Small Premature Infants Research Articles

Социально-психологическое исследование материнских установок на процесс грудного вскармливания недоношенных детей

научный биометрический журнал, который знакомит читателя с клиническими рекомендациями и особенностями применения лекарственных и вакцинных средств у детей, предоставляет исчерпывающую информацию о воздействии лекарственных средств на плод, о проводимых в

Intensive Care Unit Readmission during Childhood after Preterm Birth with Respiratory Failure

To determine the incidence and risk factors for readmission to the intensive care unit (ICU) among preterm infants who required mechanical ventilation at birth. We studied preterm newborns (birth weight 500-1250 g) who required mechanical ventilation at birth and were enrolled in a multicenter trial of inhaled nitric oxide therapy. Patients were assessed up to 4.5 years of age via annual in-person evaluations and structured telephone interviews. Univariate and multivariable analyses of baseline and birth hospitalization predictors of ICU readmission were performed. Of 512 subjects providing follow-up data, 58% were readmitted to the hospital (51% of these had multiple readmissions, averaging 3.9 readmissions per subject), 19% were readmitted to an ICU, and 12% required additional mechanical ventilation support. In univariate analyses, ICU readmission was more common among male subjects (OR 2.01; 95% CI 1.27-3.18), infants with grade 3-4 intracranial hemorrhage (OR 2.13; 95% CI 1.23-3.69), increasing duration of birth hospitalization (OR 1.01 per day; 95% CI 1.00-1.02), and prolonged oxygen therapy (OR 1.01 per day; 95% CI 1.00-1.01). In the first year after birth hospitalization, children readmitted to an ICU incurred greater health care costs (median $69,700 vs $30,200 for subjects admitted to the ward and $9600 for subjects never admitted). Small preterm infants who were mechanically ventilated at birth have substantial risk for readmission to an ICU and late mechanical ventilation, require extensive health care resources, and incur high treatment costs.

The Coagulation Status Should Be Determined

Ekkehard Schleusner in his article explains the problem clearly. In spite of this fact, however, we wish to add several comments on the topic of cerebral intraventricular hemorrhage. Unfortunately, cerebral hemorrhage occurs in more than 70% of neonates weighing 500–750g and 15% in those weighing 1500–2000g. Some 10–15% of surviving, very small preterm babies will have lifelong disabilities (1). In order to investigate the incidence of cerebral hemorrhage, 11 887 neonates were sonographically examined on the 3rdto 10th day of life in the years 1985–94. 303 babies (2.5%) had intraventricular or periventricular bleeds (2). The study found that the most important risk factor was prematurity, but the duration of gestation, birth weight, and body length correlated inversely. Furthermore, a correlation exists between pediatric infections passed by the mother and twin pregnancies (2). A possible coagulation disorder was not investigated. Schleusner mentions the problem of cerebral hemorrhage after administration of magnesium sulfate and glucocorticoids (reduction of cerebral intraventricular hemorrhage), magnesium sulfate combined with fenoterol (the highest rate of cerebral intraventricular hemorrhage altogether), and when using calcium antagonists (reduction of cerebral intraventricular hemorrhage). The causes of cerebral hemorrhage are the subject of controversy, whereas coagulation disorders hardly find any mention. In preterm babies, plasmatic coagulation becomes subject to a tendency to hemorrhage, and neonatal alloimmune thrombocytopenia (NAIT) may be present (3). Both should be considered on obstetric medicine, in order to prevent, or at least ameliorate, cerebral hemorrhage. In preterm babies, the recommendation is to determine as rapidly as possible the thrombocyte count and coagulation status, in order to alleviate postnatal hemorrhage by early administration of thrombocytes or clotting factors. This should be followed by a diagnostic evaluation of the causes by measuring thrombocyte antibodies.

Lung function after preterm birth: development from mid-childhood to adulthood

As a result of advances in perinatal care, more small preterm infants survive. There are concerns that preterm birth and its treatments may harm pulmonary development and thereby lead to chronic airway obstruction in adulthood. To assess the development of spirometric lung function variables from mid-childhood to adulthood after extreme preterm birth. Two population-based cohorts born at gestational age ≤28 weeks or with birth weight ≤1000 g performed lung function tests at 10 and 18 and at 18 and 25 years of age, respectively, together with matched term-born controls. The results are presented as z scores, normalised for age, sex and height. Longitudinal development was compared for groups born at term and preterm, split by a history of absence (n=20), mild (n=38) or moderate/severe (n=25) neonatal bronchopulmonary dysplasia (BPD). The preterm-born cohorts, particularly those with neonatal BPD, had significantly lower forced expiratory volume in 1 s and mid-expiratory flow than those born at term at all assessments (z scores in the range -0.40 to -1.84). Within each of the subgroups the mean z scores obtained over the study period were largely similar, coefficients of determination ranging from 0.64 to 0.82. The pattern of development for the BPD subgroups did not differ from each other or from the groups born at term (tests of interaction). Airway obstruction was present from mid-childhood to adulthood after extreme preterm birth, most evident after neonatal BPD. Lung function indices were tracking similarly in the preterm and term-born groups.

Are You Statistically Literate? A Basic Overview of Statistics

The relationship between high oxygen levels and blindness in small preterm infants is common knowledge in today's NI CU. However 60 years ago, tiny babies were routinely given oxygen without knowledge of the relationship between the concentration of oxygen being administered and the subsequent outcome of the infant being blind.1 Today's knowledge is the result of research methods and statistical techniques that identified this relationship and predicted the consequences of high concentrations of oxygen administration.

Bevacizumab for retinopathy of prematurity: An update

R remains a major cause of childhood blindness worldwide. The smallest, sickest infants develop the most severe cases of ROP that may not be successfully treated by near confluent laser to the avascular retina (current standard of care). There is increased survival of very small preterm infants in hospitals with few neonatologists not optimally equipped to monitor oxygen or inadequate numbers of ophthalmologists to screen and treat ROP. An understanding of ROP pathogenesis with emphasis on proper timing of administration, knowledge of systemic pharmacokinetics of available vascular endothelial growth factor inhibitors, evidence of lack of local ocular toxicity utilizing human histopathology following intravitreal bevacizumab injection, and awareness of possible systemic toxicity related to vascular thrombosis especially during development in vulnerable preterm infants are essential. Efficacy was reported for a single dose of intravitreal bevacizumab (IVB) compared to conventional laser therapy (CLT) in zone I and posterior zone II in the N Engl. J Med 2011;364(7):603-27. Refractive outcomes at age 2 years are available comparing IVB and CLT in 82% of surviving infants who have not had recurrence or complications requiring intraocular surgery. Characteristics of recurrence, especially in zone I cases, are predictable, recognizable, and treatable by one additional dose of IVB. Local complications are largely preventable in the NICU by employing topical anesthesia, restraining the infant appropriately, attending carefully to sterile technique, fixating the eye securely, and utilizing a needle of appropriate length and gauge. Systemic complications have not been reported, but long term safety has not been established. Helen A. Mintz-Hittner, Clinic Pharmacol Biopharmaceut 2013, 2:3 http://dx.doi.org/10.4172/2167-065X.S1.002

Frequency drift during intensive SSFP scanning: implications and solution for 3T neonatal CMR

Background Balanced-SSFP is widely used because of its inherent highcontrast and high-SNR efficiency, and therefore is an obvious choice for neonatal cardiac applications. Typically, multiple averages are needed due to the high-spatial and temporal resolutions required, especially for the smallest preterm infants. Therefore, prolonged intensive scans are required placing high demands on scanner hardware. Consequently, one of the two critical prerequisites for successful SSFP sufficient B0 shimming and stable scanner frequency is often not met using standard protocols.

1220 Comparison of Somatic and Neurodevelopmental Outcomes of Small and Late Preterm Infants

ObjectiveThe aim of this study was to compare the somatic and neurodevelopmental outcomes of small and late preterm infants and also to determine the prenatal, natal and postnatal factors affecting...

232 The Timing of Surfactant Prophylaxis in Very-Low-Birth-Weight Preterms: Is Earlier Better?

AimTo determine whether the immediate bolus strategy treatment could decrease the subsequent need for ventilation compared to the administration of surfactant prophylaxis at 15-minutes.MethodsAll infants born before 29 weeks’, and...

Pulmonary Hypertension in an Infant Treated with Ibuprofen

Presence of symptomatic patent ductus arteriosus is common in small preterm infants and ibuprofen is commonly used for its medical closure. While efficacy is comparable to indomethacin, there are few case reports of severe hypoxemia and pulmonary hypertension following prophylactic ibuprofen administration. Cumulative dose effects and chemical composition may be important considerations. Possible mechanisms of occurrence of this complication in a preterm infant are discussed.

Term MRI for small preterm babies: do parents really want to know and why has nobody asked them?

Term MRI for small preterm babies: do parents really want to know and why has nobody asked them?

John Inkster

John InksterJohn Inkster died on September 10th 2011. He started life early, weighing only 2 pounds (0.9 kg). The outlook for him and his twin sister was poor so his mother, who was a nurse trained at the Childrens Hospital, Great Ormond Street, took them home to look after them herself. This showed that very small premature babies could survive with special care that did not include all the modern techniques.He was educated at Epsom College and graduated as a doctor from Aberdeen University in 1945. His first job was at Hampstead where they did their ward work in the morning and took over the anesthetics in the afternoon from the anesthetists – a frightening situation as they had no training. He was in the army for 3½ years, still giving anesthetics with little training. In 1950, he went to Newcastle where he undertook 3 years training. He worked with Professor E.A. Pask, as his first assistant, and Philip Ayre who had a particular interest in cleft lips and palates.

Incidencia y evolución de membrana hialina en menores de 35 semanas según crecimiento intrauterino

ABSTRACTIncidence and evolution of hyaline membrane in newborns under 35 weeks of gestational age according intrauterine growthIntroduction: It is thought that intrauterine growth restriction induces respiratory maturation. The information varies if the studies consider analysis based on birth weight or gestational age. Objective: The goal of this stu-dy is to compare the incidence and evolution of hyaline membrane disease (HMD) between small and adequate premature babies under 35 weeks of gestational age (< 35 wGA) based on data in the literature. Patients and Methods: Two databases were created and analyzed: a) 2 022 newborns < 35 wGA admitted to the Service, whose incidence of HMD was calculated, and b) 733 newborns < 35 wGA with HMD and treated with sur-factant, to describe the evolution. Results: Analysis of GA group shows a higher incidence of HMD (35.2%) among small for GA, and less (29.1%) among those who are not small for GA (p: 0.026). If a subset is formed for the newborns < 1 500 g in brithweight, those small for gestational age have a lower incidence (47.5%) than those adequate for GA (60.7%). Logistic regression analysis for discharge with oxygen of newborns with HMD shows association with lower z score for birthweight, corticosteroid use and oxygen dependence at 36 weeks.

Pregnancy Outcome of Migrant Women Delivering in a Public Institution in Northern Italy

Background/Aim: European societies are facing a wave of incoming immigrants and the needs of a new multiethnic obstetrical population. It remains controversial whether native and immigrant women have equivalent pregnancy outcomes. Methods: Perinatal indicators of the obstetric outcome were monitored in all delivering women during a 5-year period in a large academic public general hospital. We compared rates of preterm deliveries, low birth weight, cesarean section during labor, perineal tears, and fetal acidemia in the native and immigrant parturients. Results: Immigrant women experienced very low birth weight (p < 0.005) and preterm deliveries (p < 0.05), more often than natives did. Among ethnic groups, data singled out Sub-Saharan African women to be at a higher risk for very small premature babies and cesarean section during labor. Conclusions: There are differences in perinatal outcome between immigrant and Italian woman; within the large migrant population, ethnic groups show wide disparities and challenge the health provider differently. Special attention to women at a higher risk may reduce fetal-maternal morbidities.

Neonatal IVH – mechanisms and management

Intra-ventricular hemorrhage (IVH) occurs predominantly in very low birth weight premature infants. Survivors of severe IVH frequently experience long-term consequences including major neurological deficits. Advances in neonatal and obstetric care in the last decades, have led to a steady decline in mortality and in the incidence of IVH. However, significant improvements in the survival rates small premature infants have led to an increase in the population of newborns prone to IVH. The pathogenesis of IVH is multifactorial. Prematurity of the germinal matrix, fluctuations in cerebral blood flow, hypoxic ischemic cerebral injury and developmental hemostatic abnormalities of newborns are important risk factors. The following manuscript will address the epidemiology and pathogenesis of IVH and review studies regarding potential pro-coagulant therapy.

Large spot transpupillary thermotherapy: A quicker laser for treatment of high risk prethreshold retinopathy of prematurity - A randomized study

To compare structural and functional outcome and time efficiency between standard spot sized conventional pulsed mode diode laser and continuous mode large spot transpupillary thermotherapy (LS TTT) for treatment of high risk prethreshold retinopathy of prematurity (ROP). Ten eyes of five preterm babies having bilateral symmetrical high risk prethreshold ROP were included in this study. One eye of each baby was randomized to get either standard spot sized conventional pulsed mode diode laser or continuous mode LS TTT. There was no significant difference between structural or functional outcome in either group. The mean time taken for conventional diode laser was 20.07 minutes, while that for LS TTT was 12.3 minutes. LS TTT was 40% more time efficient than the conventional laser. It may be better suited for the very small fragile premature infants as it is quicker than the conventional laser.

PP-179. Post-neonatal health, growth and psychomotor development of small preterm infants at 1–3 years of corrected age

PP-179. Post-neonatal health, growth and psychomotor development of small preterm infants at 1–3 years of corrected age

Part 15: Neonatal Resuscitation

The following guidelines are an interpretation of the evidence presented in the 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations 1 ). They apply primarily to newly born infants undergoing transition from intrauterine to extrauterine life, but the recommendations are also applicable to neonates who have completed perinatal transition and require resuscitation during the first few weeks to months following birth. Practitioners who resuscitate infants at birth or at any time during the initial hospital admission should consider following these guidelines. For the purposes of these guidelines, the terms newborn and neonate are intended to apply to any infant during the initial hospitalization. The term newly born is intended to apply specifically to an infant at the time of birth. Approximately 10% of newborns require some assistance to begin breathing at birth. Less than 1% require extensive resuscitative measures. 2,3 Although the vast majority of newly born infants do not require intervention to make the transition from intrauterine to extrauterine life, because of the large total number of births, a sizable number will require some degree of resuscitation. Those newly born infants who do not require resuscitation can generally be identified by a rapid assessment of the following 3 characteristics: ● Term gestation? ● Crying or breathing? ● Good muscle tone? If the answer to all 3 of these questions is “yes,” the baby does not need resuscitation and should not be separated from the mother. The baby should be dried, placed skin-to-skin with the mother, and covered with dry linen to maintain temperature. Observation of breathing, activity, and color should be ongoing. If the answer to any of these assessment questions is “no,” the infant should receive one or more of the following 4 categories of action in sequence:

Echocardiographically guided catheter closure of arterial ducts in small preterm infants on the neonatal intensive care unit

To describe closure of haemodynamically significant arterial ducts in preterm infants using an echocardiographically guided cardiac catheter technique in selected infants in the neonatal nursery and in preference to cardiac surgery. Persistently patent arterial ducts are common in preterm infants and are associated with significant morbidity and mortality. Cardiac catheter techniques continue to improve and occlusion of arterial ducts in preterm infants is becoming technically feasible. Closure of arterial ducts by cardiac catheter techniques would enable selected infants to avoid surgery and a lateral thoracotomy, as well as potentially obviating the need for transfer of sick preterm infants between units for duct closure. This brief report describes placement of coils or Amplatzer duct devices to occlude arterial ducts in small premature infants exclusively under echocardiographic guidance in the Neonatal Intensive Care Unit. Closing arterial ducts in the neonatal nursery by an echocardiographically guided cardiac catheter technique with minimal morbidity is becoming achievable and is a significant advance in neonatal care.

Impact of Timing of Birth and Resident Duty-Hour Restrictions on Outcomes for Small Preterm Infants

The goal was to examine the impact of birth at night, on the weekend, and during July or August (the first months of the academic year) and the impact of resident duty-hour restrictions on mortality and morbidity rates for very low birth weight infants. Outcomes were analyzed for 11,137 infants with birth weights of 501 to 1250 g who were enrolled in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network registry in 2001-2005. Approximately one-half were born before the introduction of resident duty-hour restrictions in 2003. Follow-up assessments at 18 to 22 months were completed for 4508 infants. Mortality rate, short-term morbidities, and neurodevelopmental outcome were examined with respect to the timing of birth. There was no effect of the timing of birth on mortality rate and no impact on the risks of short-term morbidities except that the risk of retinopathy of prematurity (stage > or =2) was higher after the introduction of duty-hour restrictions and the risk of retinopathy of prematurity requiring operative treatment was lower for infants born during the late night than during the day. There was no impact of the timing of birth on neurodevelopmental outcome except that the risk of hearing impairment or death was slightly lower among infants born in July or August. In this network, the timing of birth had little effect on the risks of death and morbidity for very low birth weight infants, which suggests that staffing patterns were adequate to provide consistent care.