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Kumar P, Yadav A, Anand P, Debata P. Predictors of CPAP failure with RAM cannula interface for primary respiratory support in preterm neonates. Med J Armed Forces India 2024; 80:60-67. [PMID: 38261886 PMCID: PMC10793224 DOI: 10.1016/j.mjafi.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background RAM cannula is used as interface for delivering nasal continuous positive airway pressure (nCPAP) in many neonatal care units though the bench to bedside evidence for its use in clinical settings in lacking. Methods In this prospective cohort study from tertiary care neonatal care unit, the primary objective was to determine the rate of CPAP failure using RAM interface, within 72 h of starting of therapy and secondary objective was to look for the incidence and severity of nasal trauma with the use of RAM interface for CPAP delivery. All inborn preterm neonates between 28 and 32 weeks of gestation and weight more than 1000 g who required non-invasive respiratory support within 6 h of life were included in the study. Results The enroled cohort of 250 neonates had mean gestational age of 30.73 ± 1.32 weeks and mean birth weight of 1410 ± 210 g. CPAP failure rate with the use of RAM interface was 31.2% (78/250) in the overall cohort. The failure rate was higher in subgroup of gestation between 28 and 30 week (52.1%) in comparison with the 31-32-week gestation (18.2%; p-value = 0.0001). Nasal trauma was present in 36 (14%) neonates; of whom 33 (91%) had mild and 2 (6%) and 1 (3%) had moderate and severe, respectively. On multivariate analysis, birth weight less than 1250 g, incomplete antenatal steroids, need for PEEP more than 5 cm & FiO2 > 30% at onset of distress and administration of surfactant were found be statistically significantly associated with CPAP failure with RAM interface. Conclusion The clinical outcomes with the use of RAM interface for CPAP administration are comparable to those with other interfaces with lesser incidence of nasal injury. The results of this study warrant future randomized trials to compare different CPAP interfaces for clinical outcomes and nasal injuries from the developing countries.
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Affiliation(s)
- Pradeep Kumar
- Senior Resident (Pediatrics), Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Anita Yadav
- Associate Professor (Pediatrics), Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Pratima Anand
- Chief Medical Officer (Pediatrics), Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Pradeep Debata
- Professor (Pediatrics), Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
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2
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Silva ER, Shukla VV, Tindal R, Carlo WA, Travers CP. Association of Active Postnatal Care With Infant Survival Among Periviable Infants in the US. JAMA Netw Open 2023; 6:e2250593. [PMID: 36656583 PMCID: PMC9856598 DOI: 10.1001/jamanetworkopen.2022.50593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
IMPORTANCE Active postnatal care has been associated with center differences in survival among periviable infants. Regional differences in outcomes among periviable infants in the US may be associated with differences in active postnatal care. OBJECTIVE To determine if regions with higher rates of active postnatal care will have higher gestational age-specific survival rates among periviable infants. DESIGN, SETTING, AND PARTICIPANTS This cohort study included live births from 22 to 25 weeks' gestation weighing 400 to 999 g in the US Centers for Disease Control and Prevention (CDC) WONDER 2017 to 2020 (expanded) database. Infants with congenital anomalies were excluded. Active postnatal care was defined using the CDC definition of abnormal conditions of newborn as presence of any of the following: neonatal intensive care unit (NICU) admission, surfactant, assisted ventilation, antibiotics, and seizures. Data were analyzed from August to November 2022. MAIN OUTCOMES AND MEASURES Regional gestational age-specific survival rates were compared with rates of active postnatal care in the 10 US Health and Human Services regions using Kendall τ test. RESULTS We included 41 707 periviable infants, of whom 32 674 (78%) were singletons and 19 467 (46.7%) were female. Among those studied 34 983 (83.9%) had evidence of active care, and 26 009 (62.6%) survived. Regional rates of active postnatal care were positively correlated with regional survival rates at 22 weeks' gestation (rτ[8] = 0.56; r2 = 0.31; P = .03) but the correlation was not significant at 23 weeks' gestation (rτ[8] = 0.47; r2 = 0.22; P = .07). There was no correlation between active care and survival at 24 or 25 weeks' gestation. Regional rates of both NICU admission and assisted ventilation following delivery were positively correlated with regional rates of survival at 22 weeks' gestation (both P < .05). Regional rates of antenatal corticosteroids exposure were also positively correlated with regional rates of survival at 22 weeks' gestation (rτ[8] = 0.60; r2 = 0.36; P = .02). CONCLUSIONS AND RELEVANCE In this cohort study of 41 707 periviable infants, regional differences in rates of active postnatal care, neonatal intensive care unit admission, provision of assisted ventilation and antenatal corticosteroid exposure were moderately correlated with survival at 22 weeks' gestation. Further studies focused on individual-level factors associated with active periviable care are warranted.
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Affiliation(s)
- Emani R. Silva
- University of Alabama at Birmingham School of Medicine, Birmingham
| | - Vivek V. Shukla
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham
| | - Rachel Tindal
- University of Alabama at Birmingham School of Medicine, Birmingham
| | - Waldemar A. Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham
| | - Colm P. Travers
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham
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3
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Liu JY, Sayes CM. Lung surfactant as a biophysical assay for inhalation toxicology. Curr Res Toxicol 2022; 4:100101. [PMID: 36687216 PMCID: PMC9849875 DOI: 10.1016/j.crtox.2022.100101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/21/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Lung surfactant (LS) is a mixture of lipids and proteins that forms a thin film at the gas-exchange surfaces of the alveoli. The components and ultrastructure of LS contribute to its biophysical and biochemical functions in the respiratory system, most notably the lowering of surface tension to facilitate breathing mechanics. LS inhibition can be caused by metabolic deficiencies or the intrusion of endogenous or exogenous substances. While LS has been sourced from animals or synthesized for clinical therapeutics, the biofluid mixture has also gained recent interest as a biophysical model for inhalation toxicity. Various methods can be used to evaluate LS function quantitatively or qualitatively after exposure to potential toxicants. A narrative review of the recent literature was conducted. Studies focused whether LS was inhibited by various environmental contaminants, nanoparticles, or manufactured products. A review is also conducted on synthetic lung surfactants (SLS), which have emerged as a promising alternative to conventional animal-sourced LS. The intrinsic advantages and recent advances of SLS make a strong case for more widespread usage in LS-based toxicological assays.
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Affiliation(s)
| | - Christie M. Sayes
- Corresponding author at: Baylor University, Department of Environmental Science, One Bear Place # 97266, Waco, TX 76798-7266.
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4
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Does active treatment in infants born at 22-23 weeks correlate with outcomes of more mature infants at the same hospital? An analysis of California NICU data, 2015-2019. J Perinatol 2022; 42:1301-1305. [PMID: 35361887 PMCID: PMC9522931 DOI: 10.1038/s41372-022-01381-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/10/2022] [Accepted: 03/22/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To investigate whether hospital rates of active treatment for infants born at 22-23 weeks is associated with survival of infants born at 24-27 weeks. STUDY DESIGN We included all liveborn infants 22-27 weeks of gestation delivered at California Perinatal Quality Care Collaborative hospitals from 2015 to 2019. We assessed (1) the correlation of active treatment (e.g., endotracheal intubation, epinephrine) in 22-23 week infants and survival until discharge for 24-27 week infants and (2) the association of active treatment with survival using multilevel models. RESULT The 22-23 week active treatment rate was associated with infant outcomes at 22-23 weeks but not 24-27 weeks. A 10% increase in active treatment did not relate to 24-25 week (adjusted OR: 1.00 [95% CI: 0.95-1.05]), or 26-27 week survival (aOR: 1.02 [0.95-1.09]). CONCLUSION The hospital rate of active treatment for infants born at 22-23 weeks was not associated with improved survival for 24-27 week infants.
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5
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Changes Overtime in Perinatal Management and Outcomes of Extremely Preterm Infants in One Tertiary Care Romanian Center. Medicina (B Aires) 2022; 58:medicina58081019. [PMID: 36013486 PMCID: PMC9414928 DOI: 10.3390/medicina58081019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/18/2022] [Accepted: 07/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background and Objectives: Extremely preterm infants were at increased risk of mortality and morbidity. The purpose of this study was to: (1) examine changes over time in perinatal management, mortality, and major neonatal morbidities among infants born at 250–286 weeks’ gestational age and cared for at one Romanian tertiary care unit and (2) compare the differences with available international data. Material and Methods: This study consisted of infants born at 250–286 weeks in one tertiary neonatal academic center in Romania during two 4-year periods (2007–2010 and 2015–2018). Major morbidities were defined as any of the following: severe intraventricular hemorrhage (IVH), severe retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), and bronchopulmonary dysplasia (BPD). Adjusted logistic regression models examined the association between the mortality and morbidity outcome and the study period. Results: The two cohorts differed with respect to antenatal antibiotics and rates of cesarean birth but had similar exposure to antenatal steroids and newborn referral to the tertiary care center. In logistic regression analyses, infants in the newer compared to the older cohort had a lower incidence of death (OR: 0.19; 95% CI: 0.11–0.35), a lower incidence of IVH (OR: 0.26; 95% CI: 0.15–0.46), and increased incidence of NEC (OR: 19.37; 95% CI: 2.41–155.11). Conclusions: Changes over time included higher use of antenatal antibiotics and cesarean delivery and no change in antenatal steroids administration. Overall mortality was lower in the newer cohort, especially for infants 250–266 weeks’ gestation, NEC was higher while BPD and ROP were not different.
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Sawada Y, Honda N, Narumiya M, Mizumoto H. Evaluation of the social skills of low birthweight infants using the Interaction Rating Scale. J Phys Ther Sci 2022; 34:697-703. [PMID: 36213188 PMCID: PMC9535250 DOI: 10.1589/jpts.34.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to examine, using the Interaction Rating Scale, the effect of
social skills at 18 months of life on the subsequent development of low birthweight
infants. [Participants and Methods] The study participants were made up of a total of 23
infants who were admitted to the neonatal intensive care unit of Hospital A and whose
developmental indexes were followed up at the outpatient clinic for up to 3 years of age.
The survey was conducted twice in each infant, at a corrected age of 18 months and at 36
full months of age. Social skills and developmental indexes were assessed at the corrected
age of 18 months, meanwhile only developmental indexes were assessed at 36 full months, to
examine associations. The Interaction Rating Scale was used to assess social skills. This
scale measures various aspects of social development by observing caregiver-child
interactions in situations wherein children are engaged in tasks more difficult for their
age. [Results] The results demonstrated that social skills at 18 months were associated
with the developmental indexes at 18 and 36 months, whereas more items were associated
with the developmental index at 36 months. [Conclusion] The results indicate the need for
early prediction of developmental delay and timely intervention, by assessing social
skills in low birthweight infants.
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Affiliation(s)
- Yuko Sawada
- Department of Physical Therapy, Morinomiya University of Medical Sciences: 1-26-16 Nanko-kita, Suminoe-ku, Osaka 559-8611, Japan
| | - Noritsugu Honda
- Department of Physical Therapy, Morinomiya University of Medical Sciences: 1-26-16 Nanko-kita, Suminoe-ku, Osaka 559-8611, Japan
| | - Makiko Narumiya
- Department of Pediatrics, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Japan
| | - Hiroshi Mizumoto
- Rehabilitation Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Japan
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Berger JN, Elgin TG, Dagle JM, Klein JM, Colaizy TT. Survival and short-term respiratory outcomes of <750 g infants initially intubated with 2.0 mm vs. 2.5 mm endotracheal tubes. J Perinatol 2022; 42:202-208. [PMID: 34675371 PMCID: PMC8529572 DOI: 10.1038/s41372-021-01227-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 09/17/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare survival and short-term respiratory outcomes of infants weighing <750 g initially intubated with 2.0 mm versus 2.5 mm endotracheal tube (ETT). STUDY DESIGN Retrospective, observational cohort study. RESULTS Of 149 inborn infants weighing <750 g admitted to the NICU, 69 (46%) were intubated with 2.0 mm ETT, 78 with 2.5 mm ETT (53%), and 2 infants never required intubation. Infants intubated with 2.0 mm ETT were more premature (median gestational age (GA) 23 weeks (22, 24) vs. 24 weeks (24, 25) p < 0.0001), smaller (median birth weight 545 g (450, 616) vs. 648 g (579, 700), p < 0.0001), and more frequently intubated at delivery (96% vs. 68%, p < 0.00001). Survival to discharge was similar 77%, 53/69 and 87%, 68/78 (p = 0.09). Adjusted for GA, there were no significant differences in ventilator days (p = 0.7338) or Grade 3 BPD. CONCLUSIONS Premature infants born at a median GA of 23 weeks and median birth weight of 545 g can be successfully managed with 2.0 mm ETT.
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Affiliation(s)
| | - Timothy G. Elgin
- grid.214572.70000 0004 1936 8294University of Iowa, Stead Family Department of Pediatrics, Iowa City, IA USA
| | - John M. Dagle
- grid.214572.70000 0004 1936 8294University of Iowa, Stead Family Department of Pediatrics, Iowa City, IA USA
| | - Jonathan M. Klein
- grid.214572.70000 0004 1936 8294University of Iowa, Stead Family Department of Pediatrics, Iowa City, IA USA
| | - Tarah T. Colaizy
- grid.214572.70000 0004 1936 8294University of Iowa, Stead Family Department of Pediatrics, Iowa City, IA USA
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8
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Parmigiani S, Bevilacqua G. Non-invasive administration of poractant-α in neonatal respiratory distress syndrome via a supraglottic device in the clinical practice in a second level neonatal unit: comparison of LMA® vs iGel® devices. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022045. [PMID: 35315413 PMCID: PMC8972888 DOI: 10.23750/abm.v93i1.11649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 11/24/2022]
Abstract
Non-invasive pulmonary surfactant (SF) administration for neonatal respiratory distress syndrome (NRDS) is a development of administration of SF. Administration of SF via a supraglottic device (SGD) has been shown to be effective. Here the results of administration of SF in NRDS in infants requiring oxygen and nasal-CPAP (n-CPAP) via two types of SGDs, LMA® vs iGel®, in a second level Neonatal Unit are reported in a retrospective study. Results - Fourteen infants in the LMA®Group were matched with 21 comparable infants in the iGel® Group (g.a. ≥30 wks and b.w. ≥ 1,500 gr) presenting NRDS with fraction of inspired oxygen (FiO2) ≥ 0.25 - 0.6, requiring n-CPAP. All infants presented a significant improvement of PaO2/FiO2 ratio that was seen earlier in the iGel® Group vs the LMA® Group. There was no severe adverse effect during the maneuver with both SGDs. No baby died, No.2 required endotracheal intubation for a second dose of SF as by protocol, and No. 1 was transferred to a higher level of care. Conclusion - Non-invasive SF administration via SGD has been done effectively at a second level Neonatal Unit and very early in the course of the disease therefore limiting transfer of the baby without complications with both SGDs. Improvement in gas exchange was more rapid in the iGel®Group. This result needs confirmation. In our experience iGel® was easier to use than LMA®.
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Affiliation(s)
- Stefano Parmigiani
- ASL5 Spezzino Eastern Liguria Hospital Mother-Infant Department Pediatrics and Neonatal Unit, La Spezia, Italy
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9
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Lee M, Hall ES, Taylor M, DeFranco EA. Regional Contribution of Previable Infant Deaths to Infant Mortality Rates in the United States. Am J Perinatol 2021; 38:158-165. [PMID: 31480083 DOI: 10.1055/s-0039-1695014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Lack of standardization of infant mortality rate (IMR) calculation between regions in the United States makes comparisons potentially biased. This study aimed to quantify differences in the contribution of early previable live births (<20 weeks) to U.S. regional IMR. STUDY DESIGN Population-based cohort study of all U.S. live births and infant deaths recorded between 2007 and 2014 using Centers for Disease Control and Prevention's (CDC's) WONDER database linked birth/infant death records (births from 17-47 weeks). Proportion of infant deaths attributable to births <20 vs. 20 to 47 weeks, and difference (ΔIMR) between reported and modified (births ≥20 weeks) IMRs were compared across four U.S. census regions (North, South, Midwest, and West). RESULTS Percentages of infant deaths attributable to birth <20 weeks were 6.3, 6.3, 5.3, and 4.1% of total deaths for Northeast, Midwest, South, and West, respectively, p < 0.001. Contribution of < 20-week deaths to each region's IMR was 0.34, 0.42, 0.37, and 0.2 per 1,000 live births. Modified IMR yielded less regional variation with IMRs of 5.1, 6.2, 6.6, and 4.9 per 1,000 live births. CONCLUSION Live births at <20 weeks contribute significantly to IMR as all result in infant death. Standardization of gestational age cut-off results in more consistent IMRs among U.S. regions and would result in U.S. IMR rates exceeding the healthy people 2020 goal of 6.0 per 1,000 live births.
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Affiliation(s)
- MacKenzie Lee
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Eric S Hall
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Meredith Taylor
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Emily A DeFranco
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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10
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Kim JK, Hwang JH, Lee MH, Chang YS, Park WS. Mortality rate-dependent variations in antenatal corticosteroid-associated outcomes in very low birth weight infants with 23-34 weeks of gestation: A nationwide cohort study. PLoS One 2020; 15:e0240168. [PMID: 33017428 PMCID: PMC7535030 DOI: 10.1371/journal.pone.0240168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/21/2020] [Indexed: 12/21/2022] Open
Abstract
Antenatal corticosteroid (ACS) administration has been known as one of the most effective treatment in perinatal medicine, but the beneficial effects of ACS may vary not only gestational age, but also the quality of perinatal and neonatal care of the institution. This nationwide cohort study of the Korean Neonatal Network (KNN) data was consisted of <1,500g infants born at 23–34 weeks at 67 KNN hospitals between 2013 and 2017. The 9,142 eligible infants were assigned into two groups–group 1 and 2 <50% and ≥50% mortality rate, respectively, for 23–24 weeks’ gestation–reflecting the quality of perinatal and neonatal care. Each group of infants were further stratified into 23–24, 25–26, 27–28, and 29–34 weeks of gestation age. Despite comparable ACS usage between group 1 (82%) and group 2 (81%), the benefits of ACS were only observed in group 1. In the multivariable analyses, infants of group 1 showed significant decrease in mortality and IVH at gestational age 23–24 weeks with ACS use, and the decrease was also seen in early-onset sepsis and respiratory distress syndrome at gestational age of 29–34 weeks while there were no significant decrease in group 2. In this study the overall data was congruent with the previous findings stating that ACS use decreases mortality and morbidity. These results indicate that the improved mortality of infants at 23–24 weeks’ gestation reflects the quality improvement of perinatal and neonatal intensive care, which is a prerequisite to the benefits of ACS.
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Affiliation(s)
- Jin Kyu Kim
- Department of Pediatrics, Jeonbuk National University School of Medicine, Jeonju, Korea
- Biomedical Research Institute of Jeonbuk National University Hospital, Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea
| | - Jong Hee Hwang
- Department of Pediatrics, Ilsan Paik Hospital, InJe University College of Medicine, Goyang, Korea
| | - Myung Hee Lee
- Statistic and Data Center, Samsung Medical Center, Seoul, Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Soon Park
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
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11
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Puia-Dumitrescu M, Greenberg RG, Younge N, Bidegain M, Cotten CM, McCaffrey M, Murtha A, Gutierrez S, DeJoseph J, Cochran KM, Ollendorff A. Disparities in the use of antenatal corticosteroids among women with hypertension in North Carolina. J Perinatol 2020; 40:456-462. [PMID: 31767978 PMCID: PMC7455922 DOI: 10.1038/s41372-019-0555-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 10/29/2019] [Accepted: 11/07/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate antenatal corticosteroids (ANS) use in pregnant women with hypertension. STUDY DESIGN Retrospective analysis of ANS use in the Perinatal Quality Collaborative of North Carolina between 2015 and 2017. RESULTS Twenty-five centers participated, with 9% (1580/17,692) of mothers delivering at <34 weeks; of these, 81% (1286/1580) received a full course of ANS, which was not different between phases (p = 0.32), or between Level III/IV neonatal intensive care units (NICUs; 82%), and I/II NICUs (76%) (p = 0.05). In Level III/IV NICUs, White mothers were more likely to receive ANS (87%) than African Americans (77%) or other race/ethnicity (80%) (including Hispanics) (p = 0.001). ANS use did not differ among mothers with different payers (p = 0.94). CONCLUSION The rates of full ANS courses did not significantly increase from 2015-2017 and disparities persisted. Targeted efforts to improve ANS exposures among hypertensive African American and Hispanic mothers, as well as in community hospital settings are needed.
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Affiliation(s)
- Mihai Puia-Dumitrescu
- Department of Pediatrics, University of Washington, Seattle, WA, USA,Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Rachel G. Greenberg
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA,Duke Clinical Research Institute, Durham, NC, USA,Perinatal Quality Collaborative North Carolina, Chapel Hill, NC, USA
| | - Noelle Younge
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Margarita Bidegain
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
| | - C. Michael Cotten
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Martin McCaffrey
- Perinatal Quality Collaborative North Carolina, Chapel Hill, NC, USA,Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA
| | - Amy Murtha
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Susan Gutierrez
- Perinatal Quality Collaborative North Carolina, Chapel Hill, NC, USA
| | - Jodi DeJoseph
- Perinatal Quality Collaborative North Carolina, Chapel Hill, NC, USA
| | - Keith M. Cochran
- Perinatal Quality Collaborative North Carolina, Chapel Hill, NC, USA
| | - Arthur Ollendorff
- Perinatal Quality Collaborative North Carolina, Chapel Hill, NC, USA,Mountain Area Health Education Center (MAHEC) OB/GYN Specialists, Asheville, NC, USA
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12
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Outcomes at 18 to 22 Months of Corrected Age for Infants Born at 22 to 25 Weeks of Gestation in a Center Practicing Active Management. J Pediatr 2020; 217:52-58.e1. [PMID: 31606151 DOI: 10.1016/j.jpeds.2019.08.028] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/26/2019] [Accepted: 08/12/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the outcomes in actively managed extremely preterm infants after admission to a neonatal intensive care unit. STUDY DESIGN Retrospective cohort of 255 infants born at 22-25 weeks of gestation between 2006 and 2015 at a single study institution. Infants were excluded for congenital anomaly, death in delivery room, or parental request for palliation (n = 7). Neurodevelopmental outcomes were analyzed for 169 of 214 survivors (78.9%) at 18-22 months of corrected age. Outcomes were evaluated using the Mann-Whitney U, χ2, or Fisher exact test, where appropriate. In addition, cognitive scores of the Bayley Scales of Infant-Toddler Development (3rd edition) were assessed using generalized estimating equations. RESULTS Seventy infants born at 22-23 weeks of gestation (22 weeks, n = 20; 23 weeks, n = 50) and 178 infants born at 24-25 weeks of gestation (24 weeks, n = 79; 25 weeks, n = 99 infants) were included. Survival to hospital discharge of those surviving to NICU admission was 78% (55/70; 95% CI, 69%-88%) at 22-23 weeks and 89% (159/178; 95% CI, 84%-93% at 24-25 weeks; P = .02). No or mild neurodevelopmental impairment in surviving infants was 64% (29/45; 95% CI, 50%-77%) at 22-23 weeks and 76% (94/124; 95% CI, 68%-83%; P = .16) at 24-25 weeks. CONCLUSIONS Although survival was lower in infants born at 22-23 weeks than at 24-25 weeks of gestation, the majority of survivors in both groups had positive outcomes with no or mild neurodevelopmental impairments. Further evaluation of school performance is warranted.
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13
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Morgan AS, Khoshnood B, Diguisto C, Foix L'Helias L, Marchand-Martin L, Kaminski M, Zeitlin J, Bréart G, Goffinet F, Ancel PY. Intensity of perinatal care for extremely preterm babies and outcomes at a higher gestational age: evidence from the EPIPAGE-2 cohort study. BMC Pediatr 2020; 20:8. [PMID: 31910799 PMCID: PMC6945524 DOI: 10.1186/s12887-019-1856-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background Perinatal decision-making affects outcomes for extremely preterm babies (22–26 weeks’ gestational age (GA)): more active units have improved survival without increased morbidity. We hypothesised such units may gain skills and expertise meaning babies at higher gestational ages have better outcomes than if they were born elsewhere. We examined mortality and morbidity outcomes at age two for babies born at 27–28 weeks’ GA in relation to the intensity of perinatal care provided to extremely preterm babies. Methods Fetuses from the 2011 French national prospective EPIPAGE-2 cohort, alive at maternal admission to a level 3 hospital and delivered at 27–28 weeks’ GA, were included. Morbidity-free survival (survival without sensorimotor (blindness, deafness or cerebral palsy) disability) and overall survival at age two were examined. Sensorimotor disability and Ages and Stages Questionnaire (ASQ) result below threshold among survivors were secondary outcomes. Perinatal care intensity level was based on birth hospital, grouped using the ratio of 24–25 weeks’ GA babies admitted to neonatal intensive care to fetuses of the same gestation alive at maternal admission. Sensitivity analyses used ratios based upon antenatal steroids, Caesarean section, and newborn resuscitation. Multiple imputation was used for missing data; hierarchical logistic regression accounted for births nested within centres. Results 633 of 747 fetuses (84.7%) born at 27–28 weeks’ GA survived to age two. There were no differences in survival or morbidity-free survival: respectively, fully adjusted odds ratios were 0.96 (95% CI: 0.54 to 1.71) and 1.09 (95% CI: 0.59 to 2.01) in medium and 1.12 (95% CI: 0.63 to 2.00) and 1.16 (95% CI: 0.62 to 2.16) in high compared to low-intensity hospitals. Among survivors, there were no differences in sensorimotor disability or ASQ below threshold. Sensitivity analyses were consistent with the main results. Conclusions No difference was seen in survival or morbidity-free survival at two years of age among fetuses alive at maternal hospital admission born at 27–28 weeks’ GA, or in sensorimotor disability or presence of an ASQ below threshold among survivors. There is no evidence for an impact of intensity of perinatal care for extremely preterm babies on births at a higher gestational age.
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Affiliation(s)
- Andrei Scott Morgan
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 - Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)), INRA, Hôpital Tenon, Bâtiment Recherche, Rue de la Chine, Paris, 75020, France. .,UCL Elizabeth Garrett Anderson Institute for Women's Health, 74 Huntley Street, London, WC1E 6AU, UK. .,SAMU 93 - SMUR Pédiatrique, CHI André Gregoire, Groupe Hospitalier Universitaire Paris Seine-Saint-Denis, Assistance Publique des Hôpitaux de Paris, Montreuil, France.
| | - Babak Khoshnood
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 - Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)), INRA, Hôpital Tenon, Bâtiment Recherche, Rue de la Chine, Paris, 75020, France
| | - Caroline Diguisto
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 - Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)), INRA, Hôpital Tenon, Bâtiment Recherche, Rue de la Chine, Paris, 75020, France.,Maternité Olympe de Gouges, Centre Hospitalier Regional Universitaire Tours, Tours, France.,Université François Rabelais, Tours, France
| | - Laurence Foix L'Helias
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 - Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)), INRA, Hôpital Tenon, Bâtiment Recherche, Rue de la Chine, Paris, 75020, France.,UPMC Université Paris 6, Sorbonne Universités, Paris, France.,Service de Néonatologie, Hopital Armand Trousseau, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Laetitia Marchand-Martin
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 - Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)), INRA, Hôpital Tenon, Bâtiment Recherche, Rue de la Chine, Paris, 75020, France
| | - Monique Kaminski
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 - Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)), INRA, Hôpital Tenon, Bâtiment Recherche, Rue de la Chine, Paris, 75020, France
| | - Jennifer Zeitlin
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 - Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)), INRA, Hôpital Tenon, Bâtiment Recherche, Rue de la Chine, Paris, 75020, France
| | - Gérard Bréart
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 - Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)), INRA, Hôpital Tenon, Bâtiment Recherche, Rue de la Chine, Paris, 75020, France
| | - François Goffinet
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 - Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)), INRA, Hôpital Tenon, Bâtiment Recherche, Rue de la Chine, Paris, 75020, France.,Maternité Port-Royal, University Paris-Descartes, Hôpitaux Universitaires Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Pierre-Yves Ancel
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 - Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)), INRA, Hôpital Tenon, Bâtiment Recherche, Rue de la Chine, Paris, 75020, France.,URC CIC P1419, DHU Risk in Pregnancy, Cochin Hotel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France
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14
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Salama H, Al Rifai H, Mahmoud N, Al Qubasi M, Al Obaidly S, Sabry I, Ben Hadj Khalifa O, Mousa A, Sabouni A. Selection criteria for resuscitation and survivability rates for neonates at the limit of viability. J Neonatal Perinatal Med 2020; 13:153-158. [PMID: 31744024 DOI: 10.3233/npm-190249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIM To evaluate outcomes of a cohort of infants born at 23 weeks' gestational age after introducing a new selection score for resuscitation in the delivery room (DR). METHODS This was a retrospective charts review study using data from the maternal and newborn registry funded by the Qatar National Research Fund. Parents were consulted prenatally and their wishes were honored. The plan of resuscitation was based on the new selection score. The seven components of the score were four antenatal and three immediate postnatal in the DR. Each component received a score of zero, one, or two according to its presence, uncertainty or absence, respectively. Only a score of≥7 would receive active resuscitation unless specified otherwise during prenatal consultation. RESULTS The study reviewed 60 infants that were delivered over a two year period. The DR death rate was 23 of 60 (38%). Thirty-seven infants (61%) were admitted to the NICU. The score was applied only on 37 infants where all score criteria were reported in their files. Twenty infants had score <7; of them 13 (65%) died in the DR and 7 were admitted to NICU of whom two (29%) survived to discharge. Seventeen babies with scores≥7 admitted to NICU of whom nine (51%) survived to discharge. The survival rate to discharge was 13 of 37(35%). A satisfaction survey included 33 neonatal physicians; 32 neonatologists stated the score was easy to comprehend, 26 voted for easy to implement, and 30 voted for ethical relief and moral comfort. CONCLUSIONS Using a resuscitation score of seven was associated with improved survival until the discharge of those infants resuscitated. NICU physicians described the score as functional and convenient.
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Affiliation(s)
- H Salama
- Division of Neonatal and Perinatal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - H Al Rifai
- Division of Neonatal and Perinatal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - N Mahmoud
- Division of Neonatal and Perinatal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - M Al Qubasi
- Division of Neonatal and Perinatal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - S Al Obaidly
- Division of Neonatal and Perinatal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - I Sabry
- Division of Neonatal and Perinatal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - O Ben Hadj Khalifa
- Division of Neonatal and Perinatal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - A Mousa
- Division of Neonatal and Perinatal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - A Sabouni
- Division of Neonatal and Perinatal Medicine, Hamad Medical Corporation, Doha, Qatar
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15
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Mortality Rate-Dependent Variations in the Timing and Causes of Death in Extremely Preterm Infants Born at 23-24 Weeks' Gestation. Pediatr Crit Care Med 2019; 20:630-637. [PMID: 31013260 DOI: 10.1097/pcc.0000000000001913] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To determine mortality rate-dependent variations in the timing and causes of death, and to subsequently identify the clinical factors associated with decreased mortality in extremely preterm infants born at 23-24 weeks' gestation. DESIGN A retrospective cohort study. SETTING Korean Neonatal Network registry that includes all level greater than or equal to 3 neonatal ICUs in Korea. PATIENTS Eligible, actively treated infants born at 23-24 weeks' gestation (n = 574) from January 2014 to December 2016 were arbitrarily categorized based on institutional mortality rates of less than or equal to 50% (group I, n = 381) and greater than 50% (group II, n = 193). The primary outcome was mortality before discharge and the timing and causes of death according to the mortality rate. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The overall mortality rate was significantly lower in group I (40.7%) than in group II (79.3%). Regarding causes of death, mortalities due to cardiorespiratory, infectious, and gastrointestinal causes were significantly lower in group I than in group II. Mortality rates were significantly lower in group I, including all the subgroups that were categorized according to the timing of death, than in group II. The multivariate analyses showed that antenatal corticosteroid use, absence of oligohydramnios, birth weight, and body temperature at admission to the neonatal ICU were significantly associated with reduced mortality. CONCLUSIONS The reduced mortality rate among the infants born at 23-24 weeks' gestation was attributable to decreased mortality ascribed to cardiorespiratory, infectious, and gastrointestinal causes, and it was associated with antenatal steroid use and body temperature at admission to the neonatal ICU.
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16
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Mortality rate-dependent variations in the survival without major morbidities rate of extremely preterm infants. Sci Rep 2019; 9:7371. [PMID: 31089251 PMCID: PMC6517394 DOI: 10.1038/s41598-019-43879-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/29/2019] [Indexed: 11/08/2022] Open
Abstract
The effects of improved survival of EPT infants on morbidity among survivors remain largely controversial. This retrospective cohort study of the Korean Neonatal Network data investigated whether the mortality rate of 23-24 weeks' gestation was associated with survival without major morbidities in periviable 25-26 weeks' gestation infants. The 2,083 eligible infants with 23-26 weeks' gestation were grouped based on institutional mortality rate (group 1 and 2 ≤50% and >50% mortality rate, respectively, for 23-24 weeks' gestation) and were further divided into 23-24 and 25-26 weeks' gestation subgroups. The mortality rate of 23-24 weeks' gestation infants was significantly lower in group 1 (32.7%) than in group 2 (69.9%). The survival without major morbidities rate for 25-26 weeks' gestation infants was significantly higher in group 1 (31.2%) than in group 2 (18.5%). Antenatal steroid use and Apgar score at 5 min in group 1 were associated with decreased mortality and survival without major morbidities in 23-24 and 25-26 weeks' gestation infants, respectively. In the multivariate analyses, decreased mortality rates in 23-24 weeks' gestation infants were associated with higher survival without major morbidities rates in 25-26 weeks' gestation infants due to decreased bronchopulmonary dysplasia, periventricular leukomalacia, and late-onset sepsis. Evidence-based perinatal and neonatal practices, including antenatal steroid use and better delivery room care contributing to decreased mortality in periviable 23-24 weeks' gestation infants, were associated with lower morbidity and higher survival without major morbidities in more mature 25-26 weeks' gestation infants.
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17
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Adams M, Berger TM, Borradori-Tolsa C, Bickle-Graz M, Grunt S, Gerull R, Bassler D, Natalucci G. Association between perinatal interventional activity and 2-year outcome of Swiss extremely preterm born infants: a population-based cohort study. BMJ Open 2019; 9:e024560. [PMID: 30878980 PMCID: PMC6429852 DOI: 10.1136/bmjopen-2018-024560] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To investigate if centre-specific levels of perinatal interventional activity were associated with neonatal and neurodevelopmental outcome at 2 years of age in two separately analysed cohorts of infants: cohort A born at 22-25 and cohort B born at 26-27 gestational weeks, respectively. DESIGN Geographically defined, retrospective cohort study. SETTING All nine level III perinatal centres (neonatal intensive care units and affiliated obstetrical services) in Switzerland. PATIENTS All live-born infants in Switzerland in 2006-2013 below 28 gestational weeks, excluding infants with major congenital malformation. OUTCOME MEASURES Outcomes at 2 years corrected for prematurity were mortality, survival with any major neonatal morbidity and with severe-to-moderate neurodevelopmental impairment (NDI). RESULTS Cohort A associated birth in a centre with high perinatal activity with low mortality adjusted OR (aOR 0.22; 95% CI 0.16 to 0.32), while no association was observed with survival with major morbidity (aOR 0.74; 95% CI 0.46 to 1.19) and with NDI (aOR 0.97; 95% CI 0.46 to 2.02). Median age at death (8 vs 4 days) and length of stay (100 vs 73 days) were higher in high than in low activity centres. The results for cohort B mirrored those for cohort A. CONCLUSIONS Centres with high perinatal activity in Switzerland have a significantly lower risk for mortality while having comparable outcomes among survivors. This confirms the results of other studies but in a geographically defined area applying a more restrictive approach to initiation of perinatal intensive care than previous studies. The study adds that infants up to 28 weeks benefited from a higher perinatal activity and why further research is required to better estimate the added burden on children who ultimately do not survive.
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Affiliation(s)
- Mark Adams
- Department of Neonatology, Universitätsspital Zürich, Zürich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University Zürich, Zürich, Schweiz, Switzerland
| | - Thomas M Berger
- Neonatal and Paediatric Intensive Care Unit, Kinderspital Luzern, Luzern, Switzerland
| | | | - Myriam Bickle-Graz
- Department Woman-Mother-Child, University Hospital Lausanne, Lausanne, Switzerland
| | - Sebastian Grunt
- Division of Neuropaediatrics, Development and Rehabilitation, Children’s University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Roland Gerull
- Department of Neonatology, University of Basel Children’s Hospital (UKBB), Basel, Switzerland
| | - Dirk Bassler
- Department of Neonatology, Universitätsspital Zürich, Zürich, Switzerland
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18
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Armanian AM, Barekatain B, Sohrabi F, Salehimehr N, Mansourian M. The Prevalence of Complications of Prematurity among 1000 Newborns in Isfahan, Iran. Adv Biomed Res 2019; 8:12. [PMID: 30993082 PMCID: PMC6425744 DOI: 10.4103/abr.abr_84_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Different morbidity conditions are globally reported from different nations for premature infants. The aim of this study was to identify the relative frequency of some of the most important complications of prematurity in a population of about 1000 of very low birth weight (VLBW; i.e., infants with weight of <1500 g) premature infants in our city and publish the results of the project at the level of the urban community of Isfahan in order to use it for further decisions. Materials and Methods: Demographic characteristics and information of prematurity complications of 1000-registered VLBW premature infants were collected and analyzed. Results: The mean gestational age and birth weight were 30.19 ± 2.26 weeks and 1223.96 ± 227.77 g, respectively. Seven hundred and ninety-eight individuals (79.69%) had respiratory distress syndrome (RDS) which also had the most prevalence frequency, whereas the number of newborns who had chronic lung disease was 80, with the lowest prevalence of 8.01%. The prevalence of infantile mortality was 3.10%. Conclusion: Regarding advances in medical technologies and caring system, the mortality rate for premature neonates, even VLBW infants, has decreased significantly and survival rates are grown. Alongside the low death rates, managing complications related to prematurity period should be considered more, especially caring for respiratory management should be considered remarkably since RDS stands as the most prevalent disease among them. Efforts also should be made to reduce the number of diseases that worsen the prognosis, such as intraventricular hemorrhage.
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Affiliation(s)
- Amir-Mohammad Armanian
- Department of Pediatrics, Division of Neonatology, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behzad Barekatain
- Department of Pediatrics, Division of Neonatology, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Sohrabi
- Department of Pediatrics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nima Salehimehr
- Department of Psychology, Almahdi Mehr Higher Education Institute, Isfahan, Iran
| | - Marjan Mansourian
- Department of Epidemiology and Biostatistics, Health School, Isfahan University of Medical Sciences, Isfahan, Iran
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19
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Lee JH, Noh OK, Chang YS. Neonatal Outcomes of Very Low Birth Weight Infants in Korean Neonatal Network from 2013 to 2016. J Korean Med Sci 2019; 34:e40. [PMID: 30718992 PMCID: PMC6356024 DOI: 10.3346/jkms.2019.34.e40] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 01/04/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This study was performed to determine survival and morbidity rates in very low birth weight infants (VLBWIs) in the Korean Neonatal Network (KNN), and to compare neonatal outcomes with those in other countries. METHODS Data were collected for 8,269 VLBWIs with gestational age (GA) ≥ 22 weeks who were born between January 1, 2013 and December 31, 2016, and admitted to the neonatal intensive care units of the KNN. RESULTS The survival rate of all VLBWIs and of infants with GA 22-23, 24-25, 26-27, 28-29, 30-32, and > 32 weeks were 86% (total), 33%, 65%, 84%, 94%, 97%, and 98%, respectively. The bronchopulmonary dysplasia (BPD) rates of all VLBWIs and of infants with GA 22-23, 24-25, 26-27, 28-29, 30-32, and > 32 weeks were 30% (total), 88%, 64%, 47%, 26%, 14%, and 5%, respectively. The intraventricular hemorrhage rates (≥ grade III) of all VLBWIs and of infants with GA 22-23, 24-25, 26-27, 28-29, 30-32, and > 32 weeks were 10% (total), 45%, 27%, 12%, 5%, 2%, and 1%, respectively. In an international comparison, the survival rate of VLBWIs with GA 24-27 weeks in KNN was lower, and the BPD rate of VLBWIs in the KNN was higher than that of the neonatal networks of other countries. CONCLUSION Despite overall improvements in neonatal outcomes, the survival and morbidity rates of more immature infants with GA 22-27 weeks need further improvement. Therefore, it would be necessary to develop more optimal treatment strategies and perform more active quality improvement to further improve neonatal outcomes of VLBWIs in Korea.
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Affiliation(s)
- Jang Hoon Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - O Kyu Noh
- Department of Radiation and Oncology, Ajou University School of Medicine, Suwon, Korea
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
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20
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Wang D, Yasseen AS, Marchand-Martin L, Sprague AE, Graves E, Goffinet F, Walker M, Ancel PY, Lacaze-Masmonteil T. A population-based comparison of preterm neonatal deaths (22-34 gestational weeks) in France and Ontario: a cohort study. CMAJ Open 2019; 7:E159-E166. [PMID: 30872267 PMCID: PMC6420330 DOI: 10.9778/cmajo.20180199] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The management and outcomes of preterm births can vary greatly even among developed nations with the same access to medicine, technology and expertise. We aimed to compare aspects of obstetrical management and mortality for preterm infants in France and Ontario, Canada. METHODS The Better Outcomes Registry & Network (BORN) Information System in Ontario and Épidémiologique sur les petits âges gestationnels (EPIPAGE-2) in France collected information on maternal demographics, obstetrical characteristics, obstetrical interventions and neonatal outcomes for infants born between 22 and 34 weeks gestation. We used standardized covariate definitions and extracted data from 2011 (for EPIPAGE-2) and from 2012 and 2013 (for BORN) to conduct a cohort study comparing the 2 data sets (stratified into gestational age groups of 22-26, 27-31 and 32-34 wk) using multivariable logistic regression models. RESULTS Mothers in the BORN cohort were older (30.7 yr v. 29.6 yr) but less likely to have gestational hypertension (13.4% v. 17.9%) than those in the EPIPAGE-2 cohort. Infants from EPIPAGE-2 had lower birth weights (1.3 kg v. 1.5 kg) and were more likely to be born in an institution with level 3 care (71.9% v. 55.8%). After adjustment for these differences, there was significantly higher neonatal mortality among infants from EPIPAGE-2 in the 22-26 week gestation age group (adjusted odds ratio 2.81; 95% confidence interval 1.17 to 6.74). INTERPRETATION Even after we adjusted for both intrinsic population differences and differences in management between Ontario and France, we found a higher rate of neonatal mortality at earlier gestational ages in France. This may be related to differences in ethical approaches and/or postnatal management and should be explored further.
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Affiliation(s)
- Dianna Wang
- Northern Alberta Neonatal Program (Wang), Edmonton, Alta.; Better Outcomes Registry & Network Ontario (Yasseen, Sprague, Walker); Children's Hospital of Eastern Ontario Research Institute (Yasseen, Sprague), Ottawa, Ont.; Obstetrical, Perinatal and Pediatric Epidemiology Team (Marchand-Martin, Goffinet, Ancel), Centre for Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center (U1153), Institut national de la santé et de la recherche médicale; Paris Descartes University (Marchand-Martin, Goffinet, Ancel), Paris, France; ICES (Graves), Toronto, Ont.; Département Hospitalo-Universitaire on Risks in Pregnancy (Goffinet), Assistance Publique - HÔpitaux de Paris, Paris, France; Department of Obstetrics and Gynecology (Walker), University of Ottawa, Ottawa, Ont.; Clinical Research Unit (Ancel), Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary; Alberta Children's Hospital Research Institute (Lacaze-Masmonteil), Calgary, Alta.
| | - Abdool S Yasseen
- Northern Alberta Neonatal Program (Wang), Edmonton, Alta.; Better Outcomes Registry & Network Ontario (Yasseen, Sprague, Walker); Children's Hospital of Eastern Ontario Research Institute (Yasseen, Sprague), Ottawa, Ont.; Obstetrical, Perinatal and Pediatric Epidemiology Team (Marchand-Martin, Goffinet, Ancel), Centre for Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center (U1153), Institut national de la santé et de la recherche médicale; Paris Descartes University (Marchand-Martin, Goffinet, Ancel), Paris, France; ICES (Graves), Toronto, Ont.; Département Hospitalo-Universitaire on Risks in Pregnancy (Goffinet), Assistance Publique - HÔpitaux de Paris, Paris, France; Department of Obstetrics and Gynecology (Walker), University of Ottawa, Ottawa, Ont.; Clinical Research Unit (Ancel), Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary; Alberta Children's Hospital Research Institute (Lacaze-Masmonteil), Calgary, Alta
| | - Laetitia Marchand-Martin
- Northern Alberta Neonatal Program (Wang), Edmonton, Alta.; Better Outcomes Registry & Network Ontario (Yasseen, Sprague, Walker); Children's Hospital of Eastern Ontario Research Institute (Yasseen, Sprague), Ottawa, Ont.; Obstetrical, Perinatal and Pediatric Epidemiology Team (Marchand-Martin, Goffinet, Ancel), Centre for Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center (U1153), Institut national de la santé et de la recherche médicale; Paris Descartes University (Marchand-Martin, Goffinet, Ancel), Paris, France; ICES (Graves), Toronto, Ont.; Département Hospitalo-Universitaire on Risks in Pregnancy (Goffinet), Assistance Publique - HÔpitaux de Paris, Paris, France; Department of Obstetrics and Gynecology (Walker), University of Ottawa, Ottawa, Ont.; Clinical Research Unit (Ancel), Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary; Alberta Children's Hospital Research Institute (Lacaze-Masmonteil), Calgary, Alta
| | - Ann E Sprague
- Northern Alberta Neonatal Program (Wang), Edmonton, Alta.; Better Outcomes Registry & Network Ontario (Yasseen, Sprague, Walker); Children's Hospital of Eastern Ontario Research Institute (Yasseen, Sprague), Ottawa, Ont.; Obstetrical, Perinatal and Pediatric Epidemiology Team (Marchand-Martin, Goffinet, Ancel), Centre for Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center (U1153), Institut national de la santé et de la recherche médicale; Paris Descartes University (Marchand-Martin, Goffinet, Ancel), Paris, France; ICES (Graves), Toronto, Ont.; Département Hospitalo-Universitaire on Risks in Pregnancy (Goffinet), Assistance Publique - HÔpitaux de Paris, Paris, France; Department of Obstetrics and Gynecology (Walker), University of Ottawa, Ottawa, Ont.; Clinical Research Unit (Ancel), Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary; Alberta Children's Hospital Research Institute (Lacaze-Masmonteil), Calgary, Alta
| | - Erin Graves
- Northern Alberta Neonatal Program (Wang), Edmonton, Alta.; Better Outcomes Registry & Network Ontario (Yasseen, Sprague, Walker); Children's Hospital of Eastern Ontario Research Institute (Yasseen, Sprague), Ottawa, Ont.; Obstetrical, Perinatal and Pediatric Epidemiology Team (Marchand-Martin, Goffinet, Ancel), Centre for Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center (U1153), Institut national de la santé et de la recherche médicale; Paris Descartes University (Marchand-Martin, Goffinet, Ancel), Paris, France; ICES (Graves), Toronto, Ont.; Département Hospitalo-Universitaire on Risks in Pregnancy (Goffinet), Assistance Publique - HÔpitaux de Paris, Paris, France; Department of Obstetrics and Gynecology (Walker), University of Ottawa, Ottawa, Ont.; Clinical Research Unit (Ancel), Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary; Alberta Children's Hospital Research Institute (Lacaze-Masmonteil), Calgary, Alta
| | - François Goffinet
- Northern Alberta Neonatal Program (Wang), Edmonton, Alta.; Better Outcomes Registry & Network Ontario (Yasseen, Sprague, Walker); Children's Hospital of Eastern Ontario Research Institute (Yasseen, Sprague), Ottawa, Ont.; Obstetrical, Perinatal and Pediatric Epidemiology Team (Marchand-Martin, Goffinet, Ancel), Centre for Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center (U1153), Institut national de la santé et de la recherche médicale; Paris Descartes University (Marchand-Martin, Goffinet, Ancel), Paris, France; ICES (Graves), Toronto, Ont.; Département Hospitalo-Universitaire on Risks in Pregnancy (Goffinet), Assistance Publique - HÔpitaux de Paris, Paris, France; Department of Obstetrics and Gynecology (Walker), University of Ottawa, Ottawa, Ont.; Clinical Research Unit (Ancel), Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary; Alberta Children's Hospital Research Institute (Lacaze-Masmonteil), Calgary, Alta
| | - Mark Walker
- Northern Alberta Neonatal Program (Wang), Edmonton, Alta.; Better Outcomes Registry & Network Ontario (Yasseen, Sprague, Walker); Children's Hospital of Eastern Ontario Research Institute (Yasseen, Sprague), Ottawa, Ont.; Obstetrical, Perinatal and Pediatric Epidemiology Team (Marchand-Martin, Goffinet, Ancel), Centre for Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center (U1153), Institut national de la santé et de la recherche médicale; Paris Descartes University (Marchand-Martin, Goffinet, Ancel), Paris, France; ICES (Graves), Toronto, Ont.; Département Hospitalo-Universitaire on Risks in Pregnancy (Goffinet), Assistance Publique - HÔpitaux de Paris, Paris, France; Department of Obstetrics and Gynecology (Walker), University of Ottawa, Ottawa, Ont.; Clinical Research Unit (Ancel), Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary; Alberta Children's Hospital Research Institute (Lacaze-Masmonteil), Calgary, Alta
| | - Pierre-Yves Ancel
- Northern Alberta Neonatal Program (Wang), Edmonton, Alta.; Better Outcomes Registry & Network Ontario (Yasseen, Sprague, Walker); Children's Hospital of Eastern Ontario Research Institute (Yasseen, Sprague), Ottawa, Ont.; Obstetrical, Perinatal and Pediatric Epidemiology Team (Marchand-Martin, Goffinet, Ancel), Centre for Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center (U1153), Institut national de la santé et de la recherche médicale; Paris Descartes University (Marchand-Martin, Goffinet, Ancel), Paris, France; ICES (Graves), Toronto, Ont.; Département Hospitalo-Universitaire on Risks in Pregnancy (Goffinet), Assistance Publique - HÔpitaux de Paris, Paris, France; Department of Obstetrics and Gynecology (Walker), University of Ottawa, Ottawa, Ont.; Clinical Research Unit (Ancel), Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary; Alberta Children's Hospital Research Institute (Lacaze-Masmonteil), Calgary, Alta
| | - Thierry Lacaze-Masmonteil
- Northern Alberta Neonatal Program (Wang), Edmonton, Alta.; Better Outcomes Registry & Network Ontario (Yasseen, Sprague, Walker); Children's Hospital of Eastern Ontario Research Institute (Yasseen, Sprague), Ottawa, Ont.; Obstetrical, Perinatal and Pediatric Epidemiology Team (Marchand-Martin, Goffinet, Ancel), Centre for Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center (U1153), Institut national de la santé et de la recherche médicale; Paris Descartes University (Marchand-Martin, Goffinet, Ancel), Paris, France; ICES (Graves), Toronto, Ont.; Département Hospitalo-Universitaire on Risks in Pregnancy (Goffinet), Assistance Publique - HÔpitaux de Paris, Paris, France; Department of Obstetrics and Gynecology (Walker), University of Ottawa, Ottawa, Ont.; Clinical Research Unit (Ancel), Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary; Alberta Children's Hospital Research Institute (Lacaze-Masmonteil), Calgary, Alta
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21
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Šimják P, Smíšek J, Koucký M, Lamberská T, Plavka R, Hájek Z. Proactive approach at the limits of viability improves the short-term outcome of neonates born after 23 weeks' gestation. J Perinat Med 2018; 46:103-111. [PMID: 28343176 DOI: 10.1515/jpm-2016-0264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 02/22/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this single-center study was to identify factors that affect the short-term outcome of newborns delivered around the limits of viability. METHODS A group of 137 pregnant women who gave birth between 22+0/7 and 25+6/7 weeks of gestation was retrospectively studied. The center supports a proactive approach to infants around the limits of viability. Perinatal and neonatal characteristics were obtained and statistically evaluated. RESULTS A total of 166 live-born infants were enrolled during a 6-year period; 162 (97.6%) of them were admitted to the neonatal intensive care unit (ICU) and 119 (73.5%) survived until discharge. The decrease in neonatal mortality was associated with an advanced gestational age (P<0.001) and a completed course of corticosteroids (P=0.002). Neonatal morbidities were common among infants of all gestational ages. The incidence of severe intraventricular hemorrhage significantly depended on gestational age (P<0.001) and a completed course of corticosteroids (P=0.002). Survival without severe neonatal morbidities was 39.5% and occurred mostly after 24+0/7 weeks of gestation. CONCLUSION The short-term outcome of newborns delivered around the limits of viability is mostly affected by gestational age and antenatal corticosteroid treatment. A consistently proactive approach improves the survival of infants at the limits of viability. This is most pronounced in cases where the delivery is delayed beyond 24 completed gestational weeks.
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Affiliation(s)
- Patrik Šimják
- Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Apolinářská 18, 128-51, Prague 2, Czech Republic, Tel.: +420-224-967-012
| | - Jan Smíšek
- Division of Neonatology, Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic.,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michal Koucký
- Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tereza Lamberská
- Division of Neonatology, Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Richard Plavka
- Division of Neonatology, Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Zdeněk Hájek
- Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
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22
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Travers CP, Carlo WA, McDonald SA, Das A, Bell EF, Ambalavanan N, Jobe AH, Goldberg RN, D'Angio CT, Stoll BJ, Shankaran S, Laptook AR, Schmidt B, Walsh MC, Sánchez PJ, Ball MB, Hale EC, Newman NS, Higgins RD. Mortality and pulmonary outcomes of extremely preterm infants exposed to antenatal corticosteroids. Am J Obstet Gynecol 2018; 218:130.e1-130.e13. [PMID: 29138031 DOI: 10.1016/j.ajog.2017.11.554] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/23/2017] [Accepted: 11/06/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Antenatal corticosteroids are given primarily to induce fetal lung maturation but results from meta-analyses of randomized controlled trials have not shown mortality or pulmonary benefits for extremely preterm infants although these are the infants most at risk of mortality and pulmonary disease. OBJECTIVE We sought to determine if exposure to antenatal corticosteroids is associated with a lower rate of death and pulmonary morbidities by 36 weeks' postmenstrual age. STUDY DESIGN Prospectively collected data on 11,022 infants 22 0/7 to 28 6/7 weeks' gestational age with a birthweight of ≥401 g born from Jan. 1, 2006, through Dec. 31, 2014, were analyzed. The rate of death and the rate of physiologic bronchopulmonary dysplasia by 36 weeks' postmenstrual age were analyzed by level of exposure to antenatal corticosteroids using models adjusted for maternal variables, infant variables, center, and epoch. RESULTS Infants exposed to any antenatal corticosteroids had a lower rate of death (2193/9670 [22.7%]) compared to infants without exposure (540/1302 [41.5%]) (adjusted relative risk, 0.71; 95% confidence interval, 0.65-0.76; P < .0001). Infants exposed to a partial course of antenatal corticosteroids also had a lower rate of death (654/2520 [26.0%]) compared to infants without exposure (540/1302 [41.5%]); (adjusted relative risk, 0.77; 95% confidence interval, 0.70-0.85; P < .0001). In an analysis by each week of gestation, infants exposed to a complete course of antenatal corticosteroids had lower mortality before discharge compared to infants without exposure at each week from 23-27 weeks' gestation and infants exposed to a partial course of antenatal corticosteroids had lower mortality at 23, 24, and 26 weeks' gestation. Rates of bronchopulmonary dysplasia in survivors did not differ by antenatal corticosteroid exposure. The rate of death due to respiratory distress syndrome, the rate of surfactant use, and the rate of mechanical ventilation were lower in infants exposed to any antenatal corticosteroids compared to infants without exposure. CONCLUSION Among infants 22-28 weeks' gestational age, any or partial antenatal exposure to corticosteroids compared to no exposure is associated with a lower rate of death while the rate of bronchopulmonary dysplasia in survivors did not differ.
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Affiliation(s)
- Colm P Travers
- Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Bethesda, MD
| | - Waldemar A Carlo
- Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Bethesda, MD; University of Alabama at Birmingham, Birmingham, AL.
| | - Scott A McDonald
- Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Bethesda, MD
| | - Abhik Das
- Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Bethesda, MD
| | - Edward F Bell
- Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Bethesda, MD
| | - Namasivayam Ambalavanan
- Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Bethesda, MD
| | - Alan H Jobe
- Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Bethesda, MD
| | - Ronald N Goldberg
- Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Bethesda, MD
| | - Carl T D'Angio
- Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Bethesda, MD
| | - Barbara J Stoll
- Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Bethesda, MD
| | - Seetha Shankaran
- Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Bethesda, MD
| | - Abbot R Laptook
- Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Bethesda, MD
| | - Barbara Schmidt
- Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Bethesda, MD
| | - Michele C Walsh
- Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Bethesda, MD
| | - Pablo J Sánchez
- Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Bethesda, MD
| | - M Bethany Ball
- Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Bethesda, MD
| | - Ellen C Hale
- Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Bethesda, MD
| | - Nancy S Newman
- Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Bethesda, MD
| | - Rosemary D Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Bethesda, MD
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Berti E, Puglia M, Perugi S, Gagliardi L, Bosi C, Ingargiola A, Magi L, Martelli E, Pratesi S, Sigali E, Tomasini B, Rusconi F. Feeding Practices in Very Preterm and Very Low Birth Weight Infants in an Area Where a Network of Human Milk Banks Is in Place. Front Pediatr 2018; 6:387. [PMID: 30574473 PMCID: PMC6291747 DOI: 10.3389/fped.2018.00387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/22/2018] [Indexed: 01/08/2023] Open
Abstract
Background: Great variability in enteral feeding practices for very preterm (<32 weeks gestational age-GA) and very low birth weight infants (VLBW; ≤1,500 g) have been reported. We aimed to describe data on enteral feeding in Tuscany (Italy), where a network of 6 donor milk banks is in place. Methods: A 4-years (2012-2015) observational study was performed analyzing the database "TIN Toscane online" on very preterm and VLBW infants. The database covers all 25 hospitals with a neonatal unit. Results: Data concerning the beginning of enteral nutrition were available for 1,302 newborns with a mean (standard deviation) GA of 29.3 (2.9) weeks, while information at the time of full enteral nutrition was available for 1,235 and at discharge for 1,140. Most infants (74.1%) started enteral feeding during the first 24 h of life. Overall, 80.1% of newborns were fed exclusive human milk, donor milk having the larger prevalence of use (66.8%). Few infants (13.3%) started with exclusive mother's milk. Full enteral feeding was achieved using exclusive human milk in most cases (80%). Full enteral feeding was reached earlier in newborns who were fed human milk than in those fed formula, regardless of GA. Sixty-four percent of infants were still fed with any human milk at discharge. When data at the achievement of full enteral nutrition and at discharge were analyzed stratified by the type of milk used to start enteral feeding, newborns initially fed donor milk presented the highest prevalence (91.3%) of exclusive human milk at full enteral feeding, an important period to prevent necrotizing enterocolitis, while no differences were observed at discharge. Conclusions: Donor milk was widely used for newborns during the first hours of life, when mother's milk availability may be quite challenging. Starting enteral nutrition with donor milk was associated with early start of enteral feeding and early achievement of full enteral nutrition without affecting mother lactation. The overall prevalence of human milk at discharge (when donor milk is not available anymore) was high (64%), irrespective of the type of milk used to start nutrition.
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Affiliation(s)
- Elettra Berti
- Anna Meyer Children's University Hospital, Florence, Italy
| | | | | | | | | | | | | | | | | | | | | | - Franca Rusconi
- Anna Meyer Children's University Hospital, Florence, Italy.,Health Agency of Tuscany, Florence, Italy
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Jung SM, Seok MJ, Chun JY, Sung TJ. Changes of Mortality and Morbidity of Very Low Birth Weight Infants after Neonatal Intensive Care Unit Strategy Alteration in a Single Center: Comparison with 2015 Korean Neonatal Network Report. NEONATAL MEDICINE 2018. [DOI: 10.5385/nm.2018.25.1.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Seung Mi Jung
- Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Min Jeong Seok
- Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Ji Yong Chun
- Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Tae-Jung Sung
- Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
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Abstract
"Golden Hour" of neonatal life is defined as the first hour of post-natal life in both preterm and term neonates. This concept in neonatology has been adopted from adult trauma where the initial first hour of trauma management is considered as golden hour. The "Golden hour" concept includes practicing all the evidence based intervention for term and preterm neonates, in the initial sixty minutes of postnatal life for better long-term outcome. Although the current evidence supports the concept of golden hour in preterm and still there is no evidence seeking the benefit of golden hour approach in term neonates, but neonatologist around the globe feel the importance of golden hour concept equally in both preterm and term neonates. Initial first hour of neonatal life includes neonatal resuscitation, post-resuscitation care, transportation of sick newborn to neonatal intensive care unit, respiratory and cardiovascular support and initial course in nursery. The studies that evaluated the concept of golden hour in preterm neonates showed marked reduction in hypothermia, hypoglycemia, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP). In this review article, we will discuss various components of neonatal care that are included in "Golden hour" of preterm and term neonatal care.
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Affiliation(s)
- Deepak Sharma
- National Institute of Medical Science, Jaipur, Rajasthan India
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27
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Smith LK. Ensuring the Comparability of Infant Mortality Rates: the Impact of the Management of Pre-Viable and Peri-Viable Births. Paediatr Perinat Epidemiol 2017; 31:392-393. [PMID: 28686289 DOI: 10.1111/ppe.12381] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Lucy K Smith
- Department of Health Sciences, The Infant Mortality and Morbidity Studies, University of Leicester, Leicester, UK
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28
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Pierrat V, Marchand-Martin L, Arnaud C, Kaminski M, Resche-Rigon M, Lebeaux C, Bodeau-Livinec F, Morgan AS, Goffinet F, Marret S, Ancel PY. Neurodevelopmental outcome at 2 years for preterm children born at 22 to 34 weeks' gestation in France in 2011: EPIPAGE-2 cohort study. BMJ 2017; 358:j3448. [PMID: 28814566 PMCID: PMC5558213 DOI: 10.1136/bmj.j3448] [Citation(s) in RCA: 283] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objectives To describe neurodevelopmental outcomes at 2 years corrected age for children born alive at 22-26, 27-31, and 32-34 weeks' gestation in 2011, and to evaluate changes since 1997.Design Population based cohort studies, EPIPAGE and EPIPAGE-2.Setting France.Participants 5567 neonates born alive in 2011 at 22-34 completed weeks' gestation, with 4199 survivors at 2 years corrected age included in follow-up. Comparison of outcomes reported for 3334 (1997) and 2418 (2011) neonates born alive in the nine regions participating in both studies.Main outcome measures Survival; cerebral palsy (2000 European consensus definition); scores below threshold on the neurodevelopmental Ages and Stages Questionnaire (ASQ; at least one of five domains below threshold) if completed between 22 and 26 months corrected age, in children without cerebral palsy, blindness, or deafness; and survival without severe or moderate neuromotor or sensory disabilities (cerebral palsy with Gross Motor Function Classification System levels 2-5, unilateral or bilateral blindness or deafness). Results are given as percentage of outcome measures with 95% confidence intervals.Results Among 5170 liveborn neonates with parental consent, survival at 2 years corrected age was 51.7% (95% confidence interval 48.6% to 54.7%) at 22-26 weeks' gestation, 93.1% (92.1% to 94.0%) at 27-31 weeks' gestation, and 98.6% (97.8% to 99.2%) at 32-34 weeks' gestation. Only one infant born at 22-23 weeks survived. Data on cerebral palsy were available for 3599 infants (81.0% of the eligible population). The overall rate of cerebral palsy at 24-26, 27-31, and 32-34 weeks' gestation was 6.9% (4.7% to 9.6%), 4.3% (3.5% to 5.2%), and 1.0% (0.5% to 1.9%), respectively. Responses to the ASQ were analysed for 2506 children (56.4% of the eligible population). The proportion of children with an ASQ result below threshold at 24-26, 27-31, and 32-34 weeks' gestation were 50.2% (44.5% to 55.8%), 40.7% (38.3% to 43.2%), and 36.2% (32.4% to 40.1%), respectively. Survival without severe or moderate neuromotor or sensory disabilities among live births increased between 1997 and 2011, from 45.5% (39.2% to 51.8%) to 62.3% (57.1% to 67.5%) at 25-26 weeks' gestation, but no change was observed at 22-24 weeks' gestation. At 32-34 weeks' gestation, there was a non-statistically significant increase in survival without severe or moderate neuromotor or sensory disabilities (P=0.61), but the proportion of survivors with cerebral palsy declined (P=0.01).Conclusions In this large cohort of preterm infants, rates of survival and survival without severe or moderate neuromotor or sensory disabilities have increased during the past two decades, but these children remain at high risk of developmental delay.
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Affiliation(s)
- Véronique Pierrat
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France; Paris Descartes University, Paris, France
- CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, F-59000 Lille, France
| | - Laetitia Marchand-Martin
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France; Paris Descartes University, Paris, France
| | - Catherine Arnaud
- INSERM UMR 1027, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Monique Kaminski
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France; Paris Descartes University, Paris, France
| | - Matthieu Resche-Rigon
- Biostatistics and Medical Information Department, AP-HP Saint-Louis Hospital, Paris, France
| | - Cécile Lebeaux
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France; Paris Descartes University, Paris, France
| | - Florence Bodeau-Livinec
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France; Paris Descartes University, Paris, France
- École des Hautes Études en Santé Publique (EHESP), Rennes, France
| | - Andrei S Morgan
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France; Paris Descartes University, Paris, France
| | - François Goffinet
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France; Paris Descartes University, Paris, France
- Maternité Port-Royal, Université Paris Descartes, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, DHU Risques et Grossesse, Paris, France
| | - Stéphane Marret
- Department of Neonatal Pediatrics, Intensive care, and Neuropediatrics, Rouen University Hospital, Rouen, France
- Research Unit U1245, Institute for Research and Innovation in Biomedicine, Rouen, France
| | - Pierre-Yves Ancel
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France; Paris Descartes University, Paris, France
- Clinical Research Unit, Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France
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Garfield CF, Karbownik K, Murthy K, Falciglia G, Guryan J, Figlio DN, Roth J. Educational Performance of Children Born Prematurely. JAMA Pediatr 2017; 171:764-770. [PMID: 28604933 PMCID: PMC5710633 DOI: 10.1001/jamapediatrics.2017.1020] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
IMPORTANCE Survivors of preterm birth often present with medical morbidities; however, variation in their long-term educational performance has not been well described. OBJECTIVE To estimate the association between gestational age and 4 outcomes in school-aged children: readiness to enter kindergarten, scores on standardized tests in elementary and middle school, gifted status, and low performance. DESIGN, SETTING, AND PARTICIPANTS In a retrospective cohort study, children born in Florida between 1992 and 2002 at 23 to 41 weeks' gestation who entered Florida's public schools between 1995 and 2012 were assessed for kindergarten readiness and tested in mathematics and reading in grades 3 through 8. Data analysis was performed from January 12, 2016, to March 1, 2017. EXPOSURES Gestational age at birth. MAIN OUTCOMES AND MEASURES Kindergarten readiness, scores on the Florida Comprehensive Achievement Test (FCAT), classified as gifted, and classified as low performance. RESULTS A total of 1 527 113 singleton infants with gestational ages of 23 to 41 weeks born between 1992 and 2002 were matched to Florida public school records. Of these, 1 301 497 children were included in the analysis; 641 479 (49.3%) were girls. A total of 301 (65.0%) Florida children born at 23 to 24 weeks' gestation were designated as ready to start kindergarten. When the FCAT test scores were adjusted for potentially confounding maternal and infant variables, children born at 23 to 24 weeks' gestation performed 0.66 SD (95% CI, -0.73 to -0.59) lower compared with those born at full term. A total of 123 554 (9.5%) of all Florida-born public school students were considered gifted, including 17 (1.8%) of those born at 23 to 24 weeks' gestation. In comparison, 75 458 (5.8%) of all Florida-born public school students were low performing; 310 (33.5%) of these children had been born at 23 to 24 weeks' gestation. Kindergarten readiness, FCAT scores, and gifted status were positively related to gestational age, whereas low performance was inversely related to gestational age. CONCLUSIONS AND RELEVANCE Although gestational age has long been associated with poor educational performance, a sufficient proportion of children born near the limits of viability performed within expected school norms, warranting further investigation into how and why certain children are able to overcome the educational burdens that may follow preterm birth.
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Affiliation(s)
- Craig F. Garfield
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Institute for Policy Research, Northwestern University, Evanston, Illinois
| | | | - Karna Murthy
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Gustave Falciglia
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jonathan Guryan
- Institute for Policy Research, Northwestern University, Evanston, Illinois,Human Development and Social Policy, Northwestern University School of Education and Social Policy, Evanston, Illinois
| | - David N. Figlio
- Institute for Policy Research, Northwestern University, Evanston, Illinois,Human Development and Social Policy, Northwestern University School of Education and Social Policy, Evanston, Illinois
| | - Jeffrey Roth
- Department of Pediatrics, University of Florida, Gainesville
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Bonet M, Cuttini M, Piedvache A, Boyle EM, Jarreau PH, Kollée L, Maier RF, Milligan D, Van Reempts P, Weber T, Barros H, Gadzinowki J, Draper ES, Zeitlin J. Changes in management policies for extremely preterm births and neonatal outcomes from 2003 to 2012: two population-based studies in ten European regions. BJOG 2017; 124:1595-1604. [PMID: 28294506 DOI: 10.1111/1471-0528.14639] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate changes in maternity and neonatal unit policies towards extremely preterm infants (EPTIs) between 2003 and 2012, and concurrent trends in their mortality and morbidity in ten European regions. DESIGN Population-based cohort studies in 2003 (MOSAIC study) and 2011/2012 (EPICE study) and questionnaires from hospitals. SETTING 70 hospitals in ten European regions. POPULATION Infants born at <27 weeks of gestational age (GA) in hospitals participating in both the MOSAIC and EPICE studies (1240 in 2003, 1293 in 2011/2012). METHODS We used McNemar's Chi2 test, paired t-tests and conditional logistic regression for comparisons over time. MAIN OUTCOMES MEASURES Reported policies, mortality and morbidity of EPTIs. RESULTS The lowest GA at which maternity units reported performing a caesarean section for acute distress of a singleton non-malformed fetus decreased from an average of 24.7 to 24.1 weeks (P < 0.01) when parents were in favour of active management, and 26.1 to 25.2 weeks (P = 0.01) when parents were against. Units reported that neonatologists were called more often for spontaneous deliveries starting at 22 weeks GA in 2012 and more often made decisions about active resuscitation alone, rather than in multidisciplinary teams. In-hospital mortality after live birth for EPTIs decreased from 50% to 42% (P < 0.01). Units reporting more active management in 2012 than 2003 had higher mortality in 2003 (55% versus 43%; P < 0.01) and experienced larger declines (55 to 44%; P < 0.001) than units where policies stayed the same (43 to 37%; P = 0.1). CONCLUSIONS European hospitals reporting changes in management policies experienced larger survival gains for EPTIs. TWEETABLE ABSTRACT Changes in reported policies for management of extremely preterm births were related to mortality declines.
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Affiliation(s)
- M Bonet
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - M Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - A Piedvache
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - E M Boyle
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - P H Jarreau
- Service de Médecine et Réanimation néonatales de Port-Royal, DHU Risks in Pregnancy, Université Paris Descartes and Assistance Publique Hôpitaux de Paris, Hôpitaux Universitaire Paris Centre Site Cochin, Paris, France
| | - L Kollée
- Department of Neonatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - R F Maier
- Children's Hospital, University Hospital, Philipps University Marburg, Marburg, Germany
| | - Dwa Milligan
- University of Newcastle, Newcastle-upon-Tyne, UK
| | - P Van Reempts
- Department of Neonatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium.,Study Centre for Perinatal Epidemiology Flanders, Brussels, Belgium
| | - T Weber
- Department of Obstetrics, Hvidovre University Hospital, Hvidovre, Denmark
| | - H Barros
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
| | - J Gadzinowki
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - E S Draper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - J Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
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Logan JW, Dammann O, Allred EN, Dammann C, Beam K, Joseph RM, O'Shea TM, Leviton A, Kuban KCK. Early postnatal illness severity scores predict neurodevelopmental impairments at 10 years of age in children born extremely preterm. J Perinatol 2017; 37:606-614. [PMID: 28079875 PMCID: PMC5407946 DOI: 10.1038/jp.2016.242] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 10/20/2016] [Accepted: 11/01/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE A neonatal illness severity score, The Score for Neonatal Acute Physiology-II (SNAP-II), predicts neurodevelopmental impairments at two years of age among children born extremely preterm. We sought to evaluate to what extent SNAP-II is predictive of cognitive and other neurodevelopmental impairments at 10 years of age. STUDY DESIGN In a cohort of 874 children born before 28 weeks of gestation, we prospectively collected clinical, physiologic and laboratory data to calculate SNAP-II for each infant. When the children were 10 years old, examiners who were unaware of the child's medical history assessed neurodevelopmental outcomes, including neurocognitive, gross motor, social and communication functions, diagnosis and treatment of seizures or attention deficit hyperactivity disorder (ADHD), academic achievement, and quality of life. We used logistic regression to adjust for potential confounders. RESULTS An undesirably high SNAP-II (⩾30), present in 23% of participants, was associated with an increased risk of cognitive impairment (IQ, executive function, language ability), adverse neurological outcomes (epilepsy, impaired gross motor function), behavioral abnormalities (attention deficit disorder and hyperactivity), social dysfunction (autistic spectrum disorder) and education-related adversities (school achievement and need for educational supports. In analyses that adjusted for potential confounders, Z-scores ⩽-1 on 11 of 18 cognitive outcomes were associated with SNAP-II in the highest category, and 6 of 18 were associated with SNAP-II in the intermediate category. Odds ratios and 95% confidence intervals ranged from 1.4 (1.01, 2.1) to 2.1 (1.4, 3.1). Similarly, 2 of the 8 social dysfunctions were associated with SNAP-II in the highest category, and 3 of 8 were associated with SNAP-II in the intermediate category. Odds ratios and 95% confidence intervals were slightly higher for these assessments, ranging from 1.6 (1.1, 2.4) to 2.3 (1.2, 4.6). CONCLUSION Among very preterm newborns, physiologic derangements present in the first 12 postnatal hours are associated with dysfunctions in several neurodevelopmental domains at 10 years of age. We are unable to make inferences about causality.
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Affiliation(s)
- J. Wells Logan
- Department of Pediatrics and Neonatology, Nationwide Children's Hospital, and The Ohio State University, Columbus, OH
| | - Olaf Dammann
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA,Perinatal Neuroepidemiology Unit, Hannover Medical School, Hannover, Germany
| | | | - Christiane Dammann
- Department of Pediatrics and Neonatology, Tufts University School of Medicine, Boston, MA
| | - Kristyn Beam
- Department of Pediatrics and Neonatology, Tufts University School of Medicine, Boston, MA
| | - Robert M. Joseph
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA
| | - T. Michael O'Shea
- Department of Pediatrics and Neonatology, University of North Carolina, Chapel Hill, NC
| | - Alan Leviton
- Harvard Medical School, Boston, MA,Boston Children's Hospital, Boston, MA
| | - Karl C. K. Kuban
- Department of Pediatrics, Division of Pediatric Neurology, Boston University School of Medicine, Boston, MA
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Abstract
PURPOSE OF REVIEW Quality improvement initiatives in neonatology have been promoted as an important way of improving outcomes of newborns. The purpose of this review is to examine the effectiveness of recent quality improvement work in improving the outcomes of infants requiring neonatal intensive care. RECENT FINDINGS Quality improvement collaboratives and single-center projects demonstrate improvement of clinical processes and outcomes in neonatology that impact both preterm and term infants. Declines in morbidities, resource use, and length of stay have been associated with reductions in healthcare costs. SUMMARY Recent quality improvement work has shown evidence of improvement in clinical outcomes in neonatal intensive care patients. These improvements have important implications for the reduction of healthcare costs in this population.
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Travers CP, Clark RH, Spitzer AR, Das A, Garite TJ, Carlo WA. Exposure to any antenatal corticosteroids and outcomes in preterm infants by gestational age: prospective cohort study. BMJ 2017; 356:j1039. [PMID: 28351838 PMCID: PMC5373674 DOI: 10.1136/bmj.j1039] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2017] [Indexed: 11/04/2022]
Abstract
Objective To determine whether exposure to any antenatal corticosteroids is associated with a lower rate of death at each gestational age at which administration is currently recommended.Design Prospective cohort study.Settings 300 participating neonatal intensive care units of the Pediatrix Medical Group in the United States.Participants 117 941 infants 23 0/7 to 34 6/7 weeks' gestational age born between 1 January 2009 and 31 December 2013.Exposure Any antenatal corticosteroids.Main outcomes measures Death or major hospital morbidities analyzed by gestational age and exposure to antenatal corticosteroids with models adjusted for birth weight, sex, mode of delivery, and multiple births.Results Infants exposed to antenatal corticosteroids (n=81 832) had a significantly lower rate of death before discharge at each gestation 29 weeks or less, 31 weeks, and 33-34 weeks compared with infants without exposure (range of adjusted odds ratios 0.32 to 0.55). The number needed to treat with antenatal corticosteroids to prevent one death before discharge increased from six at 23 and 24 weeks' gestation to 798 at 34 weeks' gestation. The rate of survival without major hospital morbidity was higher among infants exposed to antenatal corticosteroids at the lowest gestations. Infants exposed to antenatal corticosteroids had lower rates of severe intracranial hemorrhage or death, necrotizing enterocolitis stage 2 or above or death, and severe retinopathy of prematurity or death compared with infants without exposure at all gestations less than 30 weeks and most gestations for infants born at 30 weeks' gestation or later.Conclusion Among infants born from 23 to 34 weeks' gestation, antenatal exposure to corticosteroids compared with no exposure was associated with lower mortality and morbidity at most gestations. The effect size of exposure to antenatal corticosteroids on mortality seems to be larger in infants born at the lowest gestations.
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Affiliation(s)
- Colm P Travers
- Division of Neonatology, University of Alabama at Birmingham, AL 35233, USA
| | - Reese H Clark
- Center for Research, Education, and Quality, Pediatrix Medical Group and MEDNAX, Sunrise, FL, USA
| | - Alan R Spitzer
- Center for Research, Education, and Quality, Pediatrix Medical Group and MEDNAX, Sunrise, FL, USA
| | - Abhik Das
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC, USA
| | - Thomas J Garite
- Center for Research, Education, and Quality, Pediatrix Medical Group and MEDNAX, Sunrise, FL, USA
- Department of Obstetrics and Gynecology, University of California, Irvine, CA, USA
| | - Waldemar A Carlo
- Division of Neonatology, University of Alabama at Birmingham, AL 35233, USA
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Park JH, Chang YS, Sung S, Ahn SY, Park WS. Trends in Overall Mortality, and Timing and Cause of Death among Extremely Preterm Infants near the Limit of Viability. PLoS One 2017; 12:e0170220. [PMID: 28114330 PMCID: PMC5256888 DOI: 10.1371/journal.pone.0170220] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 01/01/2017] [Indexed: 11/18/2022] Open
Abstract
Objective To investigate the trends in mortality, as well as in the timing and cause of death, among extremely preterm infants at the limit of viability, and thus to identify the clinical factors that contribute to decreased mortality. Methods We retrospectively reviewed the medical records of 382 infants born at 23–26 weeks’ gestation; 124 of the infants were born between 2001 and 2005 (period I) and 258 were born between 2006 and 2011 (period II). We stratified the infants into two subgroups–“23–24 weeks” and “25–26 weeks”–and retrospectively analyzed the clinical characteristics and mortality in each group, as well as the timing and cause of death. Univariate and multivariate logistic regression analyses were done to identify the clinical factors associated with mortality. Results The overall mortality rate in period II was 16.7% (43/258), which was significantly lower than that in period I (30.6%; 38/124). For overall cause of death, there were significantly fewer deaths due to sepsis (2.4% [6/258] vs. 8.1% [10/124], respectively) and air-leak syndrome (0.8% [2/258] vs. 4.8% (6/124), respectively) during period II than during period I. Among the clinical factors of time period, 1-and 5-min Apgar score, antenatal steroid identified significant by univariate analyses. 5-min Apgar score and antenatal steroid use were significantly associated with mortality in multivariate analyses. Conclusion Improved mortality rate attributable to fewer deaths due to sepsis and air leak syndrome in the infants with 23–26 weeks’ gestation was associated with higher 5-minute Apgar score and more antenatal steroid use.
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Affiliation(s)
- Jae Hyun Park
- Department of Pediatrics, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sein Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - So Yoon Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Won Soon Park
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- * E-mail: ,
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Kong X, Xu F, Wu R, Wu H, Ju R, Zhao X, Tong X, Lv H, Ding Y, Liu F, Xu P, Liu W, Cheng H, Chen T, Zeng S, Jia W, Li Z, Qiu H, Wang J, Feng Z. Neonatal mortality and morbidity among infants between 24 to 31 complete weeks: a multicenter survey in China from 2013 to 2014. BMC Pediatr 2016; 16:174. [PMID: 27809893 PMCID: PMC5094017 DOI: 10.1186/s12887-016-0716-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 10/25/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The outcome of preterm infants has been varied in different hospitals and regions in developing countries. Regular clinical monitor are needed to know the effects of health care. This study aimed to describe the survival and morbidity rates of extreme to very preterm infants in 15 neonatal-intensive care hospitals in China. METHODS Data were collected from January 1, 2013 to December 31, 2014 for preterm neonates with gestational age (GA) between 24 and 31 complete weeks born in hospitals from our collaborative study group. The primary outcomes were survival and major morbidities prior to hospital discharge. Major morbidities included bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), patent ductus arteriosus (PDA) and sepsis. Mutivariate logistic regression was used to analyze the risk factor influencing on the outcomes. RESULTS The preterm birth rate was 9.9 % (13 701/138 240). The proportion of extreme to very preterm infants was 1.1 % and 11.8 % respectively. The survival rate prior to discharge was increased with increasing GA (0, 24 weeks; 28 %, 25 weeks; 84.8 %, 26 weeks; 83.5 %, 27 weeks; 87.4 %, 28 weeks; 90.7 %, 29 weeks; 93.9 %, 30 weeks; 96 %, 31 weeks). Rate of survival and without severe morbidity according to GA were 0 at 24 weeks, 8 % at 25 weeks, 60.6 % at 26 weeks; 53.2 % at 27 weeks; 62.3 % at 28 weeks; 67.9 % at 29 weeks; 79.1 % at 30 weeks, 85.8 % at 31 weeks respectively. Rate of antenatal steroid use was 56 %. The antenatal steroid use was lower in GA < 28 weeks infants than that in GA between 28 and 32 weeks (28-44.3 % vs 49.7-60.1 %, P < 0.05). Infants at the lowest GAs had a highest incidence of morbidities. Overall, 58.5 % had respiratory distress syndrome, 12.5 % bronchopulmonary dysplasia, 3.9 % necrotizing enterocolitis, 15.4 % intraventricular hemorrhage, 5.4 % retinopathy of prematurity, 28.4 % patent ductus arteriosus, and 9.7 % sepsis. Mortality and morbidity were influenced by gestational age (OR = 0.891, 95 % CI: 0.796-0.999, p = 0.0047 and OR = 0.666, 95 % CI: 0.645-0.688, p = 0.000 respectively), birth weight (OR = 0.520, 95 % CI: 0.420-0.643, p = 0.000 and OR = 0.921, 95 % CI: 0.851-0.997, p = 0.041 respectively), SGA (OR = 1.861, 95 % CI: 1.148-3.017, p = 0.012 and OR = 1.511, 95 % CI: 1.300-1.755, p = 0.000 respectively), Apgar score <7 at 5 min (OR = 1.947, 95 % CI: 1.269-2.987, p = 0.002 and OR = 2.262, 95 % CI: 1.950-2.624, p = 0.000 respectively). The survival rate was increased with more prenatal steroid use (OR = 1.615, 95 % CI: 1.233-1.901, p = 0.033). CONCLUSION Although most of the preterm infants with GAs ≥26 weeks survived, a high complication in survivors still can be observed. Rate of survival of GAs less than 26 weeks was still low, and quality improvement methods should be used to look into increasing the use of antenatal steroids in the very preterm births.
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Affiliation(s)
- XiangYong Kong
- Newborn Care Center, Bayi Children’s Hospital, the Army General Hospital, the People’s Liberation Army (PLA), 5 Nan Men Cang Hu Tong, Dongcheng District, Beijing, 100700 China
- Clinical Medical College, the Army General Hospital, Southern Medical University, Beijing, 100700 China
| | - FengDan Xu
- Clinical Medical College, the Army General Hospital, Southern Medical University, Beijing, 100700 China
| | - Rong Wu
- Neonatal Medical Center, Huaian Maternity and Child Healthcare Hospital, Yangzhou University Medical School, Huaian, 223002 China
| | - Hui Wu
- Department of Pediatrics, the First Hospital of Jilin University, Changchun, 130021 China
| | - Rong Ju
- Newborn Care Center, Chengdu Women’s and Children’s Central Hospital, Chengdu, 610000 China
| | - XiaoLin Zhao
- Department of Neonatology, North-west Women’s and Children’s Hospital, Xi’an, 710003 China
| | - XiaoMei Tong
- Department of Neonatology, The Third Hospital of Beijing University, Beijing, 100191 China
| | - HongYan Lv
- Department of Neonatology, Handan Women’s and Children’s Hospital, Handan, 056001 China
| | - YanJie Ding
- Department of Pediatrics, Yantai Yuhuangding Hospital, Yantai, 264000 China
| | - Fang Liu
- Department of Neonatology, Bethune International Peace Hospital, Shijiazhuang, 130100 China
| | - Ping Xu
- Department of Pediatrics, Liaocheng People’s Hospital, Liaocheng, 252004 China
| | - WeiPeng Liu
- Department of Pediatrics, Navy General Hospital, Beijing, 100048 China
| | - HongBin Cheng
- Department of Pediatrics, Huangshi Women’s and Children’s Hospital, Huangshi, 435003 China
| | - TieQiang Chen
- Department of Neonatology, Changsha Hospital for Maternal and Child Health Care, Changsha, 410007 China
| | - ShuJuan Zeng
- Department of Pediatrics, Longgang Central Hospital of Shenzhen, Shenzhen, 518116 China
| | - WenZheng Jia
- Department of Neonatology, 302 Hospital of P.L.A, Beijing, 100039 China
| | - ZhanKui Li
- Department of Neonatology, North-west Women’s and Children’s Hospital, Xi’an, 710003 China
| | - HuiXian Qiu
- Department of Pediatrics, Longgang Central Hospital of Shenzhen, Shenzhen, 518116 China
| | - Jin Wang
- Newborn Care Center, Chengdu Women’s and Children’s Central Hospital, Chengdu, 610000 China
| | - ZhiChun Feng
- Newborn Care Center, Bayi Children’s Hospital, the Army General Hospital, the People’s Liberation Army (PLA), 5 Nan Men Cang Hu Tong, Dongcheng District, Beijing, 100700 China
- Clinical Medical College, the Army General Hospital, Southern Medical University, Beijing, 100700 China
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Hopp CA, Baron IS. Birth at 22 gestational weeks: case report of cognitive resilience. Clin Neuropsychol 2016; 31:471-486. [DOI: 10.1080/13854046.2016.1224802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Crista A. Hopp
- Fairfax Neonatal Associates at Inova Children’s Hospital, Falls Church, VA, USA
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Caughey AB, Zupancic JAF, Greenberg JM, Garfield SS, Thung SF, Iams JD. Clinical and Cost Impact Analysis of a Novel Prognostic Test for Early Detection of Preterm Birth. AJP Rep 2016; 6:e407-e416. [PMID: 27917307 PMCID: PMC5133137 DOI: 10.1055/s-0036-1593866] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 08/18/2016] [Indexed: 01/25/2023] Open
Abstract
Objective The objective of this study was to evaluate the potential impact to the U.S. health care system by adopting a novel test that identifies women at risk for spontaneous preterm birth. Methods A decision-analytic model was developed to assess clinical and cost outcomes over a 1-year period. The use of a prognostic test to predict spontaneous preterm birth in a hypothetical population of women reflective of the U.S. population (predictive arm) was compared with the current baseline rate of spontaneous preterm birth and associated infant morbidity and mortality (baseline care arm). Results In a population of 3,528,593 births, our model predicts a 23.5% reduction in infant mortality (8,300 vs. 6,343 deaths) with use of the novel test. The rate of acute conditions at birth decreased from 11.2 to 8.1%; similarly, the rate of developmental disabilities decreased from 13.2 to 11.5%. The rate of spontaneous preterm birth decreased from 9.8 to 9.1%, a reduction of 23,430 preterm births. Direct medical costs savings was $511.7M (- 2.1%) in the first year of life. Discussion The use of a prognostic test for reducing spontaneous preterm birth is a dominant strategy that could reduce costs and improve outcomes. More research is needed once such a test is available to determine if these results are borne out upon real-world use.
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Affiliation(s)
- Aaron B. Caughey
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
| | - John A. F. Zupancic
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - James M. Greenberg
- Division of Perinatal Institute and Neonatology, Cincinnati Children's Hospital, Cincinnati, Ohio
| | | | - Stephen F. Thung
- Department of Obstetrics and Gynecology, Ohio State University, Columbus, Ohio
| | - Jay D. Iams
- Department of Obstetrics and Gynecology, Ohio State University, Columbus, Ohio
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Delmas O, Garcia P, Bernard V, Fabre M, Vialet R, Boubred F, Fayol L. Devenir à l’âge de 3ans d’une cohorte d’enfants nés à moins de 26 semaines d’aménorrhée. Arch Pediatr 2016; 23:927-34. [DOI: 10.1016/j.arcped.2016.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 02/25/2016] [Accepted: 06/11/2016] [Indexed: 10/21/2022]
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Ecker JL, Kaimal A, Mercer BM, Blackwell SC, deRegnier RAO, Farrell RM, Grobman WA, Resnik JL, Sciscione AC, Sciscione AC. Periviable birth: Interim update. Am J Obstet Gynecol 2016; 215:B2-B12.e1. [PMID: 27103153 DOI: 10.1016/j.ajog.2016.04.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Approximately 0.5% of all births occur before the third trimester of pregnancy, and these very early deliveries result in the majority of neonatal deaths and more than 40% of infant deaths. A recent executive summary of proceedings from a joint workshop defined periviable birth as delivery occurring from 20 0/7 weeks to 25 6/7 weeks of gestation. When delivery is anticipated near the limit of viability, families and health care teams are faced with complex and ethically challenging decisions. Multiple factors have been found to be associated with short-term and long-term outcomes of periviable births in addition to gestational age at birth. These include, but are not limited to, nonmodifiable factors (eg, fetal sex, weight, plurality), potentially modifiable antepartum and intrapartum factors (eg, location of delivery, intent to intervene by cesarean delivery or induction for delivery, administration of antenatal corticosteroids and magnesium sulfate), and postnatal management (eg, starting or withholding and continuing or withdrawing intensive care after birth). Antepartum and intrapartum management options vary depending upon the specific circumstances but may include short-term tocolytic therapy for preterm labor to allow time for administration of antenatal steroids, antibiotics to prolong latency after preterm premature rupture of membranes or for intrapartum group B streptococci prophylaxis, and delivery, including cesarean delivery, for concern regarding fetal well-being or fetal malpresentation. Whenever possible, periviable births for which maternal or neonatal intervention is planned should occur in centers that offer expertise in maternal and neonatal care and the needed infrastructure, including intensive care units, to support such services. This document describes newborn outcomes after periviable birth, provides current evidence and recommendations regarding interventions in this setting, and provides an outline for family counseling with the goal of incorporating informed patient preferences. Its intent is to provide support and guidance regarding decisions, including declining and accepting interventions and therapies, based on individual circumstances and patient values.
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Limit of viability: The Swiss experience. Arch Pediatr 2016; 23:944-50. [PMID: 27476994 DOI: 10.1016/j.arcped.2016.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 06/09/2016] [Accepted: 06/24/2016] [Indexed: 11/22/2022]
Abstract
Progress made in the field of perinatology over the past four decades has led to unprecedented low mortality rates for extremely low birth weight infants. However, because rates of important short-term complications and neurodevelopmental impairment among survivors have remained high, the best approach to borderline viable infants continues to be debated. Not surprisingly, guidelines from various national medical societies for the care of infants born at the limit of viability vary considerably. In 2002, the first Swiss recommendations for the care of borderline viable infants were published. They had been developed by a multidisciplinary team of experts from the fields of obstetrics, pediatrics, and neonatology. Despite the availability of national guidelines, center-to-center outcome variability has since persisted, suggesting that care for the most immature infants is not only evidence-based and guideline-driven but also strongly influenced by local neonatal intensive care unit (NICU) culture. In 2011, revised national recommendations for perinatal care at the limit of viability between 22 and 26 completed weeks of gestation were published. It remains to be seen whether this has led to more uniform outcomes across the Swiss centers in the years that followed.
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McKenzie F, Robinson BK, Tucker Edmonds B. Do maternal characteristics influence maternal-fetal medicine physicians' willingness to intervene when managing periviable deliveries? J Perinatol 2016; 36:522-8. [PMID: 26938922 DOI: 10.1038/jp.2016.15] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 12/18/2015] [Accepted: 01/04/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Determine the relative influence of patient characteristics on Maternal-Fetal Medicine (MFM) physicians' willingness to intervene when managing 23-week preterm premature rupture of membranes. STUDY DESIGN Surveyed 750 randomly sampled US members of the Society of Maternal-Fetal Medicine. Physicians rated their willingness to offer induction, order steroids and perform cesarean across eight vignettes; then completed a questionnaire querying expectations about neonatal outcomes and demographics. RESULTS Three hundred and twenty-five (43%) MFMs responded. Patient characteristics only influenced ⩽11% of participants' willingness ratings. Overall, provider characteristics and institutional norms were associated with willingness to perform antenatal interventions, for example, practice region was associated with willingness to offer induction (P<0.001), order steroids (P=0.008) and perform cesarean for distress (P=0.011); while institutional cesarean cutoffs were associated with willingness to order steroids and perform cesarean for labor and distress (all P<0.001). CONCLUSION Physician-level factors and institutional norms, more so than patient characteristics, may drive periviable care and outcomes.
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Affiliation(s)
- F McKenzie
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - B K Robinson
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NorthShore University Health System, University of Chicago, Pritzker School of Medicine, Evanston, IL, USA
| | - B Tucker Edmonds
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
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Sauer CW, Marc-Aurele KL. Attempting to Honor Beliefs of Jehovah's Witnesses at the Edge of Viability in an Infant Born at 23 Weeks' Gestational Age. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:375-8. [PMID: 27255268 PMCID: PMC4917075 DOI: 10.12659/ajcr.898002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patient: Male, 23 weeks’ gestational age newborn Final Diagnosis: 23 weeks’ extreme prematurity • intraventricular hemorrhage • anemia • respiratory distress syndrome Symptoms: Hypotension • metabolic acidosis • tachycardia Medication: — Clinical Procedure: Transfusion of packed red blood cells Specialty: Pediatrics and Neonatology
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Affiliation(s)
- Charles W Sauer
- Department of Pediatrics, University of California, San Diego, CA, USA
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Lamberska T, Luksova M, Smisek J, Vankova J, Plavka R. Premature infants born at <25 weeks of gestation may be compromised by currently recommended resuscitation techniques. Acta Paediatr 2016; 105:e142-50. [PMID: 26341533 DOI: 10.1111/apa.13178] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 03/29/2015] [Accepted: 09/01/2015] [Indexed: 01/07/2023]
Abstract
AIM Standard resuscitation guidelines are based on data from a range of gestational ages. We sought to evaluate the effectiveness of our delivery room resuscitation protocol across a range of gestational ages in preterm infants born at <29 weeks. METHODS We performed an observational study of prospectively collected video recordings of 73 preterm infants. The percentage of bradycardic patients, time to reach target oxygen saturation and the extent of all interventions were compared between three gestational age groups: 22-24 weeks (n = 22), 25-26 weeks (n = 27) and 27-28 weeks (n = 24). RESULTS Although the same resuscitation protocol was followed for all infants, bradycardic infants born <25 weeks responded poorly and required significantly longer to reach oxygen saturation targets of >70%, >80% and >90% (p < 0.03). They required significantly more interventions and had higher rate of death (p < 0.05) and severe intraventricular haemorrhage (p < 0.03). Significantly lower heart rate and oxygen saturation values were found in infants with intraventricular haemorrhage. CONCLUSION Current recommendations for resuscitation may fail to achieve timely lung aeration in infants born at the borderline of viability, leading to higher mortality and morbidity. Sustained inflation and delayed cord clamping may be effective alternatives.
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Affiliation(s)
- Tereza Lamberska
- Division of Neonatology; Department of Obstetrics and Gynaecology; General Faculty Hospital and 1st Faculty of Medicine; Charles University in Prague; Prague Czech Republic
| | - Marketa Luksova
- Division of Neonatology; Department of Obstetrics and Gynaecology; General Faculty Hospital and 1st Faculty of Medicine; Charles University in Prague; Prague Czech Republic
| | - Jan Smisek
- Division of Neonatology; Department of Obstetrics and Gynaecology; General Faculty Hospital and 1st Faculty of Medicine; Charles University in Prague; Prague Czech Republic
| | - Jana Vankova
- Division of Neonatology; Department of Obstetrics and Gynaecology; General Faculty Hospital and 1st Faculty of Medicine; Charles University in Prague; Prague Czech Republic
| | - Richard Plavka
- Division of Neonatology; Department of Obstetrics and Gynaecology; General Faculty Hospital and 1st Faculty of Medicine; Charles University in Prague; Prague Czech Republic
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Kim JK, Chang YS, Sung S, Ahn SY, Yoo HS, Park WS. Trends in Survival and Incidence of Bronchopulmonary Dysplasia in Extremely Preterm Infants at 23-26 Weeks Gestation. J Korean Med Sci 2016; 31:423-9. [PMID: 26955244 PMCID: PMC4779868 DOI: 10.3346/jkms.2016.31.3.423] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 12/14/2015] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to investigate the relationship between survival and incidence of bronchopulmonary dysplasia (BPD) in extremely premature infants, and identify clinical factors responsible for this association. Medical records of 350 infants at 23-26 weeks gestation from 2000 to 2005 (period I, n = 137) and 2006 to 2010 (period II, n = 213) were retrospectively reviewed. The infants were stratified into 23-24 and 25-26 weeks gestation, and the survival, BPD incidence, and clinical characteristics were analyzed. BPD was defined as oxygen dependency at 36 weeks postmenstrual age. The overall survival rate was significantly improved in period II compared to period I (80.3% vs. 70.0%, respectively; P = 0.028), especially in infants at 23-24 weeks gestation (73.9% vs. 47.4%, respectively; P = 0.001). The BPD incidence in survivors during period II (55.0%) was significantly decreased compared to period I (67.7%; P = 0.042), especially at 25-26 weeks gestation (41.7% vs. 62.3%, respectively; P = 0.008). Significantly improved survival at 23-24 weeks gestation was associated with a higher antenatal steroid use and an improved 5-minute Apgar score. A significant decrease in BPD incidence at 25-26 weeks gestation was associated with early extubation, prolonged use of less invasive continuous positive airway pressure, and reduced supplemental oxygen. Improved perinatal and neonatal care can simultaneously lead to improved survival and decreased BPD incidence in extremely premature infants.
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Affiliation(s)
- Jin Kyu Kim
- Department of Pediatrics, Chonbuk National University School of Medicine, Jeonju, Korea
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sein Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Yoon Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Soo Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Soon Park
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Neuropsychological Outcomes in Extremely Preterm Preschoolers Exposed to Tiered Low Oxygen Targets: An Observational Study. J Int Neuropsychol Soc 2016; 22:322-31. [PMID: 26646724 DOI: 10.1017/s1355617715001186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
An observational study of neuropsychological outcomes at preschool age of tiered lowered oxygen (O2) saturation targets in extremely preterm neonates. We studied 111 three-year-olds born <28 weeks' gestational age. Fifty-nine participants born in 2009-2010 during a time-limited quality improvement initiative each received three-tiered stratification of oxygen rates (83-93% until age 32 weeks, 85-95% until age 35 weeks, and 95% after age 35 weeks), the TieredO2 group. Comparisons were made with 52 participants born in 2007-2008 when pre-initiative saturation targets were non-tiered at 89-100%, the Non-tieredO2 group. Neuropsychological domains included general intellectual, executive, attention, language, visuoperceptual, visual-motor, and fine and gross motor functioning. Descriptive and inferential analyses were conducted. Group comparisons were not statistically significant. Descriptively, the TieredO2 group had better general intellectual, executive function, visual-motor, and motor performance and the Non-tieredO2 group had better language performance. Cohen's d and confidence intervals around d were in similar direction and magnitude across measures. A large effect size was found for recall of digits-forward in participants born at 23 and 24 weeks' gestation, d=0.99 and 1.46, respectively. Better TieredO2 outcomes in all domains except language suggests that the tiered oxygen saturation target method is not harmful and merits further investigation through further studies. Benefit in auditory attention appeared greatest in those born at 23 and 24 weeks. Participants in the tiered oxygen saturation group also had fewer ventilation days and a lower incidence of bronchopulmonary dysplasia, perhaps explanatory for these neuropsychological outcomes at age 3.
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Abstract
OBJECTIVE To evaluate in-hospital survival, survival without major morbidity, and neurodevelopmental impairment for neonates born at 23 weeks of gestation provided proactive, coordinated, and comprehensive perinatal and neonatal management. METHODS This was a retrospective cohort study conducted at a single, tertiary care center between 2004 and 2013. Enrollment was limited to mother-neonate dyads at 23 weeks of gestation who were provided a proactive approach defined as documented evidence of antenatal corticosteroid administration, willingness to provide cesarean delivery for fetal distress, and neonatal resuscitation and intensive care. Among survivors, major morbidities (predischarge) and neurodevelopmental assessments at corrected ages of 18-22 months were examined. RESULTS Among 152 live births identified, 101 neonates received proactive care, of whom 60 (59%) survived to hospital discharge. Preterm premature rupture of membranes (adjusted odds ratio [OR] 0.29, 95% confidence interval [CI] 0.09-0.94), fetal growth restriction (OR 0.16, 95% CI 0.03-0.89), delivery room cardiopulmonary resuscitation (OR 0.07, 95% CI 0.02-0.32), and prolonged intubation sequence (OR 0.15, 95% CI 0.05-0.45) were associated with lower neonatal survival. Among neonatal intensive care unit survivors, 62% had at least one major morbidity. Among 50 survivors with assessment at 18-22 months, six (12%) were unimpaired, 20 (40%) had mild impairment, and 24 (48%) had moderate or severe neurodevelopmental impairment. CONCLUSION Proactive, interdisciplinary care enabled more than half of the neonates born at 23 weeks of gestation to survive, and approximately half of children evaluated at 18 months exhibited no or mild impairment. This information should be considered when providing prognostic advice to families with threatened preterm birth at 23 weeks of gestation. LEVEL OF EVIDENCE II.
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Chang YS. Future of neonatology in Korea: the way forward. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2016. [DOI: 10.5124/jkma.2016.59.7.506] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Ecker JL, Kaimal A, Mercer BM, Blackwell SC, deRegnier RAO, Farrell RM, Grobman WA, Resnik JL, Sciscione AC, Sciscione AC. #3: Periviable birth. Am J Obstet Gynecol 2015; 213:604-14. [PMID: 26506448 DOI: 10.1016/j.ajog.2015.08.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Approximately 0.5% of all births occur before the third trimester of pregnancy, and these very early deliveries result in the majority of neonatal deaths and more than 40% of infant deaths. A recent executive summary of proceedings from a joint workshop defined periviable birth as delivery occurring from 20 0/7 weeks to 25 6/7 weeks of gestation. When delivery is anticipated near the limit of viability, families and health care teams are faced with complex and ethically challenging decisions. Multiple factors have been found to be associated with short-term and long-term outcomes of periviable births in addition to gestational age at birth. These include, but are not limited to, nonmodifiable factors (eg, fetal sex, weight, plurality), potentially modifiable antepartum and intrapartum factors (eg, location of delivery, intent to intervene by cesarean delivery or induction for delivery, administration of antenatal corticosteroids and magnesium sulfate), and postnatal management (eg, starting or withholding and continuing or withdrawing intensive care after birth). Antepartum and intrapartum management options vary depending upon the specific circumstances but may include short-term tocolytic therapy for preterm labor to allow time for administration of antenatal steroids, antibiotics to prolong latency after preterm premature rupture of membranes or for intrapartum group B streptococci prophylaxis, and delivery, including cesarean delivery, for concern regarding fetal well-being or fetal malpresentation. Whenever possible, periviable births for which maternal or neonatal intervention is planned should occur in centers that offer expertise in maternal and neonatal care and the needed infrastructure, including intensive care units, to support such services. This document describes newborn outcomes after periviable birth, provides current evidence and recommendations regarding interventions in this setting, and provides an outline for family counseling with the goal of incorporating informed patient preferences. Its intent is to provide support and guidance regarding decisions, including declining and accepting interventions and therapies, based on individual circumstances and patient values.
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