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Kienast P, Schmidbauer V, Yildirim MS, Seeliger S, Stuempflen M, Elis J, Giordano V, Fuiko R, Olischar M, Vierlinger K, Noehammer C, Berger A, Prayer D, Kasprian G, Goeral K. Neurodevelopmental outcome in preterm infants with intraventricular hemorrhages: the potential of quantitative brainstem MRI. Cereb Cortex 2024; 34:bhae189. [PMID: 38715405 PMCID: PMC11077078 DOI: 10.1093/cercor/bhae189] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES This retrospective study aimed to identify quantitative magnetic resonance imaging markers in the brainstem of preterm neonates with intraventricular hemorrhages. It delves into the intricate associations between quantitative brainstem magnetic resonance imaging metrics and neurodevelopmental outcomes in preterm infants with intraventricular hemorrhage, aiming to elucidate potential relationships and their clinical implications. MATERIALS AND METHODS Neuroimaging was performed on preterm neonates with intraventricular hemorrhage using a multi-dynamic multi-echo sequence to determine T1 relaxation time, T2 relaxation time, and proton density in specific brainstem regions. Neonatal outcome scores were collected using the Bayley Scales of Infant and Toddler Development. Statistical analysis aimed to explore potential correlations between magnetic resonance imaging metrics and neurodevelopmental outcomes. RESULTS Sixty preterm neonates (mean gestational age at birth 26.26 ± 2.69 wk; n = 24 [40%] females) were included. The T2 relaxation time of the midbrain exhibited significant positive correlations with cognitive (r = 0.538, P < 0.0001, Pearson's correlation), motor (r = 0.530, P < 0.0001), and language (r = 0.449, P = 0.0008) composite scores at 1 yr of age. CONCLUSION Quantitative magnetic resonance imaging can provide valuable insights into neurodevelopmental outcomes after intraventricular hemorrhage, potentially aiding in identifying at-risk neonates. Multi-dynamic multi-echo sequence sequences hold promise as an adjunct to conventional sequences, enhancing the sensitivity of neonatal magnetic resonance neuroimaging and supporting clinical decision-making for these vulnerable patients.
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Affiliation(s)
- Patric Kienast
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Victor Schmidbauer
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Mehmet Salih Yildirim
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Selina Seeliger
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Marlene Stuempflen
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Julia Elis
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Vito Giordano
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Renate Fuiko
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Monika Olischar
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Klemens Vierlinger
- Center for Health and Bioresources, Molecular Diagnostics, AIT Austrian Institute of Technology GmbH, Giefinggasse 4, 1210 Vienna, Austria
| | - Christa Noehammer
- Center for Health and Bioresources, Molecular Diagnostics, AIT Austrian Institute of Technology GmbH, Giefinggasse 4, 1210 Vienna, Austria
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Daniela Prayer
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Gregor Kasprian
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Katharina Goeral
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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Kiechl-Kohlendorfer U, Simma B, Berger A, Urlesberger B, Wald M, Haiden N, Fuiko R, Ndayisaba JP. Two-year neurodevelopmental outcome in extremely preterm-born children: The Austrian Preterm Outcome Study Group. Acta Paediatr 2024. [PMID: 38433292 DOI: 10.1111/apa.17187] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/24/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024]
Abstract
AIM The current study determined the neurodevelopmental outcome of extremely preterm infants at 2 years of age. METHODS All live-born infants 23-27 weeks of gestation born between 2011 and 2020 in Austria were included in a prospective registry. Neurodevelopmental outcome at 2 years of corrected age was assessed using Bayley Scales of Infant Development for both motor and cognitive scores, along with a neurological examination and an assessment of neurosensory function. RESULTS 2378 out of 2905 (81.9%) live-born infants survived to 2 years of corrected age. Follow-up data were available for 1488 children (62.6%). Overall, 43.0% had no, 35.0% mild and 22.0% moderate-to-severe impairment. The percentage of children with moderate-to-severe neurodevelopmental impairment decreased with increasing gestational age and was 31.4%, 30.5%, 23.3%, 19.0% and 16.5% at 23, 24, 25, 26 and 27 weeks gestational age (p < 0.001). Results did not change over the 10-year period. In multivariate analysis, neonatal complications as well as male sex were significantly associated with an increased risk of neurodevelopmental impairment. CONCLUSION In this cohort study, a 22.0% rate of moderate-to-severe neurodevelopmental impairment was observed among children born extremely preterm. This national data is important for both counselling parents and guiding the allocation of health resources.
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Affiliation(s)
| | - Burkhard Simma
- Department of Paediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Angelika Berger
- Division of Neonatology, Paediatric Intensive Care and Neuropediatric, Department of Paediatrics and Adolescent Medicine, Comprehensive Centre for Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Berndt Urlesberger
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria
| | - Martin Wald
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Nadja Haiden
- Department of Neonatology, Kepler University Hospital Linz, Linz, Austria
| | - Renate Fuiko
- Division of Neonatology, Paediatric Intensive Care and Neuropediatric, Department of Paediatrics and Adolescent Medicine, Comprehensive Centre for Paediatrics, Medical University of Vienna, Vienna, Austria
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Rittenschober-Boehm J, Fuiko R, Farr A, Willinger B, Berger A, Goeral K. Intrauterine Detection of Ureaplasma Species after Vaginal Colonization in Pregnancy and Neonatal Outcome. Neonatology 2023; 121:187-194. [PMID: 38052191 PMCID: PMC10994598 DOI: 10.1159/000534779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 10/20/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Intrauterine infection with Ureaplasma species (U.spp.) is mostly a result of vaginal colonization with subsequent ascending infection and is associated with adverse pregnancy outcome. Little is known about rates and risk factors for ascending infection. Aim of the current study was to analyse the frequency of ascending U.spp. infection in vaginally colonized pregnant women delivering preterm and subsequent short- and long-term outcome of infants. METHODS Women delivering ≤32 weeks of gestation with available data on vaginal U.spp. colonization in early pregnancy as well as amniotic and placental colonization screening during caesarean section were included. Neonatal short- and long-term outcome was analysed depending on vaginal and intrauterine colonization. RESULTS Seventy-two women giving birth to 104 preterm infants were included. Intrauterine microbial invasion was found in 23/72 (31.9%) pregnancies. The most commonly detected organisms were U.spp. (52.2%), followed by E. coli (21.7%) and Enterococcus faecalis (17.4%). Intrauterine growth of U.spp. occurred exclusively after previous vaginal colonization in early pregnancy (42/72; 58.3%) and was found in 12/42 (28.6%) cases. Ascending U.spp. infection mainly occurred in pregnancies delivering <28 weeks after preterm rupture of membranes or preterm labour (9/17, 52.3%). Intrauterine detection of U.spp., but not vaginal colonization, was associated with a significantly higher rate of severe intraventricular haemorrhage, retinopathy of prematurity, bronchopulmonary dysplasia, and unfavourable psychomotor outcome. CONCLUSION Ascending U.spp. infection after previous vaginal colonization occurred in almost one-third of pregnancies delivering ≤32 weeks, with particularly high rates in those <28 weeks, and was associated with adverse outcome of preterm infants.
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Affiliation(s)
- Judith Rittenschober-Boehm
- Division of Neonatology, Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Renate Fuiko
- Division of Neonatology, Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Alex Farr
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Birgit Willinger
- Division for Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Division of Neonatology, Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Katharina Goeral
- Division of Neonatology, Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
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Deindl P, Witting A, Dür M, Berger A, Klebermass-Schrehof K, Singer D, Giordano V, Fuiko R. Perceived stress of mothers and fathers on two NICUs before and during the SARS-CoV-2 pandemic. Sci Rep 2023; 13:14540. [PMID: 37666877 PMCID: PMC10477236 DOI: 10.1038/s41598-023-40836-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/17/2023] [Indexed: 09/06/2023] Open
Abstract
Parents of very low birth weight (VLBW) infants in a neonatal intensive care unit experienced additional stress during the SARS-CoV-2 pandemic due to the related restrictions in hospital visiting policies. Our study aimed to compare parents' burdens before and during the pandemic. This survey included 121 parents of 76 VLBW infants in two European Level IV perinatal centers before and during the pandemic. We performed standardized parent questionnaires with mothers and fathers separately to evaluate their emotional stress and well-being. The pandemic worsened the emotional well-being of parents of VLBW infants, particularly of mothers. During the pandemic, mothers reported significantly higher state anxiety levels (48.9 vs. 42.9, p = 0.026) and hampered bonding with the child (6.3 vs. 5.2, 0 = 0.003) than before. In addition, mothers felt more personally restricted than fathers (6.1 vs. 5.2, p = 0.003). Fathers experienced lower levels of stress than mothers; they were equally burdened before and during the pandemic. Restrictions in visiting policies for families of VLBW infants during the SARS-CoV-2 pandemic have a significant negative impact on parental stress and should therefore be applied cautiously.
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Affiliation(s)
- Philipp Deindl
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrea Witting
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Mona Dür
- Duervation, Krems, Austria
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Katrin Klebermass-Schrehof
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Dominique Singer
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vito Giordano
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.
| | - Renate Fuiko
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
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Giordano V, Fuiko R, Witting A, Unterasinger L, Steinbauer P, Bajer J, Farr A, Hoehl S, Deindl P, Olischar M, Berger A, Klebermass-Schrehof K. The impact of pandemic restrictive visiting policies on infant wellbeing in a NICU. Pediatr Res 2023; 94:1098-1103. [PMID: 36959317 PMCID: PMC10034238 DOI: 10.1038/s41390-023-02562-w] [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] [Received: 07/18/2022] [Revised: 02/20/2023] [Accepted: 02/27/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Given the countrywide lockdown in the first pandemic period and the respective Hospital restrictive policies, we aimed to investigate if the SARS-COV-2 pandemic was associated to a reduced parental presence in the NICU and in which form this had an impact on infant wellbeing. METHODS Retrospective cohort study about altered NICUs parental presence (measured by number of visits and kangaroo care time) due to pandemic restrictive policies and its impact on infant wellbeing (measured through The Neonatal Pain Agitation and Sedation scale and nurses' descriptive documentation). RESULTS Presence of both parents at the same time was significantly lower during pandemic. Contrary, maternal presence only and total kangaroo-care time were higher within the pandemic (163.36 ± 94.07 vs 122.71 ± 64.03; p = 0.000). Lower NPASS values were documented during the lookdown (1.28 ± 1.7 vs 1.78 ± 2.2; p = 0.000). CONCLUSION Data collected through the pandemic confirm the importance of parental presence for infants' wellbeing in a NICU setting. IMPACT Parental support is an extremely important aspect for infants hospitalized in an intensive care unit. Their presence was limited in many NICUs worldwide during the SARS-COV-2 pandemic. This study confirm the importance of parental presence for infants' wellbeing also in a pandemic situation. Our results support a family-centered newborn individualized developmental care approach in the NICU.
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Affiliation(s)
- Vito Giordano
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Paediatrics (CCP), Medical University of Vienna, Vienna, Austria.
| | - Renate Fuiko
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Paediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Andrea Witting
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Paediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Lukas Unterasinger
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Comprehensive Center for Paediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Philipp Steinbauer
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Paediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Johanna Bajer
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Paediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Alex Farr
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Comprehensive Center for Paediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Stefanie Hoehl
- Department of Developmental and Educational Psychology, University of Vienna, Vienna, Austria
| | - Philipp Deindl
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Monika Olischar
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Paediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Paediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Katrin Klebermass-Schrehof
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Paediatrics (CCP), Medical University of Vienna, Vienna, Austria
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Giordano V, Deindl P, Gal E, Unterasinger L, Fuiko R, Steinbauer P, Weninger M, Berger A, Olischar M. Pain and neurodevelopmental outcomes of infants born very preterm. Dev Med Child Neurol 2023; 65:1043-1052. [PMID: 36647629 DOI: 10.1111/dmcn.15505] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 12/01/2022] [Accepted: 12/07/2022] [Indexed: 01/18/2023]
Abstract
AIM To investigate the impact of the level of pain experienced by infants born preterm on neurodevelopmental outcomes during their stay in a neonatal intensive care unit. METHOD In this retrospective data analysis we included all surviving infants born preterm with a gestational age between 23 and 32 weeks from 2011 to 2015, who were assessed using the Neonatal Pain, Agitation, and Sedation Scale and examined at 1 year of age using the Bayley Scales of Infant Development. We excluded all infants who had suffered severe neurological morbidities and undergone surgical interventions. RESULTS A total of 196 infants born preterm were included in the analyses: 105 in the 'no pain group' and 91 in the 'pain group'. Significant differences between the groups were detected for both mental and motor development (p = 0.003, 95% confidence interval [CI] 2.23-10.92; p = 0.025, 95% CI 0.64-9.78). The results remained significant after controlling for other important medical conditions (p = 0.001, 95% CI -19.65 to -5.40; p = 0.010, 95% CI -16.18 to -2.29). INTERPRETATION Neonatal pain exposure was associated with altered neurodevelopmental outcomes of infants born very preterm at a corrected age of 12 months. This observation highlights the importance of adequate pain management to reduce the risk of poor neurodevelopmental outcomes in these vulnerable patients.
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Affiliation(s)
- Vito Giordano
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Philipp Deindl
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Elisabeth Gal
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Lukas Unterasinger
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Renate Fuiko
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Philipp Steinbauer
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Manfred Weninger
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Monika Olischar
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
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Gsoellpointner M, Thanhaeuser M, Eibensteiner F, Ristl R, Jilma B, Fuiko R, Brandstetter S, Berger A, Haiden N. Polyunsaturated Fatty Acid Intake during Complementary Feeding and Neurodevelopmental Outcome in Very Low Birth Weight Infants. Nutrients 2023; 15:3141. [PMID: 37513559 PMCID: PMC10385005 DOI: 10.3390/nu15143141] [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: 06/15/2023] [Revised: 07/09/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Polyunsaturated fatty acids (PUFAs) are vital for brain development, yet limited knowledge exists regarding PUFA intake during complementary feeding (CF) and its impact on neurodevelopmental outcomes in very low birth weight (VLBW) infants. This secondary analysis of a randomized intervention trial, aimed to investigate the association between dietary intake of total PUFAs, arachidonic acid (AA), and docosahexaenoic acid (DHA) during CF and neurodevelopmental outcomes at 12 and 24 months of corrected age (CA). Dietary intakes were assessed using monthly 3 day dietary protocols from 3 to 12 months CA. Neurodevelopmental outcome was evaluated using the Bayley Scales of Infant Development-III. Among the 177 randomized patients, PUFA intake and neurodevelopmental outcomes were evaluated in 140 (79%) infants. Higher total PUFA and DHA intakes significantly correlated with improved cognitive and motor function at 12 months CA, while increased AA intake notably enhanced motor scores at 12 months CA. However, median dietary intakes of AA and DHA (AA: 53.50-84.25 mg/d; DHA: 51.47-76.23 mg/d) fell short of recommended levels (AA: 140 mg/d; DHA: 100 mg/d) at any of the investigated timepoints. These findings emphasize the need to enhance total PUFA, DHA and AA intakes during CF, ensuring adherence to guidelines and unlocking the potential to improve neurodevelopmental outcomes in VLBW infants.
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Affiliation(s)
| | - Margarita Thanhaeuser
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria
| | - Fabian Eibensteiner
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria
| | - Robin Ristl
- Center for Medical Data Science, Medical University of Vienna, 1090 Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria
| | - Renate Fuiko
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria
| | - Sophia Brandstetter
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria
| | - Nadja Haiden
- Department of Neonatology, Kepler University Hospital, Johannes Kepler University, 4020 Linz, Austria
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Giordano V, Deindl P, Fuiko R, Kothgassner O. Editorial: Neurodevelopmental and behavioral outcomes following a traumatic event in infancy. Front Psychol 2023; 14:1157991. [PMID: 37179884 PMCID: PMC10169822 DOI: 10.3389/fpsyg.2023.1157991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/10/2023] [Indexed: 05/15/2023] Open
Affiliation(s)
- Vito Giordano
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Philipp Deindl
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Renate Fuiko
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Oswald Kothgassner
- Department of Child and Adolescent Psychiatry, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
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Zimmermann DL, Schned H, Unterasinger L, Kirchner L, Fuiko R, Olischar M, Klebermass-Schrehof K, Berger A, Weninger M, Giordano V. Impact of Retinopathy of Prematurity on Visual Motor Integration. Neonatology 2023:1-8. [PMID: 36996795 DOI: 10.1159/000529594] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/01/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Preterm infants are at risk for neurodevelopmental deficits. An association between retinopathy of prematurity (ROP) and impaired cognitive outcome has already been described. However, less is known about the impact of ROP on visual motor integration (VMI), which is a prerequisite not only for fine motor abilities but also for further school skills. Therefore, the aim of this study was to retrospectively investigate the impact of ROP on VMI at preschool age. METHODS The study was conducted at the Medical University of Vienna, including patients born between January 2009 and December 2014 with a gestational age of less than 30 weeks and/or a birth weight of less than 1,500 g. VMI was determined by Beery-Buktenica Developmental Test of Visual Motor Integration (Beery VMI) at the age of 5 years. RESULTS Out of 1,365 patients, 353 met inclusion criteria for this study. Two hundred sixteen of them had no ROP, while 137 had ROP (stage 1: n = 23, stage 2: n = 74, stage 3: n = 40). Mean value of the Beery VMI score was significantly lower in the ROP group compared to the No-ROP group (90 ± 16 vs. 99 ± 14; p < 0.01). By correcting for other important medical conditions, ROP still had a significant impact on Beery VMI score (p < 0.01). Particularly, lower scores were found for stage 2 (p < 0.01) and stage 3 (p < 0.01). CONCLUSION Beery VMI scores were significantly lower in preterm infants with ROP stage 2 and 3 than in infants without ROP. This study shows the negative impact of ROP on VMI skills at preschool age, even after adjustment for key demographic and medical characteristics.
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Affiliation(s)
- Daniel Lukas Zimmermann
- Division of Neonatology, Paediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Centre for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Hannah Schned
- Division of Neonatology, Paediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Centre for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Lukas Unterasinger
- Division of Neonatology, Paediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Centre for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Lieselotte Kirchner
- Division of Neonatology, Paediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Centre for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Renate Fuiko
- Division of Neonatology, Paediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Centre for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Monika Olischar
- Division of Neonatology, Paediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Centre for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Katrin Klebermass-Schrehof
- Division of Neonatology, Paediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Centre for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Division of Neonatology, Paediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Centre for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Manfred Weninger
- Division of Neonatology, Paediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Centre for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Vito Giordano
- Division of Neonatology, Paediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Centre for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
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10
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Thanhaeuser M, Steyrl D, Fuiko R, Brandstaetter S, Binder C, Thajer A, Huber-Dangl M, Haiden N, Berger A, Repa A. A secondary Outcome Analysis of a Randomized Trial Using a Mixed Lipid Emulsion Containing Fish Oil in Infants with Extremely Low Birth Weight: Cognitive and Behavioral Outcome at Preschool Age. J Pediatr 2023; 254:68-74.e3. [PMID: 36257349 DOI: 10.1016/j.jpeds.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the impact of a parenteral lipid emulsion containing fish oil compared with a soybean oil based-lipid emulsion on the cognitive outcome and behavior of preschool children with extremely low birth weight. STUDY DESIGN This was a retrospective secondary outcome analysis of a randomized controlled trial performed between June 2012 and June 2015. Infants with extremely low birth weight received either a mixed (soybean oil, medium chain triglycerides, olive oil, fish oil) or a soybean oil-based lipid emulsion for parenteral nutrition. Data from the Kaufman Assessment Battery for Children II, the Child Behavior Checklist 1.5-5, and anthropometry were collected from medical charts at 5.6 years of age. RESULTS At discharge, 206 of the 230 study participants were eligible. At 5 years 6 months of age, data of 153 of 206 infants (74%) were available for analysis. There were no significant differences in Kaufman Assessment Battery for Children II scores for Sequential/Gsm, Simultaneous/Gv, Learning/Glr, and Mental Processing Index (mixed lipid: median, 97.5 [IQR, 23.5]; soybean oil: median, 96 [IQR, 19.5]; P = .43) or Child Behavior Checklist 1.5-5 scores for internalizing problems, externalizing problems, or total problems (mixed lipid: median, 37 [IQR, 12.3]; soybean oil: median, 37 [IQR, 13.5]; P = .54). CONCLUSIONS A RandomForest machine learning regression analysis did not show an effect of type of lipid emulsion on cognitive and behavioral outcome. Parenteral nutrition using a mixed lipid emulsion containing fish oil did not affect neurodevelopment and had no impact on child behavior of infants with extremely low birth weights at preschool age. TRIAL REGISTRATION ClinicalTrials.gov: NCT01585935.
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Affiliation(s)
- Margarita Thanhaeuser
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.
| | - David Steyrl
- Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Renate Fuiko
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Sophia Brandstaetter
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Christoph Binder
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Alexandra Thajer
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Mercedes Huber-Dangl
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Nadja Haiden
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
| | - Angelika Berger
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Andreas Repa
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
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11
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Steiner M, Schwarz H, Kasprian G, Rittenschober-Boehm J, Schmidbauer V, Fuiko R, Olischar M, Klebermass-Schrehof K, Berger A, Goeral K. Brain Biometry Reveals Impaired Brain Growth in Preterm Neonates with Intraventricular Hemorrhage. Neonatology 2023; 120:225-234. [PMID: 36805535 PMCID: PMC10906469 DOI: 10.1159/000528981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/03/2023] [Indexed: 02/22/2023]
Abstract
INTRODUCTION Preterm birth and cerebral hemorrhage have adverse effects on brain development. Alterations in regional brain size on magnetic resonance imaging (MRI) can be assessed using 2D biometrical analysis, an easily applicable technique showing good correlation with 3D brain volumes. METHODS This retrospective study included 74 preterm neonates with intraventricular hemorrhage (IVH) born <32+0 weeks of gestation between 2011 and 2019. Cerebral MRI was performed at term-equivalent age, and 2D measurement techniques were used for biometrical analysis and compared to normative data of two control groups. Finally, the correlation and association of brain parameters and patterns of impaired brain growth and outcome at 2 and 3 years of age were evaluated. RESULTS Interhemispheric distance (IHD), the 3rd ventricle, and lateral ventricles presented larger, in contrast, cerebral biparietal width (cBPW), fronto-occipital diameter (FOD), and the length of the corpus callosum were smaller in IVH patients compared to respective controls. The strongest correlations with outcome were observed for the parameters FOD, anteroposterior diameter of the vermis, transverse cerebellar diameter (tCD), corpus callosum, 3rd ventricle, and left ventricular index. Patients with the small FOD, small BPW, and increased IHD pattern reached overall lower outcome scores at follow-up. DISCUSSION Preterm neonates with IVH showed reduced total brain sizes and enlarged pericerebral spaces compared to neurologically healthy controls. Biometric analysis revealed that several 2D brain parameters as well as different patterns of impaired brain growth were associated with neurodevelopmental impairment in early childhood. These findings may support prediction of long-term outcome and parental counseling in patients with IVH.
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Affiliation(s)
- Mirjam Steiner
- Division of Neonatology, Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Hannah Schwarz
- Division of Neonatology, Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Gregor Kasprian
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Judith Rittenschober-Boehm
- Division of Neonatology, Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Victor Schmidbauer
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Renate Fuiko
- Division of Neonatology, Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Monika Olischar
- Division of Neonatology, Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Katrin Klebermass-Schrehof
- Division of Neonatology, Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Division of Neonatology, Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Katharina Goeral
- Division of Neonatology, Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
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12
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Goeral K, Kasprian G, Hüning BM, Waldhoer T, Fuiko R, Schmidbauer V, Prayer D, Felderhoff‐Müser U, Berger A, Olischar M, Klebermass‐Schrehof K. A novel magnetic resonance imaging-based scoring system to predict outcome in neonates born preterm with intraventricular haemorrhage. Dev Med Child Neurol 2022; 64:608-617. [PMID: 34839534 PMCID: PMC9299734 DOI: 10.1111/dmcn.15116] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 11/28/2022]
Abstract
AIM To create a magnetic resonance imaging (MRI)-based scoring system specific to neonates born preterm with intraventricular haemorrhage (IVH), which could serve as a reliable prognostic indicator for later development and might allow for improved outcome prediction, individually-tailored parental counselling, and clinical decision-making. METHOD This retrospective, two-center observational cohort study included 103 infants born preterm with IVH (61 males, 42 females; median gestational age 26wks 6d), born between 2000 and 2016. Term-equivalent MRI was evaluated using a novel scoring system consisting of 11 items. A total MRI score was calculated and correlated with neurodevelopment between 2 years and 3 years of age. Prediction models for outcome were defined. RESULTS The proposed MRI scoring system showed high correlation and strong predictive ability with regard to later cognitive and motor outcome. The prediction models were translated into easy-to-use tables, allowing developmental risk assessment. INTERPRETATION The proposed MRI-based scoring system was created especially for infants born preterm with IVH and enables a comprehensive assessment of important brain areas as well as potential additional abnormalities commonly associated with IVH. Thus, it better represents the severity of brain damage when compared with the conventional IVH classification. Our scoring system should provide clinicians with valuable information, to optimize parental counselling and clinical decision-making.
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Affiliation(s)
- Katharina Goeral
- Division of Neonatology, Intensive Care and NeuropediatricsDepartment of Pediatrics and Adolescent MedicineComprehensive Center for PediatricsMedical University of ViennaViennaAustria
| | - Gregor Kasprian
- Division of Neuroradiology and Musculoskeletal RadiologyDepartment of RadiologyMedical University of ViennaViennaAustria
| | - Britta M Hüning
- Department of Pediatrics INeonatologyUniversity Children's Hospital EssenUniversity Duisburg‐EssenEssenGermany
| | - Thomas Waldhoer
- Department of EpidemiologyCenter of Public HealthMedical University of ViennaViennaAustria
| | - Renate Fuiko
- Division of Neonatology, Intensive Care and NeuropediatricsDepartment of Pediatrics and Adolescent MedicineComprehensive Center for PediatricsMedical University of ViennaViennaAustria
| | - Victor Schmidbauer
- Division of Neuroradiology and Musculoskeletal RadiologyDepartment of RadiologyMedical University of ViennaViennaAustria
| | - Daniela Prayer
- Division of Neuroradiology and Musculoskeletal RadiologyDepartment of RadiologyMedical University of ViennaViennaAustria
| | - Ursula Felderhoff‐Müser
- Department of Pediatrics INeonatologyUniversity Children's Hospital EssenUniversity Duisburg‐EssenEssenGermany
| | - Angelika Berger
- Division of Neonatology, Intensive Care and NeuropediatricsDepartment of Pediatrics and Adolescent MedicineComprehensive Center for PediatricsMedical University of ViennaViennaAustria
| | - Monika Olischar
- Division of Neonatology, Intensive Care and NeuropediatricsDepartment of Pediatrics and Adolescent MedicineComprehensive Center for PediatricsMedical University of ViennaViennaAustria
| | - Katrin Klebermass‐Schrehof
- Division of Neonatology, Intensive Care and NeuropediatricsDepartment of Pediatrics and Adolescent MedicineComprehensive Center for PediatricsMedical University of ViennaViennaAustria
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Giordano V, Stummer S, Lindtner C, Fuiko R, Berger A, Pichler K. Neonatal sepsis is associated with behavioral abnormalities in very low birthweight infants at preschool age. Front Pediatr 2022; 10:906379. [PMID: 35923781 PMCID: PMC9339780 DOI: 10.3389/fped.2022.906379] [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: 03/28/2022] [Accepted: 06/24/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE This study aimed to investigate neonatal sepsis as potential risk factor for adverse behavioral outcome in very low birth weight infants (VLBWI) at preschool age. Regardless of improvements in the obstetric and neonatal intensive care, preterm infants are still at high risk for behavioral problems later in life. The spectrum, origin and potential risk factors of these behavioral problems have not been well-defined. METHODS In this retrospective observational study, the influence of culture-proven neonatal sepsis on the behavioral outcome of VLBWI born at a gestational age <32 weeks was analyzed at 5 years of age in a multivariable regression model. Behavior was assessed with the Child Behavior Checklist (CBCL). Neonatal morbidities, socioeconomic status and neurodevelopmental outcome served as covariates in the analysis. RESULTS 312 VLBWI entered the final analysis, of whom 11% had experienced neonatal sepsis. Neonatal sepsis appeared to be a relevant risk factor for both internalizing, i.e., emotional reactivity and anxiety/depression, as well as externalizing behavioral problems, i.e., oppositional and aggressive behavior in this cohort of VLBWI. Low socioeconomic status and male gender were additional statistically significant risk factors for both internalizing and externalizing behavioral problems. No difference in neurocognitive development was observed between the groups. CONCLUSION The study supports the fact that VLBWI are vulnerable to multiple behavioral disorders independent of their cognitive development. In contrast to former assumptions, the results of the study emphasize that not only post-natal environment but also neonatal morbidities, especially neonatal sepsis, have an impact on behavioral outcome of VLBWI at preschool age.
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Affiliation(s)
- Vito Giordano
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Paediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Sophie Stummer
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Paediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Claudia Lindtner
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Paediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Renate Fuiko
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Paediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Paediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Karin Pichler
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Paediatrics (CCP), Medical University of Vienna, Vienna, Austria
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14
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Thanhaeuser M, Steyrl D, Fuiko R, Brandstaetter S, Binder C, Thajer A, Huber-Dangl M, Haiden N, Berger A, Repa A. Neurodevelopmental Outcome of Extremely Low Birth Weight Infants with Cholestasis at 12 and 24 Months. Neonatology 2022; 119:501-509. [PMID: 35679842 DOI: 10.1159/000525003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 02/04/2022] [Accepted: 04/08/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aims of the study were to describe the neurodevelopmental outcome of extremely low birth weight (ELBW) infants with parenteral nutrition-associated cholestasis (PNAC) and to assess whether PNAC is associated with adverse neurodevelopmental outcome. METHODS The study is a secondary analysis of controlled trial (June 2012-October 2017) on PNAC incidence in ELBW infants receiving two different parenteral lipid emulsions (mixed lipid emulsion containing fish oil vs. soybean oil-based). Neurodevelopmental follow-up at 12- and 24-month corrected age was compared in infants with and without PNAC. A machine learning-based regression analysis was used to assess whether PNAC was associated with adverse neurodevelopmental outcome. RESULTS For assessment of neurodevelopmental outcome (Bayley-III), 174 infants were available at 12-month (PNAC: n = 21; no PNAC: n = 153) and 164 infants at 24-month (PNAC: n = 20; no PNAC: n = 144) corrected age. The neurodevelopment of ELBW infants with PNAC was globally delayed, with significantly lower cognitive, language, and motor scores at both 12- and 24-month corrected age. Regression analyses revealed that PNAC was associated with an adverse motor outcome. CONCLUSION ELBW infants with PNAC are at increased risk for adverse neurodevelopmental outcome.
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Affiliation(s)
- Margarita Thanhaeuser
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care Medicine and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - David Steyrl
- Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Renate Fuiko
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care Medicine and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Sophia Brandstaetter
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care Medicine and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Christoph Binder
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care Medicine and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Alexandra Thajer
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care Medicine and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Mercedes Huber-Dangl
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care Medicine and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Nadja Haiden
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care Medicine and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Andreas Repa
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care Medicine and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
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15
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Goeral K, Fuiko R, Binder J, Lindtner C, Jernej R, Rittenschober‐Boehm J, Klebermass‐Schrehof K, Berger A, Grill A. Considerable mortality and morbidity in neonates born below 500 gram. Acta Paediatr 2021; 110:2359-2365. [PMID: 33955057 PMCID: PMC8360180 DOI: 10.1111/apa.15885] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/07/2021] [Accepted: 04/22/2021] [Indexed: 01/08/2023]
Abstract
Data evaluating mortality and morbidity in infants born ≤500 g are scarce and show wide variability. To support counselling and decision‐making, we analysed neurodevelopmental outcome in all neonates ≤500 g birth weight. Retrospective analysis including preterm infants with a birth weight ≤500 g and a gestational age >22 weeks born at a single tertiary perinatal centre between 2010 and 2017. Of 59 live births, 88% received standard care. Birth weight ranged from 318 to 500 g and gestational age from 23 to 29 weeks. 56% of neonates were born ≤3rd percentile and 42% of treated infants survived. Neurodevelopmental outcome was available in 91% of patients and was evaluated using Bayley Scales of Infant Development at two years. 50% showed a favourable mental development (normal or mild impairment), 75% a favourable motor development and 45% a favourable outcome in both outcome subcategories. When additionally considering visual and hearing disability and, or, cerebral palsy level ≥2 according to the Gross Motor Function Classification System 35% had a good neurodevelopmental outcome. Survival rate was 37% for all live births and 42% for infants with standard care. More than one‐third of survivors showed no significant neurodevelopmental impairment at two years.
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Affiliation(s)
- Katharina Goeral
- Comprehensive Center for Pediatrics Department of Pediatrics and Adolescent Medicine Division of Neonatology, Intensive Care and Neuropediatrics Medical University of Vienna Vienna Austria
| | - Renate Fuiko
- Comprehensive Center for Pediatrics Department of Pediatrics and Adolescent Medicine Division of Neonatology, Intensive Care and Neuropediatrics Medical University of Vienna Vienna Austria
| | - Julia Binder
- Comprehensive Center for Pediatrics Department of Obstetrics and Gynecology Division of Obstetrics and Fetomaternal Medicine Medical University of Vienna Vienna Austria
| | - Claudia Lindtner
- Comprehensive Center for Pediatrics Department of Pediatrics and Adolescent Medicine Division of Neonatology, Intensive Care and Neuropediatrics Medical University of Vienna Vienna Austria
| | - Raphaela Jernej
- Comprehensive Center for Pediatrics Department of Pediatrics and Adolescent Medicine Division of Neonatology, Intensive Care and Neuropediatrics Medical University of Vienna Vienna Austria
| | - Judith Rittenschober‐Boehm
- Comprehensive Center for Pediatrics Department of Pediatrics and Adolescent Medicine Division of Neonatology, Intensive Care and Neuropediatrics Medical University of Vienna Vienna Austria
| | - Katrin Klebermass‐Schrehof
- Comprehensive Center for Pediatrics Department of Pediatrics and Adolescent Medicine Division of Neonatology, Intensive Care and Neuropediatrics Medical University of Vienna Vienna Austria
| | - Angelika Berger
- Comprehensive Center for Pediatrics Department of Pediatrics and Adolescent Medicine Division of Neonatology, Intensive Care and Neuropediatrics Medical University of Vienna Vienna Austria
| | - Agnes Grill
- Comprehensive Center for Pediatrics Department of Pediatrics and Adolescent Medicine Division of Neonatology, Intensive Care and Neuropediatrics Medical University of Vienna Vienna Austria
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16
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Rittenschober-Böhm J, Habermüller T, Waldhoer T, Fuiko R, Schulz SM, Pimpel B, Goeral K, Witt A, Berger A, Pichler K. Maternal Vaginal Ureaplasma spp. Colonization in Early Pregnancy Is Associated with Adverse Short- and Long-Term Outcome of Very Preterm Infants. Children (Basel) 2021; 8:276. [PMID: 33916723 PMCID: PMC8066242 DOI: 10.3390/children8040276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 11/16/2022]
Abstract
Vaginal colonization with Ureaplasma (U.) spp. has been shown to be associated with adverse pregnancy outcome; however, data on neonatal outcome are scarce. The aim of the study was to investigate whether maternal vaginal colonization with U. spp. in early pregnancy represents a risk factor for adverse short- or long-term outcome of preterm infants. Previously, 4330 pregnant women were enrolled in an observational multicenter study, analyzing the association between vaginal U. spp. colonization and spontaneous preterm birth. U. spp. colonization was diagnosed via PCR analysis from vaginal swabs. For this study, data on short-term outcome were collected from medical records and long-term outcome was examined via Bayley Scales of Infant Development at 24 months adjusted age. Two-hundred-and-thirty-eight children were born <33 weeks gestational age. After exclusion due to asphyxia, malformations, and lost-to-follow-up, data on short-term and long-term outcome were available from 222 and 92 infants, respectively. Results show a significant association between vaginal U. spp. colonization and severe intraventricular hemorrhage (10.4% vs. 2.6%, p = 0.03), retinopathy of prematurity (21.7% vs. 10.3%, p = 0.03), and adverse psychomotor outcome (24.3% vs. 1.8%, OR 13.154, 95%CI 1.6,110.2, p = 0.005). The data suggest an association between vaginal U. spp. colonization in early pregnancy and adverse short- and long-term outcome of very preterm infants.
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Affiliation(s)
- Judith Rittenschober-Böhm
- Division of Neonatology, Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (T.H.); (R.F.); (B.P.); (K.G.); (A.B.); (K.P.)
| | - Tanja Habermüller
- Division of Neonatology, Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (T.H.); (R.F.); (B.P.); (K.G.); (A.B.); (K.P.)
| | - Thomas Waldhoer
- Department of Epidemiology, Center of Public Health, Medical University of Vienna, 1090 Vienna, Austria;
| | - Renate Fuiko
- Division of Neonatology, Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (T.H.); (R.F.); (B.P.); (K.G.); (A.B.); (K.P.)
| | - Stefan M. Schulz
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Birgit Pimpel
- Division of Neonatology, Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (T.H.); (R.F.); (B.P.); (K.G.); (A.B.); (K.P.)
| | - Katharina Goeral
- Division of Neonatology, Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (T.H.); (R.F.); (B.P.); (K.G.); (A.B.); (K.P.)
| | - Armin Witt
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Angelika Berger
- Division of Neonatology, Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (T.H.); (R.F.); (B.P.); (K.G.); (A.B.); (K.P.)
| | - Karin Pichler
- Division of Neonatology, Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (T.H.); (R.F.); (B.P.); (K.G.); (A.B.); (K.P.)
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Pichler K, Giordano V, Tropf G, Fuiko R, Berger A, Rittenschober-Boehm J. Impact of Different Types of Nosocomial Infection on the Neurodevelopmental Outcome of Very Low Birth Weight Infants. Children (Basel) 2021; 8:children8030207. [PMID: 33803213 PMCID: PMC8000764 DOI: 10.3390/children8030207] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 11/16/2022]
Abstract
Nosocomial infections (NIs) are important conditions associated with mortality and morbidity in very low birth weight infants (VLBWIs). The aim of this study was to investigate the impact of NIs and the different subtypes on neurodevelopmental outcomes in a cohort of VLBWIs. VLBWIs born with a gestational age between 23 0/7 and 31 6/7 weeks in a level III neonatal center were enrolled. Neonatal morbidities as well as the neurodevelopmental outcome at 2 years of corrected age were analyzed. Six-hundred infants completed the study successfully. Of these, 38% experienced an NI episode. NIs were associated with an increased risk of neonatal complications, such as brain injury, bronchopulmonary dysplasia (BPD) and death, and were a significant risk factor for adverse motor development at 2 years of corrected age in our cohort of VLBWIs. The negative impact of NIs on neurodevelopmental outcomes was particularly associated with necrotizing enterocolitis (NEC), suspected NIs and Gram-positive NIs. This study demonstrated that NIs are a significant risk factor for both morbidity and mortality as well as adverse neurodevelopmental outcomes in VLBWIs.
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Goeral K, Hauck A, Atkinson A, Wagner MB, Pimpel B, Fuiko R, Klebermass-Schrehof K, Leppert D, Kuhle J, Berger A, Olischar M, Wellmann S. Early life serum neurofilament dynamics predict neurodevelopmental outcome of preterm infants. J Neurol 2021; 268:2570-2577. [PMID: 33566157 PMCID: PMC8217001 DOI: 10.1007/s00415-021-10429-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 10/31/2020] [Revised: 01/23/2021] [Accepted: 01/27/2021] [Indexed: 02/07/2023]
Abstract
Background and purpose To determine whether neurofilament light chain (NfL), a promising serum and cerebrospinal fluid (CSF) biomarker of neuroaxonal damage, predicts functional outcome in preterm infants with neonatal brain injury. Methods Our prospective observational study used a sensitive single-molecule array assay to measure serum and CSF NfL concentrations in preterm infants with moderate to severe peri/intraventricular hemorrhage (PIVH). We determined temporal serum and CSF NfL profiles from the initial diagnosis of PIVH until term-equivalent age and their association with clinical and neurodevelopmental outcome until 2 years of age assessed by Bayley Scales of Infant Development (3rd edition). We fitted univariate and multivariate logistic regression models to determine risk factors for poor motor and cognitive development. Results The study included 48 infants born at < 32 weeks of gestation. Median serum NfL (sNfL) at PIVH diagnosis was 251 pg/mL [interquartile range (IQR) 139–379], decreasing markedly until term-equivalent age to 15.7 pg/mL (IQR 11.1–33.5). CSF NfL was on average 113-fold higher (IQR 40–211) than corresponding sNfL values. Additional cerebral infarction (n = 25)-but not post-hemorrhagic hydrocephalus requiring external ventricular drainage (n = 29) nor any other impairment-was independently associated with sNfL. Multivariate logistic regression models identified sNfL as an independent predictor of poor motor outcome or death at 1 and 2 years. Conclusions Serum neurofilament light chain dynamics in the first weeks of life predict motor outcome in preterm infants with PIVH. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10429-5.
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Affiliation(s)
- Katharina Goeral
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University Vienna, Vienna, Austria
| | - Annalisa Hauck
- Division of Neonatology, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Andrew Atkinson
- Division of Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel (UKBB), Basel, Switzerland
| | - Michael B Wagner
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University Vienna, Vienna, Austria
| | - Birgit Pimpel
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University Vienna, Vienna, Austria
| | - Renate Fuiko
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University Vienna, Vienna, Austria
| | - Katrin Klebermass-Schrehof
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University Vienna, Vienna, Austria
| | - David Leppert
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Angelika Berger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University Vienna, Vienna, Austria
| | - Monika Olischar
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University Vienna, Vienna, Austria
| | - Sven Wellmann
- Division of Neonatology, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland. .,Division of Neonatology, Campus Hospital St. Hedwig, University Children's Hospital Regensburg (KUNO), University of Regensburg, Steinmetzstr 1-3, 93049, Regensburg, Germany.
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Steinbauer P, Deindl P, Fuiko R, Unterasinger L, Cardona F, Wagner M, Edobor J, Werther T, Berger A, Olischar M, Giordano V. Long-term impact of systematic pain and sedation management on cognitive, motor, and behavioral outcomes of extremely preterm infants at preschool age. Pediatr Res 2021; 89:540-548. [PMID: 32454516 DOI: 10.1038/s41390-020-0979-2] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/09/2020] [Accepted: 05/12/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Providing optimal pain relief is a challenging task when caring for premature infants. The aim of this study was to compare the long-term cognitive, motor, and behavioral outcomes of preterm infants before and after the implementation of a pain and sedation protocol. In addition, we investigated whether the increased opiate administration resulting after the implementation process had an impact on these outcomes. METHODS Cognitive outcomes were evaluated using the Kaufman Assessment Battery for Children (KABC), neuromotor examinations were based on Amiel-Tison, and behavioral outcomes were assessed using the parent-reported Child Behavior Checklist (CBCL). RESULTS One hundred extremely preterm infants were included in the study (control group, n = 53; intervention group, n = 47). No significant differences were found in cognitive and motor outcomes at preschool age. However, every increase in the cumulative opiate exposure for each 100 mg/kg was weakly significantly associated with a higher risk for autism spectrum features (adjusted odds ratio (aOR) = 1.822, 95% confidence interval (CI) [1.231-2.697]; P = 0.03) and withdrawn behavior (aOR = 1.822, 95% CI [1.231-2.697]; P = 0.03) at preschool age. CONCLUSION Increased neonatal cumulative opiate exposure did not alter cognitive and motor outcomes but may represent a risk factor for autism spectrum and withdrawn behavior at preschool age. IMPACT The implementation of a protocol for the management of pain and sedation in preterm infants resulted in increased cumulative opiate exposure. Our study adds further evidence that increased neonatal opiate exposure did not alter cognitive and motor outcomes but may yield a potential risk factor for autism spectrum disorders and withdrawn behavior at preschool age. A vigilant use of opiates is recommended. Further studies are needed looking for novel pain management strategies and drugs providing optimal pain relief with minimal neurotoxicity.
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Affiliation(s)
- Philipp Steinbauer
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Philipp Deindl
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Renate Fuiko
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Lukas Unterasinger
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Francesco Cardona
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Wagner
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Joy Edobor
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Tobias Werther
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Monika Olischar
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
| | - Vito Giordano
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
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Thanhaeuser M, Fuiko R, Oberleitner-Leeb C, Brandstaetter S, Binder C, Thajer A, Huber-Dangl M, Haiden N, Pablik E, Berger A, Repa A. A Randomized Trial of Parenteral Nutrition Using a Mixed Lipid Emulsion Containing Fish Oil in Infants of Extremely Low Birth Weight: Neurodevelopmental Outcome at 12 and 24 Months Corrected Age, A Secondary Outcome Analysis. J Pediatr 2020; 226:142-148.e5. [PMID: 32590001 PMCID: PMC7612562 DOI: 10.1016/j.jpeds.2020.06.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 03/03/2020] [Revised: 06/18/2020] [Accepted: 06/18/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To examine whether parenteral nutrition using a mixed lipid emulsion containing fish oil improves the neurodevelopmental outcomes of extremely low birth weight infants. STUDY DESIGN The study is a secondary outcome analysis of a double-blind randomized trial of 230 extremely low birth weight infants performed at a single level IV neonatal care unit (Medical University Vienna; June 2012 to June 2015). Participants received either a mixed lipid emulsion composed of soybean oil, medium chain triglycerides, olive oil, and fish oil, or a soybean oil-based lipid emulsion for parenteral nutrition. Neurodevelopment of study participants was assessed at 12 and 24 months corrected age (August 2013 to October 2017) using the Bayley Scales of Infant-Toddler Development, third edition. RESULTS At discharge, 206 of the 230 study participants were eligible. At 12 and 24 months corrected age, 174 of 206 (85%) and 164 of 206 (80%) infants were evaluated. At 12 months, there was no significant difference in cognitive (mixed lipid: median, 95 [IQR, 85-101]; soybean oil: median, 95 [IQR, 85-100]; P = .71), language (mixed lipid: median, 86 [IQR, 77-94], soybean oil: median, 89 [IQR, 79-94]; P = .48), or motor scores (mixed lipid: median, 88 [IQR, 76-94], soybean oil: median, 88 [IQR, 79-94]; P = .69). At 24 months, there was again no significant difference in cognitive (mixed lipid: median, 95 [IQR, 80-105], soybean oil: median, 95 [IQR, 90-105]; P = .17), language (mixed lipid: median, 89 [IQR, 75-97], soybean oil 89 [IQR, 77-100]; P = .54), and motor scores (mixed lipid: median, 94 [IQR, 82-103], soybean oil: median, 94 [IQR, 85-103]; P = .53). CONCLUSIONS Parenteral nutrition using a mixed lipid emulsion containing fish oil did not improve neurodevelopment of extremely low birth weight infants at 12 and 24 months corrected age. TRIAL REGISTRATION ClinicalTrials.gov: NCT01585935.
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Affiliation(s)
- Margarita Thanhaeuser
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Medical University of Vienna, Austria
| | - Renate Fuiko
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Medical University of Vienna, Austria
| | - Christiane Oberleitner-Leeb
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Medical University of Vienna, Austria
| | - Sophia Brandstaetter
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Medical University of Vienna, Austria
| | - Christoph Binder
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Medical University of Vienna, Austria
| | - Alexandra Thajer
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Medical University of Vienna, Austria
| | - Mercedes Huber-Dangl
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Medical University of Vienna, Austria
| | - Nadja Haiden
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
| | - Eleonore Pablik
- Section for Medical Statistics, CeMSIIS, Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Medical University of Vienna, Austria
| | - Andreas Repa
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Medical University of Vienna, Vienna, Austria.
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Abstract
Children born preterm (PT) have a higher risk of language delays than children born full-term (FT). Expressive vocabulary plays a central role in language development, as later grammar ability can be predicted from earlier vocabulary size.To determine the effects of preterm birth on expressive vocabulary at the age of 36 to 41 months.Cross-sectional study of 27 PT (children with a gestational age of ≤ 32 + 0 weeks and/or a birth weight ≤ 1500 g) and 26 FT children (from several kindergartens in Vienna, Austria). The groups were matched regarding age, sex, and monolingual Austrian German speech. They were all examined using the active vocabulary test (AWST-R) and the development test, Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III).The AWST-R revealed significantly lower scores (46% vs 52%, P = .027) for PT children. The Bayley-III revealed significantly lower scores in language development (mean 96.3 ± 11.81 vs 105.1 ± 6.24, P = .002) and the expressive communication subscale (8.78 ± 2.01 vs 10.69 ± 1.49, P < .001) for PT children, but no differences in cognitive development (98.5 ± 11.08 vs 100.8 ± 6.43, P = .369) or on the receptive communication subscale (10.15 ± 2.23 vs 11.08 ± 1.09, P = .060).Preterm children tested had less expressive vocabulary (AWST-R and Bayley-III) than those born full-term, while test results in their cognitive development and receptive communication (Bayley-III) did not differ.
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Affiliation(s)
- Nina Brósch-Fohraheim
- Department of Paediatrics and Adolescent Medicine, Wilhelminenspital Vienna
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz
| | - Renate Fuiko
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna
| | - Peter B. Marschik
- iDN – interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz
- Department of Child and Adolescent Psychiatry and Psychotherapy, iDN – interdisciplinary Developmental Neuroscience, University Medical Center of Goettingen, Goettingen, Germany
- Center of Neurodevelopmental Disorders (KIND), Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Bernhard Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
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22
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Fuiko R, Oberleitner-Leeb C, Klebermass-Schrehof K, Berger A, Brandstetter S, Giordano V. The Impact of Norms on the Outcome of Children Born Very-Preterm when Using the Bayley-III: Differences between US and German Norms. Neonatology 2019; 116:29-36. [PMID: 30889586 DOI: 10.1159/000497138] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 07/14/2018] [Accepted: 11/28/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Bayley Scales of Infant and Toddler Development, third edition (Bayley-III) are widely used to assess the development of children born preterm. However, it is still unclear whether US norms are adequate for use in other populations. In 2014, the German version of the Bayley-III with German norms was published. OBJECTIVES We aimed to compare the performance of very-preterm infants at one, two, and three years of age using the German versus US norms of the Bayley-III. METHODS All children born prior to 32 weeks of gestational age during 2012 and 2015 and taking part in the follow-up program of the Medical University of Vienna were assessed and scored according to both German and US norms by two expert clinical psychologists at the age of one, two, and three years of age. RESULTS In total, 843 tests were obtained from 450 children. When looking at scaled scores for cognitive, language, and motor outcomes, preterm children achieved significantly lower scores in nearly all subtests with the German as compared to the US norms. In addition, the proportion of impaired children scoring < 1 standard deviation (SD) and < 2 SD below the norm was significantly higher in nearly all subtests when using the German compared to the US norms (p < 0.05). CONCLUSIONS Applying German and US norms of the Bayley-III leads to different outcomes in very-preterm children, and these differences are statistically significant and clinically relevant. Thus, comparisons of outcomes of very-preterm children using culturally specific norms are problematic, and these findings have to be considered.
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Affiliation(s)
- Renate Fuiko
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria,
| | - Christiane Oberleitner-Leeb
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Katrin Klebermass-Schrehof
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Angelika Berger
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Sophia Brandstetter
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Vito Giordano
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
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Ruiz N, Piskernik B, Witting A, Fuiko R, Ahnert L. Parent-child attachment in children born preterm and at term: A multigroup analysis. PLoS One 2018; 13:e0202972. [PMID: 30161170 PMCID: PMC6116993 DOI: 10.1371/journal.pone.0202972] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 08/13/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE While ample research exists about mother-child attachment, so far little focus has been on specifics of father-child attachment. Even less research is available on the nature of the father-child relationship for children born preterm. The objective of this study was to determine whether children born preterm (23 to 37 weeks gestation) differ in their attachment to their fathers and mothers from their term peers (> 37 weeks gestation), and whether specific child characteristics, such as gender, twin status, and developmental status, have an influence on the parent-child relationship. METHODS The sample consisted of 290 children (n = 140 girls, 48.28%), 190 born before term (including 45 twin pairs) between 12 and 36 months of age (M = 19.5, SD = 5.7) and 100 term children of the same age (M = 18.8, SD = 6.1) with their 245 fathers and mothers. Attachment of the children with their mothers and fathers was assessed using the Attachment Q-sort during two home visits. Children's developmental status was measured with the Bayley Scales of Infant and Toddler Development. RESULTS Within a multigroup analysis of parents with children born preterm and at term more secure attachment was found for both parents in the term sample than in the preterm group. Correlates of attachment specific to fathers of children born preterm accumulated to an explained variance of R2 = .82. For those fathers, less education as well as lower development scores and male gender of the child were associated with lower attachment scores. In the three other parent-child constellations the explained variance did not exceed 20%. Child development proved to be a significant predictor for father-child attachment regardless of the child's birth status. Male gender was associated with lower attachment scores for children born preterm with either parent. CONCLUSION The findings highlight the importance of including fathers in research and clinical practice and informing them about preterm birth, possible problems, and developmental consequences as well. Health professionals should be advised to create interventions focusing on both parents to enhance the quality of attachment in parent-child dyads in children born preterm.
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Affiliation(s)
- Nina Ruiz
- Department of Applied Psychology: Health, Development, Enhancement and Intervention, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Bernhard Piskernik
- Department of Applied Psychology: Health, Development, Enhancement and Intervention, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Andrea Witting
- Department of Applied Psychology: Health, Development, Enhancement and Intervention, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Renate Fuiko
- University Children´s Hospital Vienna, Vienna, Austria
| | - Lieselotte Ahnert
- Department of Applied Psychology: Health, Development, Enhancement and Intervention, Faculty of Psychology, University of Vienna, Vienna, Austria
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Dür M, Brückner V, Oberleitner-Leeb C, Fuiko R, Matter B, Berger A. Clinical relevance of activities meaningful to parents of preterm infants with very low birth weight: A focus group study. PLoS One 2018; 13:e0202189. [PMID: 30153266 PMCID: PMC6112625 DOI: 10.1371/journal.pone.0202189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 03/09/2018] [Accepted: 07/30/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction Parents have a major impact on the outcome of health care of preterm infants. Parents’ engagement in meaningful activities could have an impact on their own health and wellbeing and therefore be relevant in neonatal intensive care. The aim of this study was to explore meaningful activities of parents of very low birth weight (VLBW) preterm infants with the purpose to further the understanding of their clinical relevance and to foster their consideration in clinical practice and research of neonatal intensive care. Methods A total of 36 parents of preterm infants born prior to complete 37 weeks of gestation with VLBW (≤1.500 grams) were asked to participate in a focus group interview. Interview transcripts were used to analyse the content of the focus group interviews using meaning condensation method by Steinar Kvale. Results Thirty-six parents participated in a total of twelve focus groups. Parents reported that the meaning of certain activities changed due to preterm birth. Meaningful activities, like bathing the baby and gardening, could foster a transition from a feeling of parental immaturity to a feeling of maturity, following health care instructions to possessing health care skills, and a functioning-only state to a balance of activities. Conclusions In neonatal intensive care, nurses contribute to delivering parental education and thereby facilitate experiences of being a mature parent and of possessing health care skills. Occupational therapy could be used to help re-engage in meaningful activities and maintain a balance of activities in parents of VLBW preterm infants.
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Affiliation(s)
- Mona Dür
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Austria
- Department of Health Sciences, Master Degree Programme of Applied Health Sciences and Bachelor Degree Programme of Occupational Therapy, IMC University of Applied Sciences Krems, Austria
- * E-mail: ,
| | - Victoria Brückner
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Austria
| | - Christiane Oberleitner-Leeb
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Austria
| | - Renate Fuiko
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Austria
| | - Barbara Matter
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Wilhelminenspital, Vienna, Austria
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Austria
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25
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Giordano V, Deindl P, Fuiko R, Unterasinger L, Waldhoer T, Cardona F, Berger A, Olischar M. Effect of increased opiate exposure on three years neurodevelopmental outcome in extremely preterm infants. Early Hum Dev 2018; 123:1-5. [PMID: 29935388 DOI: 10.1016/j.earlhumdev.2018.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 03/29/2018] [Revised: 06/07/2018] [Accepted: 06/12/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND International guidelines recommend the use of item based scales for the assessment of pain and sedation. In our previous study, the implementation of the Neonatal Pain Agitation and Sedation Scale (N-PASS), and the associated systematic assessment and treatment of pain and sedation reduced pain and over-sedation in our intervention group, but lead to a significant increase of individual opiate exposure. This increased opiate exposure was not associated with impaired motor and mental development at one year of age. As one-year follow-up is not necessarily representative for future outcomes, we retested our sample at three years of age. METHODS Fifty-three patients after (intervention group) and 61 before implementation (control group) of the N-PASS and the Vienna Protocol for the Management of Neonatal Pain and Sedation (VPNPS), were compared for motor, mental and behavioural development at three-years follow-up using the Bayley Scales of Infant Development. RESULTS Cumulative opiate exposure was not associated with mental (p = .31) and motor (p = .20) problems when controlling for other important medical conditions, but was associated to lower behavioural scores (p = .007). No statistically significant differences were found with regard to mental (p = .65), psychomotor (p = .12) and behavioural (p = .61) development before and after the implementation of the N-PASS and the VPNPS. CONCLUSION Implementing a neonatal pain and sedation protocol increased opiate exposure without affecting neurodevelopmental outcome at three-years of age.
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Affiliation(s)
- V Giordano
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Austria.
| | - P Deindl
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg Eppendorf, Germany
| | - R Fuiko
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Austria
| | - L Unterasinger
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Austria
| | - T Waldhoer
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Austria
| | - F Cardona
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Austria
| | - A Berger
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Austria
| | - M Olischar
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Austria
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Giordano V, Fuiko R, Leiss U, Brandstetter S, Hayde M, Bartha-Doering E, Klebermaß-Schrehof K, Weiler LJ. Differences in attentional functioning between preterm and full-term children underline the importance of new neuropsychological detection techniques. Acta Paediatr 2017; 106:601-611. [PMID: 28004417 DOI: 10.1111/apa.13723] [Citation(s) in RCA: 9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/04/2016] [Accepted: 12/19/2016] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to investigate specific attentional components in preterm born children who had not yet started school. METHODS Between January and December 2011, we assessed 52 preterm and 52 full-term children aged between five years five months and six years two months, of comparable age and gender, at the Medical University of Vienna. Different attentional components were evaluated through selected subtests of the Test of Attentional Performance and the German version of the Wechsler Intelligence Scale for Children. Each child's behaviour was also evaluated using parental ratings and descriptive item-based evaluation during neuropsychological assessment. RESULTS Children born preterm showed poor attentional performance in sustained attention, focused attention and distractibility, as well as reductions in processing speed in divided attention and flexibility tasks. Children born preterm also showed decreased volitional attention compared with automatic attention. No problems were detected in alertness or inhibition. In addition, a higher rate of aborted tests, decreased motivation and poorer parental ratings were detected among the preterm population compared with full-term born children. CONCLUSION Our results highlighted differences in attentional functioning between preterm and full-term children, indicating the importance of new neuropsychological techniques for the detection of specific attentional disorders.
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Affiliation(s)
- V Giordano
- Department of General Pediatrics and Adolescent Medicine; Division of Neonatology; Pediatric Intensive Care and Neuropediatrics; Medical University of Vienna; Vienna Austria
- Neonatal Follow-up Clinic; Medical University of Vienna; Vienna Austria
| | - R Fuiko
- Neonatal Follow-up Clinic; Medical University of Vienna; Vienna Austria
| | - U Leiss
- Department of General Pediatrics and Adolescent Medicine; Division of Neuro-Oncology; Medical University of Vienna; Vienna Austria
| | - S Brandstetter
- Neonatal Follow-up Clinic; Medical University of Vienna; Vienna Austria
| | - M Hayde
- Department of General Pediatrics and Adolescent Medicine; Division of Neonatology; Pediatric Intensive Care and Neuropediatrics; Medical University of Vienna; Vienna Austria
| | - E Bartha-Doering
- Department of General Pediatrics and Adolescent Medicine; Division of Neonatology; Pediatric Intensive Care and Neuropediatrics; Medical University of Vienna; Vienna Austria
| | - K Klebermaß-Schrehof
- Department of General Pediatrics and Adolescent Medicine; Division of Neonatology; Pediatric Intensive Care and Neuropediatrics; Medical University of Vienna; Vienna Austria
- Neonatal Follow-up Clinic; Medical University of Vienna; Vienna Austria
| | - LJ Weiler
- Department of General Pediatrics and Adolescent Medicine; Division of Neonatology; Pediatric Intensive Care and Neuropediatrics; Medical University of Vienna; Vienna Austria
- Department of General Pediatrics and Adolescent Medicine; Division of Neuro-Oncology; Medical University of Vienna; Vienna Austria
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Deindl P, Giordano V, Fuiko R, Waldhoer T, Unterasinger L, Berger A, Olischar M. The implementation of systematic pain and sedation management has no impact on outcome in extremely preterm infants. Acta Paediatr 2016; 105:798-805. [PMID: 26792117 DOI: 10.1111/apa.13334] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 08/06/2015] [Revised: 10/30/2015] [Accepted: 01/14/2016] [Indexed: 11/28/2022]
Abstract
AIM This study compared the short-term and neurodevelopmental outcomes of extremely preterm infants before and after the implementation of a protocol to manage neonatal pain and sedation. METHODS Our study cohort comprised 140 extremely preterm infants from two neonatal intensive care units. We retrospectively analysed opiate exposure, time on mechanical ventilation, inotropic support, nutritional aspects and growth 12 months before (controls) vs 12 months after (intervention) the implementation of the Vienna Protocol for Neonatal Pain and Sedation. Infants were evaluated at the corrected age of 12 months using the Bayley Scales of Infant Development - Second Edition. RESULTS After the protocol was implemented, the cumulative opiate dose increased from a baseline of 15 mg/kg ± 41 to 89 mg/kg ± 228 morphine equivalents. Time on mechanical ventilation, inotropic support, length of parenteral nutrition, growth, length of stay and in-hospital morbidity were similar before and after the implementation, with no differences between the groups in mental, motor and behavioural development at the one-year follow-up. However, opiate exposure was a possible risk factor for lower behaviour rating scores (estimate = -0.04; p = 0.006). [Correction added on 23 February 2016, after online publication: In the preceding sentences, the cumulative opiate dose as well as the estimate value for the behavioral rating scale were previously incorrect and have been amended in this current version.] CONCLUSION Implementing a neonatal pain and sedation protocol increased opiate exposure, but had no effect on the in-hospital and neurodevelopmental outcomes of extremely preterm infants.
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Affiliation(s)
- Philipp Deindl
- Department of Neonatology and Pediatric Intensive Care Medicine; University Children's Hospital; University Medical Center Hamburg Eppendorf; Hamburg Eppendorf Germany
- Department of Pediatrics and Adolescent Medicine; Division of Neonatology; Pediatric Intensive Care and Neuropediatrics; Medical University of Vienna; Vienna Austria
| | - Vito Giordano
- Department of Pediatrics and Adolescent Medicine; Division of Neonatology; Pediatric Intensive Care and Neuropediatrics; Medical University of Vienna; Vienna Austria
| | - Renate Fuiko
- Department of Pediatrics and Adolescent Medicine; Division of Neonatology; Pediatric Intensive Care and Neuropediatrics; Medical University of Vienna; Vienna Austria
| | - Thomas Waldhoer
- Department of Epidemiology; Center for Public Health; Medical University of Vienna; Vienna Austria
| | - Lukas Unterasinger
- Department of Pediatrics and Adolescent Medicine; Division of Neonatology; Pediatric Intensive Care and Neuropediatrics; Medical University of Vienna; Vienna Austria
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine; Division of Neonatology; Pediatric Intensive Care and Neuropediatrics; Medical University of Vienna; Vienna Austria
| | - Monika Olischar
- Department of Pediatrics and Adolescent Medicine; Division of Neonatology; Pediatric Intensive Care and Neuropediatrics; Medical University of Vienna; Vienna Austria
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Schwindt E, Thaller C, Czaba-Hnizdo C, Giordano V, Olischar M, Waldhoer T, Fuiko R, Berger A, Weninger M, Klebermass-Schrehof K. Being Born Small for Gestational Age Influences Amplitude-Integrated Electroencephalography and Later Outcome in Preterm Infants. Neonatology 2015; 108:81-7. [PMID: 26044362 DOI: 10.1159/000382013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 03/31/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The impact of growth restriction on perinatal morbidity is well known, but electroencephalographic (EEG) data on its influence are still scarce. OBJECTIVES We aimed to analyze the influence of being born small for gestational age (SGA; defined as a birth weight <10th percentile) on the amplitude-integrated EEG (aEEG) score in the first 2 weeks of life in preterm infants born before 30 weeks of gestation, and its impact on later outcome. METHODS aEEG data obtained within the first 2 weeks of life on preterm infants born SGA and before 30 weeks of gestational age (GA) were analyzed retrospectively using a combined score [including background activity, occurrence of sleep-wake cycles (SWC) and suspected seizure activity]. Neurodevelopmental outcome was evaluated at 24 months by means of the Bayley Scales of Infant Development II and a standardized neurological examination. RESULTS One hundred and thirty-six patients were included (47 SGA and 89 controls). Infants with SGA had abnormal aEEG scores significantly more often (57 vs. 24%, p = 0.002) than infants born appropriate for gestational age (AGA). They also displayed SWC less frequently (65 vs. 96%, p = 0.001), were more likely to develop seizure activity (15 vs. 4%, p = 0.013) and had a normal neurodevelopmental outcome at the age of 2 years less frequently (36.2 vs. 59.6%, p = 0.02). CONCLUSION Preterm infants born SGA and before 30 weeks of GA had less optimal scores on early aEEG and a poorer neurodevelopmental outcome at 24 months than the AGA controls.
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Affiliation(s)
- Eva Schwindt
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
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Winkelbauer A, Fuiko R, Krampe J, Winkler S. Crucial elements and technical implementation of intelligent monitoring networks. Water Sci Technol 2014; 70:1926-1933. [PMID: 25521126 DOI: 10.2166/wst.2014.415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Growing complexity of water monitoring instrumentation leads to specialized solutions in respect to sensor integration across several measurement device suppliers. Despite efforts of standardization for data interfaces and protocols, problems regarding the combination of several devices to gain the complete picture in terms of water quality remain. This assessment, especially accomplished from the perspective of a catchment area, requires a transition from sole use of data collectors toward an implementation of intelligent measurement networks. Several challenges and bottlenecks concerning distributed data collection are discussed starting with data acquisition up to the user-scope of utilizing data processing software. Finally, experiences using automated data inspection and export tools are discussed and a brief overview of expectable long-term data availability is given.
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Affiliation(s)
- A Winkelbauer
- Institute for Water Quality, Resources and Waste Management, Vienna University of Technology, Karlsplatz 13/E226-1, 1040 Vienna, Austria E-mail:
| | - R Fuiko
- Institute for Water Quality, Resources and Waste Management, Vienna University of Technology, Karlsplatz 13/E226-1, 1040 Vienna, Austria E-mail:
| | - J Krampe
- Institute for Water Quality, Resources and Waste Management, Vienna University of Technology, Karlsplatz 13/E226-1, 1040 Vienna, Austria E-mail:
| | - S Winkler
- HACH LANGE GMBH, Hütteldorfer Straße 299/Top 6, A-1140 Wien, Austria
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Olischar M, Waldhör T, Berger A, Fuiko R, Weninger M, Klebermass-Schrehof K. Amplitude-integrated electroencephalography in male newborns <30 weeks' of gestation and unfavourable neurodevelopmental outcome at three years is less mature when compared to females. Acta Paediatr 2013; 102:e443-8. [PMID: 23808674 DOI: 10.1111/apa.12334] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 05/10/2013] [Revised: 06/12/2013] [Accepted: 06/25/2013] [Indexed: 11/26/2022]
Abstract
AIM To investigate gender-related differences in amplitude-integrated electroencephalography (aEEG) associated with neurodevelopmental outcome at 3 years. METHODS Preterms born <30 weeks' gestational age between 2000 and 2002 were prospectively included. aEEGs obtained within the first 2 weeks of life were classified according to aEEG composite scores - including background pattern, sleep-wake cycling (SWC) and seizure activity. Neurodevelopmental outcome was assessed at 3 years of age. RESULTS Neurodevelopmental outcome data was available for 148 of 264 eligible infants - 64 showed a normal outcome and 84 an impaired outcome. A logistic regression model revealed a significant independent influence of IVH, analgetic/sedative/anticonvulsant medication, gestational age and gender on aEEG composite scores. Odds ratios for having an abnormal aEEG composite score within the first 2 weeks of life for 'female sex', 'no IVH', 'no medication' and 'gestational age' were calculated. aEEG did not differ between males and females with normal outcomes. In patients with abnormal outcome, however, male preterms showed more burst-suppression patterns and less SWC when compared with female preterms. CONCLUSION Being male with an abnormal outcome at 3 years of age is reflected by a less mature early aEEG when compared with the one of females. This association is independent of IVH and medication and was less evident with increasing gestational age.
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Affiliation(s)
- Monika Olischar
- Division of Neonatology; Pediatric Intensive Care and Neuropediatrics; Department of Pediatrics and Adolescent Medicine; Medical University of Vienna; Vienna; Austria
| | - Thomas Waldhör
- Department of Epidemiology; Center of Public Health; Medical University of Vienna; Vienna; Austria
| | - Angelika Berger
- Division of Neonatology; Pediatric Intensive Care and Neuropediatrics; Department of Pediatrics and Adolescent Medicine; Medical University of Vienna; Vienna; Austria
| | - Renate Fuiko
- Division of Neonatology; Pediatric Intensive Care and Neuropediatrics; Department of Pediatrics and Adolescent Medicine; Medical University of Vienna; Vienna; Austria
| | - Manfred Weninger
- Division of Neonatology; Pediatric Intensive Care and Neuropediatrics; Department of Pediatrics and Adolescent Medicine; Medical University of Vienna; Vienna; Austria
| | - Katrin Klebermass-Schrehof
- Division of Neonatology; Pediatric Intensive Care and Neuropediatrics; Department of Pediatrics and Adolescent Medicine; Medical University of Vienna; Vienna; Austria
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Klebermass-Schrehof K, Wald M, Schwindt J, Grill A, Prusa AR, Haiden N, Hayde M, Waldhoer T, Fuiko R, Berger A. Less invasive surfactant administration in extremely preterm infants: impact on mortality and morbidity. Neonatology 2013; 103:252-8. [PMID: 23446061 DOI: 10.1159/000346521] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [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] [Received: 07/05/2012] [Accepted: 12/17/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND A new mode of surfactant administration without intubation - less invasive surfactant administration (LISA) - has recently been described for premature infants. OBJECTIVE We report single-center outcome data of extremely premature infants who have been managed by LISA in our department. Mortality and morbidity rates of the cohort were compared to historical controls from our own center and to data of the Vermont-Oxford Neonatal Network (VONN). PATIENTS AND METHODS All infants born at 23-27 weeks' gestational age during 01/2009 and 06/2011 (n = 224) were managed by LISA and included in the study group. RESULTS LISA was tolerated by 94% of all infants. 68% of infants stayed on continuous positive airway pressure on day 3. The rate of mechanical ventilation was 35% within the first week and 59% during the entire hospital stay. Compared to historical controls, we found significantly higher survival rates (75.8 vs. 64.1%) and significantly less intraventricular hemorrhage (IVH) (28.1 vs. 45.9%), severe IVH (13.1 vs. 23.9%) and cystic periventricular leukomalacia (1.2 vs. 5.6%); only persistent ductus arteriousus (PDA) (74.7 vs. 52.6%) and retinopathy of prematurity (ROP) (40.5 vs. 21.1%) occurred significantly more often. Compared to VONN data, we found significantly less chronic lung disease (20.6 vs. 46.4%), severe cerebral lesions (IVH 3/4 + cystic PVL; 9.4 vs. 16.1%) and ROP (all grades) (40.5 vs. 56.5%); only PDA (74.7 vs. 63.1%) and severe ROP (> grade 2) (24.1 vs. 14.1%) occurred significantly more often in our cohort. CONCLUSION Surfactant can be effectively and safely delivered via LISA and this is associated with low rates of mechanical ventilation and various adverse outcomes in extremely premature infants.
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Affiliation(s)
- Katrin Klebermass-Schrehof
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
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Ghods E, Kreissl A, Brandstetter S, Fuiko R, Widhalm K. Head circumference catch-up growth among preterm very low birth weight infants: effect on neurodevelopmental outcome. J Perinat Med 2011; 39:579-86. [PMID: 21740330 DOI: 10.1515/jpm.2011.049] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS The purpose of this study was to determine whether head circumference (HC) catch-up is associated with improved neurocognitive development. DESIGN A retrospective cohort study was conducted in 179 preterm very low birth weight (VLBW) (BW≤1500 g) infants. The infants were born in 2000-2002 and were followed to the age of 5.5 years. The association between HC catch-up and neurodevelopmental outcome was assessed and perinatal risk factors, infant characteristics and nutritional practices associated with HC catch-up were determined. RESULTS HC catch-up occurred in 59 (34%) infants and was positively correlated with neurodevelopmental outcome. The likelihood of HC catch-up increased with increasing birth weight and gestational age. HC catch-up occurred more often with breast milk feeding during hospitalization and with supplemental formula feeding at discharge, but decreased in prevalence with longer duration of breastfeeding after discharge. HC catch-up was more likely to occur in first-born infants and in families with high socioeconomic status. Most HC catch-up occurred between birth and three months corrected age. CONCLUSION Among preterm-VLBW infants, there is a close relation between HC growth and neurodevelopmental outcome. Efforts to improve neurocognitive outcomes should focus on factors associated with HC catch-up.
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Affiliation(s)
- Elaheh Ghods
- Division of Pediatric Nutrition and Prevention, Department of Pediatrics, Medical University of Vienna, Austria.
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Abstract
Changes in EEG background activity are powerful but nonspecific markers of brain dysfunction. Early EEG and amplitude-integrated EEG (aEEG) pattern predict further neurodevelopmental outcome in term infants; however, sufficient data for prognostic value of aEEG in preterm infants are not available so far. The aim of the study was to evaluate whether aEEG predicts further outcome and to compare it to cerebral ultrasound assessment. In 143 preterm infants, aEEG within the first 2 wk of life and outcome data at 3 y of age (Bayley Scales) could be obtained.aEEG was classified into a graded score according to background activity, appearance of sleep-wake cycling, and occurrence of seizure activity. In preterm infants, aEEG was significantly associated with further outcome. Specificity was 73% for assessment within the first and increased to 95% in the second week of life, whereas sensitivity stayed nearly the same 87% (first week) to 83% (second week). Cerebral ultrasound showed a specificity of 86% within the first and second week, sensitivity also stayed nearly the same (74 and 75%). aEEG has a predictive value for later outcome in preterm infants and can be used as an early prognostic tool.
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Affiliation(s)
- Katrin Klebermass
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna A-1090, Austria.
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Berger A, Witt A, Haiden N, Kaider A, Klebermasz K, Fuiko R, Langgartner M, Pollak A. Intrauterine infection with Ureaplasma species is associated with adverse neuromotor outcome at 1 and 2 years adjusted age in preterm infants. J Perinat Med 2009; 37:72-8. [PMID: 18976044 DOI: 10.1515/jpm.2009.016] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [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: 11/15/2022]
Abstract
AIMS To evaluate the association between the presence of bacterial pathogens in the amniotic cavity at the time of preterm delivery and neuromotor outcome at two years adjusted age in preterm infants born at < or =33 weeks' gestation. METHODS The cohort included 114 preterm infants, born at 23-33 weeks' gestation to mothers with amniotic cavity cultures taken during cesarean delivery who were subsequently evaluated at 24.0+/-1.1 months corrected age with the Bayley Scales of Infant Development II and a standardized neurologic examination. RESULTS A group of 67 infants with negative amniotic cavity cultures was compared to 47 infants with positive amniotic cavity cultures (Ureaplasma urealyticum (Uu) in 32 cases and other bacteria in 15 cases). Patients with positive amniotic cavity cultures had a significantly higher risk for an adverse psychomotor development index (PDI) score (OR 3.1, CI 1.3-7.1), an abnormal neurologic outcome (OR 4.8, CI 1.7-13.8), and a higher probability for diagnosis of cerebral palsy (OR 4.8, CI 1.4-16.4) at two years compared to patients with negative culture results. Isolation of Uu at birth was associated with a particular adverse outcome of preterm infants. CONCLUSIONS Isolation of pathogens from the amniotic cavity at birth is significantly associated with abnormal PDI and adverse neuromotor outcome in preterm infants, irrespective of gestational age and birthweight.
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Affiliation(s)
- Angelika Berger
- Department of Pediatrics, Medical University Vienna, Austria.
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Pollak A, Fuiko R. Extreme Frühgeburten – Überleben und Leben an der Grenze der Machbarkeit. Wien Klin Wochenschr 2005; 117:305-7. [PMID: 15989106 DOI: 10.1007/s00508-005-0351-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fuiko R, Kotten B, Zettl R, Ritschl P. Antastgenauigkeit von Orientierungspunkten bei navigierter Implantation von Knieendoprothesen. Der Orthop�de 2004; 33:338-43. [PMID: 15007558 DOI: 10.1007/s00132-003-0570-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIMS Cinematic and pointing procedures are used for non-image based navigated implantation during total knee replacement. Pointing procedures require an exact knowledge of the landmarks. In this anatomical study, landmarks are defined and repeatedly referenced. Precision and reproducibility are evaluated by means of an inter- and an intra-observer study. The axes of the femur and tibia are calculated using the landmarks. MATERIAL AND METHODS The specific landmarks of 30 femurs and 27 tibias were palpated by three surgeons and digitised by means of a photogrammetric system, as used intra-operatively. The recorded data were statistically evaluated. RESULTS The specific landmarks can be referenced with great precision. The vectors that influence the implant position show a mean femoral deviation of 0.9 mm and a mean tibial deviation of 1.0 mm. The repeating accuracy of every observer was 1.5 mm femoral and 1.0 mm tibial. The calculated long axes at the femur and tibia thus reach a precision of 0.1 degrees (min.-max.: 0-0.9 degrees) at the femur and 0.2 degrees (.0-1.1 degrees) at the tibia. The short axes at the distal femur and proximal tibia exhibit an average deviation of from 0.7 degrees to 1.9 degrees (0-11.3 degrees). CONCLUSION Long axes (mechanical axes) can be determined exactly but the precision of the short axes (rotational axes) is unsatisfactory, although palpation of landmarks was accurate. Therefore, palpation of more than one rotational axis at the femur and tibia is mandatory and should be visualized on the monitor during surgery.
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Affiliation(s)
- R Fuiko
- Orthopädisches Spital Gersthof, Vienna, Austria.
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Panagl A, Kohlhauser C, Fuiko R, Pollak A. Belastungen von Eltern auf neonatologischen Intensivstationen - Selbsteinschätzung versus Fremdeinschätzung. Geburtshilfe Frauenheilkd 2002. [DOI: 10.1055/s-2002-29107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Wurst E, Herle M, Fuiko R, Hajszan M, Katkhouda C, Kieboom A, Schubert MT. [The quality of life of chronically ill and psychiatrically disturbed children. Initial experiences with an inventory for assessing quality of life in children and adolescents]. Z Kinder Jugendpsychiatr Psychother 2002; 30:21-8. [PMID: 11876078 DOI: 10.1024/1422-4917.30.1.21] [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: 02/24/2023]
Abstract
OBJECTIVES The assessment of the quality of life in chronically ill children as well as in children with emotional and behavioural problems. METHODS A series of questionnaires (Inventar zur Erfassung der Lebensqualität bei Kindern und Jugendlichen, ILK, Mattejat et al.) were administered to 360 patients and 288 mothers at the Vienna University Children's Hospital. RESULTS The results clearly show that patients with diabetes rate themselves as the most emotionally burdened and impaired in nearly all aspects of life: a picture which is confirmed by their mothers. Children and adolescents with psychological problems judge the initial problem as well as their social environment as significantly more burdensome. The respective mothers of these psychologically ill children feel that their impairments are greater in more aspects of life than do mothers of children who are chronically ill. The children generally pinpoint most of their difficulties in the areas "ability to occupy myself" and "psychological health". Among adolescents the most negative ratings occur in the areas "school", "psychological health", and "initial problem". CONCLUSIONS The child's problems seem to weigh heavily upon the mothers. Interventions aimed at adolescents and mothers should be based on problem solving: supportive and anxiety-reducing approaches seem best suited for chronically ill children. Children with psychological problems primarily need problem-centred and practical support.
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Affiliation(s)
- E Wurst
- Univ. Klinik für Kinder und Jugendheilkunde, Wien
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Wurst E, Fuiko R, Hajszan M, Katkhouda C, Kieboom A, Schubert M, Herle M. Zur Lebensqualität chronisch kranker und psychisch auffälliger Kinder. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie 2002. [DOI: 10.1024//1422-4917.30.1.21] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung: Fragestellung: Erhebung der Lebensqualität chronisch kranker bzw. psychisch beeinträchtigter Kinder, Jugendlicher und ihrer Mütter. Methode: Das Inventar zur Erfassung der Lebensqualität bei Kindern und Jugendlichen (ILK) von Mattejat et al. wurde 360 Patienten der Universitätsklinik für Kinder- und Jugendheilkunde Wien und 288 Müttern vorgegeben. Ergebnisse: Aus den Ergebnissen geht hervor, dass - sich unter den chronisch kranken Kindern/Jugendlichen die diabetischen Patienten in nahezu allen Lebensbereichen als am meisten belastet beurteilen. Ein ähnliches Bild ergibt sich in der Stichprobe der Mütter. - Kinder und Jugendliche mit psychischen Auffälligkeiten signifikant erhöhte Beeinträchtigungen den Vorstellungsgrund und ihre sozialen Kontakte betreffend angeben. Ihre Mütter führen in mehreren Lebensbereichen stärkere Beeinträchtigungen der Lebensqualität des Kindes an als Mütter chronisch kranker Kinder. - dass Kinder in den Bereichen «Fähigkeit, sich allein zu beschäftigen» und «psychische Gesundheit» die meisten Probleme sehen. Chronisch kranke Kinder fühlen sich zusätzlich durch die Untersuchung/Behandlung, psychisch auffällige durch das Problem an sich belastet. Jugendliche geben in den Bereichen «Schule», «psychische Gesundheit» und «Problem» die negativsten Bewertungen ab. Mütter erleben sich durch das Problem des Kindes stark belastet. Schlussfolgerungen: Problemverarbeitende Interventionen sollten vorrangig für Jugendliche und Mütter, untersuchungsbegleitende, angstreduzierende Maßnahmen insbesondere für chronisch kranke Kinder vorgesehen sein. Psychisch auffällige Kinder bedürfen problemzentrierter, konkreter Hilfestellungen.
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Affiliation(s)
- E. Wurst
- 1 Univ. Klinik für Kinder und Jugendheilkunde, Wien (Vorstand: Prof. Dr. A. Pollak)
| | - R. Fuiko
- 1 Univ. Klinik für Kinder und Jugendheilkunde, Wien (Vorstand: Prof. Dr. A. Pollak)
| | - M. Hajszan
- 1 Univ. Klinik für Kinder und Jugendheilkunde, Wien (Vorstand: Prof. Dr. A. Pollak)
| | - C. Katkhouda
- 1 Univ. Klinik für Kinder und Jugendheilkunde, Wien (Vorstand: Prof. Dr. A. Pollak)
| | - A. Kieboom
- 1 Univ. Klinik für Kinder und Jugendheilkunde, Wien (Vorstand: Prof. Dr. A. Pollak)
| | - M.T. Schubert
- 1 Univ. Klinik für Kinder und Jugendheilkunde, Wien (Vorstand: Prof. Dr. A. Pollak)
| | - M. Herle
- 2 Psychologisches Institut der Universität Wien
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Kohlhauser C, Fuiko R, Brandstetter S, Panagl A, Katkhouda C, Haiden N, Pollak A. Der Einfluss prä-, peri- und neonataler Risikofaktoren auf die Entwicklung von Very-Low-Birth-Weight-Kindern im ersten Lebensjahr. Geburtshilfe Frauenheilkd 2001. [DOI: 10.1055/s-2001-17392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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41
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Kohlhauser C, Fuiko R, Panagl A, Zadra C, Haschke N, Brandstetter S, Weninger M, Pollak A. Outcome of very-low-birth-weight infants at 1 and 2 years of age. The importance of early identification of neurodevelopmental deficits. Clin Pediatr (Phila) 2000; 39:441-9; discussion 451-2. [PMID: 10961816 DOI: 10.1177/000992280003900801] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [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: 11/15/2022]
Abstract
The developmental and neurologic outcome of very-low-birth-weight infants (n=76) at 1 and 2 years, corrected for postconceptional age, and variables predicting outcome were assessed. At 1 year 24% of tile children were neurologically normal and at 2 years 61%. Developmental status was evaluated by use of the Griffiths Developmental Scales. The rate of cognitively normal children remained constant (58% at 1 year and 59% at 2 years) indicating that developmental status at 1 year was predictive for the second year. This early period is important, therefore, for the identification of developmental deficits and for establishing early, adequate interventions.
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Affiliation(s)
- C Kohlhauser
- Department of Neonatology, University Children's Hospital, Vienna, Austria
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Pillwein K, Fuiko R, Slavc I, Czech T, Hawliczek G, Bernhardt G, Nirnberger G, Köller U. Hyaluronidase additional to standard chemotherapy improves outcome for children with malignant brain tumors. Cancer Lett 1998; 131:101-8. [PMID: 9839624 DOI: 10.1016/s0304-3835(98)00205-5] [Citation(s) in RCA: 30] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Ex vivo experiments with vital brain tumor samples show that hyaluronidase enhances the permeation of carboplatin into tumor tissue with a matrix rich in hyaluronic acid. We achieved long-lasting second remissions for children with relapsed malignant brain tumors treated with carboplatin, etoposide and this enzyme. Thereafter, we initiated a pilot study where we added hyaluronidase to the first line standard therapy to prevent the deadly relapses right from the beginning. All 19 patients with malignant brain tumors admitted to our pediatric neurooncological center from 1992 to 1994 were included in the study. Kaplan-Meier estimation of event-free survival and overall survival after 3 years follow-up indicates a significantly better outcome for the hyaluronidase-treated group. The children receiving supportive hyaluronidase suffered significantly less relapses (P = 0.034) and had a significantly better chance for survival (P = 0.045) compared to the historical control of 21 children treated with the same standard regimen but without supportive hyaluronidase (product limit analysis and the log-rank test, P < 0.05). Children aged >3 years receiving hyaluronidase together with primary treatment seemed to gain the most benefit.
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Affiliation(s)
- K Pillwein
- Forschungsgesellschaft für Cerebrale Tumore, c/o Deutsch Ordens Spital, Friesach, Austria
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