Survival Rate Of Preterm Infants Research Articles

Antenatal Magnesium Sulfate for Neuroprotective Effects In Preterm Infants

<title>Abstract Fetal or neonatal brain injury can result in lifelong neurologic disability. Although survival rates for preterm infants have increased dramatically with the advent of modern perinatal and neonatal intensive care, but the rates of neurologic abnormalities in survivors, particularly motor disorders such as cerebral palsy, have not diminished. Antenatal magnesium sulfate may reduce the rates of cerebral palsy in survivors of preterm birth. There are five randomized controlled trials of magnesium sulfate administered to women at risk of preterm delivery before 34 weeks of gestation which have reported neurological outcomes for the child. From meta-analysis of these randomized trials, the rate of cerebral palsy was reduced by magnesium sulfate (RR, ᄋ·69; 95% CI, ᄋ·54-ᄋ·87; five trials; 6,145 infants) as did the moderate/severe cerebral palsy incidence (RR, 0.64; 95% CI, ᄋ·44-ᄋ·92; three trials; 4387 infants). There was no statistically significant difference between the rates of neonatal adverse outcomes of the magnesium administration group and the control group. In most prospective randomized studies, no significant difference in the severe mother-side side effects between the magnesium sul- fate administration group and the control group.</p><p>Antenataᅵ magnesium sulfate therapy is neuroprotective against motor dysfunction in offspring for the preterm infant; however the possibility of an increase in the fetal or neonatal death rate was not completely excluded.</p>

Could cord blood cell therapy reduce preterm brain injury?

Major advances in neonatal care have led to significant improvements in survival rates for preterm infants, but this occurs at a cost, with a strong causal link between preterm birth and neurological deficits, including cerebral palsy (CP). Indeed, in high-income countries, up to 50% of children with CP were born preterm. The pathways that link preterm birth and brain injury are complex and multifactorial, but it is clear that preterm birth is strongly associated with damage to the white matter of the developing brain. Nearly 90% of preterm infants who later develop spastic CP have evidence of periventricular white matter injury. There are currently no treatments targeted at protecting the immature preterm brain. Umbilical cord blood (UCB) contains a diverse mix of stem and progenitor cells, and is a particularly promising source of cells for clinical applications, due to ethical and practical advantages over other potential therapeutic cell types. Recent studies have documented the potential benefits of UCB cells in reducing brain injury, particularly in rodent models of term neonatal hypoxia–ischemia. These studies indicate that UCB cells act via anti-inflammatory and immuno-modulatory effects, and release neurotrophic growth factors to support the damaged and surrounding brain tissue. The etiology of brain injury in preterm-born infants is less well understood than in term infants, but likely results from episodes of hypoperfusion, hypoxia–ischemia, and/or inflammation over a developmental period of white matter vulnerability. This review will explore current knowledge about the neuroprotective actions of UCB cells and their potential to ameliorate preterm brain injury through neonatal cell administration. We will also discuss the characteristics of UCB-derived from preterm and term infants for use in clinical applications.

PC.122 Feeding practice in Extreme low Birth weight babies in a tertiary neonatal centre

BackgroundWith survival rates for preterm infants improving constantly, more emphasis is being placed on optimising nutrition. Suboptimal nutrition in the early neonatal period contributes significantly to postnatal malnutrition and accumulation...

Fatty acid binding protein 4 deficiency protects against oxygen-induced retinopathy in mice.

Retinopathy of prematurity (ROP) is a leading cause of blindness in children worldwide due to increasing survival rates of premature infants. Initial suppression, followed by increased production of the retinal vascular endothelial growth factor-A (VEGF) expression are key events that trigger the pathological neovascularization in ROP. Fatty acid binding protein 4 (FABP4) is an intracellular lipid chaperone that is induced by VEGF in a subset of endothelial cells. FABP4 exhibits a pro-angiogenic function in cultured endothelial cells and in airway microvasculature, but whether it plays a role in modulation of retinal angiogenesis is not known. We hypothesized that FABP4 deficiency could ameliorate pathological retinal vascularization and investigated this hypothesis using a well-characterized mouse model of oxygen-induced retinopathy (OIR). We found that FABP4 was not expressed in retinal vessels, but was present in resident macrophages/microglial cells and endothelial cells of the hyaloid vasculature in the immature retina. While FABP4 expression was not required for normal development of retinal vessels, FABP4 expression was upregulated and localized to neovascular tufts in OIR. FABP4−/− mice demonstrated a significant decrease in neovessel formation as well as a significant improvement in physiological revascularization of the avascular retinal tissues. These alterations in retinal vasculature were accompanied by reduced endothelial cell proliferation, but no effect on apoptosis or macrophage/microglia recruitment. FABP4−/− OIR samples demonstrated decreased expression of genes involved in angiogenesis, such as Placental Growth Factor, and angiopoietin 2. Collectively, our findings suggest FABP4 as a potential target of pathologic retinal angiogenesis in proliferative retinopathies.

Motor responses and weight gaining in neonates through use of two methods of earmuff and receiving silence in NICU.

Background and Aims. With technological advances in NICUs the survival rate of preterm infants has been increased. Because NICU environment is a potent source of stress for infants, its modification is an essential measure to decrease infants' morbidity. The purposes of this study were to compare the effects of wearing earmuff and provision silence for infants on their motor responses and gaining weight. Methods. In a randomized clinical trial 96 preterm infants were enrolled. Their motor responses were evaluated for two consecutive days in the morning and afternoon shifts, in the groups of earmuff and silence, and at similar time points in the control group. Also their weight was measured at days 1 and 10. Results. In the two intervention groups, means of motor responses in infants were significantly less than in the control group, and weight gain of infants was more than the control group. However weight gain was more pronounced in the earmuff group. Conclusion. Both interventions led to decreasing number of motor responses and improvement of weight gain pattern, but these effects were more pronounced in earmuff group; thus because implementation of silence in NICUs has many barriers, it is suggested to use earmuff for preterm infants in these units. This trial obtained IRCT registration number IRCT2012092010812N2.

Is the NICU Private Room Too Quiet

Survival rates for premature infants have improved substantially during the past 20 years, but adverse developmental outcomes remain a problem. Preterm infants must complete development in an abnormally noisy and bright environment, prompting rapid adoption of single-family rooms for neonatal intensive care units …

Randomized controlled trial of Family Nurture Intervention in the NICU: assessments of length of stay, feasibility and safety.

BackgroundWhile survival rates for preterm infants have increased, the risk for adverse long-term neurodevelopmental and behavioral outcomes remains very high. In response to the need for novel, evidence-based interventions that prevent such outcomes, we have assessed Family Nurture Intervention (FNI), a novel dual mother-infant intervention implemented while the infant is in the Neonatal Intensive Care Unit (NICU). Here, we report the first trial results, including the primary outcome measure, length of stay in the NICU and, the feasibility and safety of its implementation in a high acuity level IV NICU.MethodsThe FNI trial is a single center, parallel-group, randomized controlled trial at Morgan Stanley Children’s Hospital for mothers and their singleton or twin infants of 26–34 weeks gestation. Families were randomized to standard care (SC) or (FNI). FNI was implemented by nurture specialists trained to facilitate affective communication between mother and infant during specified calming interactions. These interactions included scent cloth exchange, sustained touch, vocal soothing and eye contact, wrapped or skin-to-skin holding, plus family-based support interactions.ResultsA total of 826 infants born between 26 and 34 weeks during the 3.5 year study period were admitted to the NICU. After infant and mother screening plus exclusion due to circumstances that prevented the family from participating, 373 infants were eligible for the study. Of these, we were unable to schedule a consent meeting with 56, and consent was withheld by 165. Consent was obtained for 150 infants from 115 families. The infants were block randomized to groups of N = 78, FNI and N = 72, SC. Sixteen (9.6%) of the randomized infants did not complete the study to home discharge, 7% of those randomized to SC and 12% of FNI infants. Mothers in the intervention group engaged in 3 to 4 facilitated one- to two-hour sessions/week. Intent to treat analyses revealed no significant difference between groups in medical complications. The mean length of stay was not significantly affected by the intervention.ConclusionThere was no significant effect demonstrated with this intervention amount on the primary short-term outcome, length of stay. FNI can be safely and feasibly implemented within a level IV NICU.Trial registrationClinicaltrials.gov: NCT01439269

Brain Development in Infants Born Preterm: Looking Beyond Injury

Infants born very preterm are high risk for acquired brain injury and disturbances in brain maturation. Although survival rates for preterm infants have increased in the last decades owing to improved neonatal intensive care, motor disabilities including cerebral palsy persist, and impairments in cognitive, language, social, and executive functions have not decreased. Evidence from neuroimaging studies exploring brain structure, function, and metabolism has indicated abnormalities in the brain development trajectory of very preterm-born infants that persist through to adulthood. In this chapter, we review neuroimaging approaches for the identification of brain injury in the preterm neonate. Advances in medical imaging and availability of specialized equipment necessary to scan infants have facilitated the feasibility of conducting longitudinal studies to provide greater understanding of early brain injury and atypical brain development and their effects on neurodevelopmental outcome. Improved understanding of the risk factors for acquired brain injury and associated factors that affect brain development in this population is setting the stage for improving the brain health of children born preterm.

Néonatologie : passé et présent

This review deals with early neonatal medicine and its rapid development as a medical specialty, starting with the birth of neonatology in the early 19th century. Shaffer first used the term neonatology in 1963 to cover neonatal disorders and their treatment. Between the early 19th century and the 1950s, neonatal care was ensured by obstetricians, whose main goal was to reduce neonatal mortality. After the second world war, and especially the 1960s, the development of neonatal physiology and pathophysiology provided insights into neonatal diseases and their treatment, including respiratory distress, jaundice, malnutrition, and prevention of respiratory distress and brain complications, etc. Currently, neonatal mortality, regardless of birth weight, is below 2/1000, and the survival rate of premature infants, regardless of gestational age and birth weight, exceeds 85%. This represents a resounding success, despite the associated costs, ethical issues, and inevitable morbidity.

Magnesium Sulfate: Fetal Neuroprotective Role in Reducing the Risk of Cerebral Palsy

ABSTRACT Advances in perinatal and neonatal medicine have significantly improved survival rates of preterm infants. This improvement has been associated with substantial risk of neurodevelopmental impairments and with increased number of infants with special health care needs. Cerebral palsy is the most well known and potentially most disabling motor abnormality associated with prematurity. There has been limited progress in understanding the causes of cerebral palsy and in developing primary prevention strategies. Several studies have summarized the experimental evidence that supports possible neuroprotective effects of magnesium. Five randomized controlled trials of antenatal magnesium sulfate found a trend of reduced risk of cerebral palsy in preterm infants. Three meta-analyses using the data from these five trials found that magnesium sulfate given to women at risk of premature birth significantly reduced the risk of cerebral palsy without increasing the risk of perinatal or infant death. How to cite this article Constantinescu S, Denes M, Chilianu A, Vladareanu R. Magnesium Sulfate: Fetal Neuroprotective Role in Reducing the Risk of Cerebral Palsy. Donald School J Ultrasound Obstet Gynecol 2013;7(1):98-104.

CSPEN guidelines for nutrition support in neonates.

In the last few decades, there has been a significant increase in survival rate of preterm infants, especially very low birth weight infants. The nutrition problems have become particularly relevant in neonates, and nutrition support is usually required for preterm infants and most sick term infants. The actual amount of nutrition must be calculated (not estimated) in neonates. The goals of nutrition support are to maintain development and growth while avoiding nutrition related complications. Nutrition requirements (enteral nutrition and parenteral nutrition) should be adjusted according to different weights and gestational age. Parenteral nutrition (PN), which allows the infant's requirements for growth and development to be met, is indicated in infants for whom feeding via the enteral route is impossible, inadequate, or hazardous. Enteral nutrition (EN) should be gradually introduced and should replace PN as quickly as possible in order to minimize any side-effects from exposure to PN. Inadequate substrate intake in early infancy can cause long-term detrimental effects in terms of metabolic programming of the risk of illness in later life. Optimal nutrition care of the preterm infant offers the opportunity to improve outcomes for children. This guideline aims to provide proposed advisable ranges for nutrient intakes in neonates. These recommendations are based on a considered review of available scientific reports on the subject, and on expert consensus for which the available scientific data are considered inadequate.

English

IntroductionPreterm labour is a challenging issue for the obstetricians even today. It is the largest contributor to the perinatal morbidity and mortality throughout the world. With the improvement of neonatal care, there has been a dramatic improvement in neonatal survival rates of preterm infants. But Neonatal Intensive Care Unit (NICU) care is expensive and a preterm baby is at an increased risk of many complications like respiratory distress syndrome (RDS), hyperbilirubinemia, etc. So preterm labour is not only a medical and social problem but also an economic burden. ObjectiveOur study aims at detecting the incidence of bacterial vaginosis in preterm labour and comparing it with the control i.e. Pregnant women admitted in labour room at term. Materials and MethodsThis study was conducted at Dr. D.Y. Patil Medical College and Research Centre, Pimpri, Pune from 1st August 2006 to 31st July 2008 after taking permission from the institution’s ethical board committee. The patients were divided into 2 groups: Group I60 pregnant patients diagnosed as preterm labour, between 24-36 weeks gestation, were screened for Bacterial Vaginosis. Group II60 pregnant women admitted in labour room at term were taken as control (>37 weeks gestation). Results and Observations45% of the patients in Group I and 13.33% of the patients in Group II had bacterial vaginosis. 80% of the patients in group II had normal vaginal flora as compared to only 18.33% in group I. Out of 60 preterm cases 13.33% of the patients had intermediate Bacterial Vaginosis and 45% had definite Bacterial Vaginosis. ConclusionSignificant percentage of pregnant women with preterm labour had lower genital tract infections. They can be easily screened for bacterial vaginosis using Nugent’s scoring and treated with a combination of clotrimazole and clindamycin (local application). Nugent’s method is considered the gold standard method for microbiological detection of bacterial vaginosis. KeywordsBacterial vaginosis, pre-term labour, Nugent’s scoring method

1395 Massage Therapy by Mother or Nurse: Effect on Weight Gain of Premature Infants

IntroductionSince the introduction of surfactant the survival rate of preterm infants increased significantly. This has brought the expert’s attention to maximizing the growth and development of this fragile population. Many...

Visual Impairment: A Common Sequela of Preterm Birth

Improvements in survival rates of premature infants over the past several years have resulted in an increasing number of children with brain injury. Cerebral visual impairment (CVI) is among the most common sequelae of a preterm birth and usually arises from hypoxic ischemic injury to watershed areas of the brain. The term was introduced by Whiting more than 20 years ago to replace the inappropriate term “cortical blindness” used to describe permanent visual impairments in adult patients. CVI includes all visual dysfunctions “caused by damage to, or malfunctioning of, the retrogeniculate visual pathways (optic radiations, occipital cortex, and associative visual areas) in the absence of any major ocular disease.” The existence of many different causes and symptoms makes CVI difficult to define and detect, especially when a child exhibits milder forms of visual impairment that could contribute to difficulties with self-care and academic skills during school age. It is important for pediatricians to identify and recognize CVI as a common cause of visual developmental delay in children with premature birth or pre-, peri-, or postnatal insults because recognizing CVI early is the first step toward prevention and rehabilitation.

The effects of intrauterine growth restriction and antenatal glucocorticoids on ovine fetal lung development

Intrauterine growth restriction (IUGR) is associated with high rates of neonatal morbidity. IUGR babies are often born preterm and are, therefore, exposed to antenatal glucocorticoids. Antenatal glucocorticoids significantly improve overall survival rates of preterm infants, but there is a paucity of information about their effects on IUGR Infants. We induced IUGR in sheep by single umbilical artery ligation (SUAL), or sham in control fetuses. To half the ewes, we administered betamethasone (BM) on d 5 (BM1) and 6 (BM2) following surgery, and collected fetal lung tissue on d 7. SUAL alone was associated with higher circulating fetal cortisol levels (2.8 ± 0.4 vs. 1.0 ± 0.4, P = 0.001) as compared with controls but not with changes in lung morphology or surfactant protein (SP) gene expression. BM was associated with a significant reduction in lung tissue density (P = 0.048). There were no significant differences between groups in lung DNA concentration or septal crest density. SP-A, SP-B, and SP-C gene expressions were significantly increased in control and SUAL fetuses that were administered BM. These results show that in SUAL fetuses, maternal BM is associated with acceleration of fetal lung structure, as occurs in normally grown fetuses, and that BM induces SP production, an effect not observed in SUAL-induced IUGR fetuses alone.

Transplacental versus direct fetal corticosteroid treatment for accelerating fetal lung maturation where there is a risk of preterm birth

Despite major advances in medical technology, the incidence of preterm birth remains high. The use of antenatal corticosteroid administered transplacentally, by intramuscular injection to women at risk of preterm birth, has reduced the incidence of respiratory distress syndrome and increased the survival rates of preterm infants. However, this intervention also comes with its own risks and side effects. Animal studies and early studies in pregnant women at risk of preterm birth have reported the use of an alternative route of administration, by direct intramuscular injection of corticosteroid into the fetus under ultrasound guidance, in an attempt to minimise the side effects profile. Direct fetal corticosteroid administration may have benefits over maternal administration in terms of safety and efficacy. To assess if different routes of corticosteroid administration (maternal versus direct fetal) have effects on maternal health, and the risk of stillbirth, neonatal, perinatal, infant and child mortality and morbidity. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (16 June 2011) and the WHO International Clinical Trials Registry Platform (ICTRP) (16 June 2011). Randomised controlled trials comparing maternal with direct fetal routes of antenatal corticosteroid administration in women at risk of preterm birth. We did not perform any data collection or analyses. We did not identify any eligible randomised controlled trials to include in this review. The available clinical studies carried out so far on animals and human have shown that direct intramuscular injection of corticosteroid into the fetus under ultrasound guidance is feasible, but data on health outcomes are lacking. Therefore, uncertainty persists as to which method could provide better efficacy and safety profile. Randomised controlled trials are required focusing on the benefits and harms of transplacental versus direct fetal corticosteroid treatment. Until the uncertainties have been answered, it is advisable to stay with the current standard of antenatal transplacental maternally administered corticosteroid treatment.

Actuarial day-by-day survival rates of preterm infants admitted to neonatal intensive care in New South Wales and the Australian Capital Territory

ObjectiveTo characterise the actuarial day-by-day survival of premature infants in a geographically defined population.Setting10 Neonatal Intensive Care Units (NICUs) in New South Wales (NSW) and Australian Capital Territory (ACT), Australia.DesignRetrospective...

Research progress on kangaroo mother care in nursing of preterm infants

With the development of perinatology and neonatology,the survival rate of preterm infants was improved a lot,the preterm infants become one of the important study in nowdays.there have been many studies about nursing of preterm infants,This article summarizes research progress on kangaroo mother care in nursing of preterm infants. Key words: Kangaroo mother care(KMC); Preterm infants; Nursing

Prevention of retinopathy of prematurity

Retinopathy of prematurity (ROP) is related to oxygen-regulated vascular endothelial growth factor and to insulin-like growth factor-I. After premature birth, supplemental oxygen induces a retinal hyperoxic condition with vasoconstriction and to a definitive interruption of retinal vasculogenesis. Peripheral ischemia may stimulate retinal neovascularization and the onset of additional ROP-related complications. The natural course of the disease may result in irreversible blindness if not promptly diagnosed and attended. Recently, a significant increase in the prevalence of ROP has been observed in survival rates of preterm infants, especially in emerging-economy countries in Latin America, Asia, and Eastern Europe. This article addresses the main preventive measures in ROP.

Maintaining Optimal Oxygen Saturation in Premature Infants

Advances in technology have resulted in increasing survival rates for premature infants. Oxygen therapy is commonly used in neonatal units as part of respiratory support. The number of premature infants in our institution surviving with severe (stage ≥3) retinopathy of prematurity (ROP) prompted a review of oxygen therapy as a contributing factor. Prolonged exposure to high concentrations of oxygen may cause irreversible damage to the eyes of very-low-birth-weight preterm infants and is a potential cause of blindness. We developed strategies to reduce incidence of severe ROP requiring laser surgery in premature infants. We studied 37 preterm infants who were born at a gestational age of <32 weeks, with a birth weight of <1500 g, receiving supplemental oxygen, and had been admitted to our neonatal intensive care unit. Infants received oxygen via mechanical ventilator, nasal continuous positive airway pressure (CPAP), or intranasal (I/N) and titration of oxygen was based on each infant's measured oxygen saturation (Spo(2)). For each infant, we monitored the Spo(2) trend, Spo(2) alarm limit, and the percentage of time that the alarm limit was set incorrectly. We implemented a Spo(2) targeting protocol and developed an algorithm for titrating fraction of inspired oxygen (Fio(2)). After phase 1 of implementation, the percentage of time that Spo(2) readings were >95% was reduced to between 20% and 50%. However, our findings raised concern regarding the wide fluctuation of Spo(2) readings because of inconsistency in Fio(2) titration, which can contribute to deviation from the optimal target range. Accordingly, we developed an algorithm for titrating Fio(2) aimed at maintaining each infant's Spo(2) within the optimal target range. After phase 2 of implementation, the percentage of Spo(2) readings >95% was markedly reduced to between 0% and 15%. The incidence of infants with severe ROP requiring laser surgery decreased from 5 to 1. A change in clinical practice aimed at maintaining oxygen within the target range to avoid a high Spo(2) was associated with a significant decrease in the incidence of both severe ROP and the need for laser surgery, thus reducing hospital costs and length of hospital stays for premature infants.