Outcome In Term Infants Research Articles

Excellent Survival and Long Term Outcomes in Infants Receiving Total Body Irradiation (TBI) for Conditioning Prior to Allogeneic Transplant

Excellent Survival and Long Term Outcomes in Infants Receiving Total Body Irradiation (TBI) for Conditioning Prior to Allogeneic Transplant

Impact of corticosteroid exposure on preterm labor in neonates eventually born at term.

To evaluate the impact of antenatal corticosteroid therapy (ACS) on birth outcomes in term infants exposed during pregnancy. Exposed newborns were compared with non-exposed controls in a 1 to 2 design. Multivariate analysis was used to assess the effect of ACS exposure on neonatal outcomes. 408 newborns were included (136 exposed to ACS, 272 non-exposed). Mean ± SD head circumference (HC) was 33.7 ± 1.4 vs 34.3 ± 1.6 cm, p = 0.001 in exposed vs controls; birth weight was 3.1 ± 0.4 vs 3.3 ± 0.4 kg, p = 0.0001; and birth height was 47.9 ± 2.1 vs. 49.1 ± 2.0 cm, p < 0.0001. Hypocalcemia (4.4 vs 0.7%, p = 0.019) and feeding difficulties (5.1 vs 1.5%, p = 0.047) were significantly more common in exposed newborns. Multivariate analysis for HC showed a significant independent association with ACS exposure (β = -0.5, p = 0.009). Term newborns exposed to ACS have lower birth HC and higher risk of neonatal complications. NCT05640596.

Risk Factors for Adverse Outcomes in Term Infants with CHD and Definitive Necrotising Enterocolitis.

To define the incidence of definitive necrotising enterocolitis in term infants with CHD and identify risk factors for morbidity/mortality. We performed a 20-year (2000-2020) single-institution retrospective cohort study of term infants with CHD admitted to the Boston Children's Hospital cardiac ICU with necrotising enterocolitis (Bell's stage ≥ II). The primary outcome was a composite of in-hospital mortality and post-necrotising enterocolitis morbidity (need for extracorporeal membrane oxygenation, multisystem organ failure based on the paediatric sequential organ failure assessment score, and/or need for acute gastrointestinal intervention). Predictors included patient characteristics, cardiac diagnosis/interventions, feeding regimen, and severity measures. Of 3933 term infants with CHD, 2.1% (n = 82) developed necrotising enterocolitis, with 67% diagnosed post-cardiac intervention. Thirty (37%) met criteria for the primary outcome. In-hospital mortality occurred in 14 infants (17%), of which nine (11%) deaths were attributable to necrotising enterocolitis. Independent predictors of the primary outcome included moderate to severe systolic ventricular dysfunction (odds ratio 13.4,confidence intervals 1.13-159) and central line infections pre-necrotising enterocolitis diagnosis (odds ratio 17.7, confidence intervals 3.21-97.0) and mechanical ventilation post-necrotising enterocolitis diagnosis (odds ratio 13.5, confidence intervals 3.34-54.4). Single ventricle, ductal dependency, and feeding related factors were not independently associated with the primary outcome. The incidence of necrotising enterocolitis was 2.1% in term infants with CHD. Adverse outcomes occurred in greater than 30% of patients. Presence of systolic dysfunction and central line infections prior to diagnosis and need for mechanical ventilation after diagnosis of necrotising enterocolitis can inform risk triage and prognostic counseling for families.

Neonatal Outcomes of Term Infants Born with Meconium-Stained Amniotic Fluid.

Background Meconium-stained amniotic fluid (MSAF) is considered an alarming sign of possible fetal compromise and it has recently been reported that neonatal outcome correlates with the degree of meconium thickness. Methods We retrospectively studied 400 term infants allocated in clear amniotic fluid and grade 1, 2, and 3 MSAF groups on the basis of color and thickness of AF. Multivariable logistic regression analysis was performed to evaluate the potential independent effect of delivery with MSAF of different severity on the risk of a composite adverse neonatal outcome. Results We found that delivery with grade 2 (OR 16.82, 95% Cl 2.12-33.52; p = 0.008) and 3 (OR 33.79, 95% Cl 4.24-69.33; p < 0.001) MSAF is independently correlated with the risk of adverse neonatal outcome, such as the occurrence of at least one of the following: need of resuscitation in the delivery room, blood cord pH < 7.100, occurrence of meconium aspiration syndrome (MAS), persistent pulmonary hypertension (PPH), transient tachypnea of the newborn (TTN), acute respiratory distress syndrome (ARDS), hypoxic-ischemic encephalopathy (HIE), and sepsis. Conclusions There is a positive correlation between the severity of amniotic fluid meconium staining and thickness and the outcomes of term infants. Therefore, the evaluation and grading of MSAF during labor is useful in order to plan for the presence of a neonatologist at delivery for immediate and proper neonatal care.

The Impact on Obstetric and Perinatal Outcomes in Term Infants Following the Introduction of a Color-coded, Hierarchical Cardiotocography Classification System: A Retrospective Noninferiority Study

(Aust N Z J Obstet Gynaecol. 2022;62:370–375) The effectiveness of continuous cardiotocograph (CTG) monitoring relies on the accurate interpretation of the fetal heart rate (FHR) tracing, taken together with all available clinical information, and followed by appropriate clinical responses. CTG interpretation is dependent on the observations of the obstetrical team and subject to bias. Staff training and consistent, standardized FHR interpretation may help to improve the effectiveness of CTG monitoring. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists’ (RANZCOG) Intrapartum Fetal Surveillance recommends a CTG classification system using prose that defines fetal compromise as low, unlikely, maybe, or likely. A new color-coded system, the Queensland Clinical Guidelines (QCG), complements this prose-system, by using green, blue, yellow, and red to define fetal compromise, and recommends appropriate actions in response to each CTG category. The aim of this study was to assess the effectiveness of the color-coded CTG classification system on pregnancy outcomes before and after implementation.

Short-Term and Long-Term Outcomes of Fetal Ventriculomegaly beyond Gestational 37 Weeks: A Retrospective Cohort Study.

Birth defects have brought about major public health problems, and studying the clinical outcomes of the most common prenatal central nervous system abnormality, namely, fetal ventriculomegaly (VM), is helpful for improving reproductive health and fertility quality. This is a retrospective cohort study from 2011 to 2020 in the West China Second University Hospital, Sichuan University, aiming to evaluate the short-term and long-term outcomes of VM over 37 weeks' gestation to exclude the influence of preterm birth. The study analyzed data from 401 term pregnancies, with 179 VM and 222 controls. From the short-term outcomes, the rate of the neonatal intensive care unit (NICU) admission under the VM group (10.06%) was comparatively higher than the control (0.45%), but Apgar scores between both groups at 1 min, 5 min and 10 min were not significantly different. From the long-term outcomes, there were more infants with abnormal neurodevelopment under the VM group than control (14.53% vs. 2.25%, p < 0.001). In addition, NICU admission (p = 0.006), peak width of lateral ventricles (p = 0.030) and postnatal cranial ultrasound suggestive with VM (p = 0.002) were related to infants' long-term outcomes. NICU admission during the perinatal period was an independent risk factor for the adverse long-term outcomes (OR = 3.561, 95% CI 1.029-12.320, p = 0.045). In conclusion, VM impairs short-term and long-term outcomes of term infants. Short-term outcome, especially NICU admission, could predict their adverse long-term outcomes.

Clinical outcomes following pre-, pro- and synbiotic supplementation after caesarean birth or antibiotic exposure in the first week of life in term born infants: A systematic review of the literature.

BackgroundCaesarean section and early exposure to antibiotics disrupt the developing gastrointestinal microbiome, which is associated with long-term health effects.ObjectiveThe aim of this systematic review was to summarise the impact of prebiotics, probiotics, or synbiotics supplementation on clinical health outcomes of term infants born by caesarean section or exposed to antibiotics in the first week of life.DesignA systematic search was performed in Medline and Embase from inception to August 2021. Title and abstract screening (n = 11,248), full text screening (n = 48), and quality assessment were performed independently by two researchers.ResultsSix RCTs studying caesarean born infants were included, group sizes varied between 32–193 with in total 752 children. No studies regarding supplementation after neonatal antibiotic exposure were found. Three studies administered a probiotic, one a prebiotic, one a synbiotic, and one study investigated a prebiotic and synbiotic. Several significant effects were reported at follow-up varying between 10 days and 13 years: a decrease in atopic diseases (n = 2 studies), higher immune response to tetanus and polio vaccinations (n = 2), lower response to influenza vaccination (n = 1), fewer infectious diseases (n = 2), and less infantile colic (n = 1), although results were inconsistent.ConclusionsSupplementation of caesarean-born infants with prebiotics, probiotics, or synbiotics resulted in significant improvements in some health outcomes as well as vaccination responses. Due to the variety of studied products and the paucity of studies, no recommendations can be given yet on the routine application of prebiotics, probiotics, or synbiotics to improve health outcomes after caesarean section or neonatal antibiotic exposure.

Long-Term Cognitive Outcomes and Associated Quality of Life of Young Adults Who Experienced Liver Transplantation in Early Childhood.

We evaluated long term outcomes in infants born between 1992 and 2002 with cholestatic liver disease (CLD) who underwent successful liver transplantation (LT). A total of 160 children with CLD were identified: 68 had developmental assessments before and after LT of whom 32 were excluded because they were followed up elsewhere; 16/36 consented to complete measures of IQ, anxiety, depression, health related quality of life (HRQoL), and a habits/employment survey. Illness severity and developmental attainment prior to LT were comparable with the 32 excluded and 20 patients who declined to take part. The IQ of young adults after LT (mean score = 91.13, range 75-108, SD 10.4) was not significantly improved compared to pre-LT scores (mean score = 85.7 range 50-111, SD 17), but was inversely correlated with stunting of growth and duration of disease before LT, highlighting the need for timely LT in CLD. HRQoL scores ranged from 22 to 99 (mean 64.5 SD 20.7), comparable to scores in other LT recipients. Five (31%) had mild-moderate depression; 5 (31%) had moderate-severe anxiety associated with reduced HRQoL (P = 0.01 and P = 0.06, respectively); and nine had problematic fatigue which correlated with reduced HRQoL (r 2 = 0.4 P = 0.007). Reduced medication adherence was associated with fatigue (Spearman correlation r 2 = 0.267; P = 0.09) and anxiety (Spearman correlation r 2 = 0.597; P = 0.02). Raised body mass index was also associated with reduced and health-related quality of life scores PeLTQL© (r 2 = 0.379 P = 0.011). Fifteen (94%) were undergoing education or were employed. The long-term neuro-cognitive and psychosocial outcomes of young adults transplanted as babies is encouraging, although anxiety/depression was more common than in the healthy population. Psychosocial questionnaires help identify those young adult LT recipients who may benefit from support.

Outcome Prediction and Inter-Rater Comparison of Four Brain Magnetic Resonance Imaging Scoring Systems of Infants with Perinatal Asphyxia and Therapeutic Hypothermia

Introduction: The brain magnetic resonance imaging (MRI) result is a major predictor for the outcome of term infants with perinatal asphyxia who underwent therapeutic hypothermia. In daily practice, no uniform method is used to assess these images. Purpose: The aim of this study was to determine which MRI-score best predicts adverse outcome at 24 months of age and has the highest inter-rater reliability. Methods: Four MRI scoring systems for term infants with perinatal asphyxia were selected: Rutherford score, Trivedi score, Weeke score, and NICHD NRN score. Experienced blinded raters retrospectively evaluated the brain MR Images of 161 infants using all four scoring systems. Long-term outcome (the composite outcome death or adverse outcome, and its separate components) were routinely assessed by standardized testing at the age of 24 months. The predictive accuracy was assessed by logistic regression analyses and expressed as area under the ROC curve (AUC). The inter-rater reliability of the scores was calculated by the weighted Kappa or intraclass correlation. A sensitivity analysis using only high-quality MRI scans was performed. Results: All four MRI scoring systems demonstrated an AUC of >0.66 for the prediction of adverse outcome and ≥0.80 for the prediction of death. The inter-rater reliability analyses demonstrated the highest reliability for the Weeke and Trivedi scores. When only assessing the high-quality scans, the AUC increased further. Conclusion: All four MRI brain scores proved reliable predictors for an adverse outcome at 24 months of age. The Weeke and Trivedi score demonstrated the highest inter-rater reliability. The use of high-quality MRI further improved prediction.

Does the Degree of Maternal Fever in the Setting of Chorioamnionitis Lead to Adverse Neonatal Outcomes?

Objective The effect of the degree of maternal fever in the setting of chorioamnionitis on neonatal morbidity is unclear. The objective of this study is to assess the association between high maternal fevers (≥ 39°C) on neonatal morbidity. Study Design Secondary analysis of Maternal-Fetal Medicine Units (MFMU) Cesarean Registry data obtained from 1999 to 2002 among singleton gestations with chorioamnionitis. Women with a temperature less than 39°C (low fever) compared with those with greater than or equal to 39°C (high fever). Primary outcome was a composite of adverse neonatal outcomes such as death, sepsis, necrotizing enterocolitis, grade-3 or -4 intraventricular hemorrhage, seizure within 24 hours of delivery, intubation within 24 hours of delivery, and requiring cardiopulmonary resuscitation. Demographic characteristics compared using Fisher's exact and Wilcoxon's rank-sum test as appropriate. Multivariate logistic regression analysis with performed to control for cofounders. Stratified analysis also performed to assess outcomes in term infants. Results Of 1,313 included women, 1,200 (91.3%) were in the low fever group and 113 (8.7%) were in the high fever group. Women in the high fever group were more likely to be African American and group B Streptococcus positive. No difference in primary outcome was noted between the groups (38.9% high fever vs. 35.8% low fever, p = 0.54). High maternal fever was associated with increased risk of NICU admission (48.1 vs. 50.4%, p = 0.02). When controlling for African American race, preterm birth, and delivery route, patients with high fever were not more likely to have adverse neonatal outcomes (adjusted odds ratio [aOR] = 1.28, 95% confidence interval [CI]: 0.84, 1.98). In the analysis limited to term infants, when controlling for confounders, high fever, similarly, was not associated with increased odds of adverse neonatal outcomes (aOR = 1.59, 95% CI: 0.96, 2.65). Conclusion The degree of maternal fever does not appear to be associated with an increased likelihood of adverse neonatal outcomes. Better understanding maternal factors that affect neonatal morbidity in the setting of chorioamnionitis is critical. Key Points High maternal fever in the setting of chorioamnionitis does not appear to have an increased likelihood of adverse neonatal outcomes.It is important to identify factors that may increase the risk of adverse outcomes such as early onset sepsis.Maternal fever may not be a strong indicator for neonatal outcomes and antibiotic protocols.

The impact on obstetric and perinatal outcomes in term infants following the introduction of a colour-coded, hierarchical cardiotocography classification system: A retrospective non-inferiority study.

Queensland introduced a colour-coded cardiotocograph (CTG) classification system (green, blue, yellow and red) to complement the Royal Australian and New Zealand College of Obstetricians and Gynaecologists prose-based classification system of 'low, unlikely, maybe or likely' fetal compromise. The aim of the study was to determine the clinical impact of the introduction of the colour-coded CTG classification system compared to the prose-based system. We hypothesised there would be no change in the rate of operative delivery for intrapartum fetal compromise (OD-IFC). This retrospective non-inferiority study from November 2014 to May 2018 used routinely collected data from the Mater Mother's Hospital. Non-insured women with a singleton, non-anomalous, cephalic fetus at term, attempting a vaginal birth with continuous intrapartum CTG were included. The primary outcome was OD-IFC. Secondary outcomes included various obstetric and perinatal outcomes. Non-inferiority analysis was performed with a pre-specified non-inferiority margin of 2% risk difference. Eleven thousand seven hundred and twenty-seven participants were included. The OD-IFC rate was similar across the study groups (prose-based 15.1% vs colour-coded 15.3%, adjusted odds ratio (aOR) 1.02, 95% CI 0.93-1.13) with the adjusted risk difference of 0.29% (95% CI -0.98 to 1.56), which did not exceed the inferiority margin. There were more spontaneous (aOR 1.11, 95% CI 1.04-1.19) and fewer instrumental (aOR 0.87, 95% CI 0.80-0.95) vaginal births in the colour-coded cohort. There were no differences in neonatal outcomes. Reassuringly, the colour-coded CTG classification system was non-inferior to the prose-based system, did not influence OD-IFC but was associated with more spontaneous vaginal deliveries.

Abstract 9327: Risk Factors for Adverse Outcomes in Term Infants With Congenital Heart Disease and Necrotizing Enterocolitis

Introduction: Infants with congenital heart disease (CHD) are at increased risk of developing necrotizing enterocolitis (NEC), with mortality rates up to 57%. The aim of this study was to investigate pre-NEC factors associated with adverse outcomes in term infants with CHD-NEC. Methods: We performed a 20-year (2000-2020) single-institution retrospective cohort study in term infants (&gt;37 weeks) &lt;6 months of age admitted to the Boston Children’s Hospital Cardiac Intensive Care Unit with CHD-NEC (Bell’s stage &gt; 2). The primary outcome was a composite of in-hospital mortality and post-NEC morbidity (extracorporeal life support or surgical NEC). Predictors included baseline admission patient characteristics, cardiac diagnosis and intervention, feeding regimen, and severity of illness, as measured with the pediatric sequential organ failure assessment (pSOFA) score. Results: We identified 82 patients with CHD-NEC from 3933 admissions (prevalence, 2.1%), including 54 (66%) duct dependent and 55 (67%) with NEC post cardiac surgery. Twenty-seven (33%) met the primary outcome, (in-hospital mortality in 14 (17%) with 9 (64%) attributed to NEC). In univariate analysis, pre-NEC factors significantly associated with the primary outcome included female sex, fetal growth restriction, systolic dysfunction, older age and weight at NEC ( Table ). Feeding regimen (formula, caloric density), genetic conditions, APGARs, race, cardiac lesion, outflow tract z-score or STAT category had no impact on outcome. In multivariable analysis, peri-NEC pSOFA, lower weight and older age at NEC diagnosis remained significantly associated with the primary outcome (Table) . Conclusions: Radiologically-proven NEC occurred in 2% of term infants with CHD, with death and adverse post-NEC outcomes in more than one-third. Lower weight and older age at diagnosis were associated with adverse outcomes informing risk-triage and prognostic counseling for families.

Use of Inhaled Nitric Oxide in Preterm Infants: Is There Sufficient Evidence?

Nitric oxide (NO) is a potent vasodilator. The inhaled form (iNO) improves outcomes in term infants with persistent pulmonary hypertension of the newborn (PPHN) or bronchopulmonary dysplasia-associated pulmonary hypertension in preterm infants. However, in preterm infants, the risks and benefits of iNO use are controversial. Substantial evidence reveals no significant impact on survival or other morbidities in preterm infants with iNO treatment, independent of indication, timing, or duration of use. Many scientific organizations do not recommend the use of iNO in preterm infants, except in unique clinical circumstances with echocardiographic findings of PPHN in the setting of presumed pulmonary hypoplasia.

Terapinės hipotermijos reikšmė išnešiotų naujagimių, patyrusių hipoksiją arba asfiksiją gimstant, atokiosioms baigtims

Tyrimo tikslas. Nustatyti terapinės hipotermijos (TH) reikšmę naujagimių, patyrusių hipoksiją arba asfiksiją gimstant, atokiosioms baigtims. Tyrimo metodai. Atlikta sisteminė literatūros apžvalga naudojantis „PubMed“ (MEDLINE) ir ,,Cochrane“ bibliografinėmis medicininėmis duomenų bazėmis. Atrinkti straipsniai, nagrinėjantys terapinės hipotermijos dažnį bei įtaką išnešiotų naujagimių ankstyvosioms ir vėlyvosioms baigtims, kurie gimdami patyrė hipoksiją arba asfiksiją. Paieškai naudotos reikšminių žodžių kombinacijos anglų kalba: therapeutic hypothermia in neonates, neonatal cooling, hypoxic-ischemic encephalopathy and cooling, cooling asphyxiated newborns. Taip pat naudotas filtras: anglų kalba, straipsniai, ne senesni nei penkerių metų. Rezultatai. Įvykdžius sisteminę paiešką, į analizę įtraukti septyni viso teksto moksliniai straipsniai. Iš viso bendra tiriamųjų imtis buvo 2014 naujagimių. Į sisteminę analizę įtraukti straipsniai iš šių šalių: JAV, Jungtinės Karalystės, Nyderlandų, Bosnijos ir Hercegovinos. Visuose tyrimuose analizuota TH reikšmė naujagimių, patyrusių perinatalinę asfiksiją (PA), atokiosioms baigtims. Taip pat visi tyrėjai aprašė, jog TH buvo taikyta visiems gaivintiems naujagimiams, atitikusiems atrankos kriterijus pagal protokolus. Išvados. Esant TH atrankos kriterijams, visiems naujagimiams, patyrusiems asfiksiją gimstant, skiriama TH. Ankstyvosios atokiosios baigtys naujagimių, kuriems buvo taikyta TH: mirtis, hipoksinė išeminė encefalopatija (HIE), traukuliai. Nuo 10,8 iki 32 proc. tiriamųjų mirė stacionare. Lengva HIE buvo nustatyta nuo 14,3 iki 16,9 proc. tiriamųjų, vidutinio sunkumo – nuo 52,1 iki 88 proc. tiriamųjų, sunki – nuo 12,1 iki 28,6 proc. tiriamųjų. Traukulių dažnis – nuo 17,9 iki 75,9 proc. atvejų. Ankstyvųjų baigčių dažnis, netaikant TH, reikšmingai nesiskyrė. Vėlyvosios atokiosios baigtys naujagimių, kuriems buvo taikyta TH: negalia, motorinės raidos sutrikimai, cerebrinis paralyžius (CP), klausos, regos, kalbos ir intelekto sutrikimai. Lengva negalia buvo nustatyta nuo 10 iki 21 proc., vidutinio sunkumo – nuo 1,3 iki 10 proc., sunki – nuo 11,5 iki 25 proc. atvejų. Motorinės raidos sutrikimų arba CP dažnis – nuo 11,9 iki 68,9 proc. Lengvų klausos sutrikimų dažnis – nuo 1 iki 98,6 proc., lengvų regos sutrikimų dažnis – nuo 4 iki 85,3 proc., lengvų kalbos sutrikimų dažnis – nuo 21 iki 74,3 proc. Vėlyvųjų baigčių dažnis, netaikant TH, reikšmingai nesiskyrė. Tik lengvų kalbos sutrikimų dažnis buvo reikšmingai mažesnis, o intelekto koeficientas buvo didesnis taikant TH.

Associations between household incense burning and delayed motor development among preterm infants modified by gestational age and maternal educational status.

Household incense burning is a common ritual behavior in the Asia-Pacific region but has been associated with inferior developmental outcomes in term infants. We aimed to examine these associations among preterm infants. Information from 1190 mother-infant pairs during 6- and 18-month follow-up to the Taiwan Birth Cohort Study was examined for associations between household incense burning exposure and infant neurodevelopmental milestone achievement using multivariable Cox proportional hazard model with propensity score weighting, along with stratified, sensitivity, and decomposition analysis. Household incense burning exposure was associated with delayed gross motor milestone achievement among all preterm infants according to the Cox model and after propensity score weighting. Meanwhile, associations for delayed development were found in gross motor domain milestones among late preterm infants, while fine motor domain delay was found among other preterm infants. Furthermore, the associations between household incense burning status and gross motor milestone delays were attenuated by the interaction between higher education level and household incense burning exposure status. Household incense burning exposure was associated with delays, and the motor domains affected differed according to degree of prematurity. These associations were modified by the attenuation upon higher maternal educational status and exposure status interaction.

Comparison of the neurocognitive outcomes in term infants treated with levetiracetam and phenobarbital monotherapy for neonatal clinical seizures

PurposeThis study aims to compare the neurocognitive outcome in term infants who were treated using phenobarbital (PB) and levetiracetam (LEV) monotherapy for neonatal clinical seizures. MethodsTerm infants who were treated using PB or LEV monotherapy as the first-line anti-epileptic treatment for neonatal clinical seizures and followed-up in a pediatric neurology outpatient clinic were enrolled in this study. Neurodevelopmental outcome assessments were carried out using the Bayley Scales of Infant Development, third edition (BSID-III), including cognitive, receptive language, expressive language, fine motor and gross motor subscales. ResultsThe study group consisted of 62 infants who received monotherapy with PB monotherapy (n = 22) and LEV (n = 40). The mean duration of monotherapy treatment was 8 ± 6 months. There was no statistically significant difference between PB and LEV monotherapy groups concerning each outcome parameter on the BSID-III. There was also no statistically significant difference between PB and LEV monotherapy subgroups excluding the infants with neurodevelopmental impairment with a BSID-III scale score<7 or a composite score<85. ConclusionOur findings suggest that both LEV and PB therapy can be equally safe as monotherapy for neonatal clinical seizures for the neurodevelopmental outcome assessment with BSID-III.

491: Long term infant outcomes of prenatally suspected septo-optic dysplasia

Septo-optic dysplasia (SOD) is characterized by at least 2 of 3 findings: optic nerve hypoplasia, absent cavum septi pellucidi (CSP) and hypothalamic-pituitary dysfunction. Prenatally, the condition is suspected based on an absent CSP, but the final diagnosis can only be made postnatally, when pituitary function and opthalmological assessments are performed. The aim of our study was to describe the long-term outcome of fetuses suspected prenatally to have SOD. Retrospective cohort study of all fetuses identified with an absent CSP, but no other major structural abnormalities, in a single tertiary medical center between 1/1/2008 and 31/8/2019. Pregnancy and delivery outcomes were retrieved. For liveborn babies neuroimaging, ophthalmologic, endocrine and developmental evaluations were assessed for SOD confirmation. In cases of pregnancy termination autopsies were reviewed. Of 219 fetuses with absent CSP, 104 had fused anterior horns of the lateral ventricles and forniceal columns. Of these, 23 had suspected SOD on fetal ultrasound and MRI. Five cases underwent pregnancy termination and one case was complicated by peri-viable PPROM and stillbirth. Complete postnatal follow up was available for 13 cases with an average follow up period of 9.7 years. Five children (20.8% of all prenatally suspected SOD) had a confirmed diagnosis of SOD. Neuroimaging findings included septal remnants, fused forniceal columns, dysplastic temporal horns, diffusely thinned corpus callosum and normal olfactory tracts and bulbs. Developmental delay was present in three children. Of the remaining 8 children with an isolated absent CSP, 2 had motor and/or speech delays. In 6 cases where autopsy was available, disruption of the septal leaflets, but normal pituitary and optic nerves, were noted, precluding the diagnosis of SOD. A minority of all cases of absent CSP are confirmed SOD. Establishing this diagnosis requires multidisciplinary long term follow up. Counseling remains challenging as the condition can only be confirmed postnatally and clinical presentation is variable.

Associations between Household Incense Burning and Motor Development of Preterm Infants: Results from the Taiwan Birth Cohort Study with Propensity Score Weighting Analysis

Background: Household incense burning is a common ritual behavior in Taiwan, but was found to be associated with negative neurodevelopmental outcomes in term infants. We further examined the associations between exposure status and neurodevelopmental development among preterm infants. Methods: We extracted the information from structured questionnaires upon home interview during six and eighteen months of Taiwan Birth Cohort Study (TBCS) survey. We conducted multivariate Cox proportional hazards to model the association between household exposure status and the corrected age for infant neurodevelopmental milestone achievements and we further weighted the effect with multinomial propensity score (PS). The effect among late preterm infants (gestational age 34-36 weeks) were examined with stratified analysis. Results: In this study, 1062 preterm singletons were included, and 933 of them were late preterm. Household incense burning exposure was associated with increased hazards of delay in gross motor neurodevelopmental milestones (aHR=1⋅19, 95% CI=1⋅01-1⋅41 for walking steadily), and the effects were also observed after PS-weighting (Persistent exposure: aHR=1⋅20, 95% CI=1⋅01-1⋅42 for walking with support; aHR=1⋅25, 95% CI=1⋅05-1⋅48 for walking steadily). Similar effects in gross motor neurodevelopmental milestones were observed among late preterm infants, while the effects for other preterm infants were observed in fine motor neurodevelopmental milestones. Conclusions: This study shows negative associations between household incense burning and delayed motor neurodevelopmental milestone achievement. The effects were shown in different domains for late preterm infants and earlier preterm infants. Funding Statement: Bureau of Health Promotion, Department of Health, Ministry of Science and Technology and Ministry of Education, Taiwan. Declaration of Interests: No conflicts of interest have been declared. Ethical Approval Statement: All subjects in this study provided informed consent according to the protocol approved by the institutional Ethics Review Board of the College of Public Health, National Taiwan University and the Institutional Review Board of the Bureau of Health Promotion, Ministry of Health and Welfare, Executive Yuan, Taiwan, which was in comply with the principles of the Declaration of Helsinki.

Long Term Outcome of Infants with NEC.

Necrotizing enterocolitis (NEC) is an important complication for premature newborns. Infants who survive NEC have a greater possibility of poor long-term physiological and neurodevelopmental growth. The objective of this paper is to give a comprehensive description of the long-term consequences of NEC. Despite the rise in incidence of NEC there is a scarcity of data regarding long-term outcomes of these infants that can be divided into two groups. The first group includes gastrointestinal complications that could occur in relation to the bowel disease, the surgical treatment and quality of the residual bowel. These complications are strictures and short bowel syndrome (SBS). Intestinal strictures are a common occurance after recovery from NEC that should be investigated with a contrast study in case of suspicious clinical findings of bowel obstruction or before reversal ostomy. After this diagnostic investigation, if a stricture is detected in a symptomatic patient, resection of the affected loop of bowel with anastomosis is required. SBS is the result of a massive intestinal resection or of a dysfunctional residual bowel and it can occur in a fourth of patients affected by NEC. The second group includes neurodevelopmental impairment and growth. Neurodevelopmental outcomes of patients after NEC recovery have not been widely reported. Infants with NEC is a population of patients at high risk for adverse neurodevelopmental outcomes whose cause can be multifactorial and linked to perinatal events, severity of disease, surgical treatment and its complications and hospitalization. Understanding the morbidity of NEC with a longterm follow-up would aid neonatologists and pediatric surgeons to make informed decisions in providing care for these patients. Further research on this topic is needed.

Neurodevelopment medium-term outcome after parechovirus infection

AimHuman parechoviruses (HPeV) are responsible for fever without a source (FWS), sepsis-like illness and encephalitis in neonates and children under 3 months of age. Short-term outcome is generally good, but there is great concern about medium and long- term outcome of infants after HPeV infection. The aim of this study is to assess the medium-term outcome in infants following HPeV infection without encephalitis. MethodsPatients who suffered HPeV infection involving cerebrospinal fluid were evaluated twice using Ages and Stages Questionnaire-3 (ASQ-3). The first evaluation was conducted at least one year after the infection and the second one year later. ResultsSixteen patients were evaluated in the first assessment, and three of them presented mild alterations in motor function domains. Moreover, hypotonia was observed in the neurologic exam in one case, and hemiparesis in another case. In the second assessment fifteen patients were included, and only the patient with hemiparesis continued presenting gross motor disfunction, with complete recovery of the remaining patients. InterpretationWe have observed a good medium-term prognosis in infants after HPeV infections, with improvement of mild motor alterations after at-home intervention. Infants who suffer HPeV infection without encephalitis seem to have a better prognosis than those with encephalitis.