Status Of Preterm Infants Research Articles

Acute respiratory effect of transpyloric feeding for respiratory exacerbation in preterm infants.

Gastroesophageal reflux may exacerbate chronic lung disease in preterm infants. We evaluated the short-term effects of transpyloric feeding on respiratory status in preterm infants during mechanical ventilation. We retrospectively collected data from the hospital information management system. To evaluate the effect of transpyloric feeding on oxygenation, we compared changes in SpO2/FiO2 ratios before and after commencing transpyloric feeding by a piecewise linear regression model. We examined 33 infants (median gestational age, 25.4weeks; median birth weight, 656g) who underwent transpyloric feeding. All tubes were placed at the bedside without fluoroscopy. No cases of unsuccessful placement, gastroduodenal perforation, or tracheal misinsertion occurred. Transpyloric feeding began at a median age of 18 (interquartile range, 15-23) days. Mean SpO2/FiO2 (±SD) ratios were 391 (±49), 371 (±51), 365 (±56), and 366 (±53) 72-96h before, 0-24h before, 48-72h after, and 96-120h after starting transpyloric feeding, respectively. The rate of change per hour of SpO2/FiO2 ratios increased 48-120h after compared with 0-96h before transpyloric feeding (0.03 [95% confidence interval,-0.10 to 0.17] vs.-0.29 [-0.47 to-0.12]) (p=0.007). No apparent changes occurred in the mean airway pressure, amplitude pressure, or pCO2. Transpyloric feeding during mechanical ventilation can prevent the deterioration of oxygenation without major complications at the stage of respiratory exacerbation in preterm infants.

English

BACKGROUND The prevalence of refractive errors is reported to be higher in children born preterm. Factors like gestational age, birth weight and retinopathy of prematurity status have a significant impact on the refractive development in preterm infants. Population based long term follow up studies on the refractive status in preterm infants are limited. We designed this study to assess whether prematurity is a risk factor for refractive errors in children. METHODS This study was conducted among children aged 5 - 16 years who participated in the school vision screening program over a period of one year. All children underwent detailed ocular examination including measurement of best corrected visual acuity, cycloplegic refraction and fundoscopy. Visual acuity was assessed using an internally illuminated Snellen’s chart at 6 meters. Objective refraction by streak retinoscopy after instilling 1 % cyclopentolate eye drops was done in all children with visual acuity ≤ 6 / 9. Children were divided into two groups based on their gestational age at birth - preterm group and full-term group. Preterm birth was defined as childbirth before 37 completed weeks of gestation. Children were enrolled in the study only if the hospital birth document showing gestational age and birth weight was available. Children with co-existing organic disease affecting the eye contributing to the diminished visual acuity such as congenital cataract, glaucoma, and corneal opacities were excluded from the study. Those who had undergone any ocular surgery were also excluded. RESULTS One thousand two hundred and ninety-five children were enrolled in the study of which 700 (54.1 %) were boys and 595 (45.9 %) were girls. Median age of the enrolled children was 12 years. The number of pre-term births was 287 (22.2 %). Of the 1295 students screened, 273 (21 %) had refractive errors. Among the children with refractive errors, astigmatism was the most common refractive error (10.6 %), followed by myopia (8.5 %) and hypermetropia (1.9 %). Refractive errors were statistically more prevalent in preterm group (34.1 %), when compared with term born children (17.3 %), p = < 0.001. Compared to the term born children, preterm group had significantly higher prevalence of myopia; 16.4 % vs 6.3 % (p = < 0.001) and astigmatism; 15.3 % vs 9.3% (p = 0.003). There was no statistically significant difference in the prevalence of hypermetropia among the two groups; 2.4 vs. 1.8 (p = 0.477). CONCLUSIONS There is strong association between prematurity and refractive errors. These findings prompt long term monitoring of the refractive and visual outcome in preterm infants for diagnosing refractive errors at the earliest. This helps to prevent the consequent amblyopia and the ensuing permanent visual function deficits. KEYWORDS Prematurity, Refractive Error, Myopia, Hypermetropia, Astigmatism

The influence of gestational age and neurological status of premature infants on hemostasis

The influence of gestational age and neurological status of premature infants on hemostasis

Analysis of blood gas composition indicators in premature babies with neonatal sepsis

The aim of the study was analysis of oxygen status of patients with neonatal sepsis during monitoring of premature infants.Materials and methods. Indicators of oxygen status of capillary blood were assessed in premature infants with neonatal sepsis who were treated at the Regional Perinatal Center in Khmelnytsky during 2017–2018. The study included mostly deeply premature babies, including those with extremely low weight. A full range of clinical and laboratory studies, including determination of oxygen status of capillary blood.Research results. Our results allow us to conclude that while such indicators as pH, pO2, BEb3, % SO2 do not change significantly, the trouble can be detected using indicators such as AdDO2, RI, PI, which reflect the state of oxygenation with impaired ventilation. -perfusion ratios, increased blood shunting and the processes of delivery and consumption of oxygen at the tissue level. The calculated indicator "PIP×FiO2" was less sensitive to assess changes in the lungs and did not correspond to the clinical picture of the severity of the patient's condition.Conclusion. Thus, the determination of AdDO2, RI, PI capillary blood can be used as informative indicators for determining the oxygen status in premature infants, which is of significant practical importance in terms of limited monitoring of the gas composition of arterial blood

Quality of complementary feeding and its effect on nutritional status in preterm infants: a cross-sectional study.

The first 2years of life represent a critical phase for growth and development, with the quality of the diet at this stage having repercussions throughout adulthood. The present study aimed to develop an Index for Measuring the Quality of Complementary Feeding (IMQCF) for infants, as well as to evaluate diet quality and its effects on the nutritional status of preterm infants. This cross-sectional study was conducted at a Brazilian University Hospital. The data were extracted by care protocol of outpatient preterm infants at 2years of corrected age (CA). Dietary data were collected from 24-h recalls. The diet quality was assessed by the IMQCF composed of nine items based on a Brazilian Food Guide for children aged <2years. Response options were scored 0-100, with scores closer to 100 representing a better quality diet. Association with growth indicators (Z-scores for weight- and length-for-age (WAZ and LAZ) were evaluated via tests of mean difference and multiple linear regression. The median complementary feeding (CF) score was 72.2 (61.1-77.8) A shorter breastfeeding duration or infant formula use and the early introduction of wheat-based foods, ultra-processed foods and cow's milk in the preterm's diet were the main factors interfering in the adequacy of diet. There was an association between the quality of the diet score and WAZ (0.44; 95% confidence interval=0.03-0.85; P=0.03). The introduction of poor quality food in the first 2years of life interfered with the CF quality of preterm infants and can affect nutritional status at 2years of CA, possibly in the long term.

Prevalence of Retinopathy of Prematurity and Refractive Status in Premature Infants in Sabah Women and Children Hospital (SWACH)

Introduction: Myopia has been regarded as an important cause of blindness and visual impairment by WHO. Due to higher incidence of myopia in a preterm baby with ROP, early detection and visual rehabilitation need to commence as soon as possible to give the children better quality of life and prevent blindness in this population. To determine the prevalence of ROP and refractive status in premature infants in Sabah Women and Children Hospital, Kota Kinabalu in 2018. To establish the relationship between low BW and GA with the presentation of ROP.

Plasma Oxidative Status in Preterm Infants Receiving LCPUFA Supplementation: A Pilot Study

After birth, preterm infants are deficient in arachidonic acid (ARA), docosahexaenoic acid (DHA), and antioxidants, increasing their risk of oxidative stress-related pathologies. The principal aim was to evaluate if supplementation with long-chain polyunsaturated fatty acids (LCPUFAs) improves antioxidant defenses. In total, 21 preterm infants were supplemented with ARA and DHA in a 2:1 ratio (ARA:DHA-S) or with medium-chain triglycerides (MCT-S). Plasma n-3 and n-6 LCPUFAs were measured at birth, postnatal day 28, and 36 weeks of postmenstrual age (36 WPA) by gas chromatography–mass spectroscopy. Plasma antioxidants (glutathione (GSH), catalase, and thiols) and oxidative damage biomarkers (malondialdehyde (MDA), carbonyls) were analyzed at the same time points by spectrophotometry, and scores of antioxidant status (Antiox-S) and oxidative damage (Proxy-S) were calculated. At 36 WPA, linoleic acid (LA) and dihomo-γ-linolenic acid (DGLA) were decreased in ARA:DHA-S compared to the MCT-S group (LA: ARA:DHA-S = 18.54 ± 1.68, MCT-S = 22.80 ± 1.41; p = 0.018; DGLA: ARA:DHA-S = 1.68 ± 0.38, MCT-S = 2.32 ± 0.58; p = 0.018). Furthermore, α-linolenic acid (ALA) was increased in ARA:DHA-S (ARA:DHA-S = 0.52 ± 0.33, MCT-S = 0.22 ± 0.10; p = 0.018). Additionally, LA:DHA ratio was decreased in the ARA:DHA-S compared to control group (ARA:DHA-S = 6.26 ± 2.35, MCT-S = 8.21 ± 2.65; p = 0.045). By the end of supplementation (36 WPA), catalase, thiol groups, and Antiox-S were significantly higher in neonates receiving ARA:DHA-S compared to those receiving MCT-S, with no differences in oxidative stress biomarkers. In conclusion, ARA:DHA supplementation in preterm neonates resulted in an overall improvement in antioxidant to oxidant balance and a decrease in early fatty acid precursors of the n-6 relative to the n-3 pathway. These effects may reduce oxidative stress and inflammation.

When does prone sleeping improve cardiorespiratory status in preterm infants in the NICU?

Preterm infants undergoing intensive care are often placed prone to improve respiratory function. Current clinical guidelines recommend preterm infants are slept supine from 32 weeks' postmenstrual age, regardless of gestational age at birth. However, respiratory function is also related to gestational and chronological ages and is affected by sleep state. We aimed to identify the optimal timing for adopting the supine sleeping position in preterm infants, using a longitudinal design assessing the effects of sleep position and state on cardiorespiratory stability. Twenty-three extremely (24-28 weeks' gestation) and 33 very preterm (29-34 weeks' gestation) infants were studied weekly from birth until discharge, in both prone and supine positions, in quiet and active sleep determined by behavioral scoring. Bradycardia (heart rate ≤100 bpm), desaturation (oxygen saturation ≤80%), and apnea (pause in respiratory rate ≥10 s) episodes were analyzed. Prone positioning in extremely preterm infants reduced the frequency of bradycardias and desaturations and duration of desaturations. In very preterm infants, prone positioning only reduced the frequency of desaturations. The position-related effects were not related to postmenstrual age. Quiet sleep in both preterm groups was associated with fewer bradycardias and desaturations, and also reduced durations of bradycardia and desaturations in the very preterm group. Cardiorespiratory stability is improved by the prone sleep position, predominantly in extremely preterm infants, and the improvements are not dependent on postmenstrual age. In very preterm infants, quiet sleep has a more marked effect than the prone position. This evidence should be considered in individualizing management of preterm infant positioning.

Evaluation of maturity of sleep states in preterm infants using conventional and amplitude-integrated electroencephalography

ObjectiveTo determine whether sleep state maturity can be estimated accurately using conventional electroencephalography (cEEG) or amplitude-integrated electroencephalography (aEEG) features concerning sleep in neurologically unimpaired preterm infants. MethodsA total of 51 preterm infants were monitored with cEEG-polygraphy and simultaneous aEEG. Sleep state maturity of EEG corresponded to specific postmenstrual age (PMA). PMA on cEEG was blindly estimated according to cEEG patterns (indicated as background continuity, frequencies, and voltages) as well as developmental markers in specific states. PMA on aEEG was blindly estimated based on the cycling score (cycling representing sleep state transitions) according to a pre-established scoring system. ResultsA total of 51 EEGs recorded between 32 and 37 weeks PMA were analysed. A significant relationship between estimated PMA (ePMA) and actual chronological PMA (cPMA) was shown by linear regression both on cEEG (r = 0.93, β = 0.98, 95% confidence interval (CI) 0.87–1.09, p < 0.001) and aEEG (r = 0.85, β = 0.83, 95% CI 0.69–0.98, p < 0.001). The estimation gap (defined as ePMA minus cPMA) was between −2 and +2 weeks both on cEEG and aEEG. The percentage of estimation gap between −1 and +1 weeks was 96% for cEEG, which was higher than the estimate of 88% for aEEG. ConclusionEstimated maturity of sleep state was well correlated with cPMA both on cEEG and aEEG. PMA corresponding to state maturity could be estimated within two weeks of actual cPMA using either of these two tools. However, cEEG had higher accuracy compared with aEEG in the evaluation of sleep state maturity.

Neonatal Hypotension: What Is the Efficacy of Each Anti-Hypotensive Intervention? A Systematic Review

There is no consensus in the treatment of hemodynamic instability in the preterm newborn. Blood pressure is one of the few measurable objective parameters for hemodynamic evaluation in this population. However, little is known about the efficacy of anti-hypotensive treatments in newborns. The objective of this review is to identify and analyze the efficacy of a given anti-hypotensive intervention in improving the hypotensive preterm newborn. With the increase in survival of the preterm newborns, there was an augmentation in the interest for the treatment of hypotension in this population. However, as there are doubts regarding the efficacy in anti-hypotensive treatment, new drugs are being used to reverse the hypotensive state in preterm infants: epinephrine, norepinephrine, vasopressin, and steroids. We have identified that classically used medications in the treatment of hypotension have little evidence of efficacy in rescuing the preterm infant from the hypotensive state. New therapies are emerging with potential benefits, especially in refractory hypotension such as epinephrine and norepinephrine, but more prospective studies are needed. Literature review should be careful, considering the definition used for hypotension, the time of onset, the intravascular volume status of each patient, and if the drug was used as a first or second line of treatment.

The effect of gentle human touch on behavioral states in preterm infants

The effect of gentle human touch on behavioral states in preterm infants

Vitamin D status among preterm infants with cholestasis and metabolic bone disease.

Metabolic bone disease of prematurity (MBD) is a common problem among preterm infants. Our previous study identified cholestasis as an important risk factor for the development of MBD. We conducted this study to determine the vitamin D status in preterm infants with MBD and cholestasis. We retrospectively reviewed medical record of preterm infants evaluated in NICU at Holtz Children's/Jackson Memorial Hospital between June 2014 and May 2016. Demographic, biochemical data, and vitamin D intake were collected and analyzed. We identified 58 preterm infants (median gestational age 25 weeks) with MBD during this period. Twenty five infants also developed cholestasis. Median serum 25-hydroxyvitamin D level at the time of diagnosis of MBD was similar in cholestasis (C), (29.1 ng/ml, IQR 24.4-33.5), and non-cholestasis (NC), (28.7 ng/ml, IQR 22.7-34.6), group (p = 0.41). At the second measurement, average 6 weeks after the first measurement; median serum 25-hydroxyvitamin D level was lower (p = 0.02) in the C group (31.2 ng/ml, IQR 23.0-38.8) than in the NC group (36.5 ng/ml, IQR 28-45). However, the actual percentage of infants with vitamin D deficiency was similar in both the groups. Most preterm infants with cholestasis and MBD had normal vitamin D status.

Factors affecting the catch-up growth of preterm infants after discharge in China: a multicenter study based on the health belief model

BackgroundThe purpose of this study was to analyze the growth status and to identify the risk factors that influence the catch-up growth of preterm infants after discharge and to provide evidence for feeding strategies and the need for further research.MethodsA descriptive correlational analysis was applied. The sample consisted of 309 preterm infants and their caregivers selected from June to August 2017 from five women’s and children’s hospitals. Self-designed questionnaires based on knowledge, attitude and practice and the Health Belief Model (HBM) were used to measure the catch-up growth status of preterm infants after discharge. Logistic regression was used to determine the risk factors for the catch-up growth of preterm infants.ResultsThe results showed that of 309 preterm infants, only 14 (4.5%) were underweight, and 52 (17.4%) did not meet the criteria for catch-up growth at 12 months of actual age. The logistic regression analysis showed that gestational age, regular health care, caregivers’ educational background, mothers’ daily contact with the baby, monthly average family income, the addition of a breast milk supplement, and daily milk volume were risk factors that affected the catch-up growth of preterm infants after discharge.ConclusionsThe rate of catch-up growth of preterm infants is still not high. We should pay much more attention to preterm infants of small gestational age and guide their child care on a regular basis to detect and correct risk factors in a timely fashion, especially those involving lower daily milk volume, lower degree of culture and family economic difficulties. Second, we suggest that the government publish relevant policy that appropriately increases the length of maternity leave for preterm mothers. Future studies should have larger sample sizes and explore other important factors influencing the catch-up growth of preterm infants.

Analysis of the clinical characteristics and refraction state in premature infants: a 10-year retrospective analysis.

To report the visual outcomes and refractive status in premature infants with and without retinopathy of prematurity (ROP) who were or not treated. The clinical records of all premature infants with or without ROP and with or without treatment between 2007 and 2017 were retrospectively reviewed. Basic demographic data, serial changes in ROP incidence, treatment and outcomes, and the refractive states were analyzed. Correlations among myopia and astigmatism progression, birth weight, gestational age, and treatment methods were also analyzed. A total of 562 screened premature infants (all Chinese, 1124 eyes), were recruited with a 378:184 male-to-female ratio. Birth weight did not directly influence ROP incidence. The overall ROP incidence was 16.55% (93/562 cases). The incidences in boys and girls were 16.14% (33/378 cases) and 17.39% (32/184 cases), respectively, and this difference was not significant. However, all infants with serious ROP (stage IV and V) were male. Myopia combined with astigmatism was common in premature infants with and without ROP (30.99%, 172/555 cases), and myopic refraction (including myopia and myopia combined with astigmatism) was more common in premature infants with ROP (48.84%, 42/86 cases). In the >8.00 diopter group, there were significantly more ROP infants than without ROP. Myopic refraction (including myopia and myopia combined with astigmatism) was most common in infants with ROP after treatment (63.63%, 7/11 cases). The refractive state is different between premature infants and mature infants. Those treated for ROP had a higher chance of developing myopia, astigmatism, and higher diopter.

Effectiveness of Hammock Positioning in Reducing Pain and Improving Sleep-Wakefulness State in Preterm Infants.

Hammock positioning is now frequently used with preterm infants admitted to ICUs. However, few studies have investigated the extent to which hammock positioning reduces pain and improves the sleep-wakefulness state compared with traditional positioning. Twenty-six clinically stable newborns with gestational ages from 30 to 37 weeks who were breathing spontaneously were randomly assigned to 2 groups: a hammock-positioning group (n = 13), in which newborns were placed in hammocks in the lateral position, and a traditional-positioning group (n = 13), in which they were kept nested, also in the lateral position. The following variables were evaluated at the beginning and the end of the treatment: pain (with the Premature Infant Pain Profile, and Neonatal Facial Coding System), sleep-wakefulness state (with the Brazelton Neonatal Behavioral Assessment Scale), heart rate, breathing frequency, and peripheral SpO2 . The subjects in the hammock-positioning group showed an improvement in pain compared with the traditional-positioning group(Premature Infant Pain Profile score, 2.62 ± 1.89 vs 2.31 ± 1.97, ΔP = .008) and sleep-wakefulness state score (2.08 ± 0.64 vs 1.23 ± 0.44, Δ P < .001), reduced heart rate (151.69 ± 5.44 vs 142.77 ± 5.18 beats/min, Δ P < .001), breathing frequency (52.31 ± 4.05 vs 50.23 ± 2.55 beats/min, Δ P = .024), and increased peripheral SpO2 (94.69 ± 2.14 vs 98.00 ± 1.22%, Δ P < .001). Hammock positioning was an effective treatment option to reduce pain and improve sleep-wakefulness state. It also helped to reduce heart rate and breathing frequency, and to increase peripheral SpO2 , which made it a treatment option for preterm infants.

Future perspectives on the use of deformation analysis to identify the underlying pathophysiological basis for cardiovascular compromise in neonates.

The assessment of the wellbeing of the cardiovascular status in premature infants has come to the forefront in recent years. There is an increasing realisation that myocardial performance, systemic blood flow and end-organ perfusion (particularly during the transitional period) play an important role in determining short and long-term outcomes in this population. The recent open access series on Neonatologist Performed Echocardiography (NPE) published in this journal outline the necessary techniques for image acquisition and analysis and provide a framework for the potential clinical applications of NPE in neonatal, and specifically preterm care. In this "Future Perspectives" review, we describe the important determinants of adequate cellular metabolism and myocardial performance (e.g. loading conditions, intrinsic contractility and morphological change), we discuss the maladaptive state of the preterm cardiovascular system, and highlight the emerging role that non-invasive echocardiography techniques, such as deformation analysis, serve in identifying the underlying physiological basis for cardiovascular instability.

Vegetative regulation in the first three months of life in premature infants born with intrauterine growth retardation

Goal. To study the dynamics of vegetative states in preterm infants with intrauterine growth retardation (IUGR) during the first three months of life.&#x0D; Materials and methods. Examined 34 preterm infants with IUGR – 1st group (GA – 33,3 ± 1,4 weeks, body weight – 1557,8 ± 63,8 g, length – 41,2 ± 1,7 cm) at the age of 5 days and 3 months of life; 51 premature infants without IUGR (GA – 33,2 ± 1,02 weeks, body weight 2062,0 ± 63,9 grams, length – 44,0 ± 1,4 cm) – 2nd group; a control group included 31 healthy full-term infants (GA – 38,8 ± 1,5 weeks, body weight – 3355,4 ± 147,6 grams, length – 52,7 ± 2,3 cm). The vegetative tester “Polispektr-8E/88” (2000 Hz, 12 bit), from the Russian firm “Neurosoft”, was used. Indicators of the cardiointervalogram (CIG) and spectrogram were determined in the baseline sample and in the orthostatic test (tilt-test).&#x0D; Results. Among the indicators of CIG there was a noticeable decrease of mode (Mo, s) in 2 groups of preterm infants at 5 days of life (p &lt; 0,05) and an increase in stress-index by 3 months of age in 1 group (p &lt; 0,05). The study revealed the predominance in the structure of the wave spectrum of the VLF-component in all groups of children to 3 months; children 1 group had a lower value of this indicator, but they also had a higher proportion of high frequency component (HF, %) (p &lt; 0,05). Vagotonic initial vegetative tonus (IVT) was defined only in 1 group, while the frequency of sympathicotonic and hypersympathicotonic IVT decreased (p &lt; 0,05). Asympathicotonia vegetative reactivity (AST VR) in premature infants with IUGR was increased from 38, to 72,7% to 3 months (p &lt; 0,05).&#x0D; Conclusion. The study revealed the lack of influence of the Central contour vegetative regulation, more intense adaptation and high exhaustion of the functional reserve in preterm infants with IUGR to 3 months of life.

Genetic variation in CRHR1 is associated with short-term respiratory response to corticosteroids in preterm infants at risk for bronchopulmonary dysplasia.

BackgroundBronchopulmonary Dysplasia (BPD) is an orphan disease and advances in prevention and treatment are lacking. Clinical efficacy of systemic corticosteroid therapy to reduce the severity of lung disease and BPD is highly variable. Our objective was to assess whether candidate SNPs in corticosteroid metabolism and response genes are associated with short-term phenotypic response to systemic corticosteroids in infants at high risk for BPD.MethodsPharmacogenetic analysis of data from a large randomized controlled trial (TOLSURF) in infants treated with dexamethasone or hydrocortisone using multivariate linear regression. The primary outcome was change in Respiratory Severity Score (RSS, mean airway pressure × FiO2) at day 7 of corticosteroid treatment.Resultsrs7225082 in the intron of CRHR1 is significantly associated with the magnitude of decrease in RSS 7 days after starting treatment with systemic corticosteroid (meta-analysis p=2.8×10−4). Each T allele at rs7225082 is associated with a smaller absolute change in RSS at day 7, i.e. less response to systemic corticosteroids.ConclusionGenetic variability is associated with corticosteroid responsiveness with regard to respiratory status in preterm infants. Identification of genetic markers of corticosteroid responsiveness may allow for therapeutic individualization, with the goal of optimizing the risk to benefit ratio for an individual child.

Acute Responses to Diuretic Therapy in Extremely Low Gestational Age Newborns: Results from the Prematurity and Respiratory Outcomes Program Cohort Study

To determine if daily respiratory status improved more in extremely low gestational age (GA) premature infants after diuretic exposure compared with those not exposed in modern neonatal intensive care units. The Prematurity and Respiratory Outcomes Program (PROP) was a multicenter observational cohort study of 835 extremely premature infants, GAs of 230/7-286/7 weeks, enrolled in the first week of life from 13 US tertiary neonatal intensive care units. We analyzed the PROP study daily medication and respiratory support records of infants ≤34 weeks postmenstrual age. We determined whether there was a temporal association between the administration of diuretics and an acute change in respiratory status in premature infants in the neonatal intensive care unit, using an ordered categorical ranking of respiratory status. Infants in the diuretic exposed group of PROP were of lower mean GA and lower mean birth weight (P < .0001). Compared with infants unexposed to diuretics, the probability (adjusted for infant characteristics including GA, birth weight, sex, and respiratory status before receiving diuretics) that the exposed infants were on a higher level of respiratory support was significantly greater (OR, >1) for each day after the initial day of diuretic exposure. Our analysis did not support the ability of diuretics to substantially improve the extremely premature infant's respiratory status. Further study of both safety and efficacy of diuretics in this setting are warranted. Clinicaltrials.gov: NCT01435187.

Nutritional Status, Physical and Psychomotor Development of Premature Infants: A Prospective Observational Comparative Study

Background. The development of premature infants is slower than that of term ones, often due to nutritional status disorders in preterm infants. Objective. Our aim was to study the nutritional status, physical, and psychomotor development of infants. Methods. Nutritional status — the composition (the ratio of fat and fat-free tissues) and the value of lean body mass (LBM) — was assessed by plethysmography and densitometry; physical development — by measuring the mass and length of the body, the circumference of the head and chest, calculating the body mass index (BMI); psychomotor development — assessing compliance with the schedule of neuropsychological development of infants (GNOM). The examination was carried out at 12–14 and 16–18 weeks of the corrected age for preterm and actual age for full-term infants. Initially, the diet of infants was assessed by determining the amount, content of macronutrients and energy in the breast milk and/or milk formula and complementary food consumed. The diet was considered to be balanced if the diet parameters diverged not more than 10% of the norm. Results. The study included 23 preterm infants with extremely low (ELBW), 20 — with very low (VLBW), 34 — with low body weight (LBW), and 33 full-term infants. At 12–14 weeks of the corrected age, the magnitude of LBM in infants with ELBW — 3,397 (3,096; 3,608) and with VLBW — 3,824 (3,797; 3,899) was lower than in infants with LBW — 4,497 (4,034; 4,651) and full-term infants — 4,511 (3,887; 4,647) (Kruskal–Wallis test, p = 0.048). Protein balanced diet was in 2 (9%) infants with ELBW, energy balanced diet — in 1 (4%) infant. Among infants with ELBW, 17/23 (74%) referred to the risk group, 6/23 (26%) — to the developmental disorder group. Compared with infants with ELBW and VLBW, infants with LBW and full-term infants had a higher LBM and, correspondingly, higher body weight and BMI. Improvement of the nutritional status after 4–6 weeks due to correction of protein and energy consumption in infants with ELBW was accompanied by some increase in lean body mass, while its proportion was much higher and the proportion of fat mass was lower, which was accompanied by an improvement in the psychomotor development in individual infants: 5/23 (22%) became age-appropriate, and in the risk group of developmental disorders, the proportion of infants decreased from 17 (74%) to 13/23 (57%). The obtained results testify to the influence of nutritional status on the physical and psychomotor development of infants. Conclusion . The importance of dynamic assessment of the nutritional status of premature infants with individualized correction of their diet for improving the physical and psychomotor development of the child during the first year of life is shown.