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van der Veer MAA, de Haan TR, Franken LGW, van Hest RM, Groenendaal F, Dijk PH, de Boode WP, Simons S, Dijkman KP, van Straaten HLM, Rijken M, Cools F, Nuytemans DHGM, van Kaam AH, Bijleveld YA, Mathôt RAA. Population pharmacokinetics of vancomycin in term neonates with perinatal asphyxia treated with therapeutic hypothermia. Br J Clin Pharmacol 2024. [PMID: 38450797 DOI: 10.1111/bcp.16026] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/18/2024] [Accepted: 01/31/2024] [Indexed: 03/08/2024] Open
Abstract
AIMS Little is known about the population pharmacokinetics (PPK) of vancomycin in neonates with perinatal asphyxia treated with therapeutic hypothermia (TH). We aimed to describe the PPK of vancomycin and propose an initial dosing regimen for the first 48 h of treatment with pharmacokinetic/pharmacodynamic target attainment. METHODS Neonates with perinatal asphyxia treated with TH were included from birth until Day 6 in a multicentre prospective cohort study. A vancomycin PPK model was constructed using nonlinear mixed-effects modelling. The model was used to evaluate published dosing guidelines with regard to pharmacokinetic/pharmacodynamic target attainment. The area under the curve/minimal inhibitory concentration ratio of 400-600 mg*h/L was used as target range. RESULTS Sixteen patients received vancomycin (median gestational age: 41 [range: 38-42] weeks, postnatal age: 4.4 [2.5-5.5] days, birth weight: 3.5 [2.3-4.7] kg), and 112 vancomycin plasma concentrations were available. Most samples (79%) were collected during the rewarming and normothermic phase, as vancomycin was rarely initiated during the hypothermic phase due to its nonempirical use. An allometrically scaled 1-compartment model showed the best fit. Vancomycin clearance was 0.17 L/h, lower than literature values for term neonates of 3.5 kg without perinatal asphyxia (range: 0.20-0.32 L/h). Volume of distribution was similar. Published dosing regimens led to overexposure within 24 h of treatment. A loading dose of 10 mg/kg followed by 24 mg/kg/day in 4 doses resulted in target attainment. CONCLUSION Results of this study suggest that vancomycin clearance is reduced in term neonates with perinatal asphyxia treated with TH. Lower dosing regimens should be considered followed by model-informed precision dosing.
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Affiliation(s)
- Marlotte A A van der Veer
- Department of Pharmacy & Clinical Pharmacology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Timo R de Haan
- Department of Neonatology, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Linda G W Franken
- Department of Pharmacy & Clinical Pharmacology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Reinier M van Hest
- Department of Pharmacy & Clinical Pharmacology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
- UMC Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Peter H Dijk
- University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatrics, Division of Neonatology, University of Groningen, Groningen, The Netherlands
| | - Willem P de Boode
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Sinno Simons
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Koen P Dijkman
- Department of Neonatology, Máxima Medical Center Veldhoven, Veldhoven, The Netherlands
| | | | - Monique Rijken
- Department of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Filip Cools
- Department of Neonatology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Debbie H G M Nuytemans
- Department of Neonatology, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Yuma A Bijleveld
- Department of Pharmacy & Clinical Pharmacology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Ron A A Mathôt
- Department of Pharmacy & Clinical Pharmacology, Amsterdam University Medical Center, Amsterdam, The Netherlands
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van der Veer MAA, de Haan TR, Franken LGW, Groenendaal F, Dijk PH, de Boode WP, Simons S, Dijkman KP, van Straaten HLM, Rijken M, Cools F, Nuytemans DHGM, van Kaam AH, Bijleveld YA, Mathôt RAA. Predictive Performance of a Gentamicin Pharmacokinetic Model in Term Neonates with Perinatal Asphyxia Undergoing Controlled Therapeutic Hypothermia. Ther Drug Monit 2024:00007691-990000000-00181. [PMID: 38287875 DOI: 10.1097/ftd.0000000000001166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/24/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Model validation procedures are crucial when population pharmacokinetic (PK) models are used to develop dosing algorithms and to perform model-informed precision dosing. We have previously published a population PK model describing the PK of gentamicin in term neonates with perinatal asphyxia during controlled therapeutic hypothermia (TH), which showed altered gentamicin clearance during the hypothermic phase dependent on gestational age and weight. In this study, the predictive performance and generalizability of this model were assessed using an independent data set of neonates with perinatal asphyxia undergoing controlled TH. METHODS The external data set contained a subset of neonates included in the prospective observational multicenter PharmaCool Study. Predictive performance was assessed by visually inspecting observed-versus-predicted concentration plots and calculating bias and precision. In addition, simulation-based diagnostics, model refitting, and bootstrap analyses were performed. RESULTS The external data set included 323 gentamicin concentrations of 39 neonates. Both the model-building and external data set included neonates from multiple centers. The original gentamicin PK model predicted the observed gentamicin concentrations with adequate accuracy and precision during all phases of controlled TH. Model appropriateness was confirmed with prediction-corrected visual predictive checks and normalized prediction distribution error analyses. Model refitting to the merged data set (n = 86 neonates with 935 samples) showed accurate estimation of PK parameters. CONCLUSIONS The results of this external validation study justify the generalizability of the gentamicin dosing recommendations made in the original study for neonates with perinatal asphyxia undergoing controlled TH (5 mg/kg every 36 or 24 h with gestational age 36-41 and 42 wk, respectively) and its applicability in model-informed precision dosing.
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Affiliation(s)
- Marlotte A A van der Veer
- Department of Pharmacy & Clinical Pharmacology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Timo R de Haan
- Department of Neonatology, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Linda G W Franken
- Department of Pharmacy & Clinical Pharmacology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
- UMC Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Peter H Dijk
- Division of Neonatology, Department of Pediatrics, University Medical Center Groningen, Beatrix Children's Hospital, University of Groningen, Groningen, the Netherlands
| | - Willem P de Boode
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Sinno Simons
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Koen P Dijkman
- Department of Neonatology, Máxima Medical Center Veldhoven, Veldhoven, The Netherlands
| | | | - Monique Rijken
- Department of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands; and
| | - Filip Cools
- Department of Neonatology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Debbie H G M Nuytemans
- Department of Neonatology, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Yuma A Bijleveld
- Department of Pharmacy & Clinical Pharmacology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Ron A A Mathôt
- Department of Pharmacy & Clinical Pharmacology, Amsterdam University Medical Center, Amsterdam, the Netherlands
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3
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Poppe JA, Flint RB, Smits A, Willemsen SP, Storm KK, Nuytemans DH, Onland W, Poley MJ, de Boode WP, Carkeek K, Cassart V, Cornette L, Dijk PH, Hemels MAC, Hermans I, Hütten MC, Kelen D, de Kort EHM, Kroon AA, Lefevere J, Plaskie K, Stewart B, Voeten M, van Weissenbruch MM, Williams O, Zonnenberg IA, Lacaze-Masmonteil T, Pas ABT, Reiss IKM, van Kaam AH, Allegaert K, Hutten GJ, Simons SHP. Doxapram versus placebo in preterm newborns: a study protocol for an international double blinded multicentre randomized controlled trial (DOXA-trial). Trials 2023; 24:656. [PMID: 37817255 PMCID: PMC10566117 DOI: 10.1186/s13063-023-07683-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/28/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Apnoea of prematurity (AOP) is one of the most common diagnoses among preterm infants. AOP often leads to hypoxemia and bradycardia which are associated with an increased risk of death or disability. In addition to caffeine therapy and non-invasive respiratory support, doxapram might be used to reduce hypoxemic episodes and the need for invasive mechanical ventilation in preterm infants, thereby possibly improving their long-term outcome. However, high-quality trials on doxapram are lacking. The DOXA-trial therefore aims to investigate the safety and efficacy of doxapram compared to placebo in reducing the composite outcome of death or severe disability at 18 to 24 months corrected age. METHODS The DOXA-trial is a double blinded, multicentre, randomized, placebo-controlled trial conducted in the Netherlands, Belgium and Canada. A total of 396 preterm infants with a gestational age below 29 weeks, suffering from AOP unresponsive to non-invasive respiratory support and caffeine will be randomized to receive doxapram therapy or placebo. The primary outcome is death or severe disability, defined as cognitive delay, cerebral palsy, severe hearing loss, or bilateral blindness, at 18-24 months corrected age. Secondary outcomes are short-term neonatal morbidity, including duration of mechanical ventilation, bronchopulmonary dysplasia and necrotising enterocolitis, hospital mortality, adverse effects, pharmacokinetics and cost-effectiveness. Analysis will be on an intention-to-treat principle. DISCUSSION Doxapram has the potential to improve neonatal outcomes by improving respiration, but the safety concerns need to be weighed against the potential risks of invasive mechanical ventilation. It is unknown if the use of doxapram improves the long-term outcome. This forms the clinical equipoise of the current trial. This international, multicentre trial will provide the needed high-quality evidence on the efficacy and safety of doxapram in the treatment of AOP in preterm infants. TRIAL REGISTRATION ClinicalTrials.gov NCT04430790 and EUDRACT 2019-003666-41. Prospectively registered on respectively June and January 2020.
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Affiliation(s)
- Jarinda A Poppe
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus University Medical Center Sophia Children's Hospital, Room Sk-4113, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
| | - Robert B Flint
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus University Medical Center Sophia Children's Hospital, Room Sk-4113, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Anne Smits
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Sten P Willemsen
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Kelly K Storm
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus University Medical Center Sophia Children's Hospital, Room Sk-4113, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
| | - Debbie H Nuytemans
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
| | - Wes Onland
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Reproduction & Development, Amsterdam, the Netherlands
| | - Marten J Poley
- Department of Paediatric Surgery and Intensive Care, Erasmus University Medical Center Sophia Children's Hospital, Rotterdam, the Netherlands
- Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Willem P de Boode
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Katherine Carkeek
- Neonatal Intensive Care Unit, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Vincent Cassart
- Department of Neonatology, Grand hôpital de Charleroi, Charleroi, Belgium
| | - Luc Cornette
- Department Neonatology, AZ St-Jan, Bruges, Belgium
| | - Peter H Dijk
- Division of Neonatology, Department of Paediatrics, Beatrix Children's Hospital, University Medical Centre Groningen, Groningen, the Netherlands
| | | | - Isabelle Hermans
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Matthias C Hütten
- Division of Neonatology, Department of Pediatrics, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Dorottya Kelen
- Neonatal Department, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Ellen H M de Kort
- Division of Neonatology, Department of Pediatrics, Máxima Medical Center, Veldhoven, the Netherlands
| | - André A Kroon
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus University Medical Center Sophia Children's Hospital, Room Sk-4113, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
| | - Julie Lefevere
- Neonatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Katleen Plaskie
- Department of Neonatology, GasthuisZusters Antwerpen, Antwerp, Belgium
| | - Breanne Stewart
- Quality Management in Clinical Research (QMCR), University of Alberta, Edmonton, AB, Canada
| | - Michiel Voeten
- Department of Neonatal Intensive Care, University Hospital Antwerp, Edegem, Belgium
| | - Mirjam M van Weissenbruch
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Reproduction & Development, Amsterdam, the Netherlands
| | - Olivia Williams
- Neonatology and Neonatal Intensive Care Unit, CHIREC-Delta Hospital, Brussels, Belgium
| | - Inge A Zonnenberg
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Thierry Lacaze-Masmonteil
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Maternal Infant Child & Youth Research Network (MICYRN), Vancouver, Canada
| | - Arjan B Te Pas
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, the Netherlands
| | - Irwin K M Reiss
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus University Medical Center Sophia Children's Hospital, Room Sk-4113, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
| | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Reproduction & Development, Amsterdam, the Netherlands
| | - Karel Allegaert
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - G Jeroen Hutten
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Reproduction & Development, Amsterdam, the Netherlands
| | - Sinno H P Simons
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus University Medical Center Sophia Children's Hospital, Room Sk-4113, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands.
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4
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Prins S, Linn AJ, van Kaam AHLC, van de Loo M, van Woensel JBM, van Heerde M, Dijk PH, Kneyber MCJ, de Hoog M, Simons SHP, Akkermans AA, Smets EMA, de Vos MA. Diversity of Parent Emotions and Physician Responses During End-of-Life Conversations. Pediatrics 2023; 152:e2022061050. [PMID: 37575087 DOI: 10.1542/peds.2022-061050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Accepted: 05/26/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To provide support to parents of critically ill children, it is important that physicians adequately respond to parents' emotions. In this study, we investigated emotions expressed by parents, physicians' responses to these expressions, and parents' emotions after the physicians' responses in conversations in which crucial decisions regarding the child's life-sustaining treatment had to be made. METHODS Forty-nine audio-recorded conversations between parents of 12 critically ill children and physicians working in the neonatal and pediatric intensive care units of 3 Dutch university medical centers were coded and analyzed by using a qualitative inductive approach. RESULTS Forty-six physicians and 22 parents of 12 children participated. In all 49 conversations, parents expressed a broad range of emotions, often intertwining, including anxiety, anger, devotion, grief, relief, hope, and guilt. Both implicit and explicit expressions of anxiety were prevalent. Physicians predominantly responded to parental emotions with cognition-oriented approaches, thereby limiting opportunities for parents. This appeared to intensify parents' expressions of anger and protectiveness, although their anxiety remained under the surface. In response to more tangible emotional expressions, for instance, grief when the child's death was imminent, physicians provided parents helpful support in both affect- and cognition-oriented ways. CONCLUSIONS Our findings illustrate the diversity of emotions expressed by parents during end-of-life conversations. Moreover, they offer insight into the more and less helpful ways in which physicians may respond to these emotions. More training is needed to help physicians in recognizing parents' emotions, particularly implicit expressions of anxiety, and to choose helpful combinations of responses.
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Affiliation(s)
- Sanne Prins
- Department of Pediatrics, Emma Children's Hospital
| | - Annemiek J Linn
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Moniek van de Loo
- Department of Pediatrics, Division of Neonatology, Emma Children's Hospital
| | - Job B M van Woensel
- Department of Pediatrics, Division of Pediatric Intensive Care, Emma Children's Hospital
| | - Marc van Heerde
- Department of Pediatrics, Division of Pediatric Intensive Care, Emma Children's Hospital
| | | | - Martin C J Kneyber
- Pediatric Critical Care Medicine, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Sinno H P Simons
- Neonatology, Department of Pediatrics, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Aranka A Akkermans
- Department of Medical Psychology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam University Medical Center, Amsterdam, The Netherlands
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van der Veer MAA, de Haan TR, Franken LGW, Hodiamont CJ, Groenendaal F, Dijk PH, de Boode WP, Simons S, Dijkman KP, van Straaten HLM, Rijken M, Cools F, Nuytemans DHGM, van Kaam AH, Bijleveld YA, Mathôt RAA. Population Pharmacokinetics and Dosing Optimization of Ceftazidime in Term Asphyxiated Neonates during Controlled Therapeutic Hypothermia. Antimicrob Agents Chemother 2023; 67:e0170722. [PMID: 37010414 PMCID: PMC10190683 DOI: 10.1128/aac.01707-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/23/2023] [Indexed: 04/04/2023] Open
Abstract
Ceftazidime is an antibiotic commonly used to treat bacterial infections in term neonates undergoing controlled therapeutic hypothermia (TH) for hypoxic-ischemic encephalopathy after perinatal asphyxia. We aimed to describe the population pharmacokinetics (PK) of ceftazidime in asphyxiated neonates during hypothermia, rewarming, and normothermia and propose a population-based rational dosing regimen with optimal PK/pharmacodynamic (PD) target attainment. Data were collected in the PharmaCool prospective observational multicenter study. A population PK model was constructed, and the probability of target attainment (PTA) was assessed during all phases of controlled TH using targets of 100% of the time that the concentration in the blood exceeds the MIC (T>MIC) (for efficacy purposes and 100% T>4×MIC and 100% T>5×MIC to prevent resistance). A total of 35 patients with 338 ceftazidime concentrations were included. An allometrically scaled one-compartment model with postnatal age and body temperature as covariates on clearance was constructed. For a typical patient receiving the current dose of 100 mg/kg of body weight/day in 2 doses and assuming a worst-case MIC of 8 mg/L for Pseudomonas aeruginosa, the PTA was 99.7% for 100% T>MIC during hypothermia (33.7°C; postnatal age [PNA] of 2 days). The PTA decreased to 87.7% for 100% T>MIC during normothermia (36.7°C; PNA of 5 days). Therefore, a dosing regimen of 100 mg/kg/day in 2 doses during hypothermia and rewarming and 150 mg/kg/day in 3 doses during the following normothermic phase is advised. Higher-dosing regimens (150 mg/kg/day in 3 doses during hypothermia and 200 mg/kg/day in 4 doses during normothermia) could be considered when achievements of 100% T>4×MIC and 100% T>5×MIC are desired.
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Affiliation(s)
- Marlotte A. A. van der Veer
- Department of Hospital Pharmacology and Clinical Pharmacology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Timo R. de Haan
- Department of Neonatology, Emma Children’s Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Linda G. W. Franken
- Department of Hospital Pharmacology and Clinical Pharmacology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Caspar J. Hodiamont
- Medical Microbiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter H. Dijk
- University Medical Center Groningen, Beatrix Children’s Hospital, Department of Pediatrics, Division of Neonatology, University of Groningen, Groningen, The Netherlands
| | - Willem P. de Boode
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children’s Hospital, Nijmegen, The Netherlands
| | - Sinno Simons
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Koen P. Dijkman
- Department of Neonatology, Máxima Medical Center Veldhoven, Veldhoven, The Netherlands
| | | | - Monique Rijken
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Filip Cools
- Department of Neonatology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Debbie H. G. M. Nuytemans
- Department of Neonatology, Emma Children’s Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Anton H. van Kaam
- Department of Neonatology, Emma Children’s Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Yuma A. Bijleveld
- Department of Hospital Pharmacology and Clinical Pharmacology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Ron A. A. Mathôt
- Department of Hospital Pharmacology and Clinical Pharmacology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
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6
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Hundscheid T, Onland W, Kooi EMW, Vijlbrief DC, de Vries WB, Dijkman KP, van Kaam AH, Villamor E, Kroon AA, Visser R, Mulder-de Tollenaer SM, De Bisschop B, Dijk PH, Avino D, Hocq C, Zecic A, Meeus M, de Baat T, Derriks F, Henriksen TB, Kyng KJ, Donders R, Nuytemans DHGM, Van Overmeire B, Mulder AL, de Boode WP. Expectant Management or Early Ibuprofen for Patent Ductus Arteriosus. N Engl J Med 2023; 388:980-990. [PMID: 36477458 DOI: 10.1056/nejmoa2207418] [Citation(s) in RCA: 46] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cyclooxygenase inhibitors are commonly used in infants with patent ductus arteriosus (PDA), but the benefit of these drugs is uncertain. METHODS In this multicenter, noninferiority trial, we randomly assigned infants with echocardiographically confirmed PDA (diameter, >1.5 mm, with left-to-right shunting) who were extremely preterm (<28 weeks' gestational age) to receive either expectant management or early ibuprofen treatment. The composite primary outcome included necrotizing enterocolitis (Bell's stage IIa or higher), moderate to severe bronchopulmonary dysplasia, or death at 36 weeks' postmenstrual age. The noninferiority of expectant management as compared with early ibuprofen treatment was defined as an absolute risk difference with an upper boundary of the one-sided 95% confidence interval of less than 10 percentage points. RESULTS A total of 273 infants underwent randomization. The median gestational age was 26 weeks, and the median birth weight was 845 g. A primary-outcome event occurred in 63 of 136 infants (46.3%) in the expectant-management group and in 87 of 137 (63.5%) in the early-ibuprofen group (absolute risk difference, -17.2 percentage points; upper boundary of the one-sided 95% confidence interval [CI], -7.4; P<0.001 for noninferiority). Necrotizing enterocolitis occurred in 24 of 136 infants (17.6%) in the expectant-management group and in 21 of 137 (15.3%) in the early-ibuprofen group (absolute risk difference, 2.3 percentage points; two-sided 95% CI, -6.5 to 11.1); bronchopulmonary dysplasia occurred in 39 of 117 infants (33.3%) and in 57 of 112 (50.9%), respectively (absolute risk difference, -17.6 percentage points; two-sided 95% CI, -30.2 to -5.0). Death occurred in 19 of 136 infants (14.0%) and in 25 of 137 (18.2%), respectively (absolute risk difference, -4.3 percentage points; two-sided 95% CI, -13.0 to 4.4). Rates of other adverse outcomes were similar in the two groups. CONCLUSIONS Expectant management for PDA in extremely premature infants was noninferior to early ibuprofen treatment with respect to necrotizing enterocolitis, bronchopulmonary dysplasia, or death at 36 weeks' postmenstrual age. (Funded by the Netherlands Organization for Health Research and Development and the Belgian Health Care Knowledge Center; BeNeDuctus ClinicalTrials.gov number, NCT02884219; EudraCT number, 2017-001376-28.).
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MESH Headings
- Humans
- Infant
- Infant, Newborn
- Bronchopulmonary Dysplasia/etiology
- Ductus Arteriosus, Patent/diagnostic imaging
- Ductus Arteriosus, Patent/drug therapy
- Ductus Arteriosus, Patent/mortality
- Ductus Arteriosus, Patent/therapy
- Echocardiography
- Enterocolitis, Necrotizing/etiology
- Ibuprofen/administration & dosage
- Ibuprofen/adverse effects
- Ibuprofen/therapeutic use
- Indomethacin/adverse effects
- Indomethacin/therapeutic use
- Infant, Extremely Premature
- Infant, Low Birth Weight
- Infant, Newborn, Diseases/drug therapy
- Infant, Newborn, Diseases/therapy
- Watchful Waiting
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Affiliation(s)
- Tim Hundscheid
- From the Department of Pediatrics, Division of Neonatology (T.H., W.P.B.), and the Department for Health Evidence (R.D.), Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Department of Neonatology, Amsterdam Reproduction and Development, Emma Children's Hospital, Amsterdam University Medical Centers (W.O., W.B.V., A.H.K., T.B.), and Neonatology Network Netherlands (D.H.G.M.N.), Amsterdam, University Medical Center Groningen, Beatrix Children's Hospital, and the Department of Pediatrics, Division of Neonatology, University of Groningen (E.M.W.K., P.H.D.), Groningen, the Division of Woman and Baby, Department of Neonatology, University Medical Center Utrecht, Utrecht University, Wilhelmina Children's Hospital, Utrecht (D.C.V., W.B.V.), the Department of Neonatology, Maxima Medical Center Veldhoven, Veldhoven (K.P.D.), Maastricht University Medical Center, the Department of Pediatrics, Division of Neonatology, School for Oncology and Reproduction, University of Maastricht, Maastricht (E.V.), the Department of Pediatrics, Division of Neonatology, Erasmus Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam (A.A.K.), the Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Willem Alexander Children's Hospital, Leiden (R.V.), and the Department of Pediatrics, Division of Neonatology, Isala Women's and Children's Hospital Zwolle, Zwolle (S.M.M.-T.) - all in the Netherlands; the Department of Neonatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (B.D.B.), the Department of Pediatrics, Division of Neonatology, Hôpital Universitaire des Enfants Reine Fabiola (D.A.), the Department of Pediatrics, Division of Neonatology, Cliniques Universitaires St. Luc (C.H.), the Department of Neonatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme (F.D., B.V.O.), and Kind en Gezin-Opgroeien, Flemish Government, Sint-Gillis (B.V.O.), Brussels, the Department of Pediatrics, Division of Neonatology, Ghent University Hospital, Ghent (A.Z.), and the Department of Neonatology, Antwerp University Hospital, Edegem (A.L.M., M.M.) - all in Belgium; and the Departments of Pediatrics and Adolescent Medicine and Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark (T.B.H., K.J.K.)
| | - Wes Onland
- From the Department of Pediatrics, Division of Neonatology (T.H., W.P.B.), and the Department for Health Evidence (R.D.), Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Department of Neonatology, Amsterdam Reproduction and Development, Emma Children's Hospital, Amsterdam University Medical Centers (W.O., W.B.V., A.H.K., T.B.), and Neonatology Network Netherlands (D.H.G.M.N.), Amsterdam, University Medical Center Groningen, Beatrix Children's Hospital, and the Department of Pediatrics, Division of Neonatology, University of Groningen (E.M.W.K., P.H.D.), Groningen, the Division of Woman and Baby, Department of Neonatology, University Medical Center Utrecht, Utrecht University, Wilhelmina Children's Hospital, Utrecht (D.C.V., W.B.V.), the Department of Neonatology, Maxima Medical Center Veldhoven, Veldhoven (K.P.D.), Maastricht University Medical Center, the Department of Pediatrics, Division of Neonatology, School for Oncology and Reproduction, University of Maastricht, Maastricht (E.V.), the Department of Pediatrics, Division of Neonatology, Erasmus Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam (A.A.K.), the Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Willem Alexander Children's Hospital, Leiden (R.V.), and the Department of Pediatrics, Division of Neonatology, Isala Women's and Children's Hospital Zwolle, Zwolle (S.M.M.-T.) - all in the Netherlands; the Department of Neonatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (B.D.B.), the Department of Pediatrics, Division of Neonatology, Hôpital Universitaire des Enfants Reine Fabiola (D.A.), the Department of Pediatrics, Division of Neonatology, Cliniques Universitaires St. Luc (C.H.), the Department of Neonatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme (F.D., B.V.O.), and Kind en Gezin-Opgroeien, Flemish Government, Sint-Gillis (B.V.O.), Brussels, the Department of Pediatrics, Division of Neonatology, Ghent University Hospital, Ghent (A.Z.), and the Department of Neonatology, Antwerp University Hospital, Edegem (A.L.M., M.M.) - all in Belgium; and the Departments of Pediatrics and Adolescent Medicine and Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark (T.B.H., K.J.K.)
| | - Elisabeth M W Kooi
- From the Department of Pediatrics, Division of Neonatology (T.H., W.P.B.), and the Department for Health Evidence (R.D.), Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Department of Neonatology, Amsterdam Reproduction and Development, Emma Children's Hospital, Amsterdam University Medical Centers (W.O., W.B.V., A.H.K., T.B.), and Neonatology Network Netherlands (D.H.G.M.N.), Amsterdam, University Medical Center Groningen, Beatrix Children's Hospital, and the Department of Pediatrics, Division of Neonatology, University of Groningen (E.M.W.K., P.H.D.), Groningen, the Division of Woman and Baby, Department of Neonatology, University Medical Center Utrecht, Utrecht University, Wilhelmina Children's Hospital, Utrecht (D.C.V., W.B.V.), the Department of Neonatology, Maxima Medical Center Veldhoven, Veldhoven (K.P.D.), Maastricht University Medical Center, the Department of Pediatrics, Division of Neonatology, School for Oncology and Reproduction, University of Maastricht, Maastricht (E.V.), the Department of Pediatrics, Division of Neonatology, Erasmus Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam (A.A.K.), the Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Willem Alexander Children's Hospital, Leiden (R.V.), and the Department of Pediatrics, Division of Neonatology, Isala Women's and Children's Hospital Zwolle, Zwolle (S.M.M.-T.) - all in the Netherlands; the Department of Neonatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (B.D.B.), the Department of Pediatrics, Division of Neonatology, Hôpital Universitaire des Enfants Reine Fabiola (D.A.), the Department of Pediatrics, Division of Neonatology, Cliniques Universitaires St. Luc (C.H.), the Department of Neonatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme (F.D., B.V.O.), and Kind en Gezin-Opgroeien, Flemish Government, Sint-Gillis (B.V.O.), Brussels, the Department of Pediatrics, Division of Neonatology, Ghent University Hospital, Ghent (A.Z.), and the Department of Neonatology, Antwerp University Hospital, Edegem (A.L.M., M.M.) - all in Belgium; and the Departments of Pediatrics and Adolescent Medicine and Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark (T.B.H., K.J.K.)
| | - Daniel C Vijlbrief
- From the Department of Pediatrics, Division of Neonatology (T.H., W.P.B.), and the Department for Health Evidence (R.D.), Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Department of Neonatology, Amsterdam Reproduction and Development, Emma Children's Hospital, Amsterdam University Medical Centers (W.O., W.B.V., A.H.K., T.B.), and Neonatology Network Netherlands (D.H.G.M.N.), Amsterdam, University Medical Center Groningen, Beatrix Children's Hospital, and the Department of Pediatrics, Division of Neonatology, University of Groningen (E.M.W.K., P.H.D.), Groningen, the Division of Woman and Baby, Department of Neonatology, University Medical Center Utrecht, Utrecht University, Wilhelmina Children's Hospital, Utrecht (D.C.V., W.B.V.), the Department of Neonatology, Maxima Medical Center Veldhoven, Veldhoven (K.P.D.), Maastricht University Medical Center, the Department of Pediatrics, Division of Neonatology, School for Oncology and Reproduction, University of Maastricht, Maastricht (E.V.), the Department of Pediatrics, Division of Neonatology, Erasmus Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam (A.A.K.), the Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Willem Alexander Children's Hospital, Leiden (R.V.), and the Department of Pediatrics, Division of Neonatology, Isala Women's and Children's Hospital Zwolle, Zwolle (S.M.M.-T.) - all in the Netherlands; the Department of Neonatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (B.D.B.), the Department of Pediatrics, Division of Neonatology, Hôpital Universitaire des Enfants Reine Fabiola (D.A.), the Department of Pediatrics, Division of Neonatology, Cliniques Universitaires St. Luc (C.H.), the Department of Neonatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme (F.D., B.V.O.), and Kind en Gezin-Opgroeien, Flemish Government, Sint-Gillis (B.V.O.), Brussels, the Department of Pediatrics, Division of Neonatology, Ghent University Hospital, Ghent (A.Z.), and the Department of Neonatology, Antwerp University Hospital, Edegem (A.L.M., M.M.) - all in Belgium; and the Departments of Pediatrics and Adolescent Medicine and Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark (T.B.H., K.J.K.)
| | - Willem B de Vries
- From the Department of Pediatrics, Division of Neonatology (T.H., W.P.B.), and the Department for Health Evidence (R.D.), Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Department of Neonatology, Amsterdam Reproduction and Development, Emma Children's Hospital, Amsterdam University Medical Centers (W.O., W.B.V., A.H.K., T.B.), and Neonatology Network Netherlands (D.H.G.M.N.), Amsterdam, University Medical Center Groningen, Beatrix Children's Hospital, and the Department of Pediatrics, Division of Neonatology, University of Groningen (E.M.W.K., P.H.D.), Groningen, the Division of Woman and Baby, Department of Neonatology, University Medical Center Utrecht, Utrecht University, Wilhelmina Children's Hospital, Utrecht (D.C.V., W.B.V.), the Department of Neonatology, Maxima Medical Center Veldhoven, Veldhoven (K.P.D.), Maastricht University Medical Center, the Department of Pediatrics, Division of Neonatology, School for Oncology and Reproduction, University of Maastricht, Maastricht (E.V.), the Department of Pediatrics, Division of Neonatology, Erasmus Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam (A.A.K.), the Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Willem Alexander Children's Hospital, Leiden (R.V.), and the Department of Pediatrics, Division of Neonatology, Isala Women's and Children's Hospital Zwolle, Zwolle (S.M.M.-T.) - all in the Netherlands; the Department of Neonatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (B.D.B.), the Department of Pediatrics, Division of Neonatology, Hôpital Universitaire des Enfants Reine Fabiola (D.A.), the Department of Pediatrics, Division of Neonatology, Cliniques Universitaires St. Luc (C.H.), the Department of Neonatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme (F.D., B.V.O.), and Kind en Gezin-Opgroeien, Flemish Government, Sint-Gillis (B.V.O.), Brussels, the Department of Pediatrics, Division of Neonatology, Ghent University Hospital, Ghent (A.Z.), and the Department of Neonatology, Antwerp University Hospital, Edegem (A.L.M., M.M.) - all in Belgium; and the Departments of Pediatrics and Adolescent Medicine and Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark (T.B.H., K.J.K.)
| | - Koen P Dijkman
- From the Department of Pediatrics, Division of Neonatology (T.H., W.P.B.), and the Department for Health Evidence (R.D.), Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Department of Neonatology, Amsterdam Reproduction and Development, Emma Children's Hospital, Amsterdam University Medical Centers (W.O., W.B.V., A.H.K., T.B.), and Neonatology Network Netherlands (D.H.G.M.N.), Amsterdam, University Medical Center Groningen, Beatrix Children's Hospital, and the Department of Pediatrics, Division of Neonatology, University of Groningen (E.M.W.K., P.H.D.), Groningen, the Division of Woman and Baby, Department of Neonatology, University Medical Center Utrecht, Utrecht University, Wilhelmina Children's Hospital, Utrecht (D.C.V., W.B.V.), the Department of Neonatology, Maxima Medical Center Veldhoven, Veldhoven (K.P.D.), Maastricht University Medical Center, the Department of Pediatrics, Division of Neonatology, School for Oncology and Reproduction, University of Maastricht, Maastricht (E.V.), the Department of Pediatrics, Division of Neonatology, Erasmus Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam (A.A.K.), the Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Willem Alexander Children's Hospital, Leiden (R.V.), and the Department of Pediatrics, Division of Neonatology, Isala Women's and Children's Hospital Zwolle, Zwolle (S.M.M.-T.) - all in the Netherlands; the Department of Neonatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (B.D.B.), the Department of Pediatrics, Division of Neonatology, Hôpital Universitaire des Enfants Reine Fabiola (D.A.), the Department of Pediatrics, Division of Neonatology, Cliniques Universitaires St. Luc (C.H.), the Department of Neonatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme (F.D., B.V.O.), and Kind en Gezin-Opgroeien, Flemish Government, Sint-Gillis (B.V.O.), Brussels, the Department of Pediatrics, Division of Neonatology, Ghent University Hospital, Ghent (A.Z.), and the Department of Neonatology, Antwerp University Hospital, Edegem (A.L.M., M.M.) - all in Belgium; and the Departments of Pediatrics and Adolescent Medicine and Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark (T.B.H., K.J.K.)
| | - Anton H van Kaam
- From the Department of Pediatrics, Division of Neonatology (T.H., W.P.B.), and the Department for Health Evidence (R.D.), Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Department of Neonatology, Amsterdam Reproduction and Development, Emma Children's Hospital, Amsterdam University Medical Centers (W.O., W.B.V., A.H.K., T.B.), and Neonatology Network Netherlands (D.H.G.M.N.), Amsterdam, University Medical Center Groningen, Beatrix Children's Hospital, and the Department of Pediatrics, Division of Neonatology, University of Groningen (E.M.W.K., P.H.D.), Groningen, the Division of Woman and Baby, Department of Neonatology, University Medical Center Utrecht, Utrecht University, Wilhelmina Children's Hospital, Utrecht (D.C.V., W.B.V.), the Department of Neonatology, Maxima Medical Center Veldhoven, Veldhoven (K.P.D.), Maastricht University Medical Center, the Department of Pediatrics, Division of Neonatology, School for Oncology and Reproduction, University of Maastricht, Maastricht (E.V.), the Department of Pediatrics, Division of Neonatology, Erasmus Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam (A.A.K.), the Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Willem Alexander Children's Hospital, Leiden (R.V.), and the Department of Pediatrics, Division of Neonatology, Isala Women's and Children's Hospital Zwolle, Zwolle (S.M.M.-T.) - all in the Netherlands; the Department of Neonatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (B.D.B.), the Department of Pediatrics, Division of Neonatology, Hôpital Universitaire des Enfants Reine Fabiola (D.A.), the Department of Pediatrics, Division of Neonatology, Cliniques Universitaires St. Luc (C.H.), the Department of Neonatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme (F.D., B.V.O.), and Kind en Gezin-Opgroeien, Flemish Government, Sint-Gillis (B.V.O.), Brussels, the Department of Pediatrics, Division of Neonatology, Ghent University Hospital, Ghent (A.Z.), and the Department of Neonatology, Antwerp University Hospital, Edegem (A.L.M., M.M.) - all in Belgium; and the Departments of Pediatrics and Adolescent Medicine and Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark (T.B.H., K.J.K.)
| | - Eduardo Villamor
- From the Department of Pediatrics, Division of Neonatology (T.H., W.P.B.), and the Department for Health Evidence (R.D.), Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Department of Neonatology, Amsterdam Reproduction and Development, Emma Children's Hospital, Amsterdam University Medical Centers (W.O., W.B.V., A.H.K., T.B.), and Neonatology Network Netherlands (D.H.G.M.N.), Amsterdam, University Medical Center Groningen, Beatrix Children's Hospital, and the Department of Pediatrics, Division of Neonatology, University of Groningen (E.M.W.K., P.H.D.), Groningen, the Division of Woman and Baby, Department of Neonatology, University Medical Center Utrecht, Utrecht University, Wilhelmina Children's Hospital, Utrecht (D.C.V., W.B.V.), the Department of Neonatology, Maxima Medical Center Veldhoven, Veldhoven (K.P.D.), Maastricht University Medical Center, the Department of Pediatrics, Division of Neonatology, School for Oncology and Reproduction, University of Maastricht, Maastricht (E.V.), the Department of Pediatrics, Division of Neonatology, Erasmus Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam (A.A.K.), the Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Willem Alexander Children's Hospital, Leiden (R.V.), and the Department of Pediatrics, Division of Neonatology, Isala Women's and Children's Hospital Zwolle, Zwolle (S.M.M.-T.) - all in the Netherlands; the Department of Neonatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (B.D.B.), the Department of Pediatrics, Division of Neonatology, Hôpital Universitaire des Enfants Reine Fabiola (D.A.), the Department of Pediatrics, Division of Neonatology, Cliniques Universitaires St. Luc (C.H.), the Department of Neonatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme (F.D., B.V.O.), and Kind en Gezin-Opgroeien, Flemish Government, Sint-Gillis (B.V.O.), Brussels, the Department of Pediatrics, Division of Neonatology, Ghent University Hospital, Ghent (A.Z.), and the Department of Neonatology, Antwerp University Hospital, Edegem (A.L.M., M.M.) - all in Belgium; and the Departments of Pediatrics and Adolescent Medicine and Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark (T.B.H., K.J.K.)
| | - André A Kroon
- From the Department of Pediatrics, Division of Neonatology (T.H., W.P.B.), and the Department for Health Evidence (R.D.), Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Department of Neonatology, Amsterdam Reproduction and Development, Emma Children's Hospital, Amsterdam University Medical Centers (W.O., W.B.V., A.H.K., T.B.), and Neonatology Network Netherlands (D.H.G.M.N.), Amsterdam, University Medical Center Groningen, Beatrix Children's Hospital, and the Department of Pediatrics, Division of Neonatology, University of Groningen (E.M.W.K., P.H.D.), Groningen, the Division of Woman and Baby, Department of Neonatology, University Medical Center Utrecht, Utrecht University, Wilhelmina Children's Hospital, Utrecht (D.C.V., W.B.V.), the Department of Neonatology, Maxima Medical Center Veldhoven, Veldhoven (K.P.D.), Maastricht University Medical Center, the Department of Pediatrics, Division of Neonatology, School for Oncology and Reproduction, University of Maastricht, Maastricht (E.V.), the Department of Pediatrics, Division of Neonatology, Erasmus Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam (A.A.K.), the Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Willem Alexander Children's Hospital, Leiden (R.V.), and the Department of Pediatrics, Division of Neonatology, Isala Women's and Children's Hospital Zwolle, Zwolle (S.M.M.-T.) - all in the Netherlands; the Department of Neonatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (B.D.B.), the Department of Pediatrics, Division of Neonatology, Hôpital Universitaire des Enfants Reine Fabiola (D.A.), the Department of Pediatrics, Division of Neonatology, Cliniques Universitaires St. Luc (C.H.), the Department of Neonatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme (F.D., B.V.O.), and Kind en Gezin-Opgroeien, Flemish Government, Sint-Gillis (B.V.O.), Brussels, the Department of Pediatrics, Division of Neonatology, Ghent University Hospital, Ghent (A.Z.), and the Department of Neonatology, Antwerp University Hospital, Edegem (A.L.M., M.M.) - all in Belgium; and the Departments of Pediatrics and Adolescent Medicine and Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark (T.B.H., K.J.K.)
| | - Remco Visser
- From the Department of Pediatrics, Division of Neonatology (T.H., W.P.B.), and the Department for Health Evidence (R.D.), Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Department of Neonatology, Amsterdam Reproduction and Development, Emma Children's Hospital, Amsterdam University Medical Centers (W.O., W.B.V., A.H.K., T.B.), and Neonatology Network Netherlands (D.H.G.M.N.), Amsterdam, University Medical Center Groningen, Beatrix Children's Hospital, and the Department of Pediatrics, Division of Neonatology, University of Groningen (E.M.W.K., P.H.D.), Groningen, the Division of Woman and Baby, Department of Neonatology, University Medical Center Utrecht, Utrecht University, Wilhelmina Children's Hospital, Utrecht (D.C.V., W.B.V.), the Department of Neonatology, Maxima Medical Center Veldhoven, Veldhoven (K.P.D.), Maastricht University Medical Center, the Department of Pediatrics, Division of Neonatology, School for Oncology and Reproduction, University of Maastricht, Maastricht (E.V.), the Department of Pediatrics, Division of Neonatology, Erasmus Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam (A.A.K.), the Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Willem Alexander Children's Hospital, Leiden (R.V.), and the Department of Pediatrics, Division of Neonatology, Isala Women's and Children's Hospital Zwolle, Zwolle (S.M.M.-T.) - all in the Netherlands; the Department of Neonatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (B.D.B.), the Department of Pediatrics, Division of Neonatology, Hôpital Universitaire des Enfants Reine Fabiola (D.A.), the Department of Pediatrics, Division of Neonatology, Cliniques Universitaires St. Luc (C.H.), the Department of Neonatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme (F.D., B.V.O.), and Kind en Gezin-Opgroeien, Flemish Government, Sint-Gillis (B.V.O.), Brussels, the Department of Pediatrics, Division of Neonatology, Ghent University Hospital, Ghent (A.Z.), and the Department of Neonatology, Antwerp University Hospital, Edegem (A.L.M., M.M.) - all in Belgium; and the Departments of Pediatrics and Adolescent Medicine and Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark (T.B.H., K.J.K.)
| | - Susanne M Mulder-de Tollenaer
- From the Department of Pediatrics, Division of Neonatology (T.H., W.P.B.), and the Department for Health Evidence (R.D.), Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Department of Neonatology, Amsterdam Reproduction and Development, Emma Children's Hospital, Amsterdam University Medical Centers (W.O., W.B.V., A.H.K., T.B.), and Neonatology Network Netherlands (D.H.G.M.N.), Amsterdam, University Medical Center Groningen, Beatrix Children's Hospital, and the Department of Pediatrics, Division of Neonatology, University of Groningen (E.M.W.K., P.H.D.), Groningen, the Division of Woman and Baby, Department of Neonatology, University Medical Center Utrecht, Utrecht University, Wilhelmina Children's Hospital, Utrecht (D.C.V., W.B.V.), the Department of Neonatology, Maxima Medical Center Veldhoven, Veldhoven (K.P.D.), Maastricht University Medical Center, the Department of Pediatrics, Division of Neonatology, School for Oncology and Reproduction, University of Maastricht, Maastricht (E.V.), the Department of Pediatrics, Division of Neonatology, Erasmus Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam (A.A.K.), the Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Willem Alexander Children's Hospital, Leiden (R.V.), and the Department of Pediatrics, Division of Neonatology, Isala Women's and Children's Hospital Zwolle, Zwolle (S.M.M.-T.) - all in the Netherlands; the Department of Neonatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (B.D.B.), the Department of Pediatrics, Division of Neonatology, Hôpital Universitaire des Enfants Reine Fabiola (D.A.), the Department of Pediatrics, Division of Neonatology, Cliniques Universitaires St. Luc (C.H.), the Department of Neonatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme (F.D., B.V.O.), and Kind en Gezin-Opgroeien, Flemish Government, Sint-Gillis (B.V.O.), Brussels, the Department of Pediatrics, Division of Neonatology, Ghent University Hospital, Ghent (A.Z.), and the Department of Neonatology, Antwerp University Hospital, Edegem (A.L.M., M.M.) - all in Belgium; and the Departments of Pediatrics and Adolescent Medicine and Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark (T.B.H., K.J.K.)
| | - Barbara De Bisschop
- From the Department of Pediatrics, Division of Neonatology (T.H., W.P.B.), and the Department for Health Evidence (R.D.), Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Department of Neonatology, Amsterdam Reproduction and Development, Emma Children's Hospital, Amsterdam University Medical Centers (W.O., W.B.V., A.H.K., T.B.), and Neonatology Network Netherlands (D.H.G.M.N.), Amsterdam, University Medical Center Groningen, Beatrix Children's Hospital, and the Department of Pediatrics, Division of Neonatology, University of Groningen (E.M.W.K., P.H.D.), Groningen, the Division of Woman and Baby, Department of Neonatology, University Medical Center Utrecht, Utrecht University, Wilhelmina Children's Hospital, Utrecht (D.C.V., W.B.V.), the Department of Neonatology, Maxima Medical Center Veldhoven, Veldhoven (K.P.D.), Maastricht University Medical Center, the Department of Pediatrics, Division of Neonatology, School for Oncology and Reproduction, University of Maastricht, Maastricht (E.V.), the Department of Pediatrics, Division of Neonatology, Erasmus Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam (A.A.K.), the Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Willem Alexander Children's Hospital, Leiden (R.V.), and the Department of Pediatrics, Division of Neonatology, Isala Women's and Children's Hospital Zwolle, Zwolle (S.M.M.-T.) - all in the Netherlands; the Department of Neonatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (B.D.B.), the Department of Pediatrics, Division of Neonatology, Hôpital Universitaire des Enfants Reine Fabiola (D.A.), the Department of Pediatrics, Division of Neonatology, Cliniques Universitaires St. Luc (C.H.), the Department of Neonatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme (F.D., B.V.O.), and Kind en Gezin-Opgroeien, Flemish Government, Sint-Gillis (B.V.O.), Brussels, the Department of Pediatrics, Division of Neonatology, Ghent University Hospital, Ghent (A.Z.), and the Department of Neonatology, Antwerp University Hospital, Edegem (A.L.M., M.M.) - all in Belgium; and the Departments of Pediatrics and Adolescent Medicine and Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark (T.B.H., K.J.K.)
| | - Peter H Dijk
- From the Department of Pediatrics, Division of Neonatology (T.H., W.P.B.), and the Department for Health Evidence (R.D.), Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Department of Neonatology, Amsterdam Reproduction and Development, Emma Children's Hospital, Amsterdam University Medical Centers (W.O., W.B.V., A.H.K., T.B.), and Neonatology Network Netherlands (D.H.G.M.N.), Amsterdam, University Medical Center Groningen, Beatrix Children's Hospital, and the Department of Pediatrics, Division of Neonatology, University of Groningen (E.M.W.K., P.H.D.), Groningen, the Division of Woman and Baby, Department of Neonatology, University Medical Center Utrecht, Utrecht University, Wilhelmina Children's Hospital, Utrecht (D.C.V., W.B.V.), the Department of Neonatology, Maxima Medical Center Veldhoven, Veldhoven (K.P.D.), Maastricht University Medical Center, the Department of Pediatrics, Division of Neonatology, School for Oncology and Reproduction, University of Maastricht, Maastricht (E.V.), the Department of Pediatrics, Division of Neonatology, Erasmus Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam (A.A.K.), the Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Willem Alexander Children's Hospital, Leiden (R.V.), and the Department of Pediatrics, Division of Neonatology, Isala Women's and Children's Hospital Zwolle, Zwolle (S.M.M.-T.) - all in the Netherlands; the Department of Neonatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (B.D.B.), the Department of Pediatrics, Division of Neonatology, Hôpital Universitaire des Enfants Reine Fabiola (D.A.), the Department of Pediatrics, Division of Neonatology, Cliniques Universitaires St. Luc (C.H.), the Department of Neonatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme (F.D., B.V.O.), and Kind en Gezin-Opgroeien, Flemish Government, Sint-Gillis (B.V.O.), Brussels, the Department of Pediatrics, Division of Neonatology, Ghent University Hospital, Ghent (A.Z.), and the Department of Neonatology, Antwerp University Hospital, Edegem (A.L.M., M.M.) - all in Belgium; and the Departments of Pediatrics and Adolescent Medicine and Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark (T.B.H., K.J.K.)
| | - Daniela Avino
- From the Department of Pediatrics, Division of Neonatology (T.H., W.P.B.), and the Department for Health Evidence (R.D.), Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Department of Neonatology, Amsterdam Reproduction and Development, Emma Children's Hospital, Amsterdam University Medical Centers (W.O., W.B.V., A.H.K., T.B.), and Neonatology Network Netherlands (D.H.G.M.N.), Amsterdam, University Medical Center Groningen, Beatrix Children's Hospital, and the Department of Pediatrics, Division of Neonatology, University of Groningen (E.M.W.K., P.H.D.), Groningen, the Division of Woman and Baby, Department of Neonatology, University Medical Center Utrecht, Utrecht University, Wilhelmina Children's Hospital, Utrecht (D.C.V., W.B.V.), the Department of Neonatology, Maxima Medical Center Veldhoven, Veldhoven (K.P.D.), Maastricht University Medical Center, the Department of Pediatrics, Division of Neonatology, School for Oncology and Reproduction, University of Maastricht, Maastricht (E.V.), the Department of Pediatrics, Division of Neonatology, Erasmus Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam (A.A.K.), the Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Willem Alexander Children's Hospital, Leiden (R.V.), and the Department of Pediatrics, Division of Neonatology, Isala Women's and Children's Hospital Zwolle, Zwolle (S.M.M.-T.) - all in the Netherlands; the Department of Neonatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (B.D.B.), the Department of Pediatrics, Division of Neonatology, Hôpital Universitaire des Enfants Reine Fabiola (D.A.), the Department of Pediatrics, Division of Neonatology, Cliniques Universitaires St. Luc (C.H.), the Department of Neonatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme (F.D., B.V.O.), and Kind en Gezin-Opgroeien, Flemish Government, Sint-Gillis (B.V.O.), Brussels, the Department of Pediatrics, Division of Neonatology, Ghent University Hospital, Ghent (A.Z.), and the Department of Neonatology, Antwerp University Hospital, Edegem (A.L.M., M.M.) - all in Belgium; and the Departments of Pediatrics and Adolescent Medicine and Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark (T.B.H., K.J.K.)
| | - Catheline Hocq
- From the Department of Pediatrics, Division of Neonatology (T.H., W.P.B.), and the Department for Health Evidence (R.D.), Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Department of Neonatology, Amsterdam Reproduction and Development, Emma Children's Hospital, Amsterdam University Medical Centers (W.O., W.B.V., A.H.K., T.B.), and Neonatology Network Netherlands (D.H.G.M.N.), Amsterdam, University Medical Center Groningen, Beatrix Children's Hospital, and the Department of Pediatrics, Division of Neonatology, University of Groningen (E.M.W.K., P.H.D.), Groningen, the Division of Woman and Baby, Department of Neonatology, University Medical Center Utrecht, Utrecht University, Wilhelmina Children's Hospital, Utrecht (D.C.V., W.B.V.), the Department of Neonatology, Maxima Medical Center Veldhoven, Veldhoven (K.P.D.), Maastricht University Medical Center, the Department of Pediatrics, Division of Neonatology, School for Oncology and Reproduction, University of Maastricht, Maastricht (E.V.), the Department of Pediatrics, Division of Neonatology, Erasmus Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam (A.A.K.), the Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Willem Alexander Children's Hospital, Leiden (R.V.), and the Department of Pediatrics, Division of Neonatology, Isala Women's and Children's Hospital Zwolle, Zwolle (S.M.M.-T.) - all in the Netherlands; the Department of Neonatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (B.D.B.), the Department of Pediatrics, Division of Neonatology, Hôpital Universitaire des Enfants Reine Fabiola (D.A.), the Department of Pediatrics, Division of Neonatology, Cliniques Universitaires St. Luc (C.H.), the Department of Neonatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme (F.D., B.V.O.), and Kind en Gezin-Opgroeien, Flemish Government, Sint-Gillis (B.V.O.), Brussels, the Department of Pediatrics, Division of Neonatology, Ghent University Hospital, Ghent (A.Z.), and the Department of Neonatology, Antwerp University Hospital, Edegem (A.L.M., M.M.) - all in Belgium; and the Departments of Pediatrics and Adolescent Medicine and Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark (T.B.H., K.J.K.)
| | - Alexandra Zecic
- From the Department of Pediatrics, Division of Neonatology (T.H., W.P.B.), and the Department for Health Evidence (R.D.), Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Department of Neonatology, Amsterdam Reproduction and Development, Emma Children's Hospital, Amsterdam University Medical Centers (W.O., W.B.V., A.H.K., T.B.), and Neonatology Network Netherlands (D.H.G.M.N.), Amsterdam, University Medical Center Groningen, Beatrix Children's Hospital, and the Department of Pediatrics, Division of Neonatology, University of Groningen (E.M.W.K., P.H.D.), Groningen, the Division of Woman and Baby, Department of Neonatology, University Medical Center Utrecht, Utrecht University, Wilhelmina Children's Hospital, Utrecht (D.C.V., W.B.V.), the Department of Neonatology, Maxima Medical Center Veldhoven, Veldhoven (K.P.D.), Maastricht University Medical Center, the Department of Pediatrics, Division of Neonatology, School for Oncology and Reproduction, University of Maastricht, Maastricht (E.V.), the Department of Pediatrics, Division of Neonatology, Erasmus Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam (A.A.K.), the Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Willem Alexander Children's Hospital, Leiden (R.V.), and the Department of Pediatrics, Division of Neonatology, Isala Women's and Children's Hospital Zwolle, Zwolle (S.M.M.-T.) - all in the Netherlands; the Department of Neonatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (B.D.B.), the Department of Pediatrics, Division of Neonatology, Hôpital Universitaire des Enfants Reine Fabiola (D.A.), the Department of Pediatrics, Division of Neonatology, Cliniques Universitaires St. Luc (C.H.), the Department of Neonatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme (F.D., B.V.O.), and Kind en Gezin-Opgroeien, Flemish Government, Sint-Gillis (B.V.O.), Brussels, the Department of Pediatrics, Division of Neonatology, Ghent University Hospital, Ghent (A.Z.), and the Department of Neonatology, Antwerp University Hospital, Edegem (A.L.M., M.M.) - all in Belgium; and the Departments of Pediatrics and Adolescent Medicine and Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark (T.B.H., K.J.K.)
| | - Marisse Meeus
- From the Department of Pediatrics, Division of Neonatology (T.H., W.P.B.), and the Department for Health Evidence (R.D.), Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Department of Neonatology, Amsterdam Reproduction and Development, Emma Children's Hospital, Amsterdam University Medical Centers (W.O., W.B.V., A.H.K., T.B.), and Neonatology Network Netherlands (D.H.G.M.N.), Amsterdam, University Medical Center Groningen, Beatrix Children's Hospital, and the Department of Pediatrics, Division of Neonatology, University of Groningen (E.M.W.K., P.H.D.), Groningen, the Division of Woman and Baby, Department of Neonatology, University Medical Center Utrecht, Utrecht University, Wilhelmina Children's Hospital, Utrecht (D.C.V., W.B.V.), the Department of Neonatology, Maxima Medical Center Veldhoven, Veldhoven (K.P.D.), Maastricht University Medical Center, the Department of Pediatrics, Division of Neonatology, School for Oncology and Reproduction, University of Maastricht, Maastricht (E.V.), the Department of Pediatrics, Division of Neonatology, Erasmus Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam (A.A.K.), the Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Willem Alexander Children's Hospital, Leiden (R.V.), and the Department of Pediatrics, Division of Neonatology, Isala Women's and Children's Hospital Zwolle, Zwolle (S.M.M.-T.) - all in the Netherlands; the Department of Neonatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (B.D.B.), the Department of Pediatrics, Division of Neonatology, Hôpital Universitaire des Enfants Reine Fabiola (D.A.), the Department of Pediatrics, Division of Neonatology, Cliniques Universitaires St. Luc (C.H.), the Department of Neonatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme (F.D., B.V.O.), and Kind en Gezin-Opgroeien, Flemish Government, Sint-Gillis (B.V.O.), Brussels, the Department of Pediatrics, Division of Neonatology, Ghent University Hospital, Ghent (A.Z.), and the Department of Neonatology, Antwerp University Hospital, Edegem (A.L.M., M.M.) - all in Belgium; and the Departments of Pediatrics and Adolescent Medicine and Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark (T.B.H., K.J.K.)
| | - Tessa de Baat
- From the Department of Pediatrics, Division of Neonatology (T.H., W.P.B.), and the Department for Health Evidence (R.D.), Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Department of Neonatology, Amsterdam Reproduction and Development, Emma Children's Hospital, Amsterdam University Medical Centers (W.O., W.B.V., A.H.K., T.B.), and Neonatology Network Netherlands (D.H.G.M.N.), Amsterdam, University Medical Center Groningen, Beatrix Children's Hospital, and the Department of Pediatrics, Division of Neonatology, University of Groningen (E.M.W.K., P.H.D.), Groningen, the Division of Woman and Baby, Department of Neonatology, University Medical Center Utrecht, Utrecht University, Wilhelmina Children's Hospital, Utrecht (D.C.V., W.B.V.), the Department of Neonatology, Maxima Medical Center Veldhoven, Veldhoven (K.P.D.), Maastricht University Medical Center, the Department of Pediatrics, Division of Neonatology, School for Oncology and Reproduction, University of Maastricht, Maastricht (E.V.), the Department of Pediatrics, Division of Neonatology, Erasmus Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam (A.A.K.), the Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Willem Alexander Children's Hospital, Leiden (R.V.), and the Department of Pediatrics, Division of Neonatology, Isala Women's and Children's Hospital Zwolle, Zwolle (S.M.M.-T.) - all in the Netherlands; the Department of Neonatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (B.D.B.), the Department of Pediatrics, Division of Neonatology, Hôpital Universitaire des Enfants Reine Fabiola (D.A.), the Department of Pediatrics, Division of Neonatology, Cliniques Universitaires St. Luc (C.H.), the Department of Neonatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme (F.D., B.V.O.), and Kind en Gezin-Opgroeien, Flemish Government, Sint-Gillis (B.V.O.), Brussels, the Department of Pediatrics, Division of Neonatology, Ghent University Hospital, Ghent (A.Z.), and the Department of Neonatology, Antwerp University Hospital, Edegem (A.L.M., M.M.) - all in Belgium; and the Departments of Pediatrics and Adolescent Medicine and Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark (T.B.H., K.J.K.)
| | - Frank Derriks
- From the Department of Pediatrics, Division of Neonatology (T.H., W.P.B.), and the Department for Health Evidence (R.D.), Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Department of Neonatology, Amsterdam Reproduction and Development, Emma Children's Hospital, Amsterdam University Medical Centers (W.O., W.B.V., A.H.K., T.B.), and Neonatology Network Netherlands (D.H.G.M.N.), Amsterdam, University Medical Center Groningen, Beatrix Children's Hospital, and the Department of Pediatrics, Division of Neonatology, University of Groningen (E.M.W.K., P.H.D.), Groningen, the Division of Woman and Baby, Department of Neonatology, University Medical Center Utrecht, Utrecht University, Wilhelmina Children's Hospital, Utrecht (D.C.V., W.B.V.), the Department of Neonatology, Maxima Medical Center Veldhoven, Veldhoven (K.P.D.), Maastricht University Medical Center, the Department of Pediatrics, Division of Neonatology, School for Oncology and Reproduction, University of Maastricht, Maastricht (E.V.), the Department of Pediatrics, Division of Neonatology, Erasmus Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam (A.A.K.), the Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Willem Alexander Children's Hospital, Leiden (R.V.), and the Department of Pediatrics, Division of Neonatology, Isala Women's and Children's Hospital Zwolle, Zwolle (S.M.M.-T.) - all in the Netherlands; the Department of Neonatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (B.D.B.), the Department of Pediatrics, Division of Neonatology, Hôpital Universitaire des Enfants Reine Fabiola (D.A.), the Department of Pediatrics, Division of Neonatology, Cliniques Universitaires St. Luc (C.H.), the Department of Neonatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme (F.D., B.V.O.), and Kind en Gezin-Opgroeien, Flemish Government, Sint-Gillis (B.V.O.), Brussels, the Department of Pediatrics, Division of Neonatology, Ghent University Hospital, Ghent (A.Z.), and the Department of Neonatology, Antwerp University Hospital, Edegem (A.L.M., M.M.) - all in Belgium; and the Departments of Pediatrics and Adolescent Medicine and Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark (T.B.H., K.J.K.)
| | - Tine B Henriksen
- From the Department of Pediatrics, Division of Neonatology (T.H., W.P.B.), and the Department for Health Evidence (R.D.), Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Department of Neonatology, Amsterdam Reproduction and Development, Emma Children's Hospital, Amsterdam University Medical Centers (W.O., W.B.V., A.H.K., T.B.), and Neonatology Network Netherlands (D.H.G.M.N.), Amsterdam, University Medical Center Groningen, Beatrix Children's Hospital, and the Department of Pediatrics, Division of Neonatology, University of Groningen (E.M.W.K., P.H.D.), Groningen, the Division of Woman and Baby, Department of Neonatology, University Medical Center Utrecht, Utrecht University, Wilhelmina Children's Hospital, Utrecht (D.C.V., W.B.V.), the Department of Neonatology, Maxima Medical Center Veldhoven, Veldhoven (K.P.D.), Maastricht University Medical Center, the Department of Pediatrics, Division of Neonatology, School for Oncology and Reproduction, University of Maastricht, Maastricht (E.V.), the Department of Pediatrics, Division of Neonatology, Erasmus Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam (A.A.K.), the Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Willem Alexander Children's Hospital, Leiden (R.V.), and the Department of Pediatrics, Division of Neonatology, Isala Women's and Children's Hospital Zwolle, Zwolle (S.M.M.-T.) - all in the Netherlands; the Department of Neonatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (B.D.B.), the Department of Pediatrics, Division of Neonatology, Hôpital Universitaire des Enfants Reine Fabiola (D.A.), the Department of Pediatrics, Division of Neonatology, Cliniques Universitaires St. Luc (C.H.), the Department of Neonatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme (F.D., B.V.O.), and Kind en Gezin-Opgroeien, Flemish Government, Sint-Gillis (B.V.O.), Brussels, the Department of Pediatrics, Division of Neonatology, Ghent University Hospital, Ghent (A.Z.), and the Department of Neonatology, Antwerp University Hospital, Edegem (A.L.M., M.M.) - all in Belgium; and the Departments of Pediatrics and Adolescent Medicine and Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark (T.B.H., K.J.K.)
| | - Kasper J Kyng
- From the Department of Pediatrics, Division of Neonatology (T.H., W.P.B.), and the Department for Health Evidence (R.D.), Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Department of Neonatology, Amsterdam Reproduction and Development, Emma Children's Hospital, Amsterdam University Medical Centers (W.O., W.B.V., A.H.K., T.B.), and Neonatology Network Netherlands (D.H.G.M.N.), Amsterdam, University Medical Center Groningen, Beatrix Children's Hospital, and the Department of Pediatrics, Division of Neonatology, University of Groningen (E.M.W.K., P.H.D.), Groningen, the Division of Woman and Baby, Department of Neonatology, University Medical Center Utrecht, Utrecht University, Wilhelmina Children's Hospital, Utrecht (D.C.V., W.B.V.), the Department of Neonatology, Maxima Medical Center Veldhoven, Veldhoven (K.P.D.), Maastricht University Medical Center, the Department of Pediatrics, Division of Neonatology, School for Oncology and Reproduction, University of Maastricht, Maastricht (E.V.), the Department of Pediatrics, Division of Neonatology, Erasmus Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam (A.A.K.), the Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Willem Alexander Children's Hospital, Leiden (R.V.), and the Department of Pediatrics, Division of Neonatology, Isala Women's and Children's Hospital Zwolle, Zwolle (S.M.M.-T.) - all in the Netherlands; the Department of Neonatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (B.D.B.), the Department of Pediatrics, Division of Neonatology, Hôpital Universitaire des Enfants Reine Fabiola (D.A.), the Department of Pediatrics, Division of Neonatology, Cliniques Universitaires St. Luc (C.H.), the Department of Neonatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme (F.D., B.V.O.), and Kind en Gezin-Opgroeien, Flemish Government, Sint-Gillis (B.V.O.), Brussels, the Department of Pediatrics, Division of Neonatology, Ghent University Hospital, Ghent (A.Z.), and the Department of Neonatology, Antwerp University Hospital, Edegem (A.L.M., M.M.) - all in Belgium; and the Departments of Pediatrics and Adolescent Medicine and Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark (T.B.H., K.J.K.)
| | - Rogier Donders
- From the Department of Pediatrics, Division of Neonatology (T.H., W.P.B.), and the Department for Health Evidence (R.D.), Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Department of Neonatology, Amsterdam Reproduction and Development, Emma Children's Hospital, Amsterdam University Medical Centers (W.O., W.B.V., A.H.K., T.B.), and Neonatology Network Netherlands (D.H.G.M.N.), Amsterdam, University Medical Center Groningen, Beatrix Children's Hospital, and the Department of Pediatrics, Division of Neonatology, University of Groningen (E.M.W.K., P.H.D.), Groningen, the Division of Woman and Baby, Department of Neonatology, University Medical Center Utrecht, Utrecht University, Wilhelmina Children's Hospital, Utrecht (D.C.V., W.B.V.), the Department of Neonatology, Maxima Medical Center Veldhoven, Veldhoven (K.P.D.), Maastricht University Medical Center, the Department of Pediatrics, Division of Neonatology, School for Oncology and Reproduction, University of Maastricht, Maastricht (E.V.), the Department of Pediatrics, Division of Neonatology, Erasmus Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam (A.A.K.), the Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Willem Alexander Children's Hospital, Leiden (R.V.), and the Department of Pediatrics, Division of Neonatology, Isala Women's and Children's Hospital Zwolle, Zwolle (S.M.M.-T.) - all in the Netherlands; the Department of Neonatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (B.D.B.), the Department of Pediatrics, Division of Neonatology, Hôpital Universitaire des Enfants Reine Fabiola (D.A.), the Department of Pediatrics, Division of Neonatology, Cliniques Universitaires St. Luc (C.H.), the Department of Neonatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme (F.D., B.V.O.), and Kind en Gezin-Opgroeien, Flemish Government, Sint-Gillis (B.V.O.), Brussels, the Department of Pediatrics, Division of Neonatology, Ghent University Hospital, Ghent (A.Z.), and the Department of Neonatology, Antwerp University Hospital, Edegem (A.L.M., M.M.) - all in Belgium; and the Departments of Pediatrics and Adolescent Medicine and Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark (T.B.H., K.J.K.)
| | - Debbie H G M Nuytemans
- From the Department of Pediatrics, Division of Neonatology (T.H., W.P.B.), and the Department for Health Evidence (R.D.), Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Department of Neonatology, Amsterdam Reproduction and Development, Emma Children's Hospital, Amsterdam University Medical Centers (W.O., W.B.V., A.H.K., T.B.), and Neonatology Network Netherlands (D.H.G.M.N.), Amsterdam, University Medical Center Groningen, Beatrix Children's Hospital, and the Department of Pediatrics, Division of Neonatology, University of Groningen (E.M.W.K., P.H.D.), Groningen, the Division of Woman and Baby, Department of Neonatology, University Medical Center Utrecht, Utrecht University, Wilhelmina Children's Hospital, Utrecht (D.C.V., W.B.V.), the Department of Neonatology, Maxima Medical Center Veldhoven, Veldhoven (K.P.D.), Maastricht University Medical Center, the Department of Pediatrics, Division of Neonatology, School for Oncology and Reproduction, University of Maastricht, Maastricht (E.V.), the Department of Pediatrics, Division of Neonatology, Erasmus Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam (A.A.K.), the Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Willem Alexander Children's Hospital, Leiden (R.V.), and the Department of Pediatrics, Division of Neonatology, Isala Women's and Children's Hospital Zwolle, Zwolle (S.M.M.-T.) - all in the Netherlands; the Department of Neonatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (B.D.B.), the Department of Pediatrics, Division of Neonatology, Hôpital Universitaire des Enfants Reine Fabiola (D.A.), the Department of Pediatrics, Division of Neonatology, Cliniques Universitaires St. Luc (C.H.), the Department of Neonatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme (F.D., B.V.O.), and Kind en Gezin-Opgroeien, Flemish Government, Sint-Gillis (B.V.O.), Brussels, the Department of Pediatrics, Division of Neonatology, Ghent University Hospital, Ghent (A.Z.), and the Department of Neonatology, Antwerp University Hospital, Edegem (A.L.M., M.M.) - all in Belgium; and the Departments of Pediatrics and Adolescent Medicine and Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark (T.B.H., K.J.K.)
| | - Bart Van Overmeire
- From the Department of Pediatrics, Division of Neonatology (T.H., W.P.B.), and the Department for Health Evidence (R.D.), Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Department of Neonatology, Amsterdam Reproduction and Development, Emma Children's Hospital, Amsterdam University Medical Centers (W.O., W.B.V., A.H.K., T.B.), and Neonatology Network Netherlands (D.H.G.M.N.), Amsterdam, University Medical Center Groningen, Beatrix Children's Hospital, and the Department of Pediatrics, Division of Neonatology, University of Groningen (E.M.W.K., P.H.D.), Groningen, the Division of Woman and Baby, Department of Neonatology, University Medical Center Utrecht, Utrecht University, Wilhelmina Children's Hospital, Utrecht (D.C.V., W.B.V.), the Department of Neonatology, Maxima Medical Center Veldhoven, Veldhoven (K.P.D.), Maastricht University Medical Center, the Department of Pediatrics, Division of Neonatology, School for Oncology and Reproduction, University of Maastricht, Maastricht (E.V.), the Department of Pediatrics, Division of Neonatology, Erasmus Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam (A.A.K.), the Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Willem Alexander Children's Hospital, Leiden (R.V.), and the Department of Pediatrics, Division of Neonatology, Isala Women's and Children's Hospital Zwolle, Zwolle (S.M.M.-T.) - all in the Netherlands; the Department of Neonatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (B.D.B.), the Department of Pediatrics, Division of Neonatology, Hôpital Universitaire des Enfants Reine Fabiola (D.A.), the Department of Pediatrics, Division of Neonatology, Cliniques Universitaires St. Luc (C.H.), the Department of Neonatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme (F.D., B.V.O.), and Kind en Gezin-Opgroeien, Flemish Government, Sint-Gillis (B.V.O.), Brussels, the Department of Pediatrics, Division of Neonatology, Ghent University Hospital, Ghent (A.Z.), and the Department of Neonatology, Antwerp University Hospital, Edegem (A.L.M., M.M.) - all in Belgium; and the Departments of Pediatrics and Adolescent Medicine and Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark (T.B.H., K.J.K.)
| | - Antonius L Mulder
- From the Department of Pediatrics, Division of Neonatology (T.H., W.P.B.), and the Department for Health Evidence (R.D.), Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Department of Neonatology, Amsterdam Reproduction and Development, Emma Children's Hospital, Amsterdam University Medical Centers (W.O., W.B.V., A.H.K., T.B.), and Neonatology Network Netherlands (D.H.G.M.N.), Amsterdam, University Medical Center Groningen, Beatrix Children's Hospital, and the Department of Pediatrics, Division of Neonatology, University of Groningen (E.M.W.K., P.H.D.), Groningen, the Division of Woman and Baby, Department of Neonatology, University Medical Center Utrecht, Utrecht University, Wilhelmina Children's Hospital, Utrecht (D.C.V., W.B.V.), the Department of Neonatology, Maxima Medical Center Veldhoven, Veldhoven (K.P.D.), Maastricht University Medical Center, the Department of Pediatrics, Division of Neonatology, School for Oncology and Reproduction, University of Maastricht, Maastricht (E.V.), the Department of Pediatrics, Division of Neonatology, Erasmus Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam (A.A.K.), the Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Willem Alexander Children's Hospital, Leiden (R.V.), and the Department of Pediatrics, Division of Neonatology, Isala Women's and Children's Hospital Zwolle, Zwolle (S.M.M.-T.) - all in the Netherlands; the Department of Neonatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (B.D.B.), the Department of Pediatrics, Division of Neonatology, Hôpital Universitaire des Enfants Reine Fabiola (D.A.), the Department of Pediatrics, Division of Neonatology, Cliniques Universitaires St. Luc (C.H.), the Department of Neonatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme (F.D., B.V.O.), and Kind en Gezin-Opgroeien, Flemish Government, Sint-Gillis (B.V.O.), Brussels, the Department of Pediatrics, Division of Neonatology, Ghent University Hospital, Ghent (A.Z.), and the Department of Neonatology, Antwerp University Hospital, Edegem (A.L.M., M.M.) - all in Belgium; and the Departments of Pediatrics and Adolescent Medicine and Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark (T.B.H., K.J.K.)
| | - Willem P de Boode
- From the Department of Pediatrics, Division of Neonatology (T.H., W.P.B.), and the Department for Health Evidence (R.D.), Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Department of Neonatology, Amsterdam Reproduction and Development, Emma Children's Hospital, Amsterdam University Medical Centers (W.O., W.B.V., A.H.K., T.B.), and Neonatology Network Netherlands (D.H.G.M.N.), Amsterdam, University Medical Center Groningen, Beatrix Children's Hospital, and the Department of Pediatrics, Division of Neonatology, University of Groningen (E.M.W.K., P.H.D.), Groningen, the Division of Woman and Baby, Department of Neonatology, University Medical Center Utrecht, Utrecht University, Wilhelmina Children's Hospital, Utrecht (D.C.V., W.B.V.), the Department of Neonatology, Maxima Medical Center Veldhoven, Veldhoven (K.P.D.), Maastricht University Medical Center, the Department of Pediatrics, Division of Neonatology, School for Oncology and Reproduction, University of Maastricht, Maastricht (E.V.), the Department of Pediatrics, Division of Neonatology, Erasmus Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam (A.A.K.), the Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Willem Alexander Children's Hospital, Leiden (R.V.), and the Department of Pediatrics, Division of Neonatology, Isala Women's and Children's Hospital Zwolle, Zwolle (S.M.M.-T.) - all in the Netherlands; the Department of Neonatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (B.D.B.), the Department of Pediatrics, Division of Neonatology, Hôpital Universitaire des Enfants Reine Fabiola (D.A.), the Department of Pediatrics, Division of Neonatology, Cliniques Universitaires St. Luc (C.H.), the Department of Neonatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme (F.D., B.V.O.), and Kind en Gezin-Opgroeien, Flemish Government, Sint-Gillis (B.V.O.), Brussels, the Department of Pediatrics, Division of Neonatology, Ghent University Hospital, Ghent (A.Z.), and the Department of Neonatology, Antwerp University Hospital, Edegem (A.L.M., M.M.) - all in Belgium; and the Departments of Pediatrics and Adolescent Medicine and Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark (T.B.H., K.J.K.)
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Westenberg LEH, Been JV, Willemsen SP, Vis JY, Tintu AN, Bramer WM, Dijk PH, Steegers EAP, Reiss IKM, Hulzebos CV. Diagnostic Accuracy of Portable, Handheld Point-of-Care Tests vs Laboratory-Based Bilirubin Quantification in Neonates: A Systematic Review and Meta-analysis. JAMA Pediatr 2023; 177:479-488. [PMID: 36912856 PMCID: PMC10012043 DOI: 10.1001/jamapediatrics.2023.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/14/2023]
Abstract
Importance Quantification of bilirubin in blood is essential for early diagnosis and timely treatment of neonatal hyperbilirubinemia. Handheld point-of-care (POC) devices may overcome the current issues with conventional laboratory-based bilirubin (LBB) quantification. Objective To systematically evaluate the reported diagnostic accuracy of POC devices compared with LBB quantification. Data Sources A systematic literature search was conducted in 6 electronic databases (Ovid MEDLINE, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, CINAHL, and Google Scholar) up to December 5, 2022. Study Selection Studies were included in this systematic review and meta-analysis if they had a prospective cohort, retrospective cohort, or cross-sectional design and reported on the comparison between POC device(s) and LBB quantification in neonates aged 0 to 28 days. Point-of-care devices needed the following characteristics: portable, handheld, and able to provide a result within 30 minutes. This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. Data Extraction and Synthesis Data extraction was performed by 2 independent reviewers into a prespecified, customized form. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Meta-analysis was performed of multiple Bland-Altman studies using the Tipton and Shuster method for the main outcome. Main Outcomes and Measures The main outcome was mean difference and limits of agreement in bilirubin levels between POC device and LBB quantification. Secondary outcomes were (1) turnaround time (TAT), (2) blood volumes, and (3) percentage of failed quantifications. Results Ten studies met the inclusion criteria (9 cross-sectional studies and 1 prospective cohort study), representing 3122 neonates. Three studies were considered to have a high risk of bias. The Bilistick was evaluated as the index test in 8 studies and the BiliSpec in 2. A total of 3122 paired measurements showed a pooled mean difference in total bilirubin levels of -14 μmol/L, with pooled 95% CBs of -106 to 78 μmol/L. For the Bilistick, the pooled mean difference was -17 μmol/L (95% CBs, -114 to 80 μmol/L). Point-of-care devices were faster in returning results compared with LBB quantification, whereas blood volume needed was less. The Bilistick was more likely to have a failed quantification compared with LBB. Conclusions and Relevance Despite the advantages that handheld POC devices offer, these findings suggest that the imprecision for measurement of neonatal bilirubin needs improvement to tailor neonatal jaundice management.
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Affiliation(s)
- Lauren E H Westenberg
- Division of Neonatology, Department of Pediatrics, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jasper V Been
- Division of Neonatology, Department of Pediatrics, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Obstetrics and Gynecology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sten P Willemsen
- Department of Obstetrics and Gynecology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jolande Y Vis
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Andrei N Tintu
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Peter H Dijk
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Irwin K M Reiss
- Division of Neonatology, Department of Pediatrics, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Christian V Hulzebos
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
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Siswanto JE, Adisasmita AC, Ronoatmodjo S, Dijk PH, Bos AF, Manurung F, Sauer PJJ. A risk scoring model to predict progression of retinopathy of prematurity for Indonesia. PLoS One 2023; 18:e0281284. [PMID: 36735727 PMCID: PMC9897566 DOI: 10.1371/journal.pone.0281284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 01/20/2023] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Retinopathy of prematurity (ROP) is a serious eye disease in preterm infants. Generally, the progression of this disease can be detected by screening infants regularly. In case of progression, treatment can be instituted to stop the progression. In Indonesia, however, not all infants are screened because the number of pediatric ophthalmologists trained to screen for ROP and provide treatment is limited. Therefore, other methods are required to identify infants at risk of developing severe ROP. OBJECTIVE To assess a scoring model's internal and external validity to predict ROP progression in Indonesia. METHOD To develop a scoring model and determine its internal validity, we used data on 98 preterm infants with ROP who had undergone one or more serial eye examinations between 2009 and 2014. For external validation, we analyzed data on 62 infants diagnosed with ROP irrespective of the stage between 2017 and 2020. Patients stemmed from one neonatal unit and three eye clinics in Jakarta, Indonesia. RESULTS We identified the duration of oxygen supplementation, gestational age, socio-economic status, place of birth, and oxygen saturation monitor setting as risk factors for developing ROP. We developed two models-one based on the duration of supplemental oxygen and one on the setting of the oxygen saturation monitor. The ROP risk and probabilistic models obtained the same sensitivity and specificity for progression to Type 1 ROP. The agreement, determined with the Kappa statistic, between the ROP risk model's suitability and the probabilistic model was excellent. The external validity of the ROP risk model showed 100% sensitivity, 73% specificity, 76% positive predictive value, 100% negative predictive value, positive LR +3.7, negative LR 0, 47% pre-test probability, and 77% post-test probability. CONCLUSION The ROP risk scoring model can help to predict which infants with first-stage ROP might show progression to severe ROP and may identify infants who require referral to a pediatric ophthalmologist for treatment.
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Affiliation(s)
- Johanes Edy Siswanto
- Neonatology Working Group, Department of Pediatrics, Harapan Kita Women and Children Hospital, Jakarta, Indonesia
- Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia
- * E-mail: ,
| | - Asri C. Adisasmita
- Department of Epidemiology, University of Indonesia School of Public Health, Depok, Indonesia
| | - Sudarto Ronoatmodjo
- Department of Epidemiology, University of Indonesia School of Public Health, Depok, Indonesia
| | - Peter H. Dijk
- Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Arend F. Bos
- Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Pieter J. J. Sauer
- Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, Groningen, The Netherlands
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Westenberg LEH, van der Geest BAM, Lingsma HF, Nieboer D, Groen H, Vis JY, Ista E, Poley MJ, Dijk PH, Steegers EAP, Reiss IKM, Hulzebos CV, Been JV. Better assessment of neonatal jaundice at home (BEAT Jaundice @home): protocol for a prospective, multicentre diagnostic study. BMJ Open 2022; 12:e061897. [PMID: 36396315 PMCID: PMC9677012 DOI: 10.1136/bmjopen-2022-061897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Severe neonatal hyperbilirubinaemia can place a neonate at risk for acute bilirubin encephalopathy and kernicterus spectrum disorder. Early diagnosis is essential to prevent these deleterious sequelae. Currently, screening by visual inspection followed by laboratory-based bilirubin (LBB) quantification is used to identify hyperbilirubinaemia in neonates cared for at home in the Netherlands. However, the reliability of visual inspection is limited. We aim to evaluate the effectiveness of universal transcutaneous bilirubin (TcB) screening as compared with visual inspection to: (1) increase the detection of hyperbilirubinaemia necessitating treatment, and (2) reduce the need for heel pricks to quantify bilirubin levels. In parallel, we will evaluate a smartphone app (Picterus), and a point-of-care device for quantifying total bilirubin (Bilistick) as compared with LBB. METHODS AND ANALYSIS We will undertake a multicentre prospective cohort study in nine midwifery practices across the Netherlands. Neonates born at a gestational age of 35 weeks or more are eligible if they: (1) are at home at any time between days 2 and 8 of life; (2) have their first midwife visit prior to postnatal day 6 and (3) did not previously receive phototherapy. TcB and the Picterus app will be used after visual inspection. When LBB is deemed necessary based on visual inspection and/or TcB reading, Bilistick will be used in parallel. The coprimary endpoints of the study are: (1) hyperbilirubinaemia necessitating treatment; (2) the number of heel pricks performed to quantify LBB. We aim to include 2310 neonates in a 2-year period. Using a decision tree model, a cost-effectiveness analysis will be performed. ETHICS AND DISSEMINATION This study has been approved by the Medical Research Ethical Committee of the Erasmus MC Rotterdam, Netherlands (MEC-2020-0618). Parents will provide written informed consent. The results of this study will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER Dutch Trial Register (NL9545).
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Affiliation(s)
- Lauren E H Westenberg
- Division of Neonatology, Department of Paediatrics, Erasmus MC Sophia Children Hospital, University Medical Centre Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
- Department of Obstetrics and Gynaecology, Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Berthe A M van der Geest
- Division of Neonatology, Department of Paediatrics, Erasmus MC Sophia Children Hospital, University Medical Centre Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
- Department of Obstetrics and Gynaecology, Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Hester F Lingsma
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Henk Groen
- Department of Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Jolande Y Vis
- Department of Clinical Chemistry, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Erwin Ista
- Department of Pediatric Intensive Care, Division of Paediatric Surgery, Erasmus MC Sophia Children Hospital, University Medical Centre Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
- Nursing Science, Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Marten J Poley
- Department of Pediatric Intensive Care, Division of Paediatric Surgery, Erasmus MC Sophia Children Hospital, University Medical Centre Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Peter H Dijk
- Division of Neonatology, Department of Paediatrics, Beatrix Children's Hospital, University Medical Centre Groningen, Groningen, Groningen, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Irwin K M Reiss
- Division of Neonatology, Department of Paediatrics, Erasmus MC Sophia Children Hospital, University Medical Centre Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Christian V Hulzebos
- Division of Neonatology, Department of Paediatrics, Beatrix Children's Hospital, University Medical Centre Groningen, Groningen, Groningen, The Netherlands
| | - Jasper V Been
- Division of Neonatology, Department of Paediatrics, Erasmus MC Sophia Children Hospital, University Medical Centre Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
- Department of Obstetrics and Gynaecology, Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
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van der Geest BAM, Rosman AN, Bergman KA, Smit BJ, Dijk PH, Been JV, Hulzebos CV. Severe neonatal hyperbilirubinaemia: lessons learnt from a national perinatal audit. Arch Dis Child Fetal Neonatal Ed 2022; 107:527-532. [PMID: 35091450 DOI: 10.1136/archdischild-2021-322891] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/16/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To describe characteristics of neonates with severe neonatal hyperbilirubinaemia (SNH) and to gain more insight in improvable factors that may have contributed to the development of SNH. DESIGN AND SETTING Descriptive study, based on national Dutch perinatal audit data on SNH from 2017 to 2019. PATIENTS Neonates, born ≥35 weeks of gestation and without antenatally known severe blood group incompatibility, who developed hyperbilirubinaemia above the exchange transfusion threshold. MAIN OUTCOME MEASURES Characteristics of neonates having SNH and corresponding improvable factors. RESULTS During the 3-year period, 109 neonates met the eligibility criteria. ABO antagonism was the most frequent cause (43%). All neonates received intensive phototherapy and 30 neonates (28%) received an exchange transfusion. Improvable factors were mainly related to lack of knowledge, poor adherence to the national hyperbilirubinaemia guideline, and to incomplete documentation and insufficient communication of the a priori hyperbilirubinaemia risk assessment among healthcare providers. A priori risk assessment, a key recommendation in the national hyperbilirubinaemia guideline, was documented in only six neonates (6%). CONCLUSIONS SNH remains a serious threat to neonatal health in the Netherlands. ABO antagonism frequently underlies SNH. Lack of compliance to the national guideline including insufficient a priori hyperbilirubinaemia risk assessment, and communication among healthcare providers are important improvable factors. Implementation of universal bilirubin screening and better documentation of the risk of hyperbilirubinaemia may enhance early recognition of potentially dangerous neonatal jaundice.
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Affiliation(s)
- Berthe A M van der Geest
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Foetal Medicine, Erasmus MC Sophia, Rotterdam, The Netherlands .,Department of Paediatrics, Division of Neonatology, Erasmus MC Sophia, Rotterdam, The Netherlands
| | - Ageeth N Rosman
- Department of Health Care Studies, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Foundation Perined, Utrecht, The Netherlands
| | - Klasien A Bergman
- Department of Neonatology, University Medical Centre Groningen Beatrix Children's Hospital, Groningen, The Netherlands
| | - Bert J Smit
- Directorate Quality and Patient Care, Erasmus MC, Rotterdam, The Netherlands
| | - Peter H Dijk
- Department of Neonatology, University Medical Centre Groningen Beatrix Children's Hospital, Groningen, The Netherlands
| | - Jasper V Been
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Foetal Medicine, Erasmus MC Sophia, Rotterdam, The Netherlands.,Department of Paediatrics, Division of Neonatology, Erasmus MC Sophia, Rotterdam, The Netherlands
| | - Christian V Hulzebos
- Department of Neonatology, University Medical Centre Groningen Beatrix Children's Hospital, Groningen, The Netherlands
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11
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Balink S, Onland W, Vrijlandt EJLE, Andrinopoulou ER, Bos AF, Dijk PH, Goossens L, Hulsmann AR, Nuytemans DH, Reiss IKM, Sprij AJ, Kroon AA, van Kaam AH, Pijnenburg M. Supplemental oxygen strategies in infants with bronchopulmonary dysplasia after the neonatal intensive care unit period: study protocol for a randomised controlled trial (SOS BPD study). BMJ Open 2022; 12:e060986. [PMID: 35803625 PMCID: PMC9272124 DOI: 10.1136/bmjopen-2022-060986] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Supplemental oxygen is the most important treatment for preterm born infants with established bronchopulmonary dysplasia (BPD). However, it is unknown what oxygen saturation levels are optimal to improve outcomes in infants with established BPD from 36 weeks postmenstrual age (PMA) onwards. The aim of this study is to compare the use of a higher oxygen saturation limit (≥95%) to a lower oxygen saturation limit (≥90%) after 36 weeks PMA in infants diagnosed with moderate or severe BPD. METHODS AND ANALYSIS This non-blinded, multicentre, randomised controlled trial will recruit 198 preterm born infants with moderate or severe BPD between 36 and 38 weeks PMA. Infants will be randomised to either a lower oxygen saturation limit of 95% or to a lower limit of 90%; supplemental oxygen and/or respiratory support will be weaned based on the assigned lower oxygen saturation limit. Adherence to the oxygen saturation limit will be assessed by extracting oxygen saturation profiles from pulse oximeters regularly, until respiratory support is stopped. The primary outcome is the weight SD score at 6 months of corrected age. Secondary outcomes include anthropometrics collected at 6 and 12 months of corrected age, rehospitalisations, respiratory complaints, infant stress, parental quality of life and cost-effectiveness. ETHICS AND DISSEMINATION Ethical approval for the trial was obtained from the Medical Ethics Review Committee of the Erasmus University Medical Centre, Rotterdam, the Netherlands (MEC-2018-1515). Local approval for conducting the trial in the participating hospitals has been or will be obtained from the local institutional review boards. Informed consent will be obtained from the parents or legal guardians of all study participants. TRIAL REGISTRATION NUMBER NL7149/NTR7347.
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Affiliation(s)
- Stephanie Balink
- Department of Paediatrics/Paediatric Respiratory Medicine, Erasmus MC Sophia Children Hospital, Rotterdam, The Netherlands
| | - Wes Onland
- Department of Paediatrics, Division of Neonatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Department of Paediatrics, Division of Neonatology, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Elianne J L E Vrijlandt
- Department of Paediatrics, Division of Paediatric Pulmonology and Allergology, UMCG, Groningen, The Netherlands
| | | | - Arend F Bos
- Department of Paediatrics, Division of Neonatology, UMCG, Groningen, The Netherlands
| | - Peter H Dijk
- Department of Paediatrics, Division of Neonatology, UMCG, Groningen, The Netherlands
| | - Lucas Goossens
- Erasmus School of Health Policy and Management, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | | | - Debbie H Nuytemans
- Department of Paediatrics, Division of Neonatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Department of Paediatrics, Division of Neonatology, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Irwin K M Reiss
- Department of Paediatrics, Division of Neonatology, Erasmus MC Sophia Children Hospital, Rotterdam, The Netherlands
| | - Arwen J Sprij
- Department of Paediatrics, Haga Hospital, Den Haag, The Netherlands
| | - André A Kroon
- Department of Paediatrics, Division of Neonatology, Erasmus MC Sophia Children Hospital, Rotterdam, The Netherlands
| | - Anton H van Kaam
- Department of Paediatrics, Division of Neonatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Department of Paediatrics, Division of Neonatology, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Marielle Pijnenburg
- Department of Paediatrics/Paediatric Respiratory Medicine, Erasmus MC Sophia Children Hospital, Rotterdam, The Netherlands
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12
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Prins S, Linn AJ, van Kaam AHLC, van de Loo M, van Woensel JBM, van Heerde M, Dijk PH, Kneyber MCJ, de Hoog M, Simons SHP, Akkermans AA, Smets EMA, Hillen MA, de Vos MA. How Physicians Discuss Uncertainty With Parents in Intensive Care Units. Pediatrics 2022; 149:188092. [PMID: 35603505 DOI: 10.1542/peds.2021-055980] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Accepted: 02/23/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Physicians and parents of critically ill neonates and children receiving intensive care have to make decisions on the child's behalf. Throughout the child's illness and treatment trajectory, adequately discussing uncertainties with parents is pivotal because this enhances the quality of the decision-making process and may positively affect the child's and parents' well-being. We investigated how physicians discuss uncertainty with parents and how this discussion evolves over time during the trajectory. METHODS We asked physicians working in the NICU and PICU of 3 university medical centers to audio record their conversations with parents of critically ill children from the moment doubts arose whether treatment was in the child's best interests. We qualitatively coded and analyzed the anonymized transcripts, thereby using the software tool MAXQDA 2020. RESULTS Physicians were found to adapt the way they discussed uncertainty with parents to the specific phase of the child's illness and treatment trajectory. When treatment options were still available, physicians primarily focused on uncertainty related to diagnostic procedures, treatment options, and associated risks and effects. Particularly when the child's death was imminent, physicians had less "scientific" guidance to offer. They eliminated most uncertainty and primarily addressed practical uncertainties regarding the child's dying process to offer parents guidance. CONCLUSIONS Our insights may increase physicians' awareness and enhance their skills in discussing uncertainties with parents tailored to the phase of the child's illness and treatment trajectory and to parental needs in each specific phase.
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Affiliation(s)
| | - Annemiek J Linn
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, the Netherlands
| | | | | | - Job B M van Woensel
- Pediatric Intensive Care, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Marc van Heerde
- Pediatric Intensive Care, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Peter H Dijk
- Department of Pediatrics, Divisions of Neonatology
| | - Martin C J Kneyber
- Pediatric Critical Care Medicine, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Sinno H P Simons
- Neonatology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Aranka A Akkermans
- Department of Medical Psychology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Marij A Hillen
- Department of Medical Psychology, Amsterdam University Medical Center, Amsterdam, the Netherlands
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13
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van Dokkum NH, de Kroon MLA, Dijk PH, Kraft KE, Reijneveld SA, Bos AF. Course of Stress during the Neonatal Intensive Care Unit Stay in Preterm Infants. Neonatology 2022; 119:84-92. [PMID: 34883490 DOI: 10.1159/000520513] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/25/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Understanding the course of stress during the neonatal intensive care unit stay may provide targets for interventions. Our aim was to describe the course of stress in preterm infants during the first 28 days of life, the influence of gestational age, and associations with clinical characteristics. METHODS In a single centre prospective cohort study, we included infants with a gestational age <30 weeks and/or birth weight <1,000 g. We measured stress over the first 28 days using the Neonatal Infant Stressor Scale (NISS). We plotted daily NISS total and subcategory scores by gestational age. The subcategories were (1) nursing, (2) skin-breaking, (3) monitoring and imaging, and (4) medical morbidity-related scores. We assessed associations of cumulative NISS scores over the first 7, 14, and 28 days with clinical characteristics using regression analyses. RESULTS We included 45 infants, with a median gestational age of 27 weeks. The mean daily NISS score was 66.5 (SD 8.7), with highest scores in the first 7 days of life. Scores decreased the slowest for the lowest gestational ages, in particular for nursing scores, rather than skin-breaking, monitoring and imaging, and medical morbidity-related scores. Adjusted for gestational age, infants with lower Apgar scores, sepsis, intraventricular haemorrhages, and on mechanical ventilation had significantly higher cumulative NISS scores at 7, 14, and 28 days. CONCLUSION NISS scores varied greatly within infants and over time, with the highest mean scores in the first week after birth. The course of declining NISS scores in the first 28 days depended on gestational age at birth.
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Affiliation(s)
- Nienke H van Dokkum
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marlou L A de Kroon
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Peter H Dijk
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Karianne E Kraft
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arend F Bos
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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14
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van Beek PE, Groenendaal F, Onland W, Koole S, Dijk PH, Dijkman KP, van den Dungen F, van Heijst A, Kornelisse RF, Schuerman F, van Westering-Kroon E, Witlox R, Andriessen P, Schuit E. Prognostic model for predicting survival in very preterm infants: an external validation study. BJOG 2021; 129:529-538. [PMID: 34779118 DOI: 10.1111/1471-0528.17010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To perform a temporal and geographical validation of a prognostic model, considered of highest methodological quality in a recently published systematic review, for predicting survival in very preterm infants admitted to the neonatal intensive care unit. The original model was developed in the UK and included gestational age, birthweight and gender. DESIGN External validation study in a population-based cohort. SETTING Dutch neonatal wards. POPULATION OR SAMPLE All admitted white, singleton infants born between 23+0 and 32+6 weeks of gestation between 1 January 2015 and 31 December 2019. Additionally, the model's performance was assessed in four populations of admitted infants born between 24+0 and 31+6 weeks of gestation: white singletons, non-white singletons, all singletons and all multiples. METHODS The original model was applied in all five validation sets. Model performance was assessed in terms of calibration and discrimination and, if indicated, it was updated. MAIN OUTCOME MEASURES Calibration (calibration-in-the-large and calibration slope) and discrimination (c statistic). RESULTS Out of 6092 infants, 5659 (92.9%) survived. The model showed good external validity as indicated by good discrimination (c statistic 0.82, 95% CI 0.79-0.84) and calibration (calibration-in-the-large 0.003, calibration slope 0.92, 95% CI 0.84-1.00). The model also showed good external validity in the other singleton populations, but required a small intercept update in the multiples population. CONCLUSIONS A high-quality prognostic model predicting survival in very preterm infants had good external validity in an independent, nationwide cohort. The accurate performance of the model indicates that after impact assessment, implementation of the model in clinical practice in the neonatal intensive care unit could be considered. TWEETABLE ABSTRACT A high-quality model predicting survival in very preterm infants is externally valid in an independent cohort.
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Affiliation(s)
- P E van Beek
- Department of Neonatology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - F Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht and Utrecht University, Utrecht, The Netherlands
| | - W Onland
- Department of Neonatology, Emma Children's Hospital, Amsterdam University Medical Centres, VU University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - S Koole
- The Netherlands Perinatal Registry, Utrecht, The Netherlands
| | - P H Dijk
- Department of Neonatology, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - K P Dijkman
- Department of Neonatology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Fam van den Dungen
- Department of Neonatology, Emma Children's Hospital, Amsterdam University Medical Centres, VU University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Afj van Heijst
- Department of Neonatology, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - R F Kornelisse
- Department of Paediatrics, Division of Neonatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Faba Schuerman
- Department of Neonatology, Isala Clinics, Zwolle, The Netherlands
| | - E van Westering-Kroon
- Department of Neonatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Rsgm Witlox
- Department of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
| | - P Andriessen
- Department of Neonatology, Máxima Medical Centre, Veldhoven, The Netherlands.,Department of Applied Physics, School of Medical Physics and Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - E Schuit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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15
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van Beek PE, Groenendaal F, Broeders L, Dijk PH, Dijkman KP, van den Dungen FAM, van Heijst AFJ, van Hillegersberg JL, Kornelisse RF, Onland W, Schuerman FABA, van Westering-Kroon E, Witlox RSGM, Andriessen P. Survival and causes of death in extremely preterm infants in the Netherlands. Arch Dis Child Fetal Neonatal Ed 2021; 106:251-257. [PMID: 33158971 PMCID: PMC8070636 DOI: 10.1136/archdischild-2020-318978] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 08/27/2020] [Accepted: 09/21/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE In the Netherlands, the threshold for offering active treatment for spontaneous birth was lowered from 25+0 to 24+0 weeks' gestation in 2010. This study aimed to evaluate the impact of guideline implementation on survival and causes and timing of death in the years following implementation. DESIGN National cohort study, using data from the Netherlands Perinatal Registry. PATIENTS The study population included all 3312 stillborn and live born infants with a gestational age (GA) between 240/7 and 266/7 weeks born between January 2011 and December 2017. Infants with the same GA born between January 2007 and December 2009 (N=1400) were used as the reference group. MAIN OUTCOME MEASURES Survival to discharge, as well as cause and timing of death. RESULTS After guideline implementation, there was a significant increase in neonatal intensive care unit (NICU) admission rate for live born infants born at 24 weeks' GA (27%-69%, p<0.001), resulting in increased survival to discharge in 24-week live born infants (13%-34%, p<0.001). Top three causes of in-hospital mortality were necrotising enterocolitis (28%), respiratory distress syndrome (19%) and intraventricular haemorrhage (17%). A significant decrease in cause of death either complicated or caused by respiratory insufficiency was seen over time (34% in 2011-2014 to 23% in 2015-2017, p=0.006). CONCLUSIONS Implementation of the 2010 guideline resulted as expected in increased NICU admissions rate and postnatal survival of infants born at 24 weeks' GA. In the years after implementation, a shift in cause of death was seen from respiratory insufficiency towards necrotising enterocolitis and sepsis.
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Affiliation(s)
- Pauline E van Beek
- Department of Neonatology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lisa Broeders
- The Netherlands Perinatal Registry, Utrecht, The Netherlands
| | - Peter H Dijk
- Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Koen P Dijkman
- Department of Neonatology, Máxima Medical Centre, Veldhoven, The Netherlands
| | | | - Arno F J van Heijst
- Department of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - René F Kornelisse
- Department of Pediatrics, Devision of Neonatology, Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Wes Onland
- Department of Neonatology, Emma Childrens Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | | | - Ruben S G M Witlox
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter Andriessen
- Department of Neonatology, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven, The Netherlands
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16
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Sampurna MTA, Rohsiswatmo R, Primadi A, Wandita S, Sulistijono E, Bos AF, Sauer PJJ, Hulzebos CV, Dijk PH. The knowledge of Indonesian pediatric residents on hyperbilirubinemia management. Heliyon 2021; 7:e06661. [PMID: 33898814 PMCID: PMC8056408 DOI: 10.1016/j.heliyon.2021.e06661] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/30/2021] [Accepted: 03/29/2021] [Indexed: 11/21/2022] Open
Abstract
Hyperbilirubinemia in the newborn occurs more frequently in Indonesia. Therefore, it is important that pediatric residents in Indonesia acquire adequate knowledge of hyperbilirubinemia management. This study aims to determine the pediatric residents' knowledge on hyperbilirubinemia management, whether they follow recommended guidelines, and whether differences exist between five large Indonesian teaching hospitals. We handed out a 25-question questionnaire on hyperbilirubinemia management to pediatric residents at five teaching hospitals. A total of 250 questionnaires were filled in completely, ranging from 14 to 113 respondents per hospital. Approximately 76% of the respondents used the Kramer score to recognize neonatal jaundice. Twenty-four percent correctly plotted the total serum bilirubin levels (TSB) on the phototherapy (PT) nomograms provided by the American Academy of Pediatrics (AAP) and the National Institute for Health and Care Excellence (NICE) for full-term and nearly full-term infants. Regarding preterm infants <35 weeks' gestational age, 66% of the respondents plotted TSB levels on the AAP nomogram, although this nomogram doesn't apply to this category of infants. Seventy percent of residents knew when to perform an exchange transfusion whereas 27% used a fixed bilirubin cut-off value of 20 mg/dL. Besides PT, 25% reported using additional pharmaceutical treatments, included albumin, phenobarbitone, ursodeoxycholic acid and immunoglobulins, while 47% of the respondents used sunlight therapy, as alternative treatment. The limited knowledge of the pediatric residents could be one factor for the higher incidence of severe hyperbilirubinemia and its sequelae. The limited knowledge of the residents raises doubts about the knowledge of the supervisors and the training of the residents since pediatric residents receive training from their supervisors.
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Affiliation(s)
- Mahendra T A Sampurna
- Neonatology Division, Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Rinawati Rohsiswatmo
- Neonatology Division, Department of Pediatrics, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Aris Primadi
- Department of Pediatrics, Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia
| | - Setya Wandita
- Neonatology Division, Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Eko Sulistijono
- Department of Pediatrics, Saiful Anwar Hospital, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia
| | - Arend F Bos
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Pieter J J Sauer
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Christian V Hulzebos
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Peter H Dijk
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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17
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Siswanto JE, Dijk PH, Bos AF, Sitorus RS, Adisasmita AC, Ronoatmodjo S, Sauer PJJ. How to prevent ROP in preterm infants in Indonesia? Health Sci Rep 2021; 4:e219. [PMID: 33490635 PMCID: PMC7813016 DOI: 10.1002/hsr2.219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/16/2020] [Revised: 10/21/2020] [Accepted: 11/12/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND AND AIMS Retinopathy of prematurity (ROP) is a severe disease in preterm infants. It is seen more frequently in Low-Middle Income Countries (LMIC) like Indonesia compared to High-Income Countries (HIC). Risk factors for ROP development are -extreme- preterm birth, use of oxygen, neonatal infections, respiratory problems, inadequate nutrition, and blood and exchange transfusions. In this paper, we give an overview of steps that can be taken in LMIC to prevent ROP and provide guidelines for screening and treating ROP. METHODS Based on the literature search and data obtained by us in Indonesia's studies, we propose guidelines for the prevention, screening, and treatment of ROP in preterm infants in LMIC. RESULTS Prevention of ROP starts before birth with preventing preterm labor, transferring a mother who might deliver <32 weeks to a perinatal center and giving corticosteroids to mothers that might deliver <34 weeks. Newborn resuscitation must be done using room air or, in the case of very preterm infants (<29-32 weeks) by using 30% oxygen. Respiratory problems must be prevented by starting continuous positive airway pressure (CPAP) in all preterm infants <32 weeks and in case of respiratory problems in more mature infants. If needed, the surfactant should be given in a minimally invasive manner, as ROP's lower incidence was found using this technique. The use of oxygen must be strictly regulated with a saturation monitor of 91-95%. Infections must be prevented as much as possible. Both oral and parenteral nutrition should be started in all preterm infants on day one of life with preferably mothers' milk. Blood transfusions can be prevented by reducing the amount of blood needed for laboratory analysis. DISCUSSION Preterm babies should be born in facilities able to care for them optimally. The use of oxygen must be strictly regulated. ROP screening is mandatory in infants born <34 weeks, and infants who received supplemental oxygen for a prolonged period. In case of progression of ROP, immediate mandatory treatment is required. CONCLUSION Concerted action is needed to reduce the incidence of ROP in LMIC. "STOP - R1O2P3" is an acronym that can help implement standard practices in all neonatal intensive care units in LMIC to prevent development and progression.
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Affiliation(s)
- Johanes Edy Siswanto
- Neonatology Working Group, Department of PediatricsHarapan Kita Women and Children HospitalJakartaIndonesia
- Faculty of MedicinePelita Harapan UniversityTangerangIndonesia
| | - Peter H. Dijk
- Department of PediatricsBeatrix Children's Hospital, University Medical Center GroningenGroningenThe Netherlands
| | - Arend F. Bos
- Department of PediatricsBeatrix Children's Hospital, University Medical Center GroningenGroningenThe Netherlands
| | - Rita S. Sitorus
- Department of OphthalmologyCipto Mangunkusumo HospitalJakartaIndonesia
| | - Asri C. Adisasmita
- Department of EpidemiologyUniversity of Indonesia, School of Public HealthDepokIndonesia
| | - Sudarto Ronoatmodjo
- Department of EpidemiologyUniversity of Indonesia, School of Public HealthDepokIndonesia
| | - Pieter J. J. Sauer
- Department of PediatricsBeatrix Children's Hospital, University Medical Center GroningenGroningenThe Netherlands
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Trzcionkowska K, Vehmeijer WB, Kerkhoff FT, Bauer NJ, Bennebroek CA, Dijk PH, Dijkman KP, Dungen FA, Eggink CA, Feenstra RP, Groenendaal F, Heijst AF, Hoeven MA, Kornelisse RF, Kraal‐Biezen E, Lopriore E, Onland W, Renardel de Lavalette VW, Rijn LJ, Schuerman FA, Simonsz HJ, Voskuil‐Kerkhof ES, Witlox RS, Termote JU, Schalij‐Delfos NE. Increase in treatment of retinopathy of prematurity in the Netherlands from 2010 to 2017. Acta Ophthalmol 2021; 99:97-103. [PMID: 32701185 PMCID: PMC7891652 DOI: 10.1111/aos.14501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/06/2019] [Revised: 05/11/2020] [Accepted: 05/17/2020] [Indexed: 12/21/2022]
Abstract
Purpose Compare patients treated for Retinopathy of Prematurity (ROP) in two consecutive periods. Methods Retrospective inventory of anonymized neonatal and ophthalmological data of all patients treated for ROP from 2010 to 2017 in the Netherlands, subdivided in period (P)1: 1‐1‐2010 to 31‐3‐2013 and P2: 1‐4‐2013 to 31‐12‐2016. Treatment characteristics, adherence to early treatment for ROP (ETROP) criteria, outcome of treatment and changes in neonatal parameters and policy of care were compared. Results Overall 196 infants were included, 57 infants (113 eyes) in P1 and 139 (275 eyes) in P2, indicating a 2.1‐fold increase in ROP treatment. No differences were found in mean gestational age (GA) (25.9 ± 1.7 versus 26.0 ± 1.7 weeks, p = 0.711), mean birth weight (791 ± 311 versus 764 ± 204 grams, p = 0.967) and other neonatal risk factors for ROP. In P2, the number of premature infants born <25 weeks increased by factor 1.23 and higher oxygen saturation levels were aimed at in most centres. At treatment decision, 59.6% (P1) versus 83.5% (P2) (p = 0.263) infants were classified as Type 1 ROP (ETROP classification). Infants were treated with laser photocoagulation (98 versus 96%) and intravitreal bevacizumab (2 versus 4%). Retreatment was necessary in 10 versus 21 (p = 0.160). Retinal detachment developed in 6 versus 13 infants (p = 0.791) of which 2 versus 6 bilateral (p = 0.599). Conclusion In period 2, the number of infants treated according to the ETROP criteria (Type 1) increased, the number of ROP treatments, retinal detachments and retreatments doubled and the absolute number of retinal detachments increased. Neonatal data did not provide a decisive explanation, although changes in neonatal policy were reported.
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Affiliation(s)
| | | | | | | | | | - Peter H. Dijk
- University Medical Center Groningen Groningen Netherlands
| | | | | | - Cathrien A. Eggink
- Radboud University Medical Center – Amalia Children’s Hospital Nijmegen Netherlands
| | | | | | - Arno F. Heijst
- Radboud University Medical Center – Amalia Children’s Hospital Nijmegen Netherlands
| | | | | | | | | | - Wes Onland
- Amsterdam University Medical Center Amsterdam Netherlands
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19
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Siswanto JE, Bos AF, Dijk PH, Rohsiswatmo R, Irawan G, Sulistijono E, Sianturi P, Wisnumurti DA, Wilar R, Sauer PJJ. Multicentre survey of retinopathy of prematurity in Indonesia. BMJ Paediatr Open 2021; 5:e000761. [PMID: 33532628 PMCID: PMC7831712 DOI: 10.1136/bmjpo-2020-000761] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The incidence of retinopathy of prematurity (ROP) is higher in Indonesia than in high-income countries. In order to reduce the incidence of the disease, a protocol on preventing, screening and treating ROP was published in Indonesia in 2010. To assist the practical implementation of the protocol, meetings were held in all Indonesia regions, calling attention to the high incidence of ROP and the methods to reduce it. In addition, national health insurance was introduced in 2014, making ROP screening and treatment accessible to more infants. OBJECTIVE To evaluate whether the introduction of both the guideline drawing attention to the high incidence of ROP and national health insurance may have influenced the incidence of the disease in Indonesia. SETTING Data were collected from 34 hospitals with different levels of care: national referral centres, university-based hospitals, and public and private hospitals. METHODS A survey was administered with questions on admission numbers, mortality rates, ROP incidence, and its stages for 2016-2017 in relation to gestational age and birth weight. RESULTS We identified 12 115 eligible infants with a gestational age of less than 34 weeks. Mortality was 24% and any stage ROP 6.7%. The mortality in infants aged less than 28 weeks was 67%, the incidence of all-stage ROP 18% and severe ROP 4%. In the group aged 28-32 weeks, the mortality was 24%, all-stage ROP 7% and severe ROP 4%-5%. Both mortality and the incidence of ROP were highest in university-based hospitals. CONCLUSIONS In the 2016-2017 period, the infant mortality rate before 32 weeks of age was higher in Indonesia than in high-income countries, but the incidence of ROP was comparable. This incidence is likely an underestimation due to the high mortality rate. The ROP incidence in 2016-2017 is lower than in surveys conducted before 2015. This decline is likely due to a higher practitioner awareness about ROP and national health insurance implementation in Indonesia.
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Affiliation(s)
- J Edy Siswanto
- Neonatology, Universitair Medisch Centrum Groningen, Groningen, The Netherlands.,Neonatology, Harapan Kita National Centre for Women and Children's Health, Jakarta, Indonesia
| | - Arend F Bos
- Neonatology, University Medical Center Groningen Intensive Care Medicine, Groningen, The Netherlands
| | - Peter H Dijk
- Neonatology, Universitair Medisch Centrum Groningen, Groningen, The Netherlands
| | | | - Gatot Irawan
- Pediatric, Dr Kariadi General Hospital Medical Center, Semarang, Central Java, Indonesia
| | - Eko Sulistijono
- Pediatric, Dr Saiful Anwar General Hospital, Malang, Jawa Timur, Indonesia
| | - Pertin Sianturi
- Pediatric, University of Sumatera Utara Faculty of Medicine, Medan, North Sumatera, Indonesia
| | - Dewi A Wisnumurti
- Pediatric, University of Riau Faculty of Medicine, Pekanbaru, Riau, Indonesia
| | - Rocky Wilar
- Pediatric, Sam Ratulangi University Faculty of Medicine, Manado, North Sulawesi, Indonesia
| | - Pieter J J Sauer
- Neonatology, Universitair Medisch Centrum Groningen, Groningen, The Netherlands
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20
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Sampurna MTA, Rani SAD, Sauer PJJ, Bos AF, Dijk PH, Hulzebos CV. Diagnostic Properties of a Portable Point-of-Care Method to Measure Bilirubin and a Transcutaneous Bilirubinometer. Neonatology 2021; 118:678-684. [PMID: 34818231 DOI: 10.1159/000518653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 07/17/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recently, the Bilistick®, a point-of-care instrument to measure bilirubin levels, has been developed. It is fast and cheaper than transcutaneous bilirubin (TCB)-measuring devices, but data on diagnostic properties are scarce. OBJECTIVE This study aimed to compare the performance of the Bilistick® (BM-BS 1.0 - FW version 2.0.1) and the JM-105 bilirubinometer for measuring bilirubin. METHOD This is a prospective study in infants born after ≥32 weeks' gestation, and/or a birth weight of ≥1,500 g, and a postnatal age ≤14 days in Surabaya, Indonesia. Bilirubin was measured with the Bilistick® System (BM-BS 1.0 - FW version 2.0.1), transcutaneously (TCB) with the JM-105 bilirubinometer, and in serum (TSB) with a routine laboratory technique. Mean differences and 95% limits of agreement (LOA) and correlations were calculated. RESULT We enrolled 149 neonates and 126 had paired measurements of Bilistick® bilirubin, TCB, and TSB. Bilistick® failed in 16 (10.7%) infants. Mean Bilistick® bilirubin-TSB difference was -11 µmol/L (95% LOA: -101 to 79 µmol/L) and r = 0.738 (p < 0.001). Mean TCB-TSB difference was 26 μmol/L (95% LOA: -33 to 88) and r = 0.785 (p < 0.001). The sensitivity, specificity, PPV, and NPV for Bilistick® bilirubin for a TSB above treatment thresholds were 0.74, 0.84, 0.67, and 0.88, respectively, and for TCB 0.92, 0.64, 0.54, and 0.95, respectively. CONCLUSION The Bilistick® System (BM-BS 1.0 - FW version 2.0.1) underestimates TSB, whereas TCB overestimates TSB in jaundiced Indonesian infants. Further improvement of Bilistick®'s diagnostic accuracy with less false-negative readings is essential to increase its use.
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Affiliation(s)
- Mahendra Tri Arif Sampurna
- Department of Pediatrics, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital Surabaya, Surabaya, Indonesia
| | - Siti Annisa Dewi Rani
- Department of Pediatrics, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital Surabaya, Surabaya, Indonesia
| | - Pieter J J Sauer
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Arend F Bos
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter H Dijk
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Christian V Hulzebos
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
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21
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Trzcionkowska K, Groenendaal F, Andriessen P, Dijk PH, van den Dungen FAM, van Hillegersberg JL, Koole S, Kornelisse RF, van Westering-Kroon E, von Lindern JS, Meijssen CB, Schuerman FABA, Steiner K, van Tuyl MWG, Witlox RSGM, Schalij-Delfos NE, Termote JUM. Risk Factors for Retinopathy of Prematurity in the Netherlands: A Comparison of Two Cohorts. Neonatology 2021; 118:462-469. [PMID: 34293743 DOI: 10.1159/000517247] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/01/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Retinopathy of prematurity (ROP) remains an important cause for preventable blindness. Aside from gestational age (GA) and birth weight, risk factor assessment can be important for determination of infants at risk of (severe) ROP. METHODS Prospective, multivariable risk-analysis study (NEDROP-2) was conducted, including all infants born in 2017 in the Netherlands considered eligible for ROP screening by pediatricians. Ophthalmologists provided data of screened infants, which were combined with risk factors from the national perinatal database (Perined). Clinical data and potential risk factors were compared to the first national ROP inventory (NEDROP-1, 2009). During the second period, more strict risk factor-based screening inclusion criteria were applied. RESULTS Of 1,287 eligible infants, 933 (72.5%) were screened for ROP and matched with the Perined data. Any ROP was found in 264 infants (28.3% of screened population, 2009: 21.9%) and severe ROP (sROP) (stage ≥3) in 41 infants (4.4%, 2009: 2.1%). The risk for any ROP is decreased with a higher GA (odds ratio [OR] 0.59 and 95% confidence interval [CI] 0.54-0.66) and increased for small for GA (SGA) (1.73, 1.11-2.62), mechanical ventilation >7 days (2.13, 1.35-3.37) and postnatal corticosteroids (2.57, 1.44-4.66). For sROP, significant factors were GA (OR 0.37 and CI 0.27-0.50), SGA (OR 5.65 and CI 2.17-14.92), postnatal corticosteroids (OR 3.81 and CI 1.72-8.40), and perforated necrotizing enterocolitis (OR 7.55 and CI 2.29-24.48). CONCLUSION In the Netherlands, sROP was diagnosed more frequently since 2009. No new risk factors for ROP were determined in the present study, apart from those already included in the current screening guideline.
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Affiliation(s)
| | | | | | - Peter H Dijk
- University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Sanne Koole
- Perined, The Netherlands Perinatal Registry, Utrecht, The Netherlands
| | - René F Kornelisse
- Erasmus Medical Center Sophia Children's Hospital, Rotterdam, The Netherlands
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22
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Duvekot JJ, Duijnhoven RG, van Horen E, Bax CJ, Bloemenkamp KW, Brussé IA, Dijk PH, Franssen MT, Franx A, Oudijk MA, Porath MM, Scheepers HC, van Wassenaer-Leemhuis AG, van Drongelen J, Mol BW, Ganzevoort W. Temporizing management vs immediate delivery in early-onset severe preeclampsia between 28 and 34 weeks of gestation (TOTEM study): An open-label randomized controlled trial. Acta Obstet Gynecol Scand 2020; 100:109-118. [PMID: 33319930 PMCID: PMC7754130 DOI: 10.1111/aogs.13976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/02/2020] [Accepted: 08/09/2020] [Indexed: 12/11/2022]
Abstract
Introduction There is little evidence to guide the timing of delivery of women with early‐onset severe preeclampsia. We hypothesize that immediate delivery is not inferior for neonatal outcome but reduces maternal complications compared with temporizing management. Material and methods This Dutch multicenter open‐label randomized clinical trial investigated non‐inferiority for neonatal outcome of temporizing management as compared with immediate delivery (TOTEM NTR 2986) in women between 27+5 and 33+5 weeks of gestation admitted for early‐onset severe preeclampsia with or without HELLP syndrome. In participants allocated to receive immediate delivery, either induction of labor or cesarean section was initiated at least 48 hours after admission. Primary outcomes were adverse perinatal outcome, defined as a composite of severe respiratory distress syndrome, bronchopulmonary dysplasia, culture proven sepsis, intraventricular hemorrhage grade 3 or worse, periventricular leukomalacia grade 2 or worse, necrotizing enterocolitis stage 2 or worse, and perinatal death. Major maternal complications were secondary outcomes. It was estimated 1130 women needed to be enrolled. Analysis was by intention‐to‐treat. Results The trial was halted after 35 months because of slow recruitment. Between February 2011 and December 2013, a total of 56 women were randomized to immediate delivery (n = 26) or temporizing management (n = 30). Median gestational age at randomization was 30 weeks. Median prolongation of pregnancy was 2 days (interquartile range 1‐3 days) in the temporizing management group. Mean birthweight was 1435 g after immediate delivery vs 1294 g after temporizing management (P = .14). The adverse perinatal outcome rate was 55% in the immediate delivery group vs 52% in the temporizing management group (relative risk 1.06; 95% confidence interval 0.67‐1.70). In both groups there was one neonatal death and no maternal deaths. In the temporizing treatment group, one woman experienced pulmonary edema and one placental abruption. Analyses of only the singleton pregnancies did not result in other outcomes. Conclusions Early termination of the trial precluded any conclusions for the main outcomes. We observed that temporizing management resulted in a modest prolongation of pregnancy without changes in perinatal and maternal outcome. Conducting a randomized study for this important research question did not prove feasible.
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Affiliation(s)
- Johannes J Duvekot
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ruben G Duijnhoven
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Eva van Horen
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Caroline J Bax
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Kitty W Bloemenkamp
- Department of Obstetrics, Division Woman and Baby, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ingrid A Brussé
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter H Dijk
- Department of Neonatology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maureen T Franssen
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Martijn A Oudijk
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Martina M Porath
- Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven, The Netherlands
| | - Hubertina C Scheepers
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Joris van Drongelen
- Department of Obstetrics and Gynecology, Radboud University Medical Cernter, Nijmegen, The Netherlands
| | - Ben W Mol
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam Medical Center, Amsterdam, The Netherlands.,Department of Obstetrics and Gynecology, Monash University, Clayton, VIC, Australia
| | - Wessel Ganzevoort
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam Medical Center, Amsterdam, The Netherlands
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23
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van Kempen AAMW, Eskes PF, Nuytemans DHGM, van der Lee JH, Dijksman LM, van Veenendaal NR, van der Hulst FJPCM, Moonen RMJ, Zimmermann LJI, van 't Verlaat EP, van Dongen-van Baal M, Semmekrot BA, Stas HG, van Beek RHT, Vlietman JJ, Dijk PH, Termote JUM, de Jonge RCJ, de Mol AC, Huysman MWA, Kok JH, Offringa M, Boluyt N. Lower versus Traditional Treatment Threshold for Neonatal Hypoglycemia. N Engl J Med 2020; 382:534-544. [PMID: 32023373 DOI: 10.1056/nejmoa1905593] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Worldwide, many newborns who are preterm, small or large for gestational age, or born to mothers with diabetes are screened for hypoglycemia, with a goal of preventing brain injury. However, there is no consensus on a treatment threshold that is safe but also avoids overtreatment. METHODS In a multicenter, randomized, noninferiority trial involving 689 otherwise healthy newborns born at 35 weeks of gestation or later and identified as being at risk for hypoglycemia, we compared two threshold values for treatment of asymptomatic moderate hypoglycemia. We sought to determine whether a management strategy that used a lower threshold (treatment administered at a glucose concentration of <36 mg per deciliter [2.0 mmol per liter]) would be noninferior to a traditional threshold (treatment at a glucose concentration of <47 mg per deciliter [2.6 mmol per liter]) with respect to psychomotor development at 18 months, assessed with the Bayley Scales of Infant and Toddler Development, third edition, Dutch version (Bayley-III-NL; scores range from 50 to 150 [mean {±SD}, 100±15]), with higher scores indicating more advanced development and 7.5 points (one half the SD) representing a clinically important difference). The lower threshold would be considered noninferior if scores were less than 7.5 points lower than scores in the traditional-threshold group. RESULTS Bayley-III-NL scores were assessed in 287 of the 348 children (82.5%) in the lower-threshold group and in 295 of the 341 children (86.5%) in the traditional-threshold group. Cognitive and motor outcome scores were similar in the two groups (mean scores [±SE], 102.9±0.7 [cognitive] and 104.6±0.7 [motor] in the lower-threshold group and 102.2±0.7 [cognitive] and 104.9±0.7 [motor] in the traditional-threshold group). The prespecified inferiority limit was not crossed. The mean glucose concentration was 57±0.4 mg per deciliter (3.2±0.02 mmol per liter) in the lower-threshold group and 61±0.5 mg per deciliter (3.4±0.03 mmol per liter) in the traditional-threshold group. Fewer and less severe hypoglycemic episodes occurred in the traditional-threshold group, but that group had more invasive diagnostic and treatment interventions. Serious adverse events in the lower-threshold group included convulsions (during normoglycemia) in one newborn and one death. CONCLUSIONS In otherwise healthy newborns with asymptomatic moderate hypoglycemia, a lower glucose treatment threshold (36 mg per deciliter) was noninferior to a traditional threshold (47 mg per deciliter) with regard to psychomotor development at 18 months. (Funded by the Netherlands Organization for Health Research and Development; HypoEXIT Current Controlled Trials number, ISRCTN79705768.).
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Affiliation(s)
- Anne A M W van Kempen
- From OLVG, Department of Pediatrics (A.A.M.W.K., N.R.V.), and Academic Medical Center, Emma Children's Hospital, Department of Neonatology (D.H.G.M.N., J.H.K.), the University of Amsterdam, Pediatric Clinical Research Office (J.H.L.) and the VU Medical Center, Vrije Universiteit, Department of Neonatology (R.C.J.J.), Amsterdam UMC, Amsterdam, Meander Medical Center, Department of Pediatrics, Amersfoort (P.F.E.), St. Antonius Hospital, Departments of Research and Epidemiology (L.M.D.) and Pediatrics (M.D.-B), Nieuwegein, Zaans Medical Center, Department of Pediatrics, Zaandam (F.J.P.C.M.H.), Zuyderland Medical Center Heerlen, Department of Pediatrics, Sittard-Geleen (R.M.J.M.), Maastricht University Medical Center, Department of Pediatrics-Neonatology, Schools of Oncology and Developmental Biology (GROW) and NUTRIM, Maastricht (L.J.I.Z.), Erasmus MC-Sophia, Department of Neonatology (E.P.V.), Maasstad Hospital, Department of Pediatrics (H.G.S.), and St. Franciscus Gasthuis, Department of Pediatrics (M.W.A.H.), Rotterdam, Canisius-Wilhelmina Hospital, Department of Pediatrics, Nijmegen (B.A.S.), Amphia Hospital, Department of Pediatrics, Breda (R.H.T.B.), Rijnstate Hospital, Department of Pediatrics, Arnhem (J.J.V.), the University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Neonatology, Groningen (P.H.D.), University Medical Center Utrecht, Wilhelmina Children's Hospital, Department of Neonatology, Utrecht (J.U.M.T.), Albert Schweitzer Hospital, Department of Pediatrics, Dordrecht (A.C.M.), and the National Health Care Institute (ZINL), Diemen (N.B.) - all in the Netherlands; and the Hospital for Sick Children, Division of Neonatology/Child Health Evaluative Sciences, University of Toronto, Toronto (M.O.)
| | - P Frank Eskes
- From OLVG, Department of Pediatrics (A.A.M.W.K., N.R.V.), and Academic Medical Center, Emma Children's Hospital, Department of Neonatology (D.H.G.M.N., J.H.K.), the University of Amsterdam, Pediatric Clinical Research Office (J.H.L.) and the VU Medical Center, Vrije Universiteit, Department of Neonatology (R.C.J.J.), Amsterdam UMC, Amsterdam, Meander Medical Center, Department of Pediatrics, Amersfoort (P.F.E.), St. Antonius Hospital, Departments of Research and Epidemiology (L.M.D.) and Pediatrics (M.D.-B), Nieuwegein, Zaans Medical Center, Department of Pediatrics, Zaandam (F.J.P.C.M.H.), Zuyderland Medical Center Heerlen, Department of Pediatrics, Sittard-Geleen (R.M.J.M.), Maastricht University Medical Center, Department of Pediatrics-Neonatology, Schools of Oncology and Developmental Biology (GROW) and NUTRIM, Maastricht (L.J.I.Z.), Erasmus MC-Sophia, Department of Neonatology (E.P.V.), Maasstad Hospital, Department of Pediatrics (H.G.S.), and St. Franciscus Gasthuis, Department of Pediatrics (M.W.A.H.), Rotterdam, Canisius-Wilhelmina Hospital, Department of Pediatrics, Nijmegen (B.A.S.), Amphia Hospital, Department of Pediatrics, Breda (R.H.T.B.), Rijnstate Hospital, Department of Pediatrics, Arnhem (J.J.V.), the University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Neonatology, Groningen (P.H.D.), University Medical Center Utrecht, Wilhelmina Children's Hospital, Department of Neonatology, Utrecht (J.U.M.T.), Albert Schweitzer Hospital, Department of Pediatrics, Dordrecht (A.C.M.), and the National Health Care Institute (ZINL), Diemen (N.B.) - all in the Netherlands; and the Hospital for Sick Children, Division of Neonatology/Child Health Evaluative Sciences, University of Toronto, Toronto (M.O.)
| | - Debbie H G M Nuytemans
- From OLVG, Department of Pediatrics (A.A.M.W.K., N.R.V.), and Academic Medical Center, Emma Children's Hospital, Department of Neonatology (D.H.G.M.N., J.H.K.), the University of Amsterdam, Pediatric Clinical Research Office (J.H.L.) and the VU Medical Center, Vrije Universiteit, Department of Neonatology (R.C.J.J.), Amsterdam UMC, Amsterdam, Meander Medical Center, Department of Pediatrics, Amersfoort (P.F.E.), St. Antonius Hospital, Departments of Research and Epidemiology (L.M.D.) and Pediatrics (M.D.-B), Nieuwegein, Zaans Medical Center, Department of Pediatrics, Zaandam (F.J.P.C.M.H.), Zuyderland Medical Center Heerlen, Department of Pediatrics, Sittard-Geleen (R.M.J.M.), Maastricht University Medical Center, Department of Pediatrics-Neonatology, Schools of Oncology and Developmental Biology (GROW) and NUTRIM, Maastricht (L.J.I.Z.), Erasmus MC-Sophia, Department of Neonatology (E.P.V.), Maasstad Hospital, Department of Pediatrics (H.G.S.), and St. Franciscus Gasthuis, Department of Pediatrics (M.W.A.H.), Rotterdam, Canisius-Wilhelmina Hospital, Department of Pediatrics, Nijmegen (B.A.S.), Amphia Hospital, Department of Pediatrics, Breda (R.H.T.B.), Rijnstate Hospital, Department of Pediatrics, Arnhem (J.J.V.), the University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Neonatology, Groningen (P.H.D.), University Medical Center Utrecht, Wilhelmina Children's Hospital, Department of Neonatology, Utrecht (J.U.M.T.), Albert Schweitzer Hospital, Department of Pediatrics, Dordrecht (A.C.M.), and the National Health Care Institute (ZINL), Diemen (N.B.) - all in the Netherlands; and the Hospital for Sick Children, Division of Neonatology/Child Health Evaluative Sciences, University of Toronto, Toronto (M.O.)
| | - Johanna H van der Lee
- From OLVG, Department of Pediatrics (A.A.M.W.K., N.R.V.), and Academic Medical Center, Emma Children's Hospital, Department of Neonatology (D.H.G.M.N., J.H.K.), the University of Amsterdam, Pediatric Clinical Research Office (J.H.L.) and the VU Medical Center, Vrije Universiteit, Department of Neonatology (R.C.J.J.), Amsterdam UMC, Amsterdam, Meander Medical Center, Department of Pediatrics, Amersfoort (P.F.E.), St. Antonius Hospital, Departments of Research and Epidemiology (L.M.D.) and Pediatrics (M.D.-B), Nieuwegein, Zaans Medical Center, Department of Pediatrics, Zaandam (F.J.P.C.M.H.), Zuyderland Medical Center Heerlen, Department of Pediatrics, Sittard-Geleen (R.M.J.M.), Maastricht University Medical Center, Department of Pediatrics-Neonatology, Schools of Oncology and Developmental Biology (GROW) and NUTRIM, Maastricht (L.J.I.Z.), Erasmus MC-Sophia, Department of Neonatology (E.P.V.), Maasstad Hospital, Department of Pediatrics (H.G.S.), and St. Franciscus Gasthuis, Department of Pediatrics (M.W.A.H.), Rotterdam, Canisius-Wilhelmina Hospital, Department of Pediatrics, Nijmegen (B.A.S.), Amphia Hospital, Department of Pediatrics, Breda (R.H.T.B.), Rijnstate Hospital, Department of Pediatrics, Arnhem (J.J.V.), the University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Neonatology, Groningen (P.H.D.), University Medical Center Utrecht, Wilhelmina Children's Hospital, Department of Neonatology, Utrecht (J.U.M.T.), Albert Schweitzer Hospital, Department of Pediatrics, Dordrecht (A.C.M.), and the National Health Care Institute (ZINL), Diemen (N.B.) - all in the Netherlands; and the Hospital for Sick Children, Division of Neonatology/Child Health Evaluative Sciences, University of Toronto, Toronto (M.O.)
| | - Lea M Dijksman
- From OLVG, Department of Pediatrics (A.A.M.W.K., N.R.V.), and Academic Medical Center, Emma Children's Hospital, Department of Neonatology (D.H.G.M.N., J.H.K.), the University of Amsterdam, Pediatric Clinical Research Office (J.H.L.) and the VU Medical Center, Vrije Universiteit, Department of Neonatology (R.C.J.J.), Amsterdam UMC, Amsterdam, Meander Medical Center, Department of Pediatrics, Amersfoort (P.F.E.), St. Antonius Hospital, Departments of Research and Epidemiology (L.M.D.) and Pediatrics (M.D.-B), Nieuwegein, Zaans Medical Center, Department of Pediatrics, Zaandam (F.J.P.C.M.H.), Zuyderland Medical Center Heerlen, Department of Pediatrics, Sittard-Geleen (R.M.J.M.), Maastricht University Medical Center, Department of Pediatrics-Neonatology, Schools of Oncology and Developmental Biology (GROW) and NUTRIM, Maastricht (L.J.I.Z.), Erasmus MC-Sophia, Department of Neonatology (E.P.V.), Maasstad Hospital, Department of Pediatrics (H.G.S.), and St. Franciscus Gasthuis, Department of Pediatrics (M.W.A.H.), Rotterdam, Canisius-Wilhelmina Hospital, Department of Pediatrics, Nijmegen (B.A.S.), Amphia Hospital, Department of Pediatrics, Breda (R.H.T.B.), Rijnstate Hospital, Department of Pediatrics, Arnhem (J.J.V.), the University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Neonatology, Groningen (P.H.D.), University Medical Center Utrecht, Wilhelmina Children's Hospital, Department of Neonatology, Utrecht (J.U.M.T.), Albert Schweitzer Hospital, Department of Pediatrics, Dordrecht (A.C.M.), and the National Health Care Institute (ZINL), Diemen (N.B.) - all in the Netherlands; and the Hospital for Sick Children, Division of Neonatology/Child Health Evaluative Sciences, University of Toronto, Toronto (M.O.)
| | - Nicole R van Veenendaal
- From OLVG, Department of Pediatrics (A.A.M.W.K., N.R.V.), and Academic Medical Center, Emma Children's Hospital, Department of Neonatology (D.H.G.M.N., J.H.K.), the University of Amsterdam, Pediatric Clinical Research Office (J.H.L.) and the VU Medical Center, Vrije Universiteit, Department of Neonatology (R.C.J.J.), Amsterdam UMC, Amsterdam, Meander Medical Center, Department of Pediatrics, Amersfoort (P.F.E.), St. Antonius Hospital, Departments of Research and Epidemiology (L.M.D.) and Pediatrics (M.D.-B), Nieuwegein, Zaans Medical Center, Department of Pediatrics, Zaandam (F.J.P.C.M.H.), Zuyderland Medical Center Heerlen, Department of Pediatrics, Sittard-Geleen (R.M.J.M.), Maastricht University Medical Center, Department of Pediatrics-Neonatology, Schools of Oncology and Developmental Biology (GROW) and NUTRIM, Maastricht (L.J.I.Z.), Erasmus MC-Sophia, Department of Neonatology (E.P.V.), Maasstad Hospital, Department of Pediatrics (H.G.S.), and St. Franciscus Gasthuis, Department of Pediatrics (M.W.A.H.), Rotterdam, Canisius-Wilhelmina Hospital, Department of Pediatrics, Nijmegen (B.A.S.), Amphia Hospital, Department of Pediatrics, Breda (R.H.T.B.), Rijnstate Hospital, Department of Pediatrics, Arnhem (J.J.V.), the University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Neonatology, Groningen (P.H.D.), University Medical Center Utrecht, Wilhelmina Children's Hospital, Department of Neonatology, Utrecht (J.U.M.T.), Albert Schweitzer Hospital, Department of Pediatrics, Dordrecht (A.C.M.), and the National Health Care Institute (ZINL), Diemen (N.B.) - all in the Netherlands; and the Hospital for Sick Children, Division of Neonatology/Child Health Evaluative Sciences, University of Toronto, Toronto (M.O.)
| | - Flip J P C M van der Hulst
- From OLVG, Department of Pediatrics (A.A.M.W.K., N.R.V.), and Academic Medical Center, Emma Children's Hospital, Department of Neonatology (D.H.G.M.N., J.H.K.), the University of Amsterdam, Pediatric Clinical Research Office (J.H.L.) and the VU Medical Center, Vrije Universiteit, Department of Neonatology (R.C.J.J.), Amsterdam UMC, Amsterdam, Meander Medical Center, Department of Pediatrics, Amersfoort (P.F.E.), St. Antonius Hospital, Departments of Research and Epidemiology (L.M.D.) and Pediatrics (M.D.-B), Nieuwegein, Zaans Medical Center, Department of Pediatrics, Zaandam (F.J.P.C.M.H.), Zuyderland Medical Center Heerlen, Department of Pediatrics, Sittard-Geleen (R.M.J.M.), Maastricht University Medical Center, Department of Pediatrics-Neonatology, Schools of Oncology and Developmental Biology (GROW) and NUTRIM, Maastricht (L.J.I.Z.), Erasmus MC-Sophia, Department of Neonatology (E.P.V.), Maasstad Hospital, Department of Pediatrics (H.G.S.), and St. Franciscus Gasthuis, Department of Pediatrics (M.W.A.H.), Rotterdam, Canisius-Wilhelmina Hospital, Department of Pediatrics, Nijmegen (B.A.S.), Amphia Hospital, Department of Pediatrics, Breda (R.H.T.B.), Rijnstate Hospital, Department of Pediatrics, Arnhem (J.J.V.), the University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Neonatology, Groningen (P.H.D.), University Medical Center Utrecht, Wilhelmina Children's Hospital, Department of Neonatology, Utrecht (J.U.M.T.), Albert Schweitzer Hospital, Department of Pediatrics, Dordrecht (A.C.M.), and the National Health Care Institute (ZINL), Diemen (N.B.) - all in the Netherlands; and the Hospital for Sick Children, Division of Neonatology/Child Health Evaluative Sciences, University of Toronto, Toronto (M.O.)
| | - Rob M J Moonen
- From OLVG, Department of Pediatrics (A.A.M.W.K., N.R.V.), and Academic Medical Center, Emma Children's Hospital, Department of Neonatology (D.H.G.M.N., J.H.K.), the University of Amsterdam, Pediatric Clinical Research Office (J.H.L.) and the VU Medical Center, Vrije Universiteit, Department of Neonatology (R.C.J.J.), Amsterdam UMC, Amsterdam, Meander Medical Center, Department of Pediatrics, Amersfoort (P.F.E.), St. Antonius Hospital, Departments of Research and Epidemiology (L.M.D.) and Pediatrics (M.D.-B), Nieuwegein, Zaans Medical Center, Department of Pediatrics, Zaandam (F.J.P.C.M.H.), Zuyderland Medical Center Heerlen, Department of Pediatrics, Sittard-Geleen (R.M.J.M.), Maastricht University Medical Center, Department of Pediatrics-Neonatology, Schools of Oncology and Developmental Biology (GROW) and NUTRIM, Maastricht (L.J.I.Z.), Erasmus MC-Sophia, Department of Neonatology (E.P.V.), Maasstad Hospital, Department of Pediatrics (H.G.S.), and St. Franciscus Gasthuis, Department of Pediatrics (M.W.A.H.), Rotterdam, Canisius-Wilhelmina Hospital, Department of Pediatrics, Nijmegen (B.A.S.), Amphia Hospital, Department of Pediatrics, Breda (R.H.T.B.), Rijnstate Hospital, Department of Pediatrics, Arnhem (J.J.V.), the University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Neonatology, Groningen (P.H.D.), University Medical Center Utrecht, Wilhelmina Children's Hospital, Department of Neonatology, Utrecht (J.U.M.T.), Albert Schweitzer Hospital, Department of Pediatrics, Dordrecht (A.C.M.), and the National Health Care Institute (ZINL), Diemen (N.B.) - all in the Netherlands; and the Hospital for Sick Children, Division of Neonatology/Child Health Evaluative Sciences, University of Toronto, Toronto (M.O.)
| | - Luc J I Zimmermann
- From OLVG, Department of Pediatrics (A.A.M.W.K., N.R.V.), and Academic Medical Center, Emma Children's Hospital, Department of Neonatology (D.H.G.M.N., J.H.K.), the University of Amsterdam, Pediatric Clinical Research Office (J.H.L.) and the VU Medical Center, Vrije Universiteit, Department of Neonatology (R.C.J.J.), Amsterdam UMC, Amsterdam, Meander Medical Center, Department of Pediatrics, Amersfoort (P.F.E.), St. Antonius Hospital, Departments of Research and Epidemiology (L.M.D.) and Pediatrics (M.D.-B), Nieuwegein, Zaans Medical Center, Department of Pediatrics, Zaandam (F.J.P.C.M.H.), Zuyderland Medical Center Heerlen, Department of Pediatrics, Sittard-Geleen (R.M.J.M.), Maastricht University Medical Center, Department of Pediatrics-Neonatology, Schools of Oncology and Developmental Biology (GROW) and NUTRIM, Maastricht (L.J.I.Z.), Erasmus MC-Sophia, Department of Neonatology (E.P.V.), Maasstad Hospital, Department of Pediatrics (H.G.S.), and St. Franciscus Gasthuis, Department of Pediatrics (M.W.A.H.), Rotterdam, Canisius-Wilhelmina Hospital, Department of Pediatrics, Nijmegen (B.A.S.), Amphia Hospital, Department of Pediatrics, Breda (R.H.T.B.), Rijnstate Hospital, Department of Pediatrics, Arnhem (J.J.V.), the University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Neonatology, Groningen (P.H.D.), University Medical Center Utrecht, Wilhelmina Children's Hospital, Department of Neonatology, Utrecht (J.U.M.T.), Albert Schweitzer Hospital, Department of Pediatrics, Dordrecht (A.C.M.), and the National Health Care Institute (ZINL), Diemen (N.B.) - all in the Netherlands; and the Hospital for Sick Children, Division of Neonatology/Child Health Evaluative Sciences, University of Toronto, Toronto (M.O.)
| | - Ellen P van 't Verlaat
- From OLVG, Department of Pediatrics (A.A.M.W.K., N.R.V.), and Academic Medical Center, Emma Children's Hospital, Department of Neonatology (D.H.G.M.N., J.H.K.), the University of Amsterdam, Pediatric Clinical Research Office (J.H.L.) and the VU Medical Center, Vrije Universiteit, Department of Neonatology (R.C.J.J.), Amsterdam UMC, Amsterdam, Meander Medical Center, Department of Pediatrics, Amersfoort (P.F.E.), St. Antonius Hospital, Departments of Research and Epidemiology (L.M.D.) and Pediatrics (M.D.-B), Nieuwegein, Zaans Medical Center, Department of Pediatrics, Zaandam (F.J.P.C.M.H.), Zuyderland Medical Center Heerlen, Department of Pediatrics, Sittard-Geleen (R.M.J.M.), Maastricht University Medical Center, Department of Pediatrics-Neonatology, Schools of Oncology and Developmental Biology (GROW) and NUTRIM, Maastricht (L.J.I.Z.), Erasmus MC-Sophia, Department of Neonatology (E.P.V.), Maasstad Hospital, Department of Pediatrics (H.G.S.), and St. Franciscus Gasthuis, Department of Pediatrics (M.W.A.H.), Rotterdam, Canisius-Wilhelmina Hospital, Department of Pediatrics, Nijmegen (B.A.S.), Amphia Hospital, Department of Pediatrics, Breda (R.H.T.B.), Rijnstate Hospital, Department of Pediatrics, Arnhem (J.J.V.), the University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Neonatology, Groningen (P.H.D.), University Medical Center Utrecht, Wilhelmina Children's Hospital, Department of Neonatology, Utrecht (J.U.M.T.), Albert Schweitzer Hospital, Department of Pediatrics, Dordrecht (A.C.M.), and the National Health Care Institute (ZINL), Diemen (N.B.) - all in the Netherlands; and the Hospital for Sick Children, Division of Neonatology/Child Health Evaluative Sciences, University of Toronto, Toronto (M.O.)
| | - Minouche van Dongen-van Baal
- From OLVG, Department of Pediatrics (A.A.M.W.K., N.R.V.), and Academic Medical Center, Emma Children's Hospital, Department of Neonatology (D.H.G.M.N., J.H.K.), the University of Amsterdam, Pediatric Clinical Research Office (J.H.L.) and the VU Medical Center, Vrije Universiteit, Department of Neonatology (R.C.J.J.), Amsterdam UMC, Amsterdam, Meander Medical Center, Department of Pediatrics, Amersfoort (P.F.E.), St. Antonius Hospital, Departments of Research and Epidemiology (L.M.D.) and Pediatrics (M.D.-B), Nieuwegein, Zaans Medical Center, Department of Pediatrics, Zaandam (F.J.P.C.M.H.), Zuyderland Medical Center Heerlen, Department of Pediatrics, Sittard-Geleen (R.M.J.M.), Maastricht University Medical Center, Department of Pediatrics-Neonatology, Schools of Oncology and Developmental Biology (GROW) and NUTRIM, Maastricht (L.J.I.Z.), Erasmus MC-Sophia, Department of Neonatology (E.P.V.), Maasstad Hospital, Department of Pediatrics (H.G.S.), and St. Franciscus Gasthuis, Department of Pediatrics (M.W.A.H.), Rotterdam, Canisius-Wilhelmina Hospital, Department of Pediatrics, Nijmegen (B.A.S.), Amphia Hospital, Department of Pediatrics, Breda (R.H.T.B.), Rijnstate Hospital, Department of Pediatrics, Arnhem (J.J.V.), the University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Neonatology, Groningen (P.H.D.), University Medical Center Utrecht, Wilhelmina Children's Hospital, Department of Neonatology, Utrecht (J.U.M.T.), Albert Schweitzer Hospital, Department of Pediatrics, Dordrecht (A.C.M.), and the National Health Care Institute (ZINL), Diemen (N.B.) - all in the Netherlands; and the Hospital for Sick Children, Division of Neonatology/Child Health Evaluative Sciences, University of Toronto, Toronto (M.O.)
| | - Ben A Semmekrot
- From OLVG, Department of Pediatrics (A.A.M.W.K., N.R.V.), and Academic Medical Center, Emma Children's Hospital, Department of Neonatology (D.H.G.M.N., J.H.K.), the University of Amsterdam, Pediatric Clinical Research Office (J.H.L.) and the VU Medical Center, Vrije Universiteit, Department of Neonatology (R.C.J.J.), Amsterdam UMC, Amsterdam, Meander Medical Center, Department of Pediatrics, Amersfoort (P.F.E.), St. Antonius Hospital, Departments of Research and Epidemiology (L.M.D.) and Pediatrics (M.D.-B), Nieuwegein, Zaans Medical Center, Department of Pediatrics, Zaandam (F.J.P.C.M.H.), Zuyderland Medical Center Heerlen, Department of Pediatrics, Sittard-Geleen (R.M.J.M.), Maastricht University Medical Center, Department of Pediatrics-Neonatology, Schools of Oncology and Developmental Biology (GROW) and NUTRIM, Maastricht (L.J.I.Z.), Erasmus MC-Sophia, Department of Neonatology (E.P.V.), Maasstad Hospital, Department of Pediatrics (H.G.S.), and St. Franciscus Gasthuis, Department of Pediatrics (M.W.A.H.), Rotterdam, Canisius-Wilhelmina Hospital, Department of Pediatrics, Nijmegen (B.A.S.), Amphia Hospital, Department of Pediatrics, Breda (R.H.T.B.), Rijnstate Hospital, Department of Pediatrics, Arnhem (J.J.V.), the University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Neonatology, Groningen (P.H.D.), University Medical Center Utrecht, Wilhelmina Children's Hospital, Department of Neonatology, Utrecht (J.U.M.T.), Albert Schweitzer Hospital, Department of Pediatrics, Dordrecht (A.C.M.), and the National Health Care Institute (ZINL), Diemen (N.B.) - all in the Netherlands; and the Hospital for Sick Children, Division of Neonatology/Child Health Evaluative Sciences, University of Toronto, Toronto (M.O.)
| | - Hélène G Stas
- From OLVG, Department of Pediatrics (A.A.M.W.K., N.R.V.), and Academic Medical Center, Emma Children's Hospital, Department of Neonatology (D.H.G.M.N., J.H.K.), the University of Amsterdam, Pediatric Clinical Research Office (J.H.L.) and the VU Medical Center, Vrije Universiteit, Department of Neonatology (R.C.J.J.), Amsterdam UMC, Amsterdam, Meander Medical Center, Department of Pediatrics, Amersfoort (P.F.E.), St. Antonius Hospital, Departments of Research and Epidemiology (L.M.D.) and Pediatrics (M.D.-B), Nieuwegein, Zaans Medical Center, Department of Pediatrics, Zaandam (F.J.P.C.M.H.), Zuyderland Medical Center Heerlen, Department of Pediatrics, Sittard-Geleen (R.M.J.M.), Maastricht University Medical Center, Department of Pediatrics-Neonatology, Schools of Oncology and Developmental Biology (GROW) and NUTRIM, Maastricht (L.J.I.Z.), Erasmus MC-Sophia, Department of Neonatology (E.P.V.), Maasstad Hospital, Department of Pediatrics (H.G.S.), and St. Franciscus Gasthuis, Department of Pediatrics (M.W.A.H.), Rotterdam, Canisius-Wilhelmina Hospital, Department of Pediatrics, Nijmegen (B.A.S.), Amphia Hospital, Department of Pediatrics, Breda (R.H.T.B.), Rijnstate Hospital, Department of Pediatrics, Arnhem (J.J.V.), the University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Neonatology, Groningen (P.H.D.), University Medical Center Utrecht, Wilhelmina Children's Hospital, Department of Neonatology, Utrecht (J.U.M.T.), Albert Schweitzer Hospital, Department of Pediatrics, Dordrecht (A.C.M.), and the National Health Care Institute (ZINL), Diemen (N.B.) - all in the Netherlands; and the Hospital for Sick Children, Division of Neonatology/Child Health Evaluative Sciences, University of Toronto, Toronto (M.O.)
| | - Ron H T van Beek
- From OLVG, Department of Pediatrics (A.A.M.W.K., N.R.V.), and Academic Medical Center, Emma Children's Hospital, Department of Neonatology (D.H.G.M.N., J.H.K.), the University of Amsterdam, Pediatric Clinical Research Office (J.H.L.) and the VU Medical Center, Vrije Universiteit, Department of Neonatology (R.C.J.J.), Amsterdam UMC, Amsterdam, Meander Medical Center, Department of Pediatrics, Amersfoort (P.F.E.), St. Antonius Hospital, Departments of Research and Epidemiology (L.M.D.) and Pediatrics (M.D.-B), Nieuwegein, Zaans Medical Center, Department of Pediatrics, Zaandam (F.J.P.C.M.H.), Zuyderland Medical Center Heerlen, Department of Pediatrics, Sittard-Geleen (R.M.J.M.), Maastricht University Medical Center, Department of Pediatrics-Neonatology, Schools of Oncology and Developmental Biology (GROW) and NUTRIM, Maastricht (L.J.I.Z.), Erasmus MC-Sophia, Department of Neonatology (E.P.V.), Maasstad Hospital, Department of Pediatrics (H.G.S.), and St. Franciscus Gasthuis, Department of Pediatrics (M.W.A.H.), Rotterdam, Canisius-Wilhelmina Hospital, Department of Pediatrics, Nijmegen (B.A.S.), Amphia Hospital, Department of Pediatrics, Breda (R.H.T.B.), Rijnstate Hospital, Department of Pediatrics, Arnhem (J.J.V.), the University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Neonatology, Groningen (P.H.D.), University Medical Center Utrecht, Wilhelmina Children's Hospital, Department of Neonatology, Utrecht (J.U.M.T.), Albert Schweitzer Hospital, Department of Pediatrics, Dordrecht (A.C.M.), and the National Health Care Institute (ZINL), Diemen (N.B.) - all in the Netherlands; and the Hospital for Sick Children, Division of Neonatology/Child Health Evaluative Sciences, University of Toronto, Toronto (M.O.)
| | - José J Vlietman
- From OLVG, Department of Pediatrics (A.A.M.W.K., N.R.V.), and Academic Medical Center, Emma Children's Hospital, Department of Neonatology (D.H.G.M.N., J.H.K.), the University of Amsterdam, Pediatric Clinical Research Office (J.H.L.) and the VU Medical Center, Vrije Universiteit, Department of Neonatology (R.C.J.J.), Amsterdam UMC, Amsterdam, Meander Medical Center, Department of Pediatrics, Amersfoort (P.F.E.), St. Antonius Hospital, Departments of Research and Epidemiology (L.M.D.) and Pediatrics (M.D.-B), Nieuwegein, Zaans Medical Center, Department of Pediatrics, Zaandam (F.J.P.C.M.H.), Zuyderland Medical Center Heerlen, Department of Pediatrics, Sittard-Geleen (R.M.J.M.), Maastricht University Medical Center, Department of Pediatrics-Neonatology, Schools of Oncology and Developmental Biology (GROW) and NUTRIM, Maastricht (L.J.I.Z.), Erasmus MC-Sophia, Department of Neonatology (E.P.V.), Maasstad Hospital, Department of Pediatrics (H.G.S.), and St. Franciscus Gasthuis, Department of Pediatrics (M.W.A.H.), Rotterdam, Canisius-Wilhelmina Hospital, Department of Pediatrics, Nijmegen (B.A.S.), Amphia Hospital, Department of Pediatrics, Breda (R.H.T.B.), Rijnstate Hospital, Department of Pediatrics, Arnhem (J.J.V.), the University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Neonatology, Groningen (P.H.D.), University Medical Center Utrecht, Wilhelmina Children's Hospital, Department of Neonatology, Utrecht (J.U.M.T.), Albert Schweitzer Hospital, Department of Pediatrics, Dordrecht (A.C.M.), and the National Health Care Institute (ZINL), Diemen (N.B.) - all in the Netherlands; and the Hospital for Sick Children, Division of Neonatology/Child Health Evaluative Sciences, University of Toronto, Toronto (M.O.)
| | - Peter H Dijk
- From OLVG, Department of Pediatrics (A.A.M.W.K., N.R.V.), and Academic Medical Center, Emma Children's Hospital, Department of Neonatology (D.H.G.M.N., J.H.K.), the University of Amsterdam, Pediatric Clinical Research Office (J.H.L.) and the VU Medical Center, Vrije Universiteit, Department of Neonatology (R.C.J.J.), Amsterdam UMC, Amsterdam, Meander Medical Center, Department of Pediatrics, Amersfoort (P.F.E.), St. Antonius Hospital, Departments of Research and Epidemiology (L.M.D.) and Pediatrics (M.D.-B), Nieuwegein, Zaans Medical Center, Department of Pediatrics, Zaandam (F.J.P.C.M.H.), Zuyderland Medical Center Heerlen, Department of Pediatrics, Sittard-Geleen (R.M.J.M.), Maastricht University Medical Center, Department of Pediatrics-Neonatology, Schools of Oncology and Developmental Biology (GROW) and NUTRIM, Maastricht (L.J.I.Z.), Erasmus MC-Sophia, Department of Neonatology (E.P.V.), Maasstad Hospital, Department of Pediatrics (H.G.S.), and St. Franciscus Gasthuis, Department of Pediatrics (M.W.A.H.), Rotterdam, Canisius-Wilhelmina Hospital, Department of Pediatrics, Nijmegen (B.A.S.), Amphia Hospital, Department of Pediatrics, Breda (R.H.T.B.), Rijnstate Hospital, Department of Pediatrics, Arnhem (J.J.V.), the University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Neonatology, Groningen (P.H.D.), University Medical Center Utrecht, Wilhelmina Children's Hospital, Department of Neonatology, Utrecht (J.U.M.T.), Albert Schweitzer Hospital, Department of Pediatrics, Dordrecht (A.C.M.), and the National Health Care Institute (ZINL), Diemen (N.B.) - all in the Netherlands; and the Hospital for Sick Children, Division of Neonatology/Child Health Evaluative Sciences, University of Toronto, Toronto (M.O.)
| | - Jacqueline U M Termote
- From OLVG, Department of Pediatrics (A.A.M.W.K., N.R.V.), and Academic Medical Center, Emma Children's Hospital, Department of Neonatology (D.H.G.M.N., J.H.K.), the University of Amsterdam, Pediatric Clinical Research Office (J.H.L.) and the VU Medical Center, Vrije Universiteit, Department of Neonatology (R.C.J.J.), Amsterdam UMC, Amsterdam, Meander Medical Center, Department of Pediatrics, Amersfoort (P.F.E.), St. Antonius Hospital, Departments of Research and Epidemiology (L.M.D.) and Pediatrics (M.D.-B), Nieuwegein, Zaans Medical Center, Department of Pediatrics, Zaandam (F.J.P.C.M.H.), Zuyderland Medical Center Heerlen, Department of Pediatrics, Sittard-Geleen (R.M.J.M.), Maastricht University Medical Center, Department of Pediatrics-Neonatology, Schools of Oncology and Developmental Biology (GROW) and NUTRIM, Maastricht (L.J.I.Z.), Erasmus MC-Sophia, Department of Neonatology (E.P.V.), Maasstad Hospital, Department of Pediatrics (H.G.S.), and St. Franciscus Gasthuis, Department of Pediatrics (M.W.A.H.), Rotterdam, Canisius-Wilhelmina Hospital, Department of Pediatrics, Nijmegen (B.A.S.), Amphia Hospital, Department of Pediatrics, Breda (R.H.T.B.), Rijnstate Hospital, Department of Pediatrics, Arnhem (J.J.V.), the University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Neonatology, Groningen (P.H.D.), University Medical Center Utrecht, Wilhelmina Children's Hospital, Department of Neonatology, Utrecht (J.U.M.T.), Albert Schweitzer Hospital, Department of Pediatrics, Dordrecht (A.C.M.), and the National Health Care Institute (ZINL), Diemen (N.B.) - all in the Netherlands; and the Hospital for Sick Children, Division of Neonatology/Child Health Evaluative Sciences, University of Toronto, Toronto (M.O.)
| | - Rogier C J de Jonge
- From OLVG, Department of Pediatrics (A.A.M.W.K., N.R.V.), and Academic Medical Center, Emma Children's Hospital, Department of Neonatology (D.H.G.M.N., J.H.K.), the University of Amsterdam, Pediatric Clinical Research Office (J.H.L.) and the VU Medical Center, Vrije Universiteit, Department of Neonatology (R.C.J.J.), Amsterdam UMC, Amsterdam, Meander Medical Center, Department of Pediatrics, Amersfoort (P.F.E.), St. Antonius Hospital, Departments of Research and Epidemiology (L.M.D.) and Pediatrics (M.D.-B), Nieuwegein, Zaans Medical Center, Department of Pediatrics, Zaandam (F.J.P.C.M.H.), Zuyderland Medical Center Heerlen, Department of Pediatrics, Sittard-Geleen (R.M.J.M.), Maastricht University Medical Center, Department of Pediatrics-Neonatology, Schools of Oncology and Developmental Biology (GROW) and NUTRIM, Maastricht (L.J.I.Z.), Erasmus MC-Sophia, Department of Neonatology (E.P.V.), Maasstad Hospital, Department of Pediatrics (H.G.S.), and St. Franciscus Gasthuis, Department of Pediatrics (M.W.A.H.), Rotterdam, Canisius-Wilhelmina Hospital, Department of Pediatrics, Nijmegen (B.A.S.), Amphia Hospital, Department of Pediatrics, Breda (R.H.T.B.), Rijnstate Hospital, Department of Pediatrics, Arnhem (J.J.V.), the University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Neonatology, Groningen (P.H.D.), University Medical Center Utrecht, Wilhelmina Children's Hospital, Department of Neonatology, Utrecht (J.U.M.T.), Albert Schweitzer Hospital, Department of Pediatrics, Dordrecht (A.C.M.), and the National Health Care Institute (ZINL), Diemen (N.B.) - all in the Netherlands; and the Hospital for Sick Children, Division of Neonatology/Child Health Evaluative Sciences, University of Toronto, Toronto (M.O.)
| | - Amerik C de Mol
- From OLVG, Department of Pediatrics (A.A.M.W.K., N.R.V.), and Academic Medical Center, Emma Children's Hospital, Department of Neonatology (D.H.G.M.N., J.H.K.), the University of Amsterdam, Pediatric Clinical Research Office (J.H.L.) and the VU Medical Center, Vrije Universiteit, Department of Neonatology (R.C.J.J.), Amsterdam UMC, Amsterdam, Meander Medical Center, Department of Pediatrics, Amersfoort (P.F.E.), St. Antonius Hospital, Departments of Research and Epidemiology (L.M.D.) and Pediatrics (M.D.-B), Nieuwegein, Zaans Medical Center, Department of Pediatrics, Zaandam (F.J.P.C.M.H.), Zuyderland Medical Center Heerlen, Department of Pediatrics, Sittard-Geleen (R.M.J.M.), Maastricht University Medical Center, Department of Pediatrics-Neonatology, Schools of Oncology and Developmental Biology (GROW) and NUTRIM, Maastricht (L.J.I.Z.), Erasmus MC-Sophia, Department of Neonatology (E.P.V.), Maasstad Hospital, Department of Pediatrics (H.G.S.), and St. Franciscus Gasthuis, Department of Pediatrics (M.W.A.H.), Rotterdam, Canisius-Wilhelmina Hospital, Department of Pediatrics, Nijmegen (B.A.S.), Amphia Hospital, Department of Pediatrics, Breda (R.H.T.B.), Rijnstate Hospital, Department of Pediatrics, Arnhem (J.J.V.), the University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Neonatology, Groningen (P.H.D.), University Medical Center Utrecht, Wilhelmina Children's Hospital, Department of Neonatology, Utrecht (J.U.M.T.), Albert Schweitzer Hospital, Department of Pediatrics, Dordrecht (A.C.M.), and the National Health Care Institute (ZINL), Diemen (N.B.) - all in the Netherlands; and the Hospital for Sick Children, Division of Neonatology/Child Health Evaluative Sciences, University of Toronto, Toronto (M.O.)
| | - Marianne W A Huysman
- From OLVG, Department of Pediatrics (A.A.M.W.K., N.R.V.), and Academic Medical Center, Emma Children's Hospital, Department of Neonatology (D.H.G.M.N., J.H.K.), the University of Amsterdam, Pediatric Clinical Research Office (J.H.L.) and the VU Medical Center, Vrije Universiteit, Department of Neonatology (R.C.J.J.), Amsterdam UMC, Amsterdam, Meander Medical Center, Department of Pediatrics, Amersfoort (P.F.E.), St. Antonius Hospital, Departments of Research and Epidemiology (L.M.D.) and Pediatrics (M.D.-B), Nieuwegein, Zaans Medical Center, Department of Pediatrics, Zaandam (F.J.P.C.M.H.), Zuyderland Medical Center Heerlen, Department of Pediatrics, Sittard-Geleen (R.M.J.M.), Maastricht University Medical Center, Department of Pediatrics-Neonatology, Schools of Oncology and Developmental Biology (GROW) and NUTRIM, Maastricht (L.J.I.Z.), Erasmus MC-Sophia, Department of Neonatology (E.P.V.), Maasstad Hospital, Department of Pediatrics (H.G.S.), and St. Franciscus Gasthuis, Department of Pediatrics (M.W.A.H.), Rotterdam, Canisius-Wilhelmina Hospital, Department of Pediatrics, Nijmegen (B.A.S.), Amphia Hospital, Department of Pediatrics, Breda (R.H.T.B.), Rijnstate Hospital, Department of Pediatrics, Arnhem (J.J.V.), the University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Neonatology, Groningen (P.H.D.), University Medical Center Utrecht, Wilhelmina Children's Hospital, Department of Neonatology, Utrecht (J.U.M.T.), Albert Schweitzer Hospital, Department of Pediatrics, Dordrecht (A.C.M.), and the National Health Care Institute (ZINL), Diemen (N.B.) - all in the Netherlands; and the Hospital for Sick Children, Division of Neonatology/Child Health Evaluative Sciences, University of Toronto, Toronto (M.O.)
| | - Joke H Kok
- From OLVG, Department of Pediatrics (A.A.M.W.K., N.R.V.), and Academic Medical Center, Emma Children's Hospital, Department of Neonatology (D.H.G.M.N., J.H.K.), the University of Amsterdam, Pediatric Clinical Research Office (J.H.L.) and the VU Medical Center, Vrije Universiteit, Department of Neonatology (R.C.J.J.), Amsterdam UMC, Amsterdam, Meander Medical Center, Department of Pediatrics, Amersfoort (P.F.E.), St. Antonius Hospital, Departments of Research and Epidemiology (L.M.D.) and Pediatrics (M.D.-B), Nieuwegein, Zaans Medical Center, Department of Pediatrics, Zaandam (F.J.P.C.M.H.), Zuyderland Medical Center Heerlen, Department of Pediatrics, Sittard-Geleen (R.M.J.M.), Maastricht University Medical Center, Department of Pediatrics-Neonatology, Schools of Oncology and Developmental Biology (GROW) and NUTRIM, Maastricht (L.J.I.Z.), Erasmus MC-Sophia, Department of Neonatology (E.P.V.), Maasstad Hospital, Department of Pediatrics (H.G.S.), and St. Franciscus Gasthuis, Department of Pediatrics (M.W.A.H.), Rotterdam, Canisius-Wilhelmina Hospital, Department of Pediatrics, Nijmegen (B.A.S.), Amphia Hospital, Department of Pediatrics, Breda (R.H.T.B.), Rijnstate Hospital, Department of Pediatrics, Arnhem (J.J.V.), the University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Neonatology, Groningen (P.H.D.), University Medical Center Utrecht, Wilhelmina Children's Hospital, Department of Neonatology, Utrecht (J.U.M.T.), Albert Schweitzer Hospital, Department of Pediatrics, Dordrecht (A.C.M.), and the National Health Care Institute (ZINL), Diemen (N.B.) - all in the Netherlands; and the Hospital for Sick Children, Division of Neonatology/Child Health Evaluative Sciences, University of Toronto, Toronto (M.O.)
| | - Martin Offringa
- From OLVG, Department of Pediatrics (A.A.M.W.K., N.R.V.), and Academic Medical Center, Emma Children's Hospital, Department of Neonatology (D.H.G.M.N., J.H.K.), the University of Amsterdam, Pediatric Clinical Research Office (J.H.L.) and the VU Medical Center, Vrije Universiteit, Department of Neonatology (R.C.J.J.), Amsterdam UMC, Amsterdam, Meander Medical Center, Department of Pediatrics, Amersfoort (P.F.E.), St. Antonius Hospital, Departments of Research and Epidemiology (L.M.D.) and Pediatrics (M.D.-B), Nieuwegein, Zaans Medical Center, Department of Pediatrics, Zaandam (F.J.P.C.M.H.), Zuyderland Medical Center Heerlen, Department of Pediatrics, Sittard-Geleen (R.M.J.M.), Maastricht University Medical Center, Department of Pediatrics-Neonatology, Schools of Oncology and Developmental Biology (GROW) and NUTRIM, Maastricht (L.J.I.Z.), Erasmus MC-Sophia, Department of Neonatology (E.P.V.), Maasstad Hospital, Department of Pediatrics (H.G.S.), and St. Franciscus Gasthuis, Department of Pediatrics (M.W.A.H.), Rotterdam, Canisius-Wilhelmina Hospital, Department of Pediatrics, Nijmegen (B.A.S.), Amphia Hospital, Department of Pediatrics, Breda (R.H.T.B.), Rijnstate Hospital, Department of Pediatrics, Arnhem (J.J.V.), the University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Neonatology, Groningen (P.H.D.), University Medical Center Utrecht, Wilhelmina Children's Hospital, Department of Neonatology, Utrecht (J.U.M.T.), Albert Schweitzer Hospital, Department of Pediatrics, Dordrecht (A.C.M.), and the National Health Care Institute (ZINL), Diemen (N.B.) - all in the Netherlands; and the Hospital for Sick Children, Division of Neonatology/Child Health Evaluative Sciences, University of Toronto, Toronto (M.O.)
| | - Nicole Boluyt
- From OLVG, Department of Pediatrics (A.A.M.W.K., N.R.V.), and Academic Medical Center, Emma Children's Hospital, Department of Neonatology (D.H.G.M.N., J.H.K.), the University of Amsterdam, Pediatric Clinical Research Office (J.H.L.) and the VU Medical Center, Vrije Universiteit, Department of Neonatology (R.C.J.J.), Amsterdam UMC, Amsterdam, Meander Medical Center, Department of Pediatrics, Amersfoort (P.F.E.), St. Antonius Hospital, Departments of Research and Epidemiology (L.M.D.) and Pediatrics (M.D.-B), Nieuwegein, Zaans Medical Center, Department of Pediatrics, Zaandam (F.J.P.C.M.H.), Zuyderland Medical Center Heerlen, Department of Pediatrics, Sittard-Geleen (R.M.J.M.), Maastricht University Medical Center, Department of Pediatrics-Neonatology, Schools of Oncology and Developmental Biology (GROW) and NUTRIM, Maastricht (L.J.I.Z.), Erasmus MC-Sophia, Department of Neonatology (E.P.V.), Maasstad Hospital, Department of Pediatrics (H.G.S.), and St. Franciscus Gasthuis, Department of Pediatrics (M.W.A.H.), Rotterdam, Canisius-Wilhelmina Hospital, Department of Pediatrics, Nijmegen (B.A.S.), Amphia Hospital, Department of Pediatrics, Breda (R.H.T.B.), Rijnstate Hospital, Department of Pediatrics, Arnhem (J.J.V.), the University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Neonatology, Groningen (P.H.D.), University Medical Center Utrecht, Wilhelmina Children's Hospital, Department of Neonatology, Utrecht (J.U.M.T.), Albert Schweitzer Hospital, Department of Pediatrics, Dordrecht (A.C.M.), and the National Health Care Institute (ZINL), Diemen (N.B.) - all in the Netherlands; and the Hospital for Sick Children, Division of Neonatology/Child Health Evaluative Sciences, University of Toronto, Toronto (M.O.)
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Hulzebos CV, Vader-van Imhoff DE, Bos AF, Dijk PH. Should transcutaneous bilirubin be measured in preterm infants receiving phototherapy? The relationship between transcutaneous and total serum bilirubin in preterm infants with and without phototherapy. PLoS One 2019; 14:e0218131. [PMID: 31199817 PMCID: PMC6568417 DOI: 10.1371/journal.pone.0218131] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/25/2019] [Indexed: 01/22/2023] Open
Abstract
Our objective was to analyze the relationship between transcutaneous bilirubin (TcB) measured on an unexposed area of skin and total serum bilirubin (TSB) in preterm infants before, during, and after phototherapy (PT). For this purpose paired TSB and TcB levels were measured daily during the first ten days after birth in preterm infants of less than 32 weeks’ gestation. TcB was measured with a Dräger Jaundice Meter JM-103 on the covered hipbone. Agreement between TSB and TcB levels was assessed before, during, and after PT. True negative and corresponding false negative percentages were calculated using different TcB cut-off levels. Data are presented as mean (±SD). We obtained 856 paired TcB and TSB levels in 109 preterm infants (66 boys, gestational age 29.4 ± 1.6 weeks and birth weight 1282 g ± 316 g). We found that the difference between TSB and TcB before PT was significantly lower, 44 (±36) μmol/L, than the difference during and after PT, 61 (±29) μmol/L and 63 (±25) μmol/L, respectively; P < 0.01. Blood sampling could be reduced by 42%, with 2% false negatives, when 50 μmol/L was added to the TcB level at 70% of the PT threshold. Our conclusion is that phototherapy enhances underestimation of TSB by TcB in preterms, even if measured on unexposed skin. The use of specific TcB cut-off levels substantially reduces the need for TSB measurements.
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Affiliation(s)
- Christian V. Hulzebos
- Department of Pediatrics, Division of Neonatology, Beatrix Children’s Hospital, University Medical Center Groningen, Groningen, the Netherlands
- * E-mail:
| | - Deirdre E. Vader-van Imhoff
- Department of Pediatrics, Division of Neonatology, Beatrix Children’s Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | - Arend F. Bos
- Department of Pediatrics, Division of Neonatology, Beatrix Children’s Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | - Peter H. Dijk
- Department of Pediatrics, Division of Neonatology, Beatrix Children’s Hospital, University Medical Center Groningen, Groningen, the Netherlands
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Sampurna MTA, Ratnasari KA, Saharso D, Bos AF, Sauer PJJ, Dijk PH, Hulzebos CV. Current phototherapy practice on Java, Indonesia. BMC Pediatr 2019; 19:188. [PMID: 31176379 PMCID: PMC6555918 DOI: 10.1186/s12887-019-1552-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 05/22/2019] [Indexed: 02/07/2023] Open
Abstract
Background In Indonesia, the burden of severe hyperbilirubinemia is higher compared to other countries. Whether this is related to ineffective phototherapy (PT) is unknown. The aim of this study is to investigate the performance of phototherapy devices in hospitals on Java, Indonesia. Methods In 17 hospitals we measured 77 combinations of 20 different phototherapy devices, with and without curtains drawn around the incubator/crib. With a model to mimic the silhouette of an infant, we measured the irradiance levels with an Ohmeda BiliBlanket Meter II, recorded the distance between device and model, and compared these to manufacturers’ specifications. Results In nine hospitals the irradiance levels were less than required for standard PT: < 10 μW/cm2/nm and in eight hospitals irradiance failed to reach the levels for intensive phototherapy: 30 μW/cm2/nm. Three hospitals provided very high irradiance levels: > 50 μW/cm2/nm. Half of the distances between device and model were greater than recommended. Distance was inversely correlated with irradiance levels (R2 = 0.1838; P < 0.05). The effect of curtains on irradiance levels was highly variable, ranging from − 6.15 to + 15.4 μW/cm2/nm, with a mean difference (SD) of 1.82 (3.81) μW/cm2/nm (P = 0.486). Conclusions In half of the hospitals that we studied on Java the levels of irradiance are too low and, in some cases, too high. Given the risks of insufficient phototherapy or adverse effects, we recommend that manufacturers provide radiometers so hospitals can optimize the performance of their phototherapy devices. Electronic supplementary material The online version of this article (10.1186/s12887-019-1552-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mahendra T A Sampurna
- Department of Pediatrics, Dr. Soetomo General Hospital, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia.
| | - Kinanti A Ratnasari
- Department of Pediatrics, Dr. Soetomo General Hospital, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
| | - Darto Saharso
- Department of Pediatrics, Dr. Soetomo General Hospital, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
| | - Arend F Bos
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Pieter J J Sauer
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Peter H Dijk
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Christian V Hulzebos
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Favié LMA, Groenendaal F, van den Broek MPH, Rademaker CMA, de Haan TR, van Straaten HLM, Dijk PH, van Heijst A, Dudink J, Dijkman KP, Rijken M, Zonnenberg IA, Cools F, Zecic A, van der Lee JH, Nuytemans DHGM, van Bel F, Egberts TCG, Huitema ADR. Pharmacokinetics of morphine in encephalopathic neonates treated with therapeutic hypothermia. PLoS One 2019; 14:e0211910. [PMID: 30763356 PMCID: PMC6375702 DOI: 10.1371/journal.pone.0211910] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 01/22/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Morphine is a commonly used drug in encephalopathic neonates treated with therapeutic hypothermia after perinatal asphyxia. Pharmacokinetics and optimal dosing of morphine in this population are largely unknown. The objective of this study was to describe pharmacokinetics of morphine and its metabolites morphine-3-glucuronide and morphine-6-glucuronide in encephalopathic neonates treated with therapeutic hypothermia and to develop pharmacokinetics based dosing guidelines for this population. STUDY DESIGN Term and near-term encephalopathic neonates treated with therapeutic hypothermia and receiving morphine were included in two multicenter cohort studies between 2008-2010 (SHIVER) and 2010-2014 (PharmaCool). Data were collected during hypothermia and rewarming, including blood samples for quantification of morphine and its metabolites. Parental informed consent was obtained for all participants. RESULTS 244 patients (GA mean (sd) 39.8 (1.6) weeks, BW mean (sd) 3,428 (613) g, male 61.5%) were included. Morphine clearance was reduced under hypothermia (33.5°C) by 6.89%/°C (95% CI 5.37%/°C- 8.41%/°C, p<0.001) and metabolite clearance by 4.91%/°C (95% CI 3.53%/°C- 6.22%/°C, p<0.001) compared to normothermia (36.5°C). Simulations showed that a loading dose of 50 μg/kg followed by continuous infusion of 5 μg/kg/h resulted in morphine plasma concentrations in the desired range (between 10 and 40 μg/L) during hypothermia. CONCLUSIONS Clearance of morphine and its metabolites in neonates is affected by therapeutic hypothermia. The regimen suggested by the simulations will be sufficient in the majority of patients. However, due to the large interpatient variability a higher dose might be necessary in individual patients to achieve the desired effect. TRIAL REGISTRATION www.trialregister.nl NTR2529.
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Affiliation(s)
- Laurent M. A. Favié
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marcel P. H. van den Broek
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Carin M. A. Rademaker
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Timo R. de Haan
- Department of Neonatology, Emma Children’s Hospital, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Peter H. Dijk
- Department of Neonatology, Groningen University Medical Centre, Groningen, the Netherlands
| | - Arno van Heijst
- Department of Neonatology, Radboud university medical center-Amalia Children’s Hospital, Nijmegen, the Netherlands
| | - Jeroen Dudink
- Department of Pediatrics, Division of Neonatology, Erasmus Medical Centre-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Koen P. Dijkman
- Department of Neonatology, Máxima Medical Center Veldhoven, Veldhoven, the Netherlands
| | - Monique Rijken
- Department of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Inge A. Zonnenberg
- Department of Neonatology, VU University Medical Center, Amsterdam, the Netherlands
| | - Filip Cools
- Department of Neonatology, UZ Brussel—Vrije Universiteit Brussel, Brussels, Belgium
| | - Alexandra Zecic
- Department of Neonatology, University Hospital Gent, Gent, Belgium
| | - Johanna H. van der Lee
- Paediatric Clinical Research Office, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Toine C. G. Egberts
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Alwin D. R. Huitema
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Pharmacy & Pharmacology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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Onland W, Cools F, Kroon A, Rademaker K, Merkus MP, Dijk PH, van Straaten HL, Te Pas AB, Mohns T, Bruneel E, van Heijst AF, Kramer BW, Debeer A, Zonnenberg I, Marechal Y, Blom H, Plaskie K, Offringa M, van Kaam AH. Effect of Hydrocortisone Therapy Initiated 7 to 14 Days After Birth on Mortality or Bronchopulmonary Dysplasia Among Very Preterm Infants Receiving Mechanical Ventilation: A Randomized Clinical Trial. JAMA 2019; 321:354-363. [PMID: 30694322 PMCID: PMC6439762 DOI: 10.1001/jama.2018.21443] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [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: 12/17/2022]
Abstract
IMPORTANCE Dexamethasone initiated after the first week of life reduces the rate of death or bronchopulmonary dysplasia (BPD) but may cause long-term adverse effects in very preterm infants. Hydrocortisone is increasingly used as an alternative, but evidence supporting its efficacy and safety is lacking. OBJECTIVE To assess the effect of hydrocortisone initiated between 7 and 14 days after birth on death or BPD in very preterm infants. DESIGN, SETTING, AND PARTICIPANTS Double-blind, placebo-controlled randomized trial conducted in 19 neonatal intensive care units in the Netherlands and Belgium from November 15, 2011, to December 23, 2016, among preterm infants with a gestational age of less than 30 weeks and/or birth weight of less than 1250 g who were ventilator dependent between 7 and 14 days of life, with follow-up to hospital discharge ending December 12, 2017. INTERVENTIONS Infants were randomly assigned to receive a 22-day course of systemic hydrocortisone (cumulative dose, 72.5 mg/kg) (n = 182) or placebo (n = 190). MAIN OUTCOMES AND MEASURES The primary outcome was a composite of death or BPD assessed at 36 weeks' postmenstrual age. Twenty-nine secondary outcomes were analyzed up to hospital discharge, including death and BPD at 36 weeks' postmenstrual age. RESULTS Among 372 patients randomized (mean gestational age, 26 weeks; 55% male), 371 completed the trial; parents withdrew consent for 1 child treated with hydrocortisone. Death or BPD occurred in 128 of 181 infants (70.7%) randomized to hydrocortisone and in 140 of 190 infants (73.7%) randomized to placebo (adjusted risk difference, -3.6% [95% CI, -12.7% to 5.4%]; adjusted odds ratio, 0.87 [95% CI, 0.54-1.38]; P = .54). Of 29 secondary outcomes, 8 showed significant differences, including death at 36 weeks' postmenstrual age (15.5% with hydrocortisone vs 23.7% with placebo; risk difference, -8.2% [95% CI, -16.2% to -0.1%]; odds ratio, 0.59 [95% CI, 0.35-0.995]; P = .048). Twenty-one outcomes showed nonsignificant differences, including BPD (55.2% with hydrocortisone vs 50.0% with placebo; risk difference, 5.2% [95% CI, -4.9% to 15.2%]; odds ratio, 1.24 [95% CI, 0.82-1.86]; P = .31). Hyperglycemia requiring insulin therapy was the only adverse effect reported more often in the hydrocortisone group (18.2%) than in the placebo group (7.9%). CONCLUSIONS AND RELEVANCE Among mechanically ventilated very preterm infants, administration of hydrocortisone between 7 and 14 days after birth, compared with placebo, did not improve the composite outcome of death or BPD at 36 weeks' postmenstrual age. These findings do not support the use of hydrocortisone for this indication. TRIAL REGISTRATION Netherlands National Trial Register Identifier: NTR2768.
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Affiliation(s)
- Wes Onland
- Department of Neonatology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Filip Cools
- Department of Neonatology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Andre Kroon
- Department of Neonatology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Karin Rademaker
- Department of Neonatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Maruschka P. Merkus
- Clinical Research Unit, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Peter H. Dijk
- Department of Neonatology, University Medical Center Groningen, Beatrix Children’s Hospital, University of Groningen, Groningen, the Netherlands
| | | | - Arjan B. Te Pas
- Department of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Thilo Mohns
- Department of Neonatology, Maxima Medical Center, Veldhoven, the Netherlands
| | - Els Bruneel
- Department of Neonatology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Arno F. van Heijst
- Department of Neonatology, Radboud University Medical Center–Amalia Children’s Hospital, Nijmegen, the Netherlands
| | - Boris W. Kramer
- Department of Neonatology, Medical University Center Maastricht, Maastricht, the Netherlands
| | - Anne Debeer
- Department of Neonatology, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Inge Zonnenberg
- Department of Neonatology, Emma Children’s Hospital, Amsterdam UMC, Vrije Universteit Amsterdam, Amsterdam, the Netherlands
| | - Yoann Marechal
- Department of Neonatology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Henry Blom
- Department of Neonatology, Universitair Ziekenhuis Antwerpen, Antwerp, Belgium
| | - Katleen Plaskie
- Department of Neonatology, St Augustinus Ziekenhuis, Antwerp, Belgium
| | - Martin Offringa
- Department of Neonatology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Division of Neonatology and Child Health Evaluative Sciences, the Hospital for Sick Children Research Institute, University of Toronto, Canada
| | - Anton H. van Kaam
- Department of Neonatology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Neonatology, Emma Children’s Hospital, Amsterdam UMC, Vrije Universteit Amsterdam, Amsterdam, the Netherlands
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Favié LMA, Groenendaal F, van den Broek MPH, Rademaker CMA, de Haan TR, van Straaten HLM, Dijk PH, van Heijst A, Simons SHP, Dijkman KP, Rijken M, Zonnenberg IA, Cools F, Zecic A, van der Lee JH, Nuytemans DHGM, van Bel F, Egberts TCG, Huitema ADR. Phenobarbital, Midazolam Pharmacokinetics, Effectiveness, and Drug-Drug Interaction in Asphyxiated Neonates Undergoing Therapeutic Hypothermia. Neonatology 2019; 116:154-162. [PMID: 31256150 PMCID: PMC6878731 DOI: 10.1159/000499330] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 02/28/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Phenobarbital and midazolam are commonly used drugs in (near-)term neonates treated with therapeutic hypothermia for hypoxic-ischaemic encephalopathy, for sedation, and/or as anti-epileptic drug. Phenobarbital is an inducer of cytochrome P450 (CYP) 3A, while midazolam is a CYP3A substrate. Therefore, co-treatment with phenobarbital might impact midazolam clearance. OBJECTIVES To assess pharmacokinetics and clinical anti-epileptic effectiveness of phenobarbital and midazolam in asphyxiated neonates and to develop dosing guidelines. METHODS Data were collected in the prospective multicentre PharmaCool study. In the present study, neonates treated with therapeutic hypothermia and receiving midazolam and/or phenobarbital were included. Plasma concentrations of phenobarbital and midazolam including its metabolites were determined in blood samples drawn on days 2-5 after birth. Pharmacokinetic analyses were performed using non-linear mixed effects modelling; clinical effectiveness was defined as no use of additional anti-epileptic drugs. RESULTS Data were available from 113 (phenobarbital) and 118 (midazolam) neonates; 68 were treated with both medications. Only clearance of 1-hydroxy midazolam was influenced by hypothermia. Phenobarbital co-administration increased midazolam clearance by a factor 2.3 (95% CI 1.9-2.9, p < 0.05). Anticonvulsant effectiveness was 65.5% for phenobarbital and 37.1% for add-on midazolam. CONCLUSIONS Therapeutic hypothermia does not influence clearance of phenobarbital or midazolam in (near-)term neonates with hypoxic-ischaemic encephalopathy. A phenobarbital dose of 30 mg/kg is advised to reach therapeutic concentrations. Phenobarbital co-administration significantly increased midazolam clearance. Should phenobarbital be substituted by non-CYP3A inducers as first-line anticonvulsant, a 50% lower midazolam maintenance dose might be appropriate to avoid excessive exposure during the first days after birth.
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Affiliation(s)
- Laurent M A Favié
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands, .,Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands,
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Carin M A Rademaker
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Timo R de Haan
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - Peter H Dijk
- Department of Neonatology, Groningen University Medical Centre, Groningen, The Netherlands
| | - Arno van Heijst
- Department of Neonatology, Radboud University Medical Center-Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Sinno H P Simons
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Koen P Dijkman
- Department of Neonatology, Máxima Medical Center Veldhoven, Veldhoven, The Netherlands
| | - Monique Rijken
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Inge A Zonnenberg
- Department of Neonatology, VU University Medical Center, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Filip Cools
- Department of Neonatology, UZ Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Alexandra Zecic
- Department of Neonatology, University Hospital Gent, Gent, Belgium
| | - Johanna H van der Lee
- Paediatric Clinical Research Office, Emma Children's Hospital, Academic Medical Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Debbie H G M Nuytemans
- Clinical Research Coordinator PharmaCool Study, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Toine C G Egberts
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Alwin D R Huitema
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Pharmacy and Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Sampurna MTA, Ratnasari KA, Etika R, Hulzebos CV, Dijk PH, Bos AF, Sauer PJJ. Adherence to hyperbilirubinemia guidelines by midwives, general practitioners, and pediatricians in Indonesia. PLoS One 2018; 13:e0196076. [PMID: 29672616 PMCID: PMC5909511 DOI: 10.1371/journal.pone.0196076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 04/05/2018] [Indexed: 11/18/2022] Open
Abstract
Severe hyperbilirubinemia, which may result in kernicterus, is seen more frequently in low and middle-income countries, such as Indonesia, than in high-income countries. In Indonesia midwives, general practitioners (GPs), and pediatricians are involved in the care of jaundiced newborn infants. It is unknown whether the high incidence of severe hyperbilirubinemia in this country is related to a lack of awareness of existing hyperbilirubinemia guidelines issued by, for example, the World Health Organization, the American Academy of Pediatrics, or the Indonesian Health Ministry, or to a lack of adherence to such guidelines. The aim of this questionnaire study was to assess health professionals’ awareness of existing guidelines and their adherence to these guidelines in daily practice. We handed out a ten-question questionnaire to midwives, GPs, and pediatricians that included questions about the professionals themselves as well as clinical questions. The midwives completed 291 questionnaires, the GPs 206, and the pediatricians 154, all of which we used for our analysis. Almost 30% of the midwives and 23% of the GPs were either unaware of any existing guidelines or they did not adhere to them. Only 54% of the midwives recognized the warning signs of severe hyperbilirubinemia correctly, compared to 68% of the GPs and 89% of the pediatricians. Twenty-eight percent of the midwives and 31% of the GPs indicated that their first follow-up visit was after 72 hours, while 90% of them discharged infants after less than 48 hours after birth. The awareness of and adherence to guidelines for preventing and treating hyperbilirubinemia is low amongst the midwives and GPs in Indonesia. This may be an important contributing factor in the high incidence of severe hyperbilirubinemia in Indonesia.
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Affiliation(s)
- Mahendra T. A. Sampurna
- Department of Pediatrics, Dr. Soetomo General Hospital, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
- * E-mail:
| | - Kinanti A. Ratnasari
- Department of Pediatrics, Dr. Soetomo General Hospital, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Risa Etika
- Department of Pediatrics, Dr. Soetomo General Hospital, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Christian V. Hulzebos
- Department of Pediatrics, Beatrix Children Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Peter H. Dijk
- Department of Pediatrics, Beatrix Children Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Arend F. Bos
- Department of Pediatrics, Beatrix Children Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Pieter J. J. Sauer
- Department of Pediatrics, Beatrix Children Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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30
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Zonneveld R, Holband N, Bertolini A, Bardi F, Lissone NPA, Dijk PH, Plötz FB, Juliana A. Improved referral and survival of newborns after scaling up of intensive care in Suriname. BMC Pediatr 2017; 17:189. [PMID: 29137607 PMCID: PMC5686851 DOI: 10.1186/s12887-017-0941-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 10/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Scaling up neonatal care facilities in developing countries can improve survival of newborns. Recently, the only tertiary neonatal care facility in Suriname transitioned to a modern environment in which interventions to improve intensive care were performed. This study evaluates impact of this transition on referral pattern and outcomes of newborns. METHODS A retrospective chart study amongst newborns admitted to the facility was performed and outcomes of newborns between two 9-month periods before and after the transition in March 2015 were compared. RESULTS After the transition more intensive care was delivered (RR 1.23; 95% CI 1.07-1.42) and more outborn newborns were treated (RR 2.02; 95% CI 1.39-2.95) with similar birth weight in both periods (P=0.16). Mortality of inborn and outborn newborns was reduced (RR 0.62; 95% CI 0.41-0.94), along with mortality of sepsis (RR 0.37; 95% CI 0.17-0.81) and asphyxia (RR 0.21; 95% CI 0.51-0.87). Mortality of newborns with a birth weight <1000 grams (34.8%; RR 0.90; 95% CI 0.43-1.90) and incidence of sepsis (38.8%, 95% CI 33.3-44.6) and necrotizing enterocolitis (NEC) (12.5%, 95% CI 6.2-23.6) remained high after the transition. CONCLUSIONS After scaling up intensive care at our neonatal care facility more outborn newborns were admitted and survival improved for both in- and outborn newborns. Challenges ahead are sustainability, further improvement of tertiary function, and prevention of NEC and sepsis.
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Affiliation(s)
- Rens Zonneveld
- Academic Pediatric Center Suriname, Academic Hospital Paramaribo, Flustraat 1, Paramaribo, Suriname.,Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands.,Department of Pediatrics, Tergooi Hospitals, Rijksstraatweg 1, 1261 AN, Blaricum, The Netherlands
| | - Natanael Holband
- Academic Pediatric Center Suriname, Academic Hospital Paramaribo, Flustraat 1, Paramaribo, Suriname
| | - Anna Bertolini
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Francesca Bardi
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Neirude P A Lissone
- Academic Pediatric Center Suriname, Academic Hospital Paramaribo, Flustraat 1, Paramaribo, Suriname
| | - Peter H Dijk
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Frans B Plötz
- Department of Pediatrics, Tergooi Hospitals, Rijksstraatweg 1, 1261 AN, Blaricum, The Netherlands
| | - Amadu Juliana
- Academic Pediatric Center Suriname, Academic Hospital Paramaribo, Flustraat 1, Paramaribo, Suriname.
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31
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Bijleveld YA, Mathôt R, van der Lee JH, Groenendaal F, Dijk PH, van Heijst A, Simons S, Dijkman KP, van Straaten H, Rijken M, Zonnenberg IA, Cools F, Zecic A, Nuytemans D, van Kaam AH, de Haan TR. Population Pharmacokinetics of Amoxicillin in Term Neonates Undergoing Moderate Hypothermia. Clin Pharmacol Ther 2017; 103:458-467. [PMID: 28555724 DOI: 10.1002/cpt.748] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 05/15/2017] [Indexed: 12/23/2022]
Abstract
The pharmacokinetics (PK) of amoxicillin in asphyxiated newborns undergoing moderate hypothermia were quantified using prospective data (N = 125). The population PK was described by a 2-compartment model with a priori birthweight (BW) based allometric scaling. Significant correlations were observed between clearance (Cl) and postnatal age (PNA), gestational age (GA), body temperature (TEMP), and urine output (UO). For a typical patient with GA 40 weeks, BW 3,000 g, 2 days PNA (i.e., TEMP 33.5°C), and normal UO, Cl was 0.26 L/h (interindividual variability (IIV) 41.9%) and volume of distribution of the central compartment was 0.34 L/kg (IIV of 114.6%). For this patient, Cl increased to 0.41 L/h at PNA 5 days and TEMP 37.0°C. The respective contributions of both covariates were 23% and 27%. Based on Monte Carlo simulations we recommend 50 and 75 mg/kg/24h amoxicillin in three doses for patients with GA 36-37 and 38-42 weeks, respectively.
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Affiliation(s)
- Y A Bijleveld
- Department of Pharmacy, Academic Medical Center, Amsterdam, The Netherlands
| | - Raa Mathôt
- Department of Pharmacy, Academic Medical Center, Amsterdam, The Netherlands
| | - J H van der Lee
- Paediatric Clinical Research Office, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, The Netherlands
| | - F Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P H Dijk
- Department of Neonatology, University of Groningen, Groningen, The Netherlands
| | - A van Heijst
- Department of Neonatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Shp Simons
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - K P Dijkman
- Department of Neonatology, Máxima Medical Center Veldhoven, Veldhoven, The Netherlands
| | - Hlm van Straaten
- Department of Neonatology, Isala Clinics, Zwolle, The Netherlands
| | - M Rijken
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - I A Zonnenberg
- Department of Neonatology, VU University Medical Center, Amsterdam, The Netherlands
| | - F Cools
- Department of Neonatology, Vrije Universiteit Brussel, Brussels, Belgium
| | - A Zecic
- Department of Neonatology, Academic Medical Center, Gent, Belgium
| | | | - A H van Kaam
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - T R de Haan
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
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Lap CCMM, Brizot ML, Pistorius LR, Kramer WLM, Teeuwen IB, Eijkemans MJ, Brouwers HAA, Pajkrt E, van Kaam AH, van Scheltema PNA, Eggink AJ, van Heijst AF, Haak MC, van Weissenbruch MM, Sleeboom C, Willekes C, van der Hoeven MA, van Heurn EL, Bilardo CM, Dijk PH, van Baren R, Francisco RPV, Tannuri ACA, Visser GHA, Manten GTR. Outcome of isolated gastroschisis; an international study, systematic review and meta-analysis. Early Hum Dev 2016; 103:209-218. [PMID: 27825040 DOI: 10.1016/j.earlhumdev.2016.10.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 10/02/2016] [Accepted: 10/09/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine outcome of children born with isolated gastroschisis (no extra-gastrointestinal congenital abnormalities). STUDY DESIGN International cohort study and meta-analysis. PRIMARY OUTCOME time to full enteral feeding (TFEF); secondary outcomes: Duration of mechanical ventilation, length of stay (LOS), mortality and differences in outcome between simple and complex gastroschisis (complex; born with bowel atresia, volvulus, perforation or necrosis). To compare the cohort study results with literature three databases were searched. Studies were eligible for inclusion if cases were born in developed countries with isolated gastroschisis after 1990, number of cases >20 and TFEF was reported. RESULTS The cohort study included 204 liveborn cases of isolated gastroschisis. The TFEF, median duration of ventilation and LOS was, 26days (range 6-515), 2days (range 0-90) and 33days (range 11-515), respectively. Overall mortality was 10.8%. TFEF and LOS were significantly longer (P<0.0001) and mortality was fourfold higher in the complex group. Seventeen studies, amongst the current study, were included for further meta-analysis comprising a total of 1652 patients. Mean TFEF was 35.3±4.4days, length of ventilation was 5.5±2.0days, LOS was 46.4±5.2days and mortality risk was 0.06 [0.04-0.07 95%CI]. Outcome of simple and complex gastroschisis was described in five studies. TFEF, ventilation time, LOS were significant longer and mortality rate was 3.64 [1.95-6.83 95%CI] times higher in complex cases. CONCLUSIONS These results give a good indication of the expected TFEF, ventilation time and LOS and mortality risk in children born with isolated gastroschisis, although ranges remain wide. This study shows the importance of dividing gastroschisis into simple and complex for the prediction of outcome.
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Affiliation(s)
- Chiara C M M Lap
- University Medical Center Utrecht, Division Woman and Baby, Department of Obstetrics, Utrecht, The Netherlands..
| | - Maria L Brizot
- Department of Obstetrics and Gynaecology, Hospital das Clínicas, São Paulo University Medical School, São Paulo, SP, Brazil..
| | - Lourens R Pistorius
- University Medical Center Utrecht, Division Woman and Baby, Department of Obstetrics, Utrecht, The Netherlands.; University of Stellenbosch, Department of Obstetrics and Gynaecology, Stellenbosch, South Africa..
| | - William L M Kramer
- University Medical Center Utrecht, Department of Paediatric Surgery, Utrecht, The Netherlands..
| | - Ivo B Teeuwen
- Maastricht University Medical Center+, Department of Anesthesiology, Maastricht, The Netherlands..
| | - Marinus J Eijkemans
- University Medical Center Utrecht, Biostatistics and Research Support, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands..
| | - Hens A A Brouwers
- University Medical Center Utrecht, Division Woman and Baby, Department of Neonatology, Utrecht, The Netherlands..
| | - Eva Pajkrt
- Academic Medical Center Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands..
| | - Anton H van Kaam
- Emma Children's Hospital, Academic Medical Center Amsterdam, Department of Neonatology, Amsterdam, The Netherlands..
| | | | - Alex J Eggink
- Radboud University Medical Center, Department of Obstetrics and Gynaecology, Nijmegen, The Netherlands.; Erasmus MC University Medical Centre Rotterdam, Department of Obstetrics and Gynaecology, Rotterdam, The Netherlands..
| | - Arno F van Heijst
- Radboud University Medical Center, Department of Neonatology, Nijmegen, The Netherlands..
| | - Monique C Haak
- Leiden University Medical Center, Department of Obstetrics and Gynaecology, Leiden, The Netherlands.; VU University Medical Center Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands..
| | | | - Christien Sleeboom
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital University Medical Center and VU Medical Center, Amsterdam, the Netherlands..
| | - Christine Willekes
- Maastricht University Medical Center+, Department of Obstetrics and Gynaecology, Maastricht, The Netherlands..
| | - Mark A van der Hoeven
- Maastricht University Medical Center+, Department of Neonatology, Maastricht, The Netherlands..
| | - Ernst L van Heurn
- Maastricht University Medical Center+, Department of Paediatric Surgery, Maastricht, The Netherlands.; Pediatric Surgical Center of Amsterdam, Emma Children's Hospital University Medical Center and VU Medical Center, Amsterdam, The Netherlands..
| | - Catherina M Bilardo
- University Medical Center Groningen, Department of Obstetrics and Gynaecology, Groningen, The Netherlands..
| | - Peter H Dijk
- University Medical Center Groningen, University of Groningen, Department of Neonatology Beatrix Children's Hospital, Groningen, The Netherlands..
| | - Robertine van Baren
- University Medical Center Groningen, University of Groningen, Department of Paediatric Surgery, Groningen, The Netherlands..
| | - Rossana P V Francisco
- Department of Obstetrics and Gynaecology, Hospital das Clínicas, São Paulo University Medical School, São Paulo, SP, Brazil..
| | - Ana C A Tannuri
- Department of Pediatric, Pediatric Surgery Division, São Paulo University Medical School, São Paulo, SP, Brazil
| | - Gerard H A Visser
- University Medical Center Utrecht, Division Woman and Baby, Department of Obstetrics, Utrecht, The Netherlands..
| | - Gwendolyn T R Manten
- University Medical Center Utrecht, Division Woman and Baby, Department of Obstetrics, Utrecht, The Netherlands..
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Thorsen P, Jansen-van der Weide MC, Groenendaal F, Onland W, van Straaten HLM, Zonnenberg I, Vermeulen JR, Dijk PH, Dudink J, Rijken M, van Heijst A, Dijkman KP, Cools F, Zecic A, van Kaam AH, de Haan TR. The Thompson Encephalopathy Score and Short-Term Outcomes in Asphyxiated Newborns Treated With Therapeutic Hypothermia. Pediatr Neurol 2016; 60:49-53. [PMID: 27343024 DOI: 10.1016/j.pediatrneurol.2016.03.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 12/22/2015] [Accepted: 03/19/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Thompson encephalopathy score is a clinical score to assess newborns suffering from perinatal asphyxia. Previous studies revealed a high sensitivity and specificity of the Thompson encephalopathy score for adverse outcomes (death or severe disability). Because the Thompson encephalopathy score was developed before the use of therapeutic hypothermia, its value was reassessed. OBJECTIVE The purpose of this study was to assess the association of the Thompson encephalopathy score with adverse short-term outcomes, defined as death before discharge, development of severe epilepsy, or the presence of multiple organ failure in asphyxiated newborns undergoing therapeutic hypothermia. METHODS The study period ranged from November 2010 to October 2014. A total of 12 tertiary neonatal intensive care units participated. Demographic and clinical data were collected from the "PharmaCool" multicenter study, an observational cohort study analyzing pharmacokinetics of medication during therapeutic hypothermia. With multiple logistic regression analyses the association of the Thompson encephalopathy scores with outcomes was studied. RESULTS Data of 142 newborns were analyzed (male: 86; female: 56). Median Thompson score was 9 (interquartile range: 8 to 12). Median gestational age was 40 weeks (interquartile range 38 to 41), mean birth weight was 3362 grams (standard deviation: 605). All newborns manifested perinatal asphyxia and underwent therapeutic hypothermia. Death before discharge occurred in 23.9% and severe epilepsy in 21.1% of the cases. In total, 59.2% of the patients had multiple organ failure. The Thompson encephalopathy score was not associated with multiple organ failure, but a Thompson encephalopathy score ≥12 was associated with death before discharge (odds ratio: 3.9; confidence interval: 1.3 to 11.2) and with development of severe epilepsy (odds ratio: 8.4; confidence interval: 2.5 to 27.8). CONCLUSION The Thompson encephalopathy score is a useful clinical tool, even in cooled asphyxiated newborns. A score ≥12 is associated with adverse outcomes (death before discharge and development of severe epilepsy). The Thompson encephalopathy score is not associated with the development of multiple organ failure.
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Affiliation(s)
- Patricia Thorsen
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Martine C Jansen-van der Weide
- Pediatric Clinical Research Office, Woman-Child Department, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wes Onland
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Inge Zonnenberg
- Department of Neonatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Jeroen R Vermeulen
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Peter H Dijk
- Department of Neonatology, University Medical Center Groningen, Groningen, The Netherlands
| | - Jeroen Dudink
- Department of Neonatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Monique Rijken
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arno van Heijst
- Department of Neonatology, Radboud Medical Center, Nijmegen, The Netherlands
| | - Koen P Dijkman
- Department of Neonatology, Maxima Medical Center Veldhoven, Veldhoven, The Netherlands
| | - Filip Cools
- Department of Neonatology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Alexandra Zecic
- Department of Neonatology, University Hospital Gent, Gent, Belgium
| | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Timo R de Haan
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
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Bijleveld YA, de Haan TR, van der Lee HJH, Groenendaal F, Dijk PH, van Heijst A, de Jonge RCJ, Dijkman KP, van Straaten HLM, Rijken M, Zonnenberg IA, Cools F, Zecic A, Nuytemans DHGM, van Kaam AH, Mathot RAA. Altered gentamicin pharmacokinetics in term neonates undergoing controlled hypothermia. Br J Clin Pharmacol 2016; 81:1067-77. [PMID: 26763684 DOI: 10.1111/bcp.12883] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 01/05/2016] [Accepted: 01/10/2016] [Indexed: 11/29/2022] Open
Abstract
AIM(S) Little is known about the pharmacokinetic (PK) properties of gentamicin in newborns undergoing controlled hypothermia after suffering from hypoxic−ischaemic encephalopathy due to perinatal asphyxia. This study prospectively evaluates and describes the population PK of gentamicin in these patients METHODS Demographic, clinical and laboratory data of patients included in a multicentre prospective observational cohort study (the ‘PharmaCool Study’) were collected. A non-linear mixed-effects regression analysis (nonmem®) was performed to describe the population PK of gentamicin. The most optimal dosing regimen was evaluated based on simulations of the final model. RESULTS A total of 47 patients receiving gentamicin were included in the analysis. The PK were best described by an allometric two compartment model with gestational age (GA) as a covariate on clearance (CL). During hypothermia the CL of a typical patient (3 kg, GA 40 weeks, 2 days post-natal age (PNA)) was 0.06 l kg−1 h−1 (inter-individual variability (IIV) 26.6%) and volume of distribution of the central compartment (Vc) was 0.46 l kg−1 (IIV 40.8%). CL was constant during hypothermia and rewarming, but increased by 29% after reaching normothermia (>96 h PNA). CONCLUSIONS This study describes the PK of gentamicin in neonates undergoing controlled hypothermia. The 29% higher CL in the normothermic phase compared with the preceding phases suggests a delay in normalization of CL after rewarming has occurred. Based on simulations we recommend an empiric dose of 5 mg kg−1 every 36 h or every 24 h for patients with GA 36–40 weeks and GA 42 weeks, respectively.
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Affiliation(s)
| | - Timo R de Haan
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam
| | - Hanneke J H van der Lee
- Pediatric Clinical Research Office, Division Woman-Child, Academic Medical Center, University of Amsterdam, Amsterdam
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht
| | - Peter H Dijk
- Department of Neonatology, University Medical Center Groningen, Groningen
| | - Arno van Heijst
- Department of Neonatology, Radboud University Medical Center, Nijmegen
| | - Rogier C J de Jonge
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam
| | - Koen P Dijkman
- Department of Neonatology, Máxima Medical Center Veldhoven, Veldhoven
| | | | - Monique Rijken
- Department of Neonatology, Leiden University Medical Center, Leiden
| | - Inge A Zonnenberg
- Department of Neonatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Filip Cools
- Department of Neonatology, Vrije Universiteit Brussel, Brussels
| | - Alexandra Zecic
- Department of Neonatology, Academic Medical Center, Gent, Belgium
| | | | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam
| | - Ron A A Mathot
- Department of Pharmacy, Academic Medical Center, Amsterdam
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Kerstjens JM, Nijhuis A, Hulzebos CV, van Imhoff DE, van Wassenaer-Leemhuis AG, van Haastert IC, Lopriore E, Katgert T, Swarte RM, van Lingen RA, Mulder TL, Laarman CR, Steiner K, Dijk PH. The Ages and Stages Questionnaire and Neurodevelopmental Impairment in Two-Year-Old Preterm-Born Children. PLoS One 2015; 10:e0133087. [PMID: 26193474 PMCID: PMC4508030 DOI: 10.1371/journal.pone.0133087] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 06/22/2015] [Indexed: 11/18/2022] Open
Abstract
Objective To test the ability of the Ages and Stages Questionnaire, Third Edition (ASQ3) to help identify or exclude neurodevelopmental impairment (NDI) in very preterm-born children at the corrected age of two. Methods We studied the test results of 224 children, born at <32 postmenstrual weeks, who had scores on ASQ3 and Bayley Scales of Infant and Toddler Development, Third Edition (BSIDIII) and neurological examination at 22–26 months’ corrected age. We defined NDI as a score of <70 on the cognitive—or motor composite scale of BSIDIII, or impairment on neurological examination or audiovisual screening. We compared NDI with abnormal ASQ3 scores, i.e., < -2SDs on any domain, and with ASQ3 total scores. To correct for possible overestimation of BSIDIII, we also analyzed the adjusted BSIDIII thresholds for NDI, i.e., scores <80 and <85. Results We found 61 (27%) children with abnormal ASQ3 scores, and 10 (4.5%) children who had NDI with original BSIDIII thresholds (<70). Twelve children had NDI at BSIDIII thresholds at <80, and 15 had <85. None of the 163 (73%) children who passed ASQ3 had NDI. The sensitivity of ASQ3 to detect NDI was excellent (100%), its specificity was acceptable (76%), and its negative predictive value (NPV) was 100%. Sensitivity and NPV remained high with the adjusted BSIDIII thresholds. Conclusion The Ages and Stages Questionnaire is a simple, valid and cost-effective screening tool to help identify and exclude NDI in very preterm-born children at the corrected age of two years.
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Affiliation(s)
- Jorien M. Kerstjens
- Division of Neonatology, Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Ard Nijhuis
- Division of Neonatology, Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Christian V. Hulzebos
- Division of Neonatology, Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Deirdre E. van Imhoff
- Division of Neonatology, Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Ingrid C. van Haastert
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Enrico Lopriore
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Titia Katgert
- Department of Medical Psychology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Renate M. Swarte
- Department of Neonatology, Erasmus MC-Sophia, Rotterdam, The Netherlands
| | - Richard A. van Lingen
- Princess Amalia Department of Pediatrics, Department of Neonatology, Isala, Zwolle, The Netherlands
| | - Twan L. Mulder
- Department of Pediatrics, Maastricht University Medical Center, GROW–School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Céleste R. Laarman
- Division of Neonatology, Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
| | - Katerina Steiner
- Division of Neonatology, Department of Pediatrics, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Peter H. Dijk
- Division of Neonatology, Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
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Verhagen EA, Van Braeckel KNJA, van der Veere CN, Groen H, Dijk PH, Hulzebos CV, Bos AF. Cerebral oxygenation is associated with neurodevelopmental outcome of preterm children at age 2 to 3 years. Dev Med Child Neurol 2015; 57:449-55. [PMID: 25382744 DOI: 10.1111/dmcn.12622] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [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] [Accepted: 09/04/2014] [Indexed: 11/28/2022]
Abstract
AIM The aim of the study was to determine whether regional cerebral tissue oxygen saturation (r(c)SO2) and fractional tissue oxygen extraction (FTOE), using near-infrared spectroscopy, are associated with neurodevelopmental outcome of preterm infants. METHOD We measured rc SO2 on days 1, 2, 3, 4, 5, 8, and 15 after birth in 83 preterm infants (<32wks gestational age), and calculated FTOE=(SpO2 -r(c)SO2)/SpO2. Cognitive, motor, neurological, and behavioural outcomes were determined at 2 to 3 years using the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III), an age-specific neurological examination, and the Child Behavior Checklist (CBCL) respectively. Multiple linear regression analyses were used to determine whether r(c)SO2 and FTOE contributed to outcome. RESULTS We followed up 67 infants. The lower quartile (P(25-50)) and highest quartile (P(75-100)) of r(c)SO2 on day 1 were associated with poorer cognitive outcome (p=0.044 and p=0.008 respectively). A lower area under the curve (AUC; over 15d) of r(c)SO2 was associated with poorer cognitive outcome (p=0.014). The lower quartile (P(25-50)) AUC of r(c)SO2 was associated with poorer fine motor outcome (p=0.004). The amount of time r(c)SO2 <50% on day 1 was negatively associated with gross motor outcome (p=0.002). The highest quartile of FTOE on day 1 was associated with poorer total motor outcome (p=0.041). INTERPRETATION Cerebral oxygen saturation during the first 2 weeks after birth is associated with neurodevelopmental outcome of preterm infants at 2 to 3 years. High and low r(c)SO2 on day 1 were associated with poorer neurodevelopmental outcome.
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Affiliation(s)
- Elise A Verhagen
- Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Abstract
Treatment for unconjugated hyperbilirubinemia is predominantly based on one parameter, i.e., total serum bilirubin (TSB) levels. Yet, overt kernicterus has been reported in preterm infants at relatively low TSB levels, and it has been repeatedly shown that free unconjugated bilirubin (freeUCB) levels, or bilirubin/albumin (B/A) ratios for that matter, are more closely associated with bilirubin neurotoxicity. In this article, we review bilirubin-albumin binding, UCBfree levels, and B/A ratios in addition to TSB levels to individualize and optimize treatment especially in preterm infants. Methods to measure bilirubin-albumin binding or UCBfree are neither routinely performed in Western clinical laboratories nor incorporated in current management guidelines on unconjugated hyperbilirubinemia. For bilirubin-albumin binding, this seems justified because several of these methods have been challenged, and sufficiently powered prospective trials on the clinical benefits are lacking. Technological advances in the measurement of UCBfree may provide a convenient means for integrating UCBfree measurements into routine clinical management of jaundiced infants. A point-of-care method, as well as determination of UCBfree levels in various newborn populations, is desirable to learn more about variations in time and how various clinical pathophysiological conditions affect UCBfree levels. This will improve the estimation of approximate UCBfree levels associated with neurotoxicity. To delineate the role of UCBfree in the management of jaundiced (preterm) infants, trials are needed using UCBfree as treatment parameter. The additional use of the B/A ratio in jaundiced preterms has been evaluated in the Bilirubin Albumin Ratio Trial (BARTrial; Clinical Trials: ISRCTN74465643) but failed to demonstrate better neurodevelopmental outcome in preterm infants <32 weeks assigned to the study group. Awaiting a study in which infants are assigned to be managed solely on the basis of their B/A ratio (with TSB excluded ) versus TSB levels alone-and determining which group does better-the additional use of the B/A ratio in the management of hyperbilirubinemia in preterms is not advised. In conjunction with TSB levels, other parameters possibly allow for more accurate prediction of bilirubin toxicity. Yet, different methodologies for estimating these parameters exist, and sufficiently powered, prospective clinical trials supporting their clinical benefit, i.e., reduced bilirubin neurotoxicity when using these parameters, are lacking. Their use in addition to TSB needs to be prospectively evaluated, especially in preterm neonates, and preferentially in randomized clinical trials, which include specific risk factors and assessment of clinical relevant outcome measures for detecting those infants at risk of bilirubin toxicity.
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Affiliation(s)
- Christian V Hulzebos
- Department of Pediatrics, Beatrix Children׳s Hospital, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen 9713 GZ, The Netherlands.
| | - Peter H Dijk
- Department of Pediatrics, Beatrix Children׳s Hospital, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen 9713 GZ, The Netherlands
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Hulzebos CV, Dijk PH, van Imhoff DE, Bos AF, Lopriore E, Offringa M, Ruiter SAJ, van Braeckel KNJA, Krabbe PFM, Quik EH, van Toledo-Eppinga L, Nuytemans DHGM, van Wassenaer-Leemhuis AG, Benders MJN, Korbeeck-van Hof KKM, van Lingen RA, Groot Jebbink LJM, Liem D, Mansvelt P, Buijs J, Govaert P, van Vliet I, Mulder TLM, Wolfs C, Fetter WPF, Laarman C. The bilirubin albumin ratio in the management of hyperbilirubinemia in preterm infants to improve neurodevelopmental outcome: a randomized controlled trial--BARTrial. PLoS One 2014; 9:e99466. [PMID: 24927259 PMCID: PMC4057208 DOI: 10.1371/journal.pone.0099466] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 05/13/2014] [Indexed: 12/14/2022] Open
Abstract
Background and Objective High bilirubin/albumin (B/A) ratios increase the risk of bilirubin neurotoxicity. The B/A ratio may be a valuable measure, in addition to the total serum bilirubin (TSB), in the management of hyperbilirubinemia. We aimed to assess whether the additional use of B/A ratios in the management of hyperbilirubinemia in preterm infants improved neurodevelopmental outcome. Methods In a prospective, randomized controlled trial, 615 preterm infants of 32 weeks' gestation or less were randomly assigned to treatment based on either B/A ratio and TSB thresholds (consensus-based), whichever threshold was crossed first, or on the TSB thresholds only. The primary outcome was neurodevelopment at 18 to 24 months' corrected age as assessed with the Bayley Scales of Infant Development III by investigators unaware of treatment allocation. Secondary outcomes included complications of preterm birth and death. Results Composite motor (100±13 vs. 101±12) and cognitive (101±12 vs. 101±11) scores did not differ between the B/A ratio and TSB groups. Demographic characteristics, maximal TSB levels, B/A ratios, and other secondary outcomes were similar. The rates of death and/or severe neurodevelopmental impairment for the B/A ratio versus TSB groups were 15.4% versus 15.5% (P = 1.0) and 2.8% versus 1.4% (P = 0.62) for birth weights ≤1000 g and 1.8% versus 5.8% (P = 0.03) and 4.1% versus 2.0% (P = 0.26) for birth weights of >1000 g. Conclusions The additional use of B/A ratio in the management of hyperbilirubinemia in preterm infants did not improve their neurodevelopmental outcome. Trial Registration Controlled-Trials.com ISRCTN74465643
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Affiliation(s)
- Christian V. Hulzebos
- Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter H. Dijk
- Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Deirdre E. van Imhoff
- Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Arend F. Bos
- Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Enrico Lopriore
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, University of Toronto, Toronto, Canada
| | - Selma A. J. Ruiter
- Department of Orthopedagogy, University of Groningen, Groningen, The Netherlands
| | - Koen N. J. A. van Braeckel
- Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul F. M. Krabbe
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elise H. Quik
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Letty van Toledo-Eppinga
- Department of Neonatology, Emma Children's Hospital Academic Medical Center, Amsterdam, The Netherlands
| | - Debbie H. G. M. Nuytemans
- Department of Neonatology, Emma Children's Hospital Academic Medical Center, Amsterdam, The Netherlands
| | | | - Manon J. N. Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karen K. M. Korbeeck-van Hof
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Richard A. van Lingen
- Princess Amalia Department of Pediatrics, Department of Neonatology, Isala, Zwolle, The Netherlands
| | | | - Djien Liem
- Division of Neonatology, Department of Pediatrics, UMC St. Radboud Nijmegen, Nijmegen, The Netherlands
| | - Petri Mansvelt
- Division of Neonatology, Department of Pediatrics, UMC St. Radboud Nijmegen, Nijmegen, The Netherlands
| | - Jan Buijs
- Department of Pediatrics, Máxima Medical Center, Veldhoven, The Netherlands
| | - Paul Govaert
- Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ineke van Vliet
- Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Twan L. M. Mulder
- Department of Pediatrics, Maastricht University Medical Center, GROW–School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Cecile Wolfs
- Department of Pediatrics, Maastricht University Medical Center, GROW–School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Willem P. F. Fetter
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
| | - Celeste Laarman
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
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Hulzebos CV, van Dommelen P, Verkerk PH, Dijk PH, Van Straaten HLM. Evaluation of treatment thresholds for unconjugated hyperbilirubinemia in preterm infants: effects on serum bilirubin and on hearing loss? PLoS One 2013; 8:e62858. [PMID: 23667532 PMCID: PMC3647062 DOI: 10.1371/journal.pone.0062858] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 03/26/2013] [Indexed: 11/19/2022] Open
Abstract
Background Severe unconjugated hyperbilirubinemia may cause deafness. In the Netherlands, 25% lower total serum bilirubin (TSB) treatment thresholds were recently implemented for preterm infants. Objective To determine the rate of hearing loss in jaundiced preterms treated at high or at low TSB thresholds. Design/Methods In this retrospective study conducted at two neonatal intensive care units in the Netherlands, we included preterms (gestational age <32 weeks) treated for unconjugated hyperbilirubinemia at high or low TSB thresholds. Infants with major congenital malformations, syndromes, chromosomal abnormalities or toxoplasmosis, rubella, cytomegalovirus, herpes, syphilis, and human immunodeficiency infections were excluded. We analyzed clinical characteristics and TSB levels during the first ten postnatal days. After two failed automated Auditory Brainstem Response (ABR) tests we used the results of the diagnostic ABR examination to define normal, unilateral, and bilateral hearing loss (>35 dB). Results There were 479 patients in the high and 144 in the low threshold group. Both groups had similar gestational ages (29.5 weeks) and birth weights (1300 g). Mean and mean peak TSB levels were significantly lower after the implementation of the novel thresholds: 152±43 µmol/L and 212±52 µmol/L versus 131±37 µmol/L and 188±46 µmol/L for the high versus low thresholds, respectively (P<0.001). The incidence of hearing loss was 2.7% (13/479) in the high and 0.7% (1/144) in the low TSB threshold group (NNT = 50, 95% CI, 25–3302). Conclusions Implementation of lower treatment thresholds resulted in reduced mean and peak TSB levels. The incidence of hearing impairment in preterms with a gestational age <32 weeks treated at low TSB thresholds was substantially lower compared to preterms treated at high TSB thresholds. Further research with larger sample sizes and power is needed to determine if this effect is statistically significant.
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Affiliation(s)
- Christian V Hulzebos
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, UMC Groningen, Groningen, The Netherlands.
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van Imhoff DE, Hulzebos CV, van der Heide M, van den Belt VW, Vreman HJ, Dijk PH. High variability and low irradiance of phototherapy devices in Dutch NICUs. Arch Dis Child Fetal Neonatal Ed 2013; 98:F112-6. [PMID: 22611115 DOI: 10.1136/archdischild-2011-301486] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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: 11/04/2022]
Abstract
OBJECTIVE To evaluate phototherapy practices by measuring the irradiance levels of phototherapy (PT) devices. DESIGN Prospective study. SETTING Tertiary neonatal intensive care units. PATIENTS None. INTERVENTIONS Irradiance levels of PT devices used in the 10 Dutch Neonatal Intensive Care Units (NICUs) were measured according to the local PT practice patterns. The irradiance levels of all overhead and fibre-optic PT devices were measured with a radiometer using an infant silhouette model. RESULTS Eight different PT devices were used in the 10 NICUs; five were overhead devices and three fibre-optic pads. The median (range) irradiance level for overhead PT devices was 9.7 (4.3-32.6) µW/cm(2)/nm and for fibre-optic pads 6.8 (0.8-15.6) µW/cm(2)/nm. Approximately 50% of PT devices failed to meet the minimal recommended irradiance level of 10 µW/cm(2)/nm. Maximal irradiance levels for overhead PT spot lights were inversely related to the distance between device and infant model (R2=0.33). The distances ranged from 37 cm to 65 cm. CONCLUSIONS PT devices in the Dutch NICUs show considerable variability with often too low irradiance levels. These results indicate that suboptimal PT is frequently applied and may even be ineffective towards reducing total serum bilirubin levels. These results underline the need for greater awareness among all healthcare workers towards the requirements for effective PT including measurements of irradiance and distance.
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Affiliation(s)
- Deirdre E van Imhoff
- Department of Neonatology, Beatrix Children’s Hospital, University Medical Center Groningen, The Netherlands
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Gotink MJ, Benders MJ, Lavrijsen SW, Rodrigues Pereira R, Hulzebos CV, Dijk PH. Severe neonatal hyperbilirubinemia in the Netherlands. Neonatology 2013; 104:137-42. [PMID: 23887661 DOI: 10.1159/000351274] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [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] [Received: 11/26/2012] [Accepted: 04/05/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The occurrence of severe neonatal hyperbilirubinemia (SH) is partly attributed to nonhospitalized perinatal care. The Netherlands have a high frequency of home births and nonhospitalized perinatal care, and the incidence of SH is unknown. OBJECTIVE To assess the effects of home births and early hospital discharge on the incidence of SH in term-born infants in the Netherlands. METHODS In this nationwide prospective surveillance study between 2005 and 2009, infants (≥37 weeks GA) were included if total serum bilirubin (TSB) was ≥500 µmol/l or if they received an exchange transfusion when TSB was ≥340 µmol/l. RESULTS Seventy-one infants had SH (incidence 10.4/100,000); 43 had a TSB ≥500 μmol/l (incidence 6.3/100,000) and 45 (63%) underwent an exchange transfusion. 26% of the infants with SH were born at home, which is similar to 22% of all term infants who are born at home in the Netherlands (p = 0.41). Maximum TSB levels were similar in infants born at home (523 ± 114 μmol/l) and infants born in hospital (510 ± 123 μmol/l; p = 0.70). Of the 51 infants born in hospital, 33 were discharged and readmitted with SH, with maximal TSB levels (567 ± 114 μmol/l), which were higher than in infants who remained hospitalized (406 ± 47 μmol/l; p = 0.0001). CONCLUSION The incidence of severe hyperbilirubinemia in term-born infants in the Netherlands is 10.4 per 100,000, which is similar to other developed countries. Home birth and early hospital discharge do not necessarily lead to a higher incidence of SH, provided that perinatal home care is well organized.
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Affiliation(s)
- Mark J Gotink
- Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
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de Haan TR, Bijleveld YA, van der Lee JH, Groenendaal F, van den Broek MPH, Rademaker CMA, van Straaten HLM, van Weissenbruch MM, Vermeulen JR, Dijk PH, Dudink J, Rijken M, van Heijst A, Dijkman KP, Gavilanes D, van Kaam AH, Offringa M, Mathôt RAA. Pharmacokinetics and pharmacodynamics of medication in asphyxiated newborns during controlled hypothermia. The PharmaCool multicenter study. BMC Pediatr 2012; 12:45. [PMID: 22515424 PMCID: PMC3358232 DOI: 10.1186/1471-2431-12-45] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 04/19/2012] [Indexed: 01/12/2023] Open
Abstract
Background In the Netherlands, perinatal asphyxia (severe perinatal oxygen shortage) necessitating newborn resuscitation occurs in at least 200 of the 180–185.000 newly born infants per year. International randomized controlled trials have demonstrated an improved neurological outcome with therapeutic hypothermia. During hypothermia neonates receive sedative, analgesic, anti-epileptic and antibiotic drugs. So far little information is available how the pharmacokinetics (PK) and pharmacodynamics (PD) of these drugs are influenced by post resuscitation multi organ failure and the metabolic effects of the cooling treatment itself. As a result, evidence based dosing guidelines are lacking. This multicenter observational cohort study was designed to answer the question how hypothermia influences the distribution, metabolism and elimination of commonly used drugs in neonatal intensive care. Methods/Design Multicenter cohort study. All term neonates treated with hypothermia for Hypoxic Ischemic Encephalopathy (HIE) resulting from perinatal asphyxia in all ten Dutch Neonatal Intensive Care Units (NICUs) will be eligible for this study. During hypothermia and rewarming blood samples will be taken from indwelling catheters to investigate blood concentrations of several antibiotics, analgesics, sedatives and anti-epileptic drugs. For each individual drug the population PK will be characterized using Nonlinear Mixed Effects Modelling (NONMEM). It will be investigated how clearance and volume of distribution are influenced by hypothermia also taking maturation of neonate into account. Similarly, integrated PK-PD models will be developed relating the time course of drug concentration to pharmacodynamic parameters such as successful seizure treatment; pain assessment and infection clearance. Discussion On basis of the derived population PK-PD models dosing guidelines will be developed for the application of drugs during neonatal hypothermia treatment. The results of this study will lead to an evidence based drug treatment of hypothermic neonatal patients. Results will be published in a national web based evidence based paediatric formulary, peer reviewed journals and international paediatric drug references. Trial registration NTR2529.
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Affiliation(s)
- Timo R de Haan
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
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Abstract
INTRODUCTION We conducted a review of the evidence which contributes to the current care of jaundiced newborn infants. METHODS Literature was searched for reviews and randomized controlled trials (RCTs). RESULTS Six Cochrane reviews and eight other reviews and eighteen recent RCTs are discussed. CONCLUSIONS Many children still suffer life-long consequences of severe hyperbilirubinaemia, which could almost always have been prevented relatively easily. Up to date, guidelines summarizing the available evidence into unambiguous recommendations are needed to guide healthcare professionals in the prevention, diagnosis and treatment for infants with hyperbilirubinaemia.
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Affiliation(s)
- Peter H Dijk
- Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Hanzeplein 1, Groningen, the Netherlands.
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Onland W, Offringa M, Cools F, De Jaegere AP, Rademaker K, Blom H, Cavatorta E, Debeer A, Dijk PH, van Heijst AF, Kramer BW, Kroon AA, Mohns T, van Straaten HL, te Pas AB, Theyskens C, van Weissenbruch MM, van Kaam AH. Systemic Hydrocortisone To Prevent Bronchopulmonary Dysplasia in preterm infants (the SToP-BPD study); a multicenter randomized placebo controlled trial. BMC Pediatr 2011; 11:102. [PMID: 22070744 PMCID: PMC3245429 DOI: 10.1186/1471-2431-11-102] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 11/09/2011] [Indexed: 12/05/2022] Open
Abstract
Background Randomized controlled trials have shown that treatment of chronically ventilated preterm infants after the first week of life with dexamethasone reduces the incidence of the combined outcome death or bronchopulmonary dysplasia (BPD). However, there are concerns that dexamethasone may increase the risk of adverse neurodevelopmental outcome. Hydrocortisone has been suggested as an alternative therapy. So far no randomized controlled trial has investigated its efficacy when administered after the first week of life to ventilated preterm infants. Methods/Design The SToP-BPD trial is a randomized double blind placebo controlled multicenter study including 400 very low birth weight infants (gestational age < 30 weeks and/or birth weight < 1250 grams), who are ventilator dependent at a postnatal age of 7 - 14 days. Hydrocortisone (cumulative dose 72.5 mg/kg) or placebo is administered during a 22 day tapering schedule. Primary outcome measure is the combined outcome mortality or BPD at 36 weeks postmenstrual age. Secondary outcomes are short term effects on the pulmonary condition, adverse effects during hospitalization, and long-term neurodevelopmental sequelae assessed at 2 years corrected gestational age. Analysis will be on an intention to treat basis. Discussion This trial will determine the efficacy and safety of postnatal hydrocortisone administration at a moderately early postnatal onset compared to placebo for the reduction of the combined outcome mortality and BPD at 36 weeks postmenstrual age in ventilator dependent preterm infants. Trial registration number Netherlands Trial Register (NTR): NTR2768
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Affiliation(s)
- Wes Onland
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands
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van Imhoff DE, Dijk PH, Weykamp CW, Cobbaert CM, Hulzebos CV. Measurements of neonatal bilirubin and albumin concentrations: a need for improvement and quality control. Eur J Pediatr 2011; 170:977-82. [PMID: 21213112 PMCID: PMC3139054 DOI: 10.1007/s00431-010-1383-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 12/14/2010] [Indexed: 11/17/2022]
Abstract
Accurate and precise bilirubin and albumin measurements are essential for proper management of jaundiced neonates. Data hereon are lacking for Dutch laboratories. We aimed to determine variability of measurements of bilirubin and albumin concentrations typical for (preterm) neonates. Aqueous, human serum albumin-based samples with different concentrations of bilirubin (100, 200, 300, 400, and 500 μmol/L) and albumin (0, 10, 15, 20, 25, and 30 g/L) were sent to laboratories of all Dutch neonatal intensive care units (n = 10). Bilirubin and albumin recoveries of the specimens were measured using locally available routine analytical methods. The mean, standard deviation, and coefficients of variations (CV) were calculated per sample. Bilirubin concentrations were underestimated in the absence of albumin (maximal CV 26.0%). When the albumin concentration was 10 or 20 g/L, the bilirubin concentrations of the samples were overestimated (maximal CV 14.1% and 9.2%, respectively). Variability increased with higher weighed-in bilirubin concentrations. Measured albumin levels were ~10% lower than albumin levels of manufactured samples. Bilirubin concentration did not influence albumin measurements. The maximal CV was 6.8%. In conclusion, interlaboratory variability of bilirubin and albumin measurements is high. Recalibration and introduction of a specific quality assessment scheme for neonatal samples is recommended to ensure exchangeability of bilirubin and albumin measurements among laboratories and to control the observed large variability.
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Affiliation(s)
- Deirdre E. van Imhoff
- Division of Neonatology, Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - Peter H. Dijk
- Division of Neonatology, Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - Cas W. Weykamp
- Department of Clinical Chemistry, Queen Beatrix Hospital, Winterswijk, The Netherlands
| | - Christa M. Cobbaert
- Department of Clinical Chemistry, University Medical Center Leiden, Leiden, The Netherlands
| | - Christian V. Hulzebos
- Division of Neonatology, Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - On behalf of the BARTrial Study Group
- Division of Neonatology, Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
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van Imhoff DE, Dijk PH, Hulzebos CV. [Uniform intervention criteria for jaundice in hyperbilirubinemia in preterm infants]. Ned Tijdschr Geneeskd 2009; 153:A94. [PMID: 19785878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To compare the guidelines of the 10 Dutch neonatal intensive care units (NICUs) for the treatment of preterm infants with hyperbilirubinemia, in order to develop uniform threshold levels for the total serum concentration of bilirubin (TSB) above which treatment with phototherapy or exchange transfusion is indicated. DESIGN Survey. METHODS Guidelines for hyperbilirubinemia in preterm infants (gestational age < 32 weeks) from all 10 Dutch NICUs were obtained and compared with each other and with international guidelines. RESULTS All 10 NICUs used intervention criteria based on TSB. 9 NICUs used TSB thresholds based on birth weight (1 used gestational age) with 2, 3 or 5 categories. 6 NICUs used age-specific TSB thresholds and 4 NICUs used a constant TSB threshold. The maximum range in TSB thresholds was 170 micromol/l for phototherapy and 125 micromol/l for exchange transfusion. Acidosis, sepsis, asphyxia, active haemolysis and intraventricular haemorrhage were the risk factors most frequently used. During a consensus meeting with representatives of the 10 NICUs, a guideline was agreed upon that will now be used for all neonates with a gestational age < 35 weeks. CONCLUSION There was considerable variation in the TSB thresholds used to date by the 10 NICUs. Now in the Netherlands, in addition to guideline 'Hyperbilirubinemia' for children with a gestational age >or= 35 weeks, 'uniform yellow thresholds' shall be used for jaundiced preterm infants with a gestational age < 35 weeks.
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MESH Headings
- Bilirubin/blood
- Birth Weight/physiology
- Exchange Transfusion, Whole Blood
- Gestational Age
- Humans
- Hyperbilirubinemia, Neonatal/blood
- Hyperbilirubinemia, Neonatal/therapy
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/blood
- Infant, Premature, Diseases/therapy
- Intensive Care Units, Neonatal/statistics & numerical data
- Jaundice, Neonatal/blood
- Jaundice, Neonatal/therapy
- Netherlands
- Phototherapy
- Practice Guidelines as Topic
- Risk Factors
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Affiliation(s)
- Deirdre E van Imhoff
- Universitair Medisch Centrum Groningen, Beatrix Kinderziekenhuis, Groningen, The Netherlands
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Dijk PH, de Vries TW, de Beer JJAH. [Guideline 'Prevention, diagnosis and treatment of hyperbilirubinemia in the neonate with a gestational age of 35 or more weeks']. Ned Tijdschr Geneeskd 2009; 153:A93. [PMID: 19785881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Bilirubin encephalopathy and kernicterus are preventable conditions. Nevertheless cases continue to occur. It is difficult to identify those infants who may develop severe hyperbilirubinemia, because icterus neonatorum occurs in most newborns. The aim of this guideline is to reduce the incidence of severe neonatal hyperbilirubinemia and bilirubin encephalopathy, and at the same time to minimise the risk of unintended side effects. At the initiative of the Dutch Pediatric Association and with methodological support from the Dutch Institute for Healthcare Improvement (CBO), a multidisciplinary working group adapted the clinical practice guideline on hyperbilirubinemia of the American Academy of Pediatrics (AAP) to the Dutch situation. This guideline provides recommendations for the prevention, diagnosis and treatment of hyperbilirubinemia in neonates (>or= 35 weeks). For all newborns a risk assessment for the development of hyperbilirubinemia is made and they are to be systematically assessed during the first week of life. The guideline provides various intervention thresholds for risk groups, recommendations for the use of intravenous immunoglobulin in the event of severe hyperbilirubinemia on the basis of blood group antagonisms, and recommendations for conjugated hyperbilirubinemia. During the transfer of care, information about the risk factors in particular must be satisfactorily passed on.
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Affiliation(s)
- Peter H Dijk
- Universitair Medisch Centrum Groningen, Beatrix Kinderziekenhuis, afd. Kindergeneeskunde, Groningen, The Netherlands.
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Hulzebos CV, van Imhoff DE, Bos AF, Ahlfors CE, Verkade HJ, Dijk PH. Usefulness of the bilirubin/albumin ratio for predicting bilirubin-induced neurotoxicity in premature infants. Arch Dis Child Fetal Neonatal Ed 2008; 93:F384-8. [PMID: 18450807 DOI: 10.1136/adc.2007.134056] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [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: 11/04/2022]
Abstract
Unconjugated hyperbilirubinaemia occurs in almost all premature infants and is potentially neurotoxic. Treatment is based on total serum bilirubin (TSB), but treatment thresholds are not evidence based. Free bilirubin (Bf)-that is, not bound to albumin, seems a better parameter for bilirubin neurotoxicity, but measurements of Bf are not available in clinical practice. The bilirubin/albumin (B/A) ratio is considered a surrogate parameter for Bf and an interesting additional parameter in the management of hyperbilirubinaemia. This paper reviewed the evidence supporting the use of B/A ratios for predicting bilirubin-induced neurological dysfunction (BIND) including neurodevelopmental delay in jaundiced premature infants (gestational age less than 32 weeks). A literature search was performed and six publications reviewed regarding B/A ratios in the management and outcome of jaundiced premature infants. No prospective clinical trials had been undertaken to show whether bilirubin-induced neurotoxicity is reduced or whether unnecessary treatment is avoided by using the B/A ratio in addition to TSB. Recently, a randomised controlled trial evaluating the effect of the additional use of the B/A ratio on neurodevelopmental outcome in jaundiced premature infants has been initiated. Based on the prevailing evidence many authorities suggest that the additional use of the B/A ratio may be valuable when evaluating jaundiced premature infants.
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Affiliation(s)
- C V Hulzebos
- Department of Pediatrics, Division of Neonatology, University Medical Center Groningen, The Netherlands.
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Dijk PH, Heikamp A, Oetomo SB. A comparison of the hemodynamic and respiratory effects of surfactant instillation during interrupted ventilation versus noninterrupted ventilation in rabbits with severe respiratory failure. Pediatr Res 1999; 45:235-40. [PMID: 10022596 DOI: 10.1203/00006450-199902000-00013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 11/06/2022]
Abstract
The purpose of this study was to evaluate whether avoiding interruption of ventilation during surfactant instillation improves the effects on lung function and surfactant distribution and whether it prevents the adverse effects on blood pressure and cerebral blood flow. The study was performed using rabbits with severe respiratory failure induced by lung lavages. These rabbits were randomized to 99mTc-Nanocoll labeled surfactant instillation through a side lumen of the endotracheal tube without interrupting ventilation or instillation during a short interruption of ventilation. After surfactant instillation with interruption of ventilation, PaO2 rose from 8.7+/-1.3 to 24.9+/-6.4 kPa (mean+/-SEM). Without interruption, PaO2 rose from 8.4+/-0.8 to 32.4+/-4.3 kPa. PaCO2 decreased with interruption from 4.69+/-0.51 to 3.61+/-0.26 kPa and without interruption from 5.06+/-0.41 to 4.13+/-0.23 kPa. Dynamic and static compliance indices were not statistically different after both procedures. Surfactant distribution tended to be less nonuniform after instillation without interrupting ventilation. In contrast, avoidance of interruption of ventilation resulted in less uniform lobar distribution and less peripheral deposition of surfactant. By instillation with interruption, blood pressure increased quickly (28+/-6.6%), followed by a 22+/-5.3% decrease. Blood pressure increased quickly (16+/-4.2%), followed by a 40+/-10% decrease by surfactant instillation without interruption. Cerebral blood flow, measured by an ultrasonic transit time flow probe on the carotid artery, increased quickly (45+/-14%), followed by a 64+/-11% decrease with interruption, whereas it increased 15+/-4.9% (p = 0.06 versus with interruption) and decreased 61+/-13% without interruption of ventilation. Therefore, avoiding interruption of ventilation during surfactant instillation tends to prevent the potential adverse effects of a rapid rise in cerebral blood flow, and furthermore, tends to improve uniformity of surfactant distribution, whereas having no detrimental effect on respiratory function.
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Affiliation(s)
- P H Dijk
- Beatrix Children's Hospital, Division of Neonatology, The Netherlands
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50
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Abstract
Surfactant nebulization improves lung function at low alveolar doses of surfactant. However, efficiency of nebulization is low, and lung deposition seems to depend on lung aeration. High frequency ventilation (HFV) has been shown to improve lung aeration. We hypothesize that the combination of HFV and surfactant nebulization may benefit lung deposition of surfactant and consequently, lung function. The aim of this study was to compare the effect of surfactant nebulization versus instillation during HFV on lung function, surfactant distribution, and cerebral blood flow. Therefore, severe respiratory failure was induced by lung lavages in 18 rabbits. HFV was applied: frequency = 8 Hz, mean airway pressure = 12 cm H2O, amplitude = 100%, fraction of inspired O2 = 1.0. Technetium-99m-labeled surfactant (Alveofact, 100 mg/kg of BW) was nebulized or instilled (n = 6 each). Six other rabbits did not receive surfactant (control, HFV only). We found that after instillation partial arterial O2 tension increased from 7.0 kPa (95% confidence interval, 6.3-8.0 kPa) to 34 kPa (16-51 kPa), and during nebulization from 7.0 kPa (6.0-9.0 kPa) to 46 kPa (27-58 kPa). Partial arterial CO2 tension decreased after instillation from 6.1 kPa (5.3-7.1 kPa) to 4.8 kPa (3.9-5.6 kPa), and during nebulization, after an initial rise, it decreased from 6.3 kPa (5.3-7.4 kPa) to 4.9 kPa (4.4-5.6 kPa). Both treatments resulted in nonuniform distribution. Surfactant deposition after nebulization was 9.8%. Instillation resulted in a drop of mean arterial blood pressure of 17% (8-31%), and an even more pronounced drop in cerebral blood flow of 39% (18-57%). Nebulization did not affect blood pressure. Cerebral blood flow decreased with a maximum of 27% (10-37%). We conclude that surfactant nebulization during HFV improves lung function in rabbits with severe respiratory failure, without improving distribution, but with less effects on blood pressure and cerebral blood flow, when compared with surfactant instillation.
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Affiliation(s)
- P H Dijk
- Beatrix Childrens Hospital, Division of Neonatology, Groningen, The Netherlands
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