Preterm infants with peri/intraventricular hemorrhage have poorer habituation responses to external stimuli

A Review of the Occurrence of Intraventricular Hemorrhage in Preterm Newborns and its Future Neurodevelopmental Consequences

Intraventricular hemorrhage (IVH) is a type of bleeding that occurs through the germinal matrix and comes through the ependymal cells into the ventricular cavity. It is mostly seen in preterm neonates but can also be seen sometimes in term neonates. Various factors predispose to preterm delivery; it can be spontaneous or medically induced. Spontaneous IVH occurs in cases of intrauterine infections in the mother, and it can be induced in cases of medical emergencies such as preeclampsia and eclampsia. The brain of a preterm newborn is not fully developed as it does not have pericytes and proteins, so it can bleed very quickly, which can cause IVH. Also, the vessels supplying the germinal matrix are immature and highly vascularized. IVH has four grades based on findings detected on cranial ultrasound and MRI. Management includes medical and surgical management; medical management includes phenobarbitone used for seizures and prophylaxis. Surgical management includes drainage, irrigation, and fibrinolytic therapy (DRIFT), and neuro-endoscopic lavage. IVH causes various short-term and long-term neurodevelopmental consequences. Long-term complications include cerebral palsy and intellectual disability, which hamper the life of the child. It mainly presents with seizures, flaccidity, decerebrate posture, etc. Various preventive measures can be taken to tackle IVH in newborns. First of all, preterm delivery should be avoided, and intrauterine infections in mothers should be treated. The administration of corticosteroids should be done for all preterm deliveries as it helps in the maturation of organs. The administration of magnesium sulfate should be done as it is neuroprotective and reduces cerebral palsy in the future. Delayed cord clamping is to be done to reduce recurrent blood transfusions and decrease the risk of IVH. This article explains the pathogenesis, management, prevention, and future outcomes of IVH.

Description of a Nutrition Screening and Assessment Tool and Associations with Clinical Outcomes in Preterm Newborns

BACKGROUND

Preterm newborns have higher nutrition risk and mortality. Nutrition risk screening enables early intervention. This article evaluates a nutrition screening tool in a neonatal intensive care unit (NICU).

METHOD

Retrospective longitudinal study of preterm newborns (aged <37 weeks) in a NICU in Brazil from May 2018 to January 2019. Weight, length, and head circumference (HC) were analyzed. Nutrition screening was defined by care levels (CLs). Outcomes analyzed were bronchopulmonary dysplasia (BPD), peri-intraventricular hemorrhage (PIVH), retinopathy of prematurity (ROP), late sepsis, length of stay, mortality, and time receiving enteral and parenteral nutrition.

RESULTS

Data on 110 newborns were studied, with median gestational age 34 (31-35) weeks, mean weight 1914.92 g (±657.7), length 42.2 cm (±4.45), and HC 29.9 cm (±2.97). Most (82.7%) of them were adequate for gestational age. Screening classifications were 41.8% (n = 46) at CL 2, 41.8% (n = 46) at CL 3, and 16.4% (n = 18) at CL 4. CL 3 and CL 4 patients had higher frequencies of BPD (P = .003), ROP (P = .027), and PIVH (P = .006) and longer enteral time (P < .001) and length of stay (P < .001). All mortality occurred in CL 4 patients (P < .001).

CONCLUSIONS

CL 3 and CL 4 patients had more BPD, ROP, PIVH, and mortality and longer enteral nutrition. Hospital stay was longer for CL ≥3 than CL 2 patients. Patients classified as CL 3 and CL 4 by the nutrition screening tool may have higher nutrition risk.

Assessment of child development in premature babies based on the ICF biopsychosocial model

BACKGROUND

The International Classification of Functionality (ICF) has been recommended to enable a broader and more holistic view of an individual's health condition. In addition, it works as an important reference for multiprofessional teams. In low-income countries, like Brazil, the attempts to systematize and incorporate the ICF model in health services has been a challenge.

AIM

The aim was to analyze the development of premature babies considering the biopsychosocial model of the ICF.

DESIGN

A longitudinal study.

SETTING

Maternity in the northeast Brazil.

POPULATION

Thirty-five premature babies were evaluated in the first stage and 20 in the second.

METHODS

Pre, perinatal, socioeconomic data and environmental factors were collected, and general movements assessed during the 38^th (±1.79) week of corrected gestational age. The Age and Stages Questionnaire (ASQ-3) was used to assess child development, in the 13^th (±1.50) month of life. The instruments were chosen with the objective of evaluating information necessary for the follow-up of premature infants and to represent the five domains of the ICF.

RESULTS

Of the 35 newborns initially evaluated, 20 were reassessed at 1 year of age and 70% were boys. In the function and structure domain, 55% exhibited altered general movements and 35% grade 1 intraventricular hemorrhage; in activity and participation, 15% displayed delayed communication, 20% delayed ample motor coordination, 40% fine motor coordination and problem resolution and 35% personal/social delay in the ASQ-3. Only one item of the personal factors (male sex) and function and structure domain (intraventricular hemorrhage) exhibited an association with atypical child development.

CONCLUSIONS

Given the susceptibility of premature newborn neurodevelopment and the magnitude of the biopsychosocial model of the ICF, even at this early stage of life, it was possible to observe the influence of personal factors, body function and structure domains on atypical child development.

CLINICAL REHABILITATION IMPACT

The care for the premature newborn with global look of the classification of functioning, disability and health.