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El Rafei R, Maier RF, Jarreau PH, Norman M, Barros H, Van Reempts P, Van Heijst A, Pedersen P, Cuttini M, Johnson S, Costa R, Zemlin M, Draper ES, Zeitlin J. Postnatal growth restriction and neurodevelopment at 5 years of age: a European extremely preterm birth cohort study. Arch Dis Child Fetal Neonatal Ed 2023; 108:492-498. [PMID: 36868809 DOI: 10.1136/archdischild-2022-324988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/28/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVE To investigate whether extrauterine growth restriction (EUGR) during the neonatal hospitalisation by sex among extremely preterm (EPT) infants is associated with cerebral palsy (CP) and cognitive and motor abilities at 5 years of age. STUDY DESIGN Population-based cohort of births <28 weeks of gestation with data from obstetric and neonatal records and parental questionnaires and clinical assessments at 5 years of age. SETTING 11 European countries. PATIENTS 957 EPT infants born in 2011-2012. MAIN OUTCOMES EUGR at discharge from the neonatal unit was defined as (1) the difference between Z-scores at birth and discharge with <-2 SD as severe, -2 to -1 SD as moderate using Fenton's growth charts (Fenton) and (2) average weight-gain velocity using Patel's formula in grams (g) per kilogram per day (Patel) with <11.2 g (first quartile) as severe, 11.2-12.5 g (median) as moderate. Five-year outcomes were: a CP diagnosis, intelligence quotient (IQ) using the Wechsler Preschool and Primary Scales of Intelligence tests and motor function using the Movement Assessment Battery for Children, second edition. RESULTS 40.1% and 33.9% children were classified as having moderate and severe EUGR, respectively, by Fenton and 23.8% and 26.3% by Patel. Among children without CP, those with severe EUGR had lower IQ than children without EUGR (-3.9 points, 95% Confidence Interval (CI)=-7.2 to -0.6 for Fenton and -5.0 points, 95% CI=-8.2 to -1.8 for Patel), with no interaction by sex. No significant associations were observed between motor function and CP. CONCLUSIONS Severe EUGR among EPT infants was associated with decreased IQ at 5 years of age.
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Affiliation(s)
- Rym El Rafei
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, F-75004 Paris, France
- Sorbonne Université, Collège Doctoral, F-75005 Paris, France
| | - Rolf Felix Maier
- Children's Hospital, University Hospital, Philipps University Marburg, Marburg, Germany
| | - Pierre Henri Jarreau
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, F-75004 Paris, France
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Henrique Barros
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Patrick Van Reempts
- Laboratory of Experimental Medicine and Pediatrics, Division of Neonatology, Study Centre for Perinatal Epidemiology Flanders, University of Antwerp, Flanders, Brussels, Belgium
| | - Arno Van Heijst
- Department of Neonatology, Radboud University Medical Center, Nijmegen,the Netherlands/Erasmusmc, Rotterdam, The Netherlands
| | | | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, Rome, Italy
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Raquel Costa
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
| | - Michael Zemlin
- Department of General Paediatrics and Neonatology, Saarland University, Saarland University Medical School, Homburg, Germany
| | | | - Jennifer Zeitlin
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, F-75004 Paris, France
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Geurtzen MR, Van Heijst A, Hermens R, Scheepers H, Woiski M, Draaisma J, Hogeveen M. Correction to: Preferred prenatal counselling at the limits of viability: a survey among Dutch perinatal professionals. BMC Pregnancy Childbirth 2018; 18:54. [PMID: 29458341 PMCID: PMC5817849 DOI: 10.1186/s12884-018-1680-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 02/05/2018] [Indexed: 11/21/2022] Open
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Geurtzen R, Van Heijst A, Hermens R, Scheepers H, Woiski M, Draaisma J, Hogeveen M. Preferred prenatal counselling at the limits of viability: a survey among Dutch perinatal professionals. BMC Pregnancy Childbirth 2018; 18:7. [PMID: 29298669 PMCID: PMC5751814 DOI: 10.1186/s12884-017-1644-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 12/21/2017] [Indexed: 01/10/2023] Open
Abstract
Background Since 2010, intensive care can be offered in the Netherlands at 24+0 weeks gestation (with parental consent) but the Dutch guideline lacks recommendations on organization, content and preferred decision-making of the counselling. Our aim is to explore preferred prenatal counselling at the limits of viability by Dutch perinatal professionals and compare this to current care. Methods Online nationwide survey as part of the PreCo study (2013) amongst obstetricians and neonatologists in all Dutch level III perinatal care centers (n = 205).The survey regarded prenatal counselling at the limits of viability and focused on the domains of organization, content and decision-making in both current and preferred practice. Results One hundred twenty-two surveys were returned out of 205 eligible professionals (response rate 60%). Organization-wise: more than 80% of all professionals preferred (but currently missed) having protocols for several aspects of counselling, joint counselling by both neonatologist and obstetrician, and the use of supportive materials. Most professionals preferred using national or local data (70%) on outcome statistics for the counselling content, in contrast to the international statistics currently used (74%). Current decisions on initiation care were mostly made together (in 99% parents and doctor). This shared decision model was preferred by 95% of the professionals. Conclusions Dutch perinatal professionals would prefer more protocolized counselling, joint counselling, supportive material and local outcome statistics. Further studies on both barriers to perform adequate counselling, as well as on Dutch outcome statistics and parents’ opinions are needed in order to develop a national framework. Trial registration Clinicaltrials.gov, NCT02782650, retrospectively registered May 2016. Electronic supplementary material The online version of this article (10.1186/s12884-017-1644-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R Geurtzen
- Amalia Children's Hospital, Department of Pediatrics, Radboud university Medical Center, PO Box 9101, 6500HB, Nijmegen, The Netherlands.
| | - Arno Van Heijst
- Amalia Children's Hospital, Department of Pediatrics, Radboud university Medical Center, PO Box 9101, 6500HB, Nijmegen, The Netherlands
| | - Rosella Hermens
- Scientific Institute for Quality of Care, Radboud university medical center, Nijmegen, The Netherlands
| | | | - Mallory Woiski
- Amalia Children's Hospital, Department of Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jos Draaisma
- Amalia Children's Hospital, Department of Pediatrics, Radboud university Medical Center, PO Box 9101, 6500HB, Nijmegen, The Netherlands
| | - Marije Hogeveen
- Amalia Children's Hospital, Department of Pediatrics, Radboud university Medical Center, PO Box 9101, 6500HB, Nijmegen, The Netherlands
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Norman M, Piedvache A, Børch K, Huusom LD, Bonamy AKE, Howell EA, Jarreau PH, Maier RF, Pryds O, Toome L, Varendi H, Weber T, Wilson E, Van Heijst A, Cuttini M, Mazela J, Barros H, Van Reempts P, Draper ES, Zeitlin J. Association of Short Antenatal Corticosteroid Administration-to-Birth Intervals With Survival and Morbidity Among Very Preterm Infants: Results From the EPICE Cohort. JAMA Pediatr 2017; 171:678-686. [PMID: 28505223 PMCID: PMC5710338 DOI: 10.1001/jamapediatrics.2017.0602] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Administration-to-birth intervals of antenatal corticosteroids (ANS) vary. The significance of this variation is unclear. Specifically, to our knowledge, the shortest effective administration-to-birth interval is unknown. OBJECTIVE To explore the associations between ANS administration-to-birth interval and survival and morbidity among very preterm infants. DESIGN, SETTING, AND PARTICIPANTS The Effective Perinatal Intensive Care in Europe (EPICE) study, a population-based prospective cohort study, gathered data from 19 regions in 11 European countries in 2011 and 2012 on 4594 singleton infants with gestational ages between 24 and 31 weeks, without severe anomalies and unexposed to repeated courses of ANS. Data were analyzed November 2016. EXPOSURE Time from first injection of ANS to delivery in hours and days. MAIN OUTCOMES AND MEASURES Three outcomes were studied: in-hospital mortality; a composite of mortality or severe neonatal morbidity, defined as an intraventricular hemorrhage grade of 3 or greater, cystic periventricular leukomalacia, surgical necrotizing enterocolitis, or stage 3 or greater retinopathy of prematurity; and severe neonatal brain injury, defined as an intraventricular hemorrhage grade of 3 or greater or cystic periventricular leukomalacia. RESULTS Of the 4594 infants included in the cohort, 2496 infants (54.3%) were boys, and the mean (SD) gestational age was 28.5 (2.2) weeks and mean (SD) birth weight was 1213 (400) g. Mortality for the 662 infants (14.4%) unexposed to ANS was 20.6% (136 of 661). Administration of ANS was associated with an immediate and rapid decline in mortality, reaching a plateau with more than 50% risk reduction after an administration-to-birth interval of 18 to 36 hours. A similar pattern for timing was seen for the composite mortality or morbidity outcome, whereas a significant risk reduction of severe neonatal brain injury was associated with longer administration-to-birth intervals (greater than 48 hours). For all outcomes, the risk reduction associated with ANS was transient, with increasing mortality and risk for severe neonatal brain injury associated with administration-to-birth intervals exceeding 1 week. Under the assumption of a causal relationship between timing of ANS and mortality, a simulation of ANS administered 3 hours before delivery to infants who did not receive ANS showed that their estimated decline in mortality would be 26%. CONCLUSIONS AND RELEVANCE Antenatal corticosteroids may be effective even if given only hours before delivery. Therefore, the infants of pregnant women at risk of imminent preterm delivery may benefit from its use.
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Affiliation(s)
- Mikael Norman
- Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden,Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Aurelie Piedvache
- INSERM Joint Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, University Hospital Department Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Klaus Børch
- Department of Neonatology, Hvidovre University Hospital, Hvidovre, Denmark
| | | | - Anna-Karin Edstedt Bonamy
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden,Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Elizabeth A. Howell
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York,Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Pierre-Henri Jarreau
- University Paris Descartes and Department of Neonatal Medicine and Intensive Care Unit of Port-Royal, Cochin University Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Rolf F. Maier
- Children’s Hospital, University Hospital, Philipp University of Marburg, Marburg, Germany
| | - Ole Pryds
- Department of Neonatology, Hvidovre University Hospital, Hvidovre, Denmark
| | - Liis Toome
- Tallinn Children’s Hospital, Tallinn, Estonia,University of Tartu, Tartu, Estonia
| | - Heili Varendi
- Tartu University Hospital, University of Tartu, Tartu, Estonia
| | - Tom Weber
- Department of Obstetrics, Hvidovre University Hospital, Hvidovre, Denmark
| | - Emilija Wilson
- Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden,Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Arno Van Heijst
- Department of Neonatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marina Cuttini
- Research Unit of Perinatal Epidemiology, Clinical Care and Management Innovation Research Area, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Jan Mazela
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Henrique Barros
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Patrick Van Reempts
- Department of Neonatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium,Study Centre for Perinatal Epidemiology Flanders, Brussels, Belgium
| | | | - Jennifer Zeitlin
- INSERM Joint Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, University Hospital Department Risks in Pregnancy, Paris Descartes University, Paris, France
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Jani J, Benachi A, Mitanchez D, Allegaert K, Tibboel D, Moreno O, Eisenberg V, Nicolaides K, Gratacos E, Van Heijst A, Storme L, Matis J, Deprest J. Lung-to-head ratio and liver position to predict neonatal morbidity in fetuses with isolated congenital diaphragmatic hernia: A multicenter study. Am J Obstet Gynecol 2006. [DOI: 10.1016/j.ajog.2006.10.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Van Heijst A, Liem D, Hopman J, Van Der Staak F, Sengers R. Oxygenation and hemodynamics in left and right cerebral hemispheres during induction of veno-arterial extracorporeal membrane oxygenation. J Pediatr 2004; 144:223-8. [PMID: 14760266 DOI: 10.1016/j.jpeds.2003.11.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Oxygenation and hemodynamics in the left and right cerebral hemispheres were measured during induction of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). STUDY DESIGN Using near infrared spectrophotometry, effects of right common carotid artery (RCCA) and right internal jugular vein (RIJV) ligation and start of VA-ECMO on concentrations of oxyhemoglobin, deoxyhemoglobin, and cerebral blood volume (CBV) were evaluated in 10 newborn infants. Mean cerebral blood flow velocity (CBFV) in the major cerebral arteries was compared before and after the start of VA-ECMO (pulsed Doppler ultrasonography). RESULTS RCCA ligation caused a decrease in oxyhemoglobin concentration and an increase in deoxyhemoglobin concentration. RIJV ligation caused no changes. Sixty minutes after the start of VA-ECMO, oxyhemoglobin concentration and CBV had increased, and deoxyhemoglobin concentration had decreased. There were no differences between the hemispheres. Mean CBFV had increased in the left internal carotid artery, and it increased equally in both middle cerebral arteries. Flow direction was reversed in the right internal carotid artery. Three patients had asymmetric cerebral lesions, not related to differences in the measurements between the cerebral hemispheres. CONCLUSION The initiation of VA-ECMO causes changes in cerebral oxygenation and hemodynamics but without a difference in effect on left and right cerebral hemispheres.
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Affiliation(s)
- Arno Van Heijst
- Departments of Pediatrics and Pediatric Surgery, University Medical Centre Nijmegen, Nijmegen, The Netherlands.
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Van Heijst A, Liem D, Van Der Staak F, Klaessens J, Festen C, De Haan T, Geven W, Van De Bor M. Hemodynamic changes during opening of the bridge in venoarterial extracorporeal membrane oxygenation. Pediatr Crit Care Med 2001; 2:265-270. [PMID: 12793953 DOI: 10.1097/00130478-200107000-00014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE: To investigate the cause of the hemodynamic changes occurring during opening of the bridge in venoarterial (VA) extracorporeal membrane oxygenation (ECMO). DESIGN: Prospective intervention study in animals. SETTING: Animal research laboratory of a university medical center. SUBJECTS: Eight anesthetized lambs installed on VA-ECMO. INTERVENTIONS: During VA-ECMO the bridge was randomly opened during 1, 2.5, 5, 7.5, 10, and 15 secs at ECMO flow rates of 500, 400, 300, 200, 100, and 50 mL/min. Flows in the ECMO circuit between venous cannula and bridge and bridge and arterial cannula, mean arterial blood pressure, mean left carotid artery blood flow, central venous pressure, superior sagittal sinus pressure, inline mixed venous oxygen saturation, heart rate, and arterial oxygen saturation were measured continuously. Using near infrared spectrophotometry, changes in concentrations of cerebral oxygenated and deoxygenated hemoglobin and cerebral blood volume were also measured. Values during bridge opening were compared with values before opening. The same variables were determined with a roller pump on the bridge with a flow over the bridge at various flow rates. MEASUREMENTS AND MAIN RESULTS: Bridge opening resulted in a change of flow direction between venous cannula and bridge and bridge and arterial cannula. A biphasic response with initial decrease and secondary increase occurred in mean arterial blood pressure and mean left carotid artery blood flow. Central venous pressure, superior sagittal sinus pressure, deoxygenated hemoglobin, and cerebral blood volume increased, whereas cerebral oxygenated hemoglobin decreased. These effects occurred in each combination of ECMO flow rate and opening time. These effects could be abolished by installing a roller pump on the bridge. CONCLUSIONS: Bridge opening in VA-ECMO resulted in significant cerebral hemodynamic changes caused by an arteriovenous shunt over the bridge. The decreased cerebral perfusion pressure may contribute to the occurrence of cerebral ischemia, and the venous congestion may result in intracranial hemorrhages. These could be prevented by installing a roller pump on the bridge.
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Affiliation(s)
- Arno Van Heijst
- Departments of Pediatrics (Drs. Liem and van de Bor and Mr. Klaessens), Pediatric Surgery (Drs. van der Staak and Festen), and Medical Statistics (Mr. de Haan), University Medical Center St. Radboud, Nijmegen, The Netherlands; and the Department of Pediatrics, University Hospital Groningen, Groningen, The Netherlands (Dr. Geven)
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