–80. Fetal distress, breech delivery and Caesarean section were the major causes of neonatal asphyxia. Early detection of fetal distress and appropriate care decreased both the incidence of neonatal asphyxia and the neurological signs even in severely asphyxiated infants.