Treatment Of Preterm Infants Research Articles

Sex Differences in Patent Ductus Arteriosus Incidence and Response to Pharmacological Treatment in Preterm Infants: A Systematic Review, Meta-Analysis and Meta-Regression.

A widely accepted concept in perinatal medicine is that boys are more susceptible than girls to complications of prematurity. However, whether this ‘male disadvantage of prematurity’ also involves persistent patent ductus arteriosus (PDA) has been scarcely investigated. Our aim was to conduct a systematic review and meta-analysis on studies addressing sex differences in the risk of developing PDA among preterm infants. We also investigated whether the response to pharmacological treatment of PDA differs between boys and girls. PubMed/Medline and Embase databases were searched. The random-effects male/female risk ratio (RR) and 95% confidence interval (CI) were calculated. We included 146 studies (357,781 infants). Meta-analysis could not demonstrate sex differences in risk of developing any PDA (37 studies, RR 1.03, 95% CI 0.97 to 1.08), hemodynamically significant PDA (81 studies, RR 1.00, 95% CI 0.97 to 1.02), or in the rate of response to pharmacological treatment (45 studies, RR 1.01, 95% CI 0.98 to 1.04). Subgroup analysis and meta-regression showed that the absence of sex differences was maintained over the years and in different geographic settings. In conclusion, both the incidence of PDA in preterm infants and the response rate to pharmacological treatment of PDA are not different between preterm boys and girls.

Oxygen saturation histogram classification system to evaluate response to doxapram treatment in preterm infants.

An oxygen saturation (SpO2) histogram classification system has been shown to enable quantification of SpO2 instability into five types, based on histogram distribution and time spent at SpO2 ≤ 80%. We aimed to investigate this classification system as a tool to describe response to doxapram treatment in infants with severe apnea of prematurity. This retrospective study included 61 very-low-birth-weight infants who received doxapram. SpO2 histograms were generated over the 24-h before and after doxapram start. Therapy response was defined as a decrease of ≥1 histogram types after therapy start. The median (IQR) histogram type decreased from 4 (3-4) before to 3 (2-3) after therapy start (p < 0.001). The median (IQR) FiO2 remained constant before (27% [24-35%]) and after (26% [22-35%]) therapy. Thirty-six infants (59%) responded to therapy within 24 h. In 34/36 (94%) of the responders, invasive mechanical ventilation (IMV) was not required during the first 72 h of therapy, compared to 15/25 (60%) of non-responders (p = 0.002). Positive and negative predictive values of the 24-h response for no IMV requirement within 72 h were 0.46 and 0.94, respectively. Classification of SpO2 histograms provides an objective bedside measure to assess response to doxapram therapy and can serve as a tool to detect changes in oxygenation status around respiratory interventions. The SpO2 histogram classification system provides a tool for quantifying response to doxapram therapy. The classification system allowed estimation of the probability of invasive mechanical ventilation requirement, already within a few hours of treatment. The SpO2 histogram classification system allows an objective bedside assessment of the oxygenation status of the preterm infant, making it possible to assess the changes in oxygenation status in response to respiratory interventions.

The Gut Microbiome of Preterm Infants Treated With Aminophylline Is Closely Related to the Occurrence of Feeding Intolerance and the Weight Gain

BackgroundAminophylline is widely used in the treatment of preterm infants, but it can cause feeding intolerance events, in which gut microbial dysbiosis may have a role. This study aims to investigate the relationship between the gut microbiome of preterm infants treated with aminophylline and the occurrence of feeding intolerance and weight gain rate.MethodsThis study included a cohort of 118 preterm infants. Survival analysis and multivariate Cox regression were used to evaluate the relationship between aminophylline treatment and the occurrence of feeding intolerance. 16S rRNA V4 region gene sequencing was used to characterize the microbiome of fecal samples from the cohort. Linear discriminant analysis effect size was used to analyze the differential abundance of bacteria related to aminophylline treatment. Wilcoxon test, Kruskal–Wallis test, Spearman correlation coefficients and generalized linear mixed models were used to analyze the correlation between the differential bacteria and feeding intolerance events as well as the weight gain.ResultsThe results showed that the use of aminophylline could significantly increase the occurrence of feeding intolerance. The relative abundances of Streptococcus and Rothia in the gut microbiome of preterm infants were positively correlated with both the occurrence of feeding intolerance and the use of aminophylline, while the relative abundance of Staphylococcus was negatively correlated. In particular, preterm infants with a lower relative abundance of Rothia were more likely to develop feeding intolerance associated with aminophylline, and this difference existed before the onset of feeding intolerance. Moreover, it took longer for individuals with a lower relative abundance of Streptococcus to reach 2 kg weight. The contribution of Streptococcus to weight gain was greater than that of Bifidobacterium or Lactobacillus.ConclusionThe gut microbiome in preterm infants treated with aminophylline was characterized by a decrease in Streptococcus and Rothia and an increase in Staphylococcus. These microbes, especially Rothia, were positively correlated with the occurrence of feeding intolerance. Streptococcus but not Bifidobacter likely participated in the weight gain of preterm infants in early life.

Resuscitation of preterm infants in Nigeria - A national survey on practice.

Preterm births constitute a major clinical problem associated with significant morbidity and mortality in the perinatal, neonatal, and childhood periods. Decisions around initiating and/or continuing resuscitation and treatment of preterm infants (PI) both at birth and afterwards need careful consideration. While the developed countries have published guidelines for the resuscitation and care of the PI, this is not the case in developing countries where availability of resources and the absence of a published guidelines impacts on practice. Our study was therefore carried out to access the practice and decision-making that surrounds the resuscitation of PIs by neonatologists and neonatal nurses working in neonatal intensive care units (NICU) across Nigeria. We conducted an online national survey on neonatal care providers working in level 2 and level 3 neonatal units (NICU) across Nigeria. Around 190 participants were selected from the six geopolitical zones of the country and they were asked about current practices relating to resuscitation and stopping life-sustaining treatment as well as estimated survival rates at different gestational ages (GA). In total, 138 clinicians responded to our survey. Of this, 73% completed the survey. Majority (83%) of the respondents worked in government-funded public hospitals while the remaining 17% worked in the private hospitals. 74% of the respondents' report having a guideline on the PI. Resuscitation practice varied amongst different neonatologists and neonatal nurses with 48% of the clinicians providing resuscitation at 23-26 weeks and the remainder providing resuscitation at a GA >26 weeks with a median GA threshold for initiating resuscitation at 27 weeks. From an institutional perspective, 75% of PIs <26 weeks were resuscitated in public hospitals while the remaining 25% were resuscitated in private hospital, however this is not statistically significant (P = 0.385). In situations when the GA is unknown, we found a median fetal weight of 700 g as the threshold for providing active treatment. We noticed wide variations in responses on the estimated survival rates of the PIs, however a common finding is the increased chances of survival with increasing GA. Also, PIs across all GAs had higher chances of survival in public hospitals than in private hospitals, however, this is not statistically significant (P = 0.385-0.956). The major factor influencing a clinicians' decision to limit resuscitation was the "risk of poor quality of life" (50%) and the prevalent way of palliating the newborn amongst respondents is by stopping life-sustaining treatment (34%). Our survey revealed considerable variation in resuscitation practices amongst different neonatal care providers. Having a framework that will formulate and publish a national guideline based on factors like local survival rates, societal norms, and resources and ensuring that it is adopted by all NICUs will generate greater consistency of care.

The Clinical and Cost Utility of Cardiac Catheterizations in Infants with Bronchopulmonary Dysplasia

To evaluate the cost-utility of catheterization-obligate treatment in preterm infants with pulmonary hypertension, as compared with empiric initiation of sildenafil based on echocardiographic findings alone. A Markov state transition model was constructed to simulate the clinical scenario of a preterm infant with echocardiographic evidence of pulmonary hypertension associated with bronchopulmonary dysplasia (BPD) and without congenital heart disease under consideration for the initiation of pulmonary vasodilator therapy via one of two modeled treatment strategies-empiric or catheterization-obligate. Transitional probabilities, costs and utilities were extracted from the literature. Forecast quality-adjusted life-years was the metric for strategy effectiveness. Sensitivity analyses for each variable were performed. A 1000-patient Monte Carlo microsimulation was used to test the durability of our findings. The catheterization-obligate strategy resulted in an increased cost of $10 778 and 0.02 fewer quality-adjusted life-years compared with the empiric treatment strategy. Empiric treatment remained the more cost-effective paradigm across allscenariosmodeled through one-way sensitivity analyses and the Monte Carlo microsimulation (cost-effective in 98% of cases). Empiric treatment with sildenafil in infants with pulmonary hypertension associated with BPD is a superior strategy with both decreased costs and increased effectiveness when compared with catheterization-obligate treatment. These findings suggest that foregoing catheterization before the initiation of sildenafil is a reasonable strategy in preterm infants with uncomplicated pulmonary hypertension associated with BPD.

Скрининг, наблюдение и лечение недоношенных детей

Purpose. Тo analyze of the effectiveness of the screening, monitoring and treatment of premature babies. Material and methods. From 2012 to 2021 we observed 2298 preterm infants. Retinopathy of prematurity (ROP) was revealed in 796 cases (34.64 %), 34 of them with aggressive posterior ROP (AP-ROP) (4.27 %). 217 patients (27.26 %) had indications for laser coagulation of the retina (LCR); repeated interventions were performed in 26 cases (11.98 %). In 190 case (87.55 %), an induced regression of the disease occurred. An unfavorable outcome of ROP was diagnosed in 27 cases (12.45 %). 265 children with a cicatricial phase of ROP were dynamic observed. Results and conclusions. The effectiveness of LCR at the threshold stage has reached at 95.12 %. Regression in type-I occurred in 88.33 %. In cases of AP-ROP, the efficiency of LCR was 55.88 %. The total number of children with terminal stages was 109 people (13.69 %). In the cicatricial period of 265 people, 141 revealed ametropia, secondary glaucoma in 7 patients, complicated cataract in 6 and strabismus in 38. Timely screening and monitoring reveals early signs of ROP, if necessary, perform surgical treatment. These activities minimize risk of disability from blindness and low vision. An insignificant number of LCR performed, a small number of patients with terminal stages of ROP indicates the high efficiency of modern conditions for nursing premature babies. Functional results in long-term periods depend on the degree of residual changes, refractive pathology and strabismus. Correction of ametropia, functional treatment, strabismus surgery in the preschool period, allow to develop and maintain visual function in the most of patients with ROP. Keywords: retinopathy of prematurity, laser coagulation of the retina, aggressive posterior retinopathy of prematurity.

Ventriculomegaly thresholds for prediction of symptomatic post-hemorrhagic ventricular dilatation in preterm infants.

Benefits from early surgical intervention in preterm infants with intraventricular hemorrhage (IVH) prior to symptomatic ventriculomegaly must be weighed against risks of surgery. We calculated thresholds of common ventriculomegaly indices at a late-intervention institution to predict subsequent symptomatic ventriculomegaly requiring neurosurgery. We retrospectively reviewed neuroimaging and neurosurgical outcomes in preterm infants with grade III/IV IVH between 2007 and 2020. Frontal-occipital horn ratio (FOHR), frontal-temporal horn ratio (FTHR), anterior horn width (AHW), and ventricular index (VI) were measured. Area under the receiver operating curve (AUC) for predicting intervention (initiated after progressive symptomatic ventriculomegaly) was calculated for diagnostic scan, scans during weeks 1-4, and maximum measurement prior to intervention. Threshold values that optimized sensitivity and specificity were derived. A total of 1254 scans in 132 patients were measured. In all, 37 patients had a neurosurgical intervention. All indices differed between those with and without intervention from the first diagnostic scan (p < 0.001). AUC of maximum measurement was 97.1% (95% CI 94.6-99.7) for FOHR, 97.7% (95% CI 95.6-99.8) for FTHR, 96.6% (95% CI 93.9-99.4) for AHW, and 96.8% (95% CI 94.0-99.5) for VI. Calculated thresholds were FOHR 0.66, FTHR 0.62, AHW 15.5 mm, and VI 8.4 mm > p97 (sensitivities >86.8%, specificities >90.1%). Ventriculomegaly indices were greater for patients who developed progressive persistent ventriculomegaly from the first diagnostic scan and predicted neurosurgical intervention. We derived thresholds of common ventriculomegaly indices (ventricular index, anterior frontal horn width, fronto-occipital horn and fronto-temporal horn index) to best predict the development of progressive symptomatic post-hemorrhage hydrocephalus in preterm infants with intraventricular hemorrhage. While current thresholds were established by a priori expert consensus, we report the first data-driven derivation of ventriculomegaly thresholds across all indices for the prediction of symptomatic hydrocephalus. Data-derived thresholds will more precisely weigh the risks and benefits of early intervention.

Difficulties in monitoring of premature infants in outpatient facilities (third stage of nursing)

Premature birth remains an urgent problem of modern healthcare around the world. At the same time, the improvement of neonatal care for premature babies has led to a significant decrease in infant mortality and an increase in the survival rate of children with very low and extremely low body weight. Nursing and monitoring such children requires a special approach. A premature baby has one or more reasons for the early development of chronic pathology and needs a long-term, differentiated, continuous monitoring, provided a clear continuity of all stages of nursing.The article presents the results of observation of premature babies in 20 polyclinics of Saint Petersburg in the first year of life at the time of the study. The authors analyzed medical histories (form 112/y) of 88 children born prematurely (from 22 to 36 weeks of gestation). It has been determined that most often the dispensary observation groups include children with pathology of the central nervous system, organs of vision, and surgical pathology. Insufficient coverage with vaccine prophylaxis (from 33 to 78% for various vaccine-preventable infections) was revealed not only with additional drugs for the risk group, but also with the main vaccinations of the National Calendar. Monitoring premature babies, their rehabilitation and habilitation are the responsibility of the third (outpatient) level of nursing. However, the lack of uniform approaches to dispensary observation, rehabilitation treatment of premature babies, the lack of clear routing create difficulties in the management of such children in a polyclinic. The authors proposed options for solving this important problem in order to increase the efficiency of the primary pediatric care for premature babies at the place of residence of the child.

Development of the Ontogenetic Self-Regulation Clock.

To date, there is no overarching proposition for the ontogenetic-neurobiological basis of self-regulation. This paper suggests that the balanced self-regulatory reaction of the fetus, newborn and infant is based on a complex mechanism starting from early brainstem development and continuing to progressive control of the cortex over the brainstem. It is suggested that this balance occurs through the synchronous reactivity between the sympathetic and parasympathetic systems, both which originate from the brainstem. The paper presents an evidence-based approach in which molecular excitation-inhibition balance, interchanges between excitatory and inhibitory roles of neurotransmitters as well as cardiovascular and white matter development across gestational ages, are shown to create sympathetic-parasympathetic synchrony, including the postnatal development of electroencephalogram waves and vagal tone. These occur in developmental milestones detectable in the same time windows (sensitive periods of development) within a convergent systematic progress. This ontogenetic stepwise process is termed “the self-regulation clock” and suggest that this clock is located in the largest connection between the brainstem and the cortex, the corticospinal tract. This novel evidence-based new theory paves the way towards more accurate hypotheses and complex studies of self-regulation and its biological basis, as well as pointing to time windows for interventions in preterm infants. The paper also describes the developing indirect signaling between the suprachiasmatic nucleus and the corticospinal tract. Finally, the paper proposes novel hypotheses for molecular, structural and functional investigation of the “clock” circuitry, including its associations with other biological clocks. This complex circuitry is suggested to be responsible for the developing self-regulatory functions and their neurobehavioral correlates.

Evaluation of melatonin efficacy in prevention of bronchopulmonary dysplasia in preterm newborn infants.

Excessive production of reactive oxygen species play an important role in the pathogenesis of bronchopulmonary dysplasia (BPD). Melatonin is an effective antioxidant and free radical scavenger. The aim of this study was to evaluate the efficacy of melatonin in the prevention of BPD in preterm infants with respiratory distress syndrome. In a randomized clinical trial, 80 preterm newborn infants with respiratory distress syndrome and gestation age of 27-32 weeks were allocated randomly in two groups. Group A consisted of 40 neonates who received surfactant with the INSURE technique. Patients in group B received melatonin 5mg/kg /day per gastric tube for 3 days in addition to the surfactant. The primary outcome was on the occurrence of BPD. The secondary outcome was considered other complications of prematurity, duration of hospital stay and mortality. The mean gestational age and birth weight of studied patients were 31.3±3.8 weeks and 1189±84 grams, respectively. Thirty-five (43.8%) patients were girls and 45 (56.2%) were boys. BPD was diagnosed in 24 (60%) neonates of group A and 18 (45%) patients in group B, p=0.02. The duration of hospital stay, need for mechanical ventilation and mortality rate were significantly lower in patients in group B (p=0.02, 0.003, 0.009 respectively). Our study results showed that BPD, mortality and hospital stay reduced with melatonin treatment in preterm infants. However, future studies with a larger number of patients are needed to confirm these beneficial effects.

Profound Effect of Pulmonary Surfactant on the Treatment of Preterm Infants with Respiratory Distress Syndrome.

Inherited diseases caused by dysfunction of pulmonary surfactant metabolism or surfactant dysfunction have recently been considered the underlying causes of neonatal and pediatric respiratory diseases. Respiratory distress syndrome in premature infants is a common respiratory disease in pediatrics. It is caused by underdeveloped lungs in infants and a lack of active substances on the surface of the alveoli, which leads to insufficiency of lung function, which can lead to difficulty breathing, increased heart rate, facial bruising, and more. Neonatal Respiratory Distress Syndrome is a very dangerous disease with a high mortality rate and a great threat to children's lives and health. Therefore, enough attention and treatment should be caused in clinical practice. Natural pulmonary surfactant (PS) has achieved positive effects in the treatment of neonatal respiratory distress syndrome (RDS), reducing neonatal mortality, the application of mechanical ventilation, and the occurrence of late complications. To further explore the role of pulmonary surfactants in the treatment of neonatal respiratory distress syndrome, to analyze the best time to use PS to prevent RDS, this paper has selected premature infants with RDS received by the neonatal department of a hospital in a province from March 2019 to October 2020 to compare the efficacy of pulmonary surfactant (PS) in preterm infants with respiratory distress syndrome (RDS). The experiment has found that the average mechanical ventilation time (5.1 d) and oxygen therapy time (7.3 d) in the early group are shorter than the average mechanical ventilation time (6.4 d) and oxygen therapy time (10.6 d) in the late group. It has been demonstrated that early administration of pulmonary surfactant (PS) therapy is of great help in improving respiratory distress syndrome in premature infants.

Management of Preterm Infants with Respiratory Distress Syndrome Using Non-Invasive High Frequency Ventilation versus Nasal Continuous Positive Airway Pressure

Background: Preterm infants have a risk of the respiratory distress syndrome (RDS). Helpful effects of high-frequency ventilators have been shown within management of RDS as well as the use of these ventilators as the initial mode of support or as a rescue treatment once failure of standard mechanical ventilation. Objective: This study aimed to compare between the nasal high-frequency oscillatory ventilation (nHFOV) and nasal continuous positive airway pressure (NCPAP) in the treatment of preterm infants with RDS in. Patients and methods: A study included 62 neonates with respiratory distress syndrome and was conducted at neonatal intensive care unit, Pediatrics Department, Zagazig University Hospital. Cases were divided into; group (A) was managed with non-invasive high frequency nasal ventilation and group (B) was managed with nasal continuous positive airway pressure. All cases were subjected to full medical history, clinical assessment, laboratory investigations and Silverman Score for respiratory distress grading. Results: There was statistically non-significant difference between the studied groups regarding occurrence of nasal injury, oxygen supply after study and need for use of surfactant. There was statistically non-significant difference between the studied groups regarding x ray findings before or by the end of the study. There was statistically significant relation between gestational age groups and need for surfactant in NHFV group. Conclusion: Noninvasive high frequency ventilation (NHFV) represent a better primary non-invasive mode than NCPAP in treatment of preterm infants with RDS.

A study of heated, humidified high flow nasal cannula as an initial respiratory support in preterm neonates

Abstract Background There is an increased use of heated, humidified, high-flow nasal cannula (HHFNC) as a non-invasive respiratory support. Yet, there are limited data that compares it with nasal continuous positive airway pressure (nCPAP) as regard the efficacy &amp; outcome when used for initial treatment in preterm infants with respiratory distress syndrome (RDS) shortly postnatal. Method A prospective study conducted aiming to evaluate the effectiveness &amp; outcome of HHFNC compared to nCPAP for the treatment of preterm infants with RDS. Preterms &amp;lt; 35 weeks of gestational age with symptoms and signs of RDS early after birth were randomized to HHFNC or nCPAP. Primary outcome was the incidence of treatment failure (defined as need for upgrading to noninvasive positive pressure ventilation or invasive ventilation). Results Analysis of the randomly allocated infants to HHFNC and nCPAP showed no significant difference in treatment failure (P &amp;gt; 0.05). There was also no significant difference (P &amp;gt; 0.05) among groups as regard mortality, sepsis, necrotizing enterocolitis, incidence of interventricular hemorrhage and bronchopulmonary dysplasia. Conclusion This indicates that HHFNC may be used as an equally effective and safe method of non-invasive ventilation when compared to nCPAP for initial respiratory support in preterm infants with respiratory distress.

Head Growth and Neurodevelopment of Preterm Infants with Surgical Necrotizing Enterocolitis and Spontaneous Intestinal Perforation.

Spontaneous intestinal perforation (SIP) and surgical necrotizing enterocolitis (NEC) are intestinal conditions requiring surgical intervention in preterm infants. We aimed to compare the head growth and neurodevelopment of preterm infants with SIP and surgical NEC. A retrospective single-center study was performed in preterm infants born at less than 32 weeks of gestation and who had undergone surgery for NEC or SIP. Data from the Bayley Scales of Infant and Toddler Development 3rd Edition (Bayley-III) at 24 months of corrected age (CA) and the Korean Ages and Stages Questionnaire (K-ASQ) or Korean Developmental Screening Test (K-DST) at 36 months were collected. Among 82 eligible infants, 60 infants had surgical NEC, and 22 infants were diagnosed with SIP. Head growth was faster until CA 4 months in preterm infants with SIP than in those with surgical NEC. At 36 months, abnormal findings in the K-ASQ or K-DST were more prevalent in the NEC group than in the SIP group in the gross motor (48.2% vs. 0%, p = 0.015), fine motor (40.7% vs. 0%, p = 0.037), cognitive (55.6% vs. 12.5%, p = 0.047), and social domains (44.4% vs. 0%, p = 0.032). More studies evaluating the neurodevelopmental outcomes of preterm infants with surgical NEC and SIP are required.

Predictive Tool for Closure of Ductus Arteriosus with Pharmacologic or Surgical Treatment in Preterm Infants.

To construct a model with the indices obtained by echocardiography to predict whether patent ductus arteriosus (PDA) was required to be treated with pharmacologic treatment or surgical ligation, we performed a prospective observational study, including all neonates with gestational age ≤ 30 weeks and assessed the hemodynamics of PDA by serial daily echocardiography examination at postnatal age of 0–12 h, 24 h, 48 h, and 72 h, respectively. The infants were classified in two groups based on whether they were treated with non-steroidal anti-inflammatory drugs (NSAIDs) and/or surgical ligation to close the PDA from the second week after birth. We compared the echocardiographic indices between the two groups and utilized the indices to construct a model to predict which premature infants’ PDA requires intervention. The results showed that a total of forty-two preterm infants were enrolled in the study. 15 (35.7%) preterms were in the intervention group and 27 (64.3%) preterms were in the non-intervention group. Compared with the non-intervention group, the intervention group had a higher proportion of left ventricular volume overload and systemic shunt effect. In addition, the combined indicators of PDA size/weight > 3.2 mm/kg and LA/Ao > 1.4 at postnatal age of 72 h had a highest value to predict whether PDA requires intervention. These findings denoted that serial daily echocardiographic assessment can be useful in predicting whether a PDA will be closed with NSAIDs and/or surgical ligation in preterm infants with gestational age ≤ 30 weeks.Trial registration Number: IRB No. 2018-IRB-073. Date: 2018/09/21, retrospectively registered.

Effect of physical rehabilitation programs on the recovery sensorimotor functions in premature infants during the postnatal ontogenes’s period

Introduction.Improving the treatment of premature infants is one of the priorities in the development of perinatal care for children in Russia. The widespread introduction of modern high-tech methods of resuscitation of premature children has shown its effectiveness in improving their survival. However this has led to an increase in various health disorders. Therefore, it is extremely important to determine and practically use effective technologies of medical care that will not only save the lives of children born prematurely, but also significantly affect their health indicators in subsequent age periods.Purpose of the study. To study the influence of various physical rehabilitation programs on the development of adaptive reactions and correction of impaired sensorimotor functions in early postnatal ontogenesis in premature infants.Materials and methods.A comprehensive study of 120 infants in the first year of life was carried out, including functional testing, anthropometric, general clinical and physiological methods for the development and assessment of the impact of physical rehabilitation programs of different volume and content on sensorimotor development and the state of adaptive capabilities of the body of premature infants in the first year of life.Results.The maximum effectiveness of rehabilitation measures for premature infants of the first year of life was noted only with a combination of sympathetic type of autonomic regulation of the heart rate and a program that included therapeutic exercises, massage, dry immersion and hydrokinesitherapy. In premature babies with a pronounced predominance of sympathetic regulation of the heart rhythm, the smallest rehabilitation programs are most appropriate.Conclusions. When developing a physical rehabilitation program, it is necessary to take into account the state of the adaptive capabilities of the body of premature infants in the first year of life, which can be determined by the type of autonomic regulation of the heart rate.

Effect of Oral Motor Intervention on Oral Feeding in Preterm Infants: A Systematic Review and Meta-Analysis.

Objective This review article aimed to explore the effect of oral motor intervention on oral feeding in preterm infants through a meta-analysis. Method Eligible studies were retrieved from four databases (PubMed, Embase, Cochrane Library, and Web of Science) up to July 2020 and screened based on established selection criteria. Thereafter, relevant data were extracted and heterogeneity tests were conducted to select appropriate effect models according to the chi-square test and I 2 statistics. Assessment of risk of bias was performed among the included studies. Finally, a meta-analysis was carried out to evaluate the effect of oral motor intervention in preterm infants according to four clinical indicators: transition time for oral feeding, length of hospital stay, feeding efficiency, and weight gain. Results Eighteen randomized controlled trials with 848 participants were selected to evaluate the effect of oral motor intervention on preterm infants. The meta-analysis results revealed that oral motor intervention could effectively reduce the transition time to full oral feeds and the length of hospital stay as well as increase feeding efficiency and weight gain. Conclusions Oral motor intervention was an effective way to improve oral feeding in preterm infants. It is worthy to be used widely in hospitals to improve the clinical outcomes of preterm infants and reduce the economic burdens of families and society. Future studies should seek to identify detailed intervention processes and intervention durations for clinical application.

Система диагностики, наблюдения и лечения недоношенных детей

Purpose. Тo analyze of the effectiveness of the monitoring and treatment of premature babies. Material and methods. From 2012 to 2020 we observed 2113 preterm infants. Retinopathy of prematurity (ROP) was revealed in 731 cases (34.59%), 29 of them with aggressive posterior ROP (AP-ROP) (3.97%). 199 patients (27.22%) had indications for laser coagulation of the retina (LCR); repeated interventions were performed in 23 cases (11.56%). In 173 case (86.94%), an induced regression of the disease occurred. An unfavorable outcome of ROP was diagnosed in 26 cases (13.06%). 258 children with a cicatricial phase of ROP were dynamic observed. Results and conclusions. The effectiveness of LCR at the threshold stage has reached at 94.78%. Regression in type-I occurred in 89.09%. In cases of AP-ROP, the efficiency of LCR was 51.72%. The total number of children with terminal stages was 106 people (14.5%). In the cicatricial period of 258 people, 134 revealed ametropia, secondary glaucoma in 7 patients, complicated cataract in 6 and strabismus in 35. Timely diagnostics and monitoring reveals early signs of ROP and laser treatment. These activities minimize risk of disability from blindness and low vision. An insignificant number of LCR performed, a small number of patients with terminal stages of ROP indicates the high efficiency of modern conditions for nursing premature babies. Functional results depend on the degree of residual changes, refractive pathology and strabismus. Correction of ametropia, functional treatment, strabismus surgery in the preschool period, allow to develop and maintain visual function in the most of patients in the cicatricial phase of ROP. Key words: retinopathy of prematurity, laser coagulation of the retina, aggressive posterior retinopathy of prematurity.

Comparative study on the early growth of preterm infants with the World Health Organization growth standards and the China growth charts.

BackgroundThis study focused on comparing the applicability and efficacy of the World Health Organization (WHO) growth standards and the China growth charts in diagnosing malnutrition and indicating nutritional interventions in preterm infants.MethodsSix hundred and eighty‐three preterm infants were involved and their anthropometric data were collected. The proportion of weight and head circumference less than the 10th percentile (P10), weight less than the 25th percentile (P25), and weight for length greater than the 90th percentile (P90) identified by the WHO growth standards and the China growth charts were compared.ResultsAt corrected age (CA) 1 ~< 2 months (m), the proportion of head circumference <P10 assessed by the WHO growth standards was higher than that assessed by the China growth charts by approximately 4.4% in boys and 6.6% in girls. During infancy, both boys and girls had lower proportions of weight <P10 and weight <P25 with the WHO growth standards than with the China growth charts: 5.1% and 5.6%, respectively, for weight <P10 and 7.0% and 8.8%, respectively, for weight <P25. For boys older than CA 1 m and for girls older than CA 3 m, the proportion of weight‐for‐length >P90 assessed by the WHO growth standards was greater than that assessed by the China growth charts.ConclusionsCompared with the China growth charts, the WHO growth standards can further reduce the number of diagnoses of abnormal physical growth, are more helpful in avoiding overnutrition interventions, and are more sensitive in the early detection of delayed head circumference growth.

Diuretic therapy and acute kidney injury in preterm neonates and infants.

Acute kidney injury (AKI) in preterm infants is associated with prolonged hospitalization and high mortality. Diuretic therapy has been used to enhance urine output in preterm infants with AKI. Treatment with diuretics, prescription patterns, and relationship with length of stay (LOS), mechanical ventilation (MV), and mortality in preterm infants who also had AKI have not been fully evaluated. This multicenter retrospective study used the Pediatric Hospital Information System database. We included 2121 preterm infants with AKI diagnosis from 46 hospital Neonatal Intensive Care Units (NICUs) born <37 weeks gestational age (GA). Treatment with diuretics, practice patterns across 46 NICUs in the USA, and associated outcomes including LOS, MV, and mortality were evaluated. Seventy-six percent of infants received at least one dose of diuretics (median treatment 18 days). Diuretic prescription varied significantly across hospitals and ranged from 42 to 96%. Diuretics were used more frequently in infants with younger GA and smaller birth weight. Infants with older GA who received diuretics at or before 28 days postnatally had worse survival even after adjusting for known confounders. Preterm infants with AKI diagnosis were frequently treated with diuretics. Moreover, infants with younger GA and smaller birth weight were more likely to receive diuretics. Worse survival in infants with older GA who received diuretics could be the result of more underlying severe illness in these infants and not the cause of more severe illness. Prospective studies are needed to best determine patient safety and outcomes with diuretic treatment in preterm infants with AKI. A higher resolution version of the Graphical abstract is available as Supplementary information.