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Ogata R, Watanabe K, Chong PF, Okamoto J, Sakemi Y, Nakashima T, Ohno T, Nomiyama H, Sonoda Y, Ichimiya Y, Inoue H, Ochiai M, Yamashita H, Sakai Y, Ohga S. Divergent neurodevelopmental profiles of very-low-birth-weight infants. Pediatr Res 2024; 95:233-240. [PMID: 37626120 DOI: 10.1038/s41390-023-02778-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 07/29/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Advanced perinatal medicine has decreased the mortality rate of preterm infants. Long-term neurodevelopmental outcomes of very-low-birth-weight infants (VLBWIs) remain to be investigated. METHODS Participants were 124 VLBWIs who had in-hospital birth from 2007 to 2015. Perinatal information, developmental or intelligence quotient (DQ/IQ), and neurological comorbidities at ages 3 and 6 years were analyzed. RESULTS Fifty-eight (47%) VLBWIs received neurodevelopmental assessments at ages 3 and 6 years. Among them, 15 (26%) showed DQ/IQ <75 at age 6 years. From age 3 to 6 years, 21 (36%) patients showed a decrease (≤-10), while 5 (9%) showed an increase (≥+10) in DQ/IQ scores. Eight (17%) with autism spectrum disorder or attention-deficit hyperactivity disorder (ASD/ADHD) showed split courses of DQ/IQ, including two with ≤-10 and one with +31 to their scores. On the other hand, all 7 VLBWIs with cerebral palsy showed DQ ≤35 at these ages. Magnetic resonance imaging detected severe brain lesions in 7 (47%) of those with DQ <75 and 1 (18%) with ASD/ADHD. CONCLUSIONS VLBWIs show a broad spectrum of neurodevelopmental outcomes after 6 years. These divergent profiles also indicate that different risks contribute to the development of ASD/ADHD from those of cerebral palsy and epilepsy in VLBWIs. IMPACT Very-low-birth-weight infants (VLBWIs) show divergent neurodevelopmental outcomes from age 3 to 6 years. A deep longitudinal study depicts the dynamic change in neurodevelopmental profiles of VLBWIs from age 3 to 6 years. Perinatal brain injury is associated with developmental delay, cerebral palsy and epilepsy, but not with ASD or ADHD at age 6 years.
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Affiliation(s)
- Reina Ogata
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, Kitakyushu, 802-8533, Japan
| | - Kyoko Watanabe
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, Kitakyushu, 802-8533, Japan.
| | - Pin Fee Chong
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Jun Okamoto
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, Kitakyushu, 802-8533, Japan
| | - Yoshihiro Sakemi
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, Kitakyushu, 802-8533, Japan
| | - Toshinori Nakashima
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, Kitakyushu, 802-8533, Japan
| | - Takuro Ohno
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, Kitakyushu, 802-8533, Japan
| | - Hiroyuki Nomiyama
- Department of Radiology, National Hospital Organization Kokura Medical Center, Kitakyushu, 802-8533, Japan
| | - Yuri Sonoda
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Yuko Ichimiya
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Hirosuke Inoue
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Masayuki Ochiai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Hironori Yamashita
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, Kitakyushu, 802-8533, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan.
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
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Fujiyoshi J, Inoue H, Sawano T, Mushimoto Y, Motomura Y, Nishiyama K, Kaku N, Nagata H, Yamamura K, Ishimura M, Koga Y, Ochiai M, Sakai Y, Tajiri T, Ohga S. Critical diseases in neonates after discharge home from birth hospital: A retrospective study from a tertiary hospital in Japan. Early Hum Dev 2023; 186:105869. [PMID: 37774632 DOI: 10.1016/j.earlhumdev.2023.105869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/01/2023]
Abstract
INTRODUCTION To establish actionable neonatal screening during the first month of life, we investigated critical diseases in seemingly healthy newborns discharged from birth hospitals. METHODS This retrospective study enrolled previously healthy full-term infants who visited our hospital, a tertiary hospital in Japan, from home between 5 and 28 days after birth from 2009 to 2018. Infants with known perinatal or congenital diseases, positive newborn screening results, or accidental injuries were excluded. Data were collected from electronic medical records, including principal diagnosis, clinical details, and prognosis at 18 months of age. RESULTS Ninety-seven (58 %) of 168 eligible neonates were admitted to the hospital, and 71 (42 %) were not. The median admission rate in patients with disease onset at ≤14 days after birth (80 %) was significantly higher than that in patients with disease onset at ≥15 days (42 %). Among 45 patients who received intensive medical care, 5 died and 10 developed neurodevelopmental sequelae. Four of 5 patients died by 100 days. Among 25 diseases treated in intensive care unit, 17 (68 %) diseases had a prevalence of <1 per 2000 live births. The commonly used diagnostic methods were imaging (n = 58, 35 %) and physical examination (n = 34, 20 %). CONCLUSION Critical diseases due to rare and heterogeneous causes in ostensibly healthy newborns occurred predominantly in the first two weeks of life. Optimal newborn screening and health check-up protocols may benefit from the wide spectrum of life-threatening diseases occurring in home after birth.
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Affiliation(s)
- Junko Fujiyoshi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Comprehensive Maternity and Perinatal Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Hirosuke Inoue
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Comprehensive Maternity and Perinatal Care Center, Kyushu University Hospital, Fukuoka, Japan.
| | - Toru Sawano
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Comprehensive Maternity and Perinatal Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Yuichi Mushimoto
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshitomo Motomura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kei Nishiyama
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Noriyuki Kaku
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Emergency & Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Hazumu Nagata
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenichiro Yamamura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Perinatal and Pediatric Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masataka Ishimura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuhki Koga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masayuki Ochiai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tatsuro Tajiri
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Kim SH, Jung E, Lee HN, Lee JM, Park SH, Jeong J, Lee BS, Kim EAR, Kim KS. Outcomes at 18-24 Months of Infants with Birth Weight under 500 g Born in Korea during 2013-2017: A Nationwide Cohort Study. Neonatology 2023; 121:74-80. [PMID: 37866355 DOI: 10.1159/000534194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/15/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION This study aimed to investigate the outcomes of infants at 18-24 months born in the Korean Neonatal Network with a birth weight <500 g. METHODS The anthropometric and neurodevelopmental data of infants with a birth weight <500 g at a gestational age of ≥22 weeks who were registered in the Korean Neonatal Network 2013-2017 and followed up at a corrected age of 18-24 months were reviewed. Neurodevelopmental impairment was defined as the presence of any of the following: (1) cerebral palsy; (2) severe visual impairment; (3) hearing impairment; or (4) cognitive impairment. Cognitive impairment was defined as (1) a Bayley Scales of Infant Development-II Mental Development Index score <70; and (2) Bayley Scales of Infant and Toddler Development-III Cognitive and Language Composite scores <85. Cognitive testing was performed for infants with suspected problems upon clinician's referral to developmental specialists. RESULTS At a median corrected age of 20 months, 26/52 (50%) of included infants had neurodevelopmental impairment. Cerebral palsy, severe visual impairment, wearing of glasses, hearing impairment, and cognitive impairment occurred in 22%, 0%, 8%, 5%, and 57% of the included infants, respectively. The proportions of infants with <2 standard deviations of weight, length, and head circumference were 54%, 52%, and 56%, respectively. The majority (70%) of infants were rehospitalized, and the most common cause was respiratory problems. CONCLUSION Half of infants with a birth weight <500 g in Korea may exhibit neurodevelopmental impairment and growth retardation at a corrected age of 18-24 months. Multidisciplinary follow-up along with continuous rehabilitation will be needed to improve neurological and physical development in this special population.
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Affiliation(s)
- Soo Hyun Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea,
| | - Euiseok Jung
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ha Na Lee
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Min Lee
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Hyeon Park
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jiyoon Jeong
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Byong Sop Lee
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ellen Ai-Rhan Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ki-Soo Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Inoue T, Nishikubo T, Hirano S, Kamamoto T, Takahashi Y, Kusuda S. Risk factor analyses for intraventricular hemorrhage in preterm infants: A retrospective cohort study. Pediatr Int 2023; 65:e15599. [PMID: 37551656 DOI: 10.1111/ped.15599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/09/2023] [Accepted: 06/07/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Very-low-birthweight (VLBW) infants can experience severe intraventricular hemorrhage (IVH) that can lead to life-long disability by impairing neurodevelopment. The aim of this study was to identify the risk and protective factors for severe IVH in VLBW infants. METHODS A retrospective, cross-sectional review of VLBW infants born at 22-28 weeks' gestation between January 2003 and December 2012 and listed in the Database of Neonatal Research Network in Japan was performed using a statistical model incorporating an odds ratio (OR) and medical center variation as a center variance ratio (CVR). A two-dimensional analysis using a combination of OR and the CVR described evolving measures of a clinical trial (for OR > 1) and standardization (for CVR > 1) concerning a factor of interest. RESULTS The noteworthy significant protective factors were antenatal steroids (ANS) with and without premature rupture of membrane (OR: 0.43, CVR: 1.08, and OR: 0.68, CVR: 1.14, respectively) and the number of neonatal beds (OR: 0.94, CVR: 0.99) and staff nurses per neonatal bed (OR: 0.89, CVR: 0.99). CONCLUSIONS Active promotion of ANS administration and consolidation of perinatal medical centers can mitigate the development of severe IVH in VLBW infants.
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Affiliation(s)
- Takashi Inoue
- Department of Evidence-Based Medicine, Nara Medical University, Kashihara, Japan
| | - Toshiya Nishikubo
- Neonatal Intensive Care, Maternal, Fetal and Neonatal Medical Center, Nara Medical University Hospital, Kashihara, Japan
| | - Shinya Hirano
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Tomoyuki Kamamoto
- Neonatal Intensive Care, Maternal, Fetal and Neonatal Medical Center, Nara Medical University Hospital, Kashihara, Japan
| | | | - Satoshi Kusuda
- Department of Pediatrics, School of Medicine, Kyorin University, Mitaka, Japan
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5
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Itoshima R, Oda A, Ogawa R, Yanagisawa T, Hiroma T, Nakamura T. Neurodevelopment and physical measurements in infants with birthweight of 500 grams or less. Pediatr Int 2023; 65:e15689. [PMID: 37991183 DOI: 10.1111/ped.15689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND In infants born weighing ≤500 g, little has been studied about the association between neurodevelopmental prognosis and growth. This study aimed to evaluate the association between neurodevelopmental impairment (NDI) and z-scores of physical measurements in infants born weighing ≤500 g. METHODS A single-center, retrospective cohort study in a level IV neonatal intensive care unit in Japan. Infants born weighing ≤500 g between 2010 and 2019 were eligible. Z-scores in weight, length/height, and head circumference at birth, due date (or discharge), 6 and 18 months of corrected age, and 3 years of age were compared between infants with and without NDI at 3 years of age. Three infants with severe intraventricular hemorrhage or periventricular leukomalacia were excluded from the comparison analyses. NDI was defined as having a developmental quotient of ≤70, cerebral palsy, visual impairment, or hearing impairment. RESULTS Of 22 eligible infants, the incidence of NDI at 3 years of age was 54.5%. The z-score was significantly smaller in the NDI group (n = 10) than that in the non-NDI group (n = 9) in head circumference at birth (median, -1.94 vs. -0.75; Z = 0.54; p = 0.020), and in height at 18 months of corrected age (median, -2.84 vs. -1.79; Z = 0.58; p = 0.013) and 3 years of age (median, -2.02 vs. -1.21; Z = 0.47; p = 0.046). CONCLUSIONS NDI at 3 years of age was associated with a small head circumference z-score at birth, height at 18 months of corrected age, and height at 3 years of age in infants born weighing ≤500 g.
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Affiliation(s)
- Ryo Itoshima
- Division of Neonatology, Nagano Children's Hospital, Azumino, Japan
- Life Science Research Center, Nagano Children's Hospital, Azumino, Japan
- Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Arata Oda
- Division of Neonatology, Nagano Children's Hospital, Azumino, Japan
- Life Science Research Center, Nagano Children's Hospital, Azumino, Japan
| | - Ryo Ogawa
- Division of Neonatology, Nagano Children's Hospital, Azumino, Japan
- Life Science Research Center, Nagano Children's Hospital, Azumino, Japan
| | | | - Takehiko Hiroma
- Division of Neonatology, Nagano Children's Hospital, Azumino, Japan
- Life Science Research Center, Nagano Children's Hospital, Azumino, Japan
| | - Tomohiko Nakamura
- Division of Neonatology, Nagano Children's Hospital, Azumino, Japan
- Life Science Research Center, Nagano Children's Hospital, Azumino, Japan
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6
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Kono Y, Yonemoto N, Nakanishi H, Hosono S, Hirano S, Kusuda S, Fujimura M. A Retrospective Cohort Study on Mortality and Neurodevelopmental Outcomes of Preterm Very Low Birth Weight Infants Born to Mothers with Hypertensive Disorders of Pregnancy. Am J Perinatol 2022; 39:1465-1477. [PMID: 33535243 DOI: 10.1055/s-0041-1722874] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE We examined the effects of maternal hypertensive disorders of pregnancy (HDP) on the mortality and neurodevelopmental outcomes in preterm very low birth weight (VLBW) infants (BW ≤1,500 g) based on their intrauterine growth status and gestational age (GA). STUDY DESIGN We included singleton VLBW infants born at <32 weeks' gestation registered in the Neonatal Research Network Japan database. The composite outcomes including death, cerebral palsy (CP), and developmental delay (DD) at 3 years of age were retrospectively compared among three groups: appropriate for GA (AGA) infants of mothers with and without HDP (H-AGA and N-AGA) and small for GA (SGA) infants of mothers with HDP (H-SGA). The adjusted odds ratios (AOR) and 95% confidence intervals (CI) stratified by the groups of every two gestational weeks were calculated after adjusting for the center, year of birth, sex, maternal age, maternal diabetes, antenatal steroid use, clinical chorioamnionitis, premature rupture of membranes, non-life-threatening congenital anomalies, and GA. RESULTS Of 19,323 eligible infants, outcomes were evaluated in 10,192 infants: 683 were H-AGA, 1,719 were H-SGA, and 7,790 were N-AGA. Between H-AGA and N-AGA, no significant difference was observed in the risk for death, CP, or DD in any GA groups. H-AGA had a lower risk for death, CP, or DD than H-SGA in the 24 to 25 weeks group (AOR: 0.434, 95% CI: 0.202-0.930). The odds for death, CP, or DD of H-SGA against N-AGA were found to be higher in the 24 to 25 weeks (AOR: 2.558, 95% CI: 1.558-3.272) and 26 to 27 weeks (AOR: 1.898, 95% CI: 1.427-2.526) groups, but lower in the 30 to 31 weeks group (AOR: 0.518, 95% CI: 0.335-0.800). CONCLUSION There was a lack of follow-up data; however, the outcomes of liveborn preterm VLBW infants of mothers with HDP depended on their intrauterine growth status and GA at birth. KEY POINTS · The effects of HDP on preterm low birth weight infants need to be further examined.. · The outcomes were not different between AGA infants with and without maternal HDP.. · The outcomes of SGA infants with maternal HDP were dependent on their GA..
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Affiliation(s)
- Yumi Kono
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Naohiro Yonemoto
- Department of Psychoneuropharmacology, National institute of Mental Health, National Center of Neurology and Psychiatry, Kodira, Tokyo, Japan
| | - Hidehiko Nakanishi
- Division of Neonatal Intensive Care Medicine, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Shigeharu Hosono
- Department of Perinatal and Neonatal Medicine, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan
| | - Shinya Hirano
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Satoshi Kusuda
- Department of Pediatrics, Kyorin University, Mitaka, Tokyo, Japan
| | - Masanori Fujimura
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
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Caporali C, Longo S, Tritto G, Perotti G, Pisoni C, Naboni C, Gardella B, Spinillo A, Manzoni F, Ghirardello S, Borgatti R, Orcesi S. Neurodevelopmental outcome of Italian preterm ELBW infants: an eleven years single center cohort. Ital J Pediatr 2022; 48:117. [PMID: 35854369 PMCID: PMC9297614 DOI: 10.1186/s13052-022-01303-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preterm extremely low birth weight infants (ELBWi) are known to be at greater risk of developing neuropsychiatric diseases. Identifying early predictors of outcome is essential to refer patients for early intervention. Few studies have investigated neurodevelopmental outcomes in Italian ELBWi. This study aims to describe neurodevelopmental outcome at 24 months of corrected age in an eleven-year single-center cohort of Italian ELBWi and to identify early risk factors for adverse neurodevelopmental outcomes. METHODS All infants born with birth weight < 1000 g and admitted to the Neonatal Intensive Care Unit of the "Fondazione IRCCS Policlinico San Matteo" hospital in Pavia, Italy, from Jan 1, 2005 to Dec 31, 2015 were eligible for inclusion. At 24 months, Griffiths' Mental Developmental Scales Extended Revised (GMDS-ER) were administered. Neurodevelopmental outcome was classified as: normal, minor sequelae (minor neurological signs, General Quotient between 76 and 87), major sequelae (cerebral palsy; General Quotient ≤ 75; severe sensory impairment). Univariate and multivariate multinomial logistic regression models were performed to analyze the correlation between neonatal variables and neurodevelopmental outcome. RESULTS 176 ELBWi were enrolled (mean gestational age 26.52 weeks sd2.23; mean birthweight 777.45 g sd142.89). 67% showed a normal outcome at 24 months, 17% minor sequelae and 16% major sequelae (4.6% cerebral palsy on overall sample). The most frequent major sequela was cognitive impairment (8.52%). In the entire sample the median score on the Hearing-Speech subscale was lower than the median scores recorded on the other subscales and showed a significantly weaker correlation to each of the other subscales of the GMDS-ER. Severely abnormal cUS findings (RRR 10.22 p 0.043) and bronchopulmonary dysplasia (RRR 4.36 p 0.008) were independent risk factors for major sequelae and bronchopulmonary dysplasia for minor sequelae (RRR 3.00 p 0.018) on multivariate multinomial logistic regression. CONCLUSIONS This study showed an improvement in ELBWI survival rate without neurodevelopmental impairment at 24 months compared to previously reported international cohorts. Cognitive impairment was the most frequent major sequela. Median scores on GMDS-ER showed a peculiar developmental profile characterized by a selective deficit in the language domain. Severely abnormal cUS findings and bronchopulmonary dysplasia were confirmed as independent risk factors for major sequelae.
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Affiliation(s)
- Camilla Caporali
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.,Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Stefania Longo
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giovanna Tritto
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.,Fondazione Stella Maris Mediterraneo, Chiaromonte, Potenza, Italy
| | - Gianfranco Perotti
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Camilla Pisoni
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Cecilia Naboni
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Barbara Gardella
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Federica Manzoni
- Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Health Promotion - Environmental Epidemiology Unit, Hygene and Health Prevention Department, Health Protection Agency, Pavia, Italy
| | - Stefano Ghirardello
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Renato Borgatti
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.,Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Simona Orcesi
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.,Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
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Abstract
Advances in perinatal care have seen substantial improvements in survival without disability for extremely preterm infants. Protecting the developing brain and reducing neurodevelopmental sequelae of extremely preterm birth are strategic priorities for both research and clinical care. A number of evidence-based interventions exist for neuroprotection in micropreemies, inclusive of prevention of preterm birth and multiple births with implantation of only one embryo during in vitro fertilisation, as well as antenatal care to optimize fetal wellbeing, strategies for supporting neonatal transition, and neuroprotective developmental care. Avoidance of complications that trigger ischemia and inflammation is vital for minimizing brain dysmaturation and injury, particularly of the white matter. Neurodevelopmental surveillance, early diagnosis of cerebral palsy and early intervention are essential for optimizing long-term outcomes and quality of life. Research priorities include further evaluation of putative neuroprotective agents, and investigation of common neonatal interventions in trials adequately powered to assess neurodevelopmental outcome.
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Itoshima R, Oda A, Ogawa R, Yanagisawa T, Hiroma T, Nakamura T. Respiratory and Gastrointestinal Management of an Infant with a Birth Weight of 258 Grams. AJP Rep 2022; 12:e89-e95. [PMID: 35154903 PMCID: PMC8828450 DOI: 10.1055/a-1678-3755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/20/2021] [Indexed: 11/25/2022] Open
Abstract
Today, more infants weighing less than or equal to 300 g are born, and they survive because of the improvements in neonatal care and treatment. However, their detailed clinical course and neonatal intensive care unit management remain unknown due to their low survival rate and dearth of reports. A male infant was born at 24 weeks and 5 days of gestation and weighed 258 g. The infant received 72 days of invasive and 92 days of noninvasive respiratory support, including high-frequency oscillatory ventilation with volume guarantee and noninvasive neurally adjusted ventilatory assist. Meconium-related ileus was safely treated using diatrizoate. Although the infant was diagnosed with severe bronchopulmonary dysplasia and retinopathy of prematurity requiring laser photocoagulation, he had no other severe complications. He was discharged 201 days postdelivery (3 months of corrected age) with a weight of 3.396 kg. Although managing infants weighing less than or equal to 300 g is difficult, our experience shows that it is possible by combining traditional and modern management methods. The management of such infants requires an understanding of the expected difficulties and adaptation of existing methods to their management. The management techniques described here should help improve their survival and long-term prognosis.
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Affiliation(s)
- Ryo Itoshima
- Division of Neonatology, Nagano Children's Hospital, Nagano, Japan.,Department of Pediatrics, University of Turku, Turku, Finland
| | - Arata Oda
- Division of Neonatology, Nagano Children's Hospital, Nagano, Japan
| | - Ryo Ogawa
- Division of Neonatology, Nagano Children's Hospital, Nagano, Japan
| | | | - Takehiko Hiroma
- Division of Neonatology, Nagano Children's Hospital, Nagano, Japan
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10
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Torio M, Iwayama M, Sawano T, Inoue H, Ochiai M, Taira R, Yonemoto K, Ichimiya Y, Sonoda Y, Sasazuki M, Ishizaki Y, Sanefuji M, Yamane K, Yamashita H, Torisu H, Kira R, Hara T, Kanba S, Sakai Y, Ohga S. Neurodevelopmental Outcomes of High-Risk Preterm Infants: A Prospective Study in Japan. Neurol Clin Pract 2021; 11:398-405. [PMID: 34840866 DOI: 10.1212/cpj.0000000000000920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 07/07/2020] [Indexed: 11/15/2022]
Abstract
Objectives To determine the neurodevelopmental outcomes of very-low-birth-weight infants (VLBWIs, birth weight <1,500 g) after 9 years of follow-up. Methods This study prospectively recruited 224 VLBWIs born from 2003 to 2009 in Kyushu University Hospital, Japan. Comorbidities of neurocognitive impairment, epilepsy, and autism spectrum disorder or attention-deficit hyperactivity disorder (ASD/ADHD) were assessed at age 3, 6, and 9 years. Results Neurodevelopmental profiles were obtained from 185 (83%), 150 (67%), and 119 (53%) participants at age 3, 6, and 9 years, respectively. At age 9 years, 25 (21%) VLBWIs showed intelligence quotient (IQ) <70, 11 (9%) developed epilepsy, and 14 (12%) had a diagnosis of ASD/ADHD. The prevalence of epilepsy was higher in children with an IQ <70 at age 9 years than in those with an IQ ≥70 (44% vs 0%). In contrast, ASD/ADHD appeared at similar frequencies in children with an IQ <70 (16%) and ≥70 (11%). Perinatal complications and severe brain lesions on MRI were considered common perinatal risks for developmental delay and epilepsy but not for ASD/ADHD. Male sex was identified as a unique risk factor for ASD/ADHD. Conclusion These data suggest that VLBWIs showed a higher prevalence of developmental delay, epilepsy, and ASD/ADHD at age 9 years than the general population. Distinct mechanisms might be involved in the pathogenic process of ASD/ADHD from those of developmental delay and epilepsy.
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Affiliation(s)
- Michiko Torio
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Mariko Iwayama
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Toru Sawano
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Hirosuke Inoue
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Masayuki Ochiai
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Ryoji Taira
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Kousuke Yonemoto
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Yuko Ichimiya
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Yuri Sonoda
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Momoko Sasazuki
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Yoshito Ishizaki
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Masafumi Sanefuji
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Kenichi Yamane
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Hiroshi Yamashita
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Hiroyuki Torisu
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Ryutaro Kira
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Toshiro Hara
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Shigenobu Kanba
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Yasunari Sakai
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
| | - Shouichi Ohga
- Department of Pediatrics (MT, MI, TS, HI, MO, RT, K. Yonemoto, Y. Ichimiya, Y. Sonoda, M. Sasazuki, Y. Ishizaki, M. Sanefuji, Y. Sakai, SO), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Health and Welfare (M. Sasazuki), Seinan Jogakuin University, Kitakyushu; Department of Neuropsychiatry (K. Yamane, HY, SK), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Section of Pediatrics (HT), Department of Medicine, Fukuoka Dental College; and Fukuoka Children's Hospital (RK, TH), Japan
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11
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Bührer C. Frühgeborene an der Grenze der Lebensfähigkeit. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-021-01294-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Kono Y. Neurodevelopmental outcomes of very low birth weight infants in the Neonatal Research Network of Japan: importance of neonatal intensive care unit graduate follow-up. Clin Exp Pediatr 2021; 64:313-321. [PMID: 33171036 PMCID: PMC8255508 DOI: 10.3345/cep.2020.01312] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/19/2020] [Indexed: 11/30/2022] Open
Abstract
Here we describe the neurodevelopmental outcomes of very low birth weight (VLBW) infants (birth weight ≤1,500 g) at 3 years of age in the Neonatal Research Network of Japan (NRNJ) database in the past decade and review the methodological issues identified in follow-up studies. The follow-up protocol for children at 3 years of chronological age in the NRNJ consists of physical and comprehensive neurodevelopmental assessments in each participating center. Neurodevelopmental impairment (NDI)-moderate to severe neurological disability-is defined as cerebral palsy (CP) with a Gross Motor Function Classification System score ≥2, visual impairment such as uni- or bilateral blindness, hearing impairment requiring hearing amplification, or cognitive impairment with a developmental quotient (DQ) of Kyoto Scale of Psychological Development score <70 or judgment as delayed by pediatricians. We used death or NDI as an unfavorable outcome in all study subjects and NDI in survivors using number of assessed infants as the denominator. Follow-up data were collected from 49% of survivors in the database. Infants with follow-up data had lower birth weights and were of younger gestational age than those without followup data. Mortality rates of 40,728 VLBW infants born between 2003 and 2012 were 8.2% before discharge and 0.7% after discharge. The impairment rates in the assessed infants were 7.1% for CP, 1.8% for blindness, 0.9% for hearing impairment, 15.9% for a DQ <70, and 19.1% for NDI. The mortality or NDI rate in all study subjects, including infants without followup data, was 17.4%, while that in the subjects with outcome data was 32.5%. The NRNJ follow-up study results suggested that children born with a VLBW remained at high risk of NDI in early childhood. It is important to establish a network followup protocol and complete assessments with fewer dropouts to enable clarification of the outcomes of registered infants.
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Affiliation(s)
- Yumi Kono
- Department of Pediatrics, Jichi Medical University, Shimotsuke Tochigi, Japan
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13
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Shitara Y, Kakiuchi S, Mukai T, Kashima K, Kato M, Takahashi N. Case Report: Treatment of Extremely Preterm Infants With Birthweight Below 300 g: Case Series. Front Pediatr 2021; 9:758683. [PMID: 34938697 PMCID: PMC8685408 DOI: 10.3389/fped.2021.758683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/26/2021] [Indexed: 11/19/2022] Open
Abstract
Reports on the birth of infants weighing <300 g are quite rare and little is known about the best practices in treating such micropreemies. Therefore, we report here on three cases of low birthweight infants weighing <300 g, of whom two infants survived. The birthweights and gestational ages were ranging 279-293 g and 22 + 6/7 - 23 + 6/7 weeks, respectively. All the infants had severe fetal growth restriction and prematurity. The infant in case 1 died of hepatic rupture, perhaps due to birth trauma, which emphasized the need for less invasive obstetric procedures including en caul delivery. The infant in case 2 managed to survive through severe prematurity secondary to hydrops fetalis. However, complications followed soon as tracheal granulation tissue was formed with neurodevelopmental impairment. The infant in case 3 was born recently and her clinical course was less remarkable without severe complications, despite having the least gestational age and birthweight among the three patients. The improved care protocols for extremely low birthweight infants over these years through experiential learning including that with cases 1 and 2 may have ensured the better outcome of case 3. Accumulating evidence and recording the experience of such cases with continuous constructive discussion can contribute to better outcomes and appropriate parental counseling for extremely small babies in the future.
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Affiliation(s)
- Yoshihiko Shitara
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Satsuki Kakiuchi
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Takeo Mukai
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Kohei Kashima
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Motohiro Kato
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Naoto Takahashi
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
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14
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Gu Q, Liu H, Ma J, Yuan J, Li X, Qiao L. A Narrative Review of Circular RNAs in Brain Development and Diseases of Preterm Infants. Front Pediatr 2021; 9:706012. [PMID: 34621711 PMCID: PMC8490812 DOI: 10.3389/fped.2021.706012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/23/2021] [Indexed: 02/01/2023] Open
Abstract
Circular RNAs (circRNAs) generated by back-splicing are the vital class of non-coding RNAs (ncRNAs). Circular RNAs are highly abundant and stable in eukaryotes, and many of them are evolutionarily conserved. They are blessed with higher expression in mammalian brains and could take part in the regulation of physiological and pathophysiological processes. In addition, premature birth is important in neurodevelopmental diseases. Brain damage in preterm infants may represent the main cause of long-term neurodevelopmental disorders in surviving babies. Until recently, more and more researches have been evidenced that circRNAs are involved in the pathogenesis of encephalopathy of premature. We aim at explaining neuroinflammation promoting the brain damage. In this review, we summarize the current findings of circRNAs properties, expression, and functions, as well as their significances in the neurodevelopmental impairments, white matter damage (WMD) and hypoxic-ischemic encephalopathy (HIE). So we think that circRNAs have a direct impact on neurodevelopment and brain injury, and will be a powerful tool in the repair of the injured immature brain. Even though their exact roles and mechanisms of gene regulation remain elusive, circRNAs have potential applications as diagnostic biomarkers for brain damage and the target for neuroprotective intervention.
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Affiliation(s)
- Qianying Gu
- School of Medicine, Southeast University, Nanjing, China.,Department of Pediatrics, Zhongda Hospital, Southeast University, Nanjing, China
| | - Heng Liu
- Department of Pediatrics, Zhongda Hospital, Southeast University, Nanjing, China
| | - Jingjing Ma
- School of Medicine, Southeast University, Nanjing, China.,Department of Pediatrics, Zhongda Hospital, Southeast University, Nanjing, China
| | - Jiaming Yuan
- Department of Pediatrics, Tianchang People's Hospital, Anhui, China
| | - Xinger Li
- Department of Biobank, Zhongda Hospital, Southeast University, Nanjing, China
| | - Lixing Qiao
- School of Medicine, Southeast University, Nanjing, China.,Department of Pediatrics, Zhongda Hospital, Southeast University, Nanjing, China
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15
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Bührer C, Felderhoff-Müser U, Gembruch U, Hecher K, Kainer F, Kehl S, Kidszun A, Kribs A, Krones T, Lipp V, Maier RF, Mitschdörfer B, Nicin T, Roll C, Schindler M. Frühgeborene an der Grenze der Lebensfähigkeit
(Entwicklungsstufe S2k, AWMF-Leitlinien-Register Nr. 024/019, Juni
2020). Z Geburtshilfe Neonatol 2020; 224:244-254. [PMID: 33075837 DOI: 10.1055/a-1230-0810] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Redaktionskomitee
Federführende Fachgesellschaft
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Affiliation(s)
- Christoph Bührer
- Klinik für Neonatologie, Charité - Universitätsmedizin Berlin, Berlin
| | | | - Ulrich Gembruch
- Zentrum für Geburtshilfe und Frauenheilkunde, Universitätsklinikum Bonn, Bonn
| | - Kurt Hecher
- Klinik für Geburtshilfe und Pränatalmedizin, Universitätskrankenhaus Eppendorf, Hamburg
| | - Franz Kainer
- Abteilung für Geburtshilfe und Pränatalmedizin, Klinik Hallerwiese, Nürnberg
| | - Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - André Kidszun
- Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin Mainz, Mainz
| | | | - Tanja Krones
- Klinische Ethik, Universitätsspital Zürich, Zürich
| | - Volker Lipp
- Lehrstuhl für Bürgerliches Recht, Zivilprozessrecht, Medizinrecht und Rechtsvergleichung, Juristische Fakultät / Institut für Notarrecht / Zentrum für Medizinrecht, Universität Göttingen, Göttingen
| | - Rolf F Maier
- Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Marburg, Marburg
| | | | - Tatjana Nicin
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Hanau, Hanau
| | - Claudia Roll
- Abteilung Neonatologie, Pädiatrische Intensivmedizin, Schlafmedizin, Vestische Kinder- und Jugendklinik Datteln, Universität Witten/Herdecke, Datteln
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16
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Hirata K, Iwasaki E, Shoji Y, Yoneda A, Wada K. Early ileostomy in a 419 g infant and long-term follow up: A case report. Pediatr Int 2020; 62:94-95. [PMID: 31880008 DOI: 10.1111/ped.14045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 06/10/2019] [Accepted: 06/17/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Katsuya Hirata
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Eriko Iwasaki
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Yasuko Shoji
- Department of Pediatric Gastroenterology, Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Akihiro Yoneda
- Department of Pediatric Surgery, Osaka City General Hospital, Osaka, Osaka, Japan
| | - Kazuko Wada
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
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17
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Association of perinatal factors of epilepsy in very low birth weight infants, using a nationwide database in Japan. J Perinatol 2019; 39:1472-1479. [PMID: 31527650 PMCID: PMC6892414 DOI: 10.1038/s41372-019-0494-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 07/27/2019] [Accepted: 08/05/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine clinical features of very low birth weight infants (VLBWIs) who had developed epilepsy by age 3 years. STUDY DESIGN Multicenter cohort study using the Neonatal Research Network of Japan database. We analyzed clinical variables of 8431 VLBWIs who had recorded data of neurological sequelae at age 3 years. Logistic regression identified the association between variables and development of epilepsy. RESULT One hundred and forty-three (1.7%) infants developed epilepsy, 683 (8.1%) showed cerebral palsy (CP), and 1114 (13.2%) had psychomotor delay. Epilepsy was associated with history of sepsis [adjusted odds ratio (AOR) 3.23], severe intraventricular hemorrhage (IVH; AOR 5.13), and cystic periventricular leukomalacia (PVL; AOR 12.7). Severe IVH and cystic PVL were also frequently associated with CP and psychomotor delay. CONCLUSION Severe IVH and cystic PVL are strongly associated with development of epilepsy, as well as other neurological sequelae, and are potential critical therapeutic targets.
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