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Rösch L, Hofstätter E, Krasnitzer-Leitner F, Wald M. Premature Babies Can Be Cared for in the Maternity Ward without an Increased Risk and Discharged with a Feeding Tube If Necessary. Children (Basel) 2024; 11:456. [PMID: 38671673 PMCID: PMC11049494 DOI: 10.3390/children11040456] [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] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/30/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024]
Abstract
In general, premature babies are discharged home when they reach full self-feeding. We established a discharge management protocol which allows for discharging late preterm babies with a feeding tube if necessary. This retrospective study included 108 preterm infants (34+ weeks) born in 2019 and 2020. The preterm infants discharged with a feeding tube (n = 32) were born at 35.23 weeks' gestation (±0.884), with a birth weight of 2423 g (±375.1), and were discharged at 7.22 days (±3.63) and had a weight of 3466 g (±591.3) at the first outpatient visit around the expected birth date. The preterm infants discharged without a feeding tube were born at 35.97 weeks' gestation (±0.702) with a birth weight of 2589 g (±424.84), discharged home at 6.82 days (±7.11) and a weight of 3784 g (±621.8) at the first outpatient visit. The gestational week and birth weight were statistically significantly different between the groups, with a p-value of <0.001 for each, and the length of hospital stay (p = 0.762) and weight at follow-up (p = 0.064) did not significantly differ. No infant required tube-feeding at the time of the first outpatient visit, i.e., the time of expected birth. Therefore, with well-thought-out management, it is possible and safe to discharge preterm infants home with a feeding tube.
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Affiliation(s)
| | | | | | - Martin Wald
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Paracelsus Medical University, Salzburg 5020, Austria
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Standish KR, Combs G, McMahon M, Slater C, Zani L, Pindar C, Serafin K, Parker MG, Philipp BL. Early Bloomers: A Nursing-Driven Program to Support Human Milk Feeding Among Late Preterm Infants in the Mother-Baby Unit. J Hum Lact 2024; 40:96-100. [PMID: 37994675 DOI: 10.1177/08903344231211513] [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] [Indexed: 11/24/2023]
Abstract
Late preterm infants have lower breastfeeding rates than term infants, yet few published interventions or guidelines exist to guide hospitals in managing them in the non-intensive nursery setting. Here we describe the development and implementation of an interdisciplinary, hospital-based, breastfeeding support program among late preterm infants not requiring intensive care. The Early Bloomer Program includes an order set applied at birth, immediate lactation consultation, availability of donor milk, parent education on late preterm infants, hand expression teaching and kit including spoon and video link, and daily interdisciplinary team huddles. The program was developed with staff input using Diffusion of Innovation Theory, and implemented first among early adopters before expanding to all postpartum nurses. Nursing staff received education on late preterm infant physiology and feeding, and trainings on the Early Bloomers program through various learning modalities during the year leading up to implementation. To further understand the strengths and weakness of the program, we surveyed nurses (n = 43). Nurses reported that they were more attentive to the needs of late preterm infants, more confident in their care, and more aware of possible complications and feeding needs. Areas noted in need of improvement included lack of overnight lactation consults and little involvement of labor and delivery staff in the program. The Early Bloomers program increased confidence in care and was well received by nurses. Well-designed clinical studies are needed to identify effective breastfeeding support practices for late preterm infants.
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Affiliation(s)
- Katherine R Standish
- Department of Family Medicine, Boston University School of Medicine, Boston, MA, USA
| | | | | | | | - Lisa Zani
- Boston Medical Center, Boston, MA, USA
| | - Christina Pindar
- Department of Family Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Karol Serafin
- Boston University School of Medicine, Boston, MA, USA
| | - Margaret G Parker
- Department of Pediatrics, UMass Chan Memorial Medical School, Boston, MA, USA
- Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
| | - Barbara L Philipp
- Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
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Kodidhi A, Riley M, Vesoulis Z. The influence of late prematurity on the encephalopathy exam of infants with neonatal encephalopathy. J Neonatal Perinatal Med 2023; 16:693-700. [PMID: 38073399 PMCID: PMC10753960 DOI: 10.3233/npm-230041] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
BACKGROUND Late preterm (LPT) infants are increasingly treated for hypoxic-ischemic encephalopathy (HIE). However, neurodevelopmental differences of LPT infants may independently influence the neurologic exam and confound care. METHODS Perinatal and outcome characteristics were extracted along with the worst autonomic and state/neuromuscular/reflex Sarnat components in a cross-section of infants with moderate/severe HIE. Infants were classified as late preterm (LPT, 34-36 weeks) or term (>36 weeks). RESULTS 250 infants were identified, 55 were late preterm. LPT infants had lower mean gestational age and birthweight and greater length of stay (LOS). LPT infants had higher median scores for the Moro and respiratory autonomic components, but no difference in total score. CONCLUSIONS LPT infants had increased LOS, worse Moro reflex, and respiratory status, but no clinically or statistically significant differences in total Sarnat scores. Although it is important to note the impact of immaturity on the exam, it is unlikely to independently alter management.
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Affiliation(s)
- A Kodidhi
- Department of Pediatrics, St. Louis Children's Hospital, St. Louis, MO, USA
| | - M Riley
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Z Vesoulis
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
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Weimer KED, Bidegain M, Shaikh SK, Couchet P, Tanaka DT, Athavale K. Comparison of short-term outcomes of 35-weeks' gestation infants cared for in a level II NICU vs mother-baby, a retrospective study. J Neonatal Perinatal Med 2022; 15:643-651. [PMID: 35661024 DOI: 10.3233/npm-221015] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Late preterm infants are at high risk for medical complications and represent a growing NICU population. While 34-weeks' gestation infants are generally admitted to the NICU and 36-weeks'gestation infants stay in mother-baby, there is wide practice variation for 35-weeks'gestation infants. The objective of this study was to compare short-term outcomes of 35-weeks' gestation infants born at two hospitals within the same health system (DUHS), where one (DRH) admits all 35-weeks' gestation infants to their level II NICU and the other (DUH) admits all 35-weeks' gestation infants to mother-baby, unless clinical concern. METHODS We conducted a retrospective cohort analysis of 35-weeks' gestation infants born at DUHS from 2014-2019. Infant specific data were collected for birth, demographics, medications, medical therapies, LOS, ED visits and readmissions. 35-weeks' gestation infants at each hospital (DRH vs DUH) that met inclusion criteria were compared, regardless of unit(s) of care. RESULTS 726 infants of 35-weeks' gestation were identified, 591 met our inclusion criteria (DUH -462, DRH -129). Infants discharged from DRH were more likely to receive medical therapies (caffeine, antibiotics, blood culture, phototherapy, NGT), had a 4 day longer LOS, but were more likely to feed exclusively MBM at discharge. There were no differences in ED visits; however, more infants from DUH were readmitted within 30 days of discharge. CONCLUSIONS Our findings suggest admitting 35-weeks' gestation infants directly to the NICU increases medical interventions and LOS, but might reduce hospital readmissions.
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Affiliation(s)
- K E D Weimer
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - M Bidegain
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - S K Shaikh
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - P Couchet
- Department of Pediatrics, Duke University, Durham, NC, USA.,Hospital de Clínicas, Departamento de Neonatología, UDELAR, Montevideo, Uruguay
| | - D T Tanaka
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - K Athavale
- Department of Pediatrics, Duke University, Durham, NC, USA
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Ulus HZ, Tekbudak MY, Allen JC. Processing Human Milk to Increase Nutrient Density for Preterm Infants. J Hum Lact 2021; 39:333-342. [PMID: 34775878 DOI: 10.1177/08903344211056933] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Human milk is the optimal food for newborns. Choices to feed preterm infants in neonatal intensive care units are mother's milk, donor milk, or formula. Preterm infants have better tolerance for human milk, but the lower caloric density of donor milk might not meet preterm infant growth needs. Preterm infants have higher protein and energy requirements with a limited stomach capacity. Therefore, there is a need for human milk with increased nutrient density. RESEARCH AIM To concentrate donor milk to have a higher caloric and protein density while avoiding side effects of high osmolality by precipitating lactose at low temperatures. METHODS We investigated the results of volume reduction and lactose removal processes on the lactose, protein, osmolality, and viscosity of human milk. Donor milk was obtained from WakeMed Mothers' Milk Bank. Homogenization and evaporative condensation were applied to samples (N = 36) before they were stored frozen overnight, followed by refrigerated centrifugation for lactose removal at 0 °C. Supernatants were separated and compared to the composition of controls. RESULTS A significant reduction of lactose (SW = -262, p < .0001) and osmolality (SW = -211.5 p < .01) was achieved in the concentrated milk without a significant protein loss from centrifugation (SW = -44.5, p = .49). A 30%-40% volume reduction is within the American Academy of Pediatrics recommended osmolality for infant feeding. CONCLUSION Concentrating human milk in a milk bank setting for feeding preterm infants might be a simple and low-cost process to achieve a product with higher nutrient density and no non-human components.
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Affiliation(s)
- Hande Z Ulus
- Department of Food, Bioprocessing and Nutrition Science, North Carolina State University, Raleigh, NC, USA
| | - Merve Yasemin Tekbudak
- Department of Statistics, Gazi University, Ankara, Turkey.,Department of Statistics, North Carolina State University, Raleigh, NC, USA
| | - Jonathan C Allen
- Department of Food, Bioprocessing and Nutrition Science, North Carolina State University, Raleigh, NC, USA
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Handayani KD, Irwanto, Masturina M, Etika R, Harianto A, Sauer PJJ. Duration of Breastfeeding in Late Preterm Infants: Maternal and Infant Factors. J Hum Lact 2021; 37:795-802. [PMID: 33275502 DOI: 10.1177/0890334420978380] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND More than 550,000 late preterm infants are born each year in Indonesia. These infants, born between 340/7-366/7 weeks, have more complications than term infants. Breastfeeding is considered the most optimal nutrition for newborn infants. Two groups of factors are important for successful breastfeeding: infant and maternal factors. The infant factors can be evaluated using the Infant Breastfeeding Assessment Tool and the maternal aspects with the Breastfeeding Self-Efficacy Scale-Short Form. AIM To determine whether the Infant Breastfeeding Assessment Tool or the Breastfeeding Self-Efficacy Scale-Short Form was more predictive of successful breastfeeding among late preterm infants. METHODS This study was conducted in the Academic Teaching Hospital in Surabaya, Indonesia in March-July 2017. Mothers who delivered their infant between a gestational age of 340/7 and 366/7 weeks were included. RESULTS Fifty-four single born participant mother-infant pairs were included. The mean total Breastfeeding Self-Efficacy Scale-Short Form score was 57.8 (SD = 8.9). The mean Infant Breastfeeding Assessment Tool score was 8.3 (SD = 1.8). There was a significant correlation between the total Breastfeeding Self-Efficacy Scale-Short Form score and the Infant Breastfeeding Assessment Tool score (p = .020, r = 0.316). The Breastfeeding Self-Efficacy Scale-Short Form was significantly higher in the participant (mothers) of the infants breastfed ≥ 4 months, compared to < 4 months, 61.59 (SD = 5.78) versus 51.78 (SD = 11.64; p = .001). No correlation was found between the duration of breastfeeding and Infant Breastfeeding Assessment Tool score (p = .087). CONCLUSION Maternal factors were more important for successful breastfeeding in these late preterm infants than infant factors in our sample.
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Affiliation(s)
- Kartika Darma Handayani
- 194160 Neonatology Division, Department of Pediatrics, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Irwanto
- Growth and Development Division, Department of Pediatrics, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Melinda Masturina
- 194160 Neonatology Division, Department of Pediatrics, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Risa Etika
- 194160 Neonatology Division, Department of Pediatrics, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Agus Harianto
- 194160 Neonatology Division, Department of Pediatrics, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Pieter J J Sauer
- 10173 Neonatology Division, Department of Pediatrics, University Medical Center Groningen, Groningen, The Netherland
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Abstract
OBJECTIVE To study the perinatal complications of late preterm twins (LPTs) versus early term twins (ETTs). METHODS A retrospective analysis was performed for the complications of 246 LPTs, 496 ETTs, and their mothers. The risk factors for late preterm birth were analyzed. According to gestational age, the twins were divided into five groups: 34-34+6 weeks (n=44), 35-35+6 weeks (n=70), 36-36+6 weeks (n=132), 37-37+6 weeks (n=390), and 38-38+6 weeks (n=106). The perinatal complications were compared between groups. RESULTS Maternal hypertension, maternal thrombocytopenia, placenta previa, and premature rupture of membranes were independent risk factors for late preterm birth in twins (P < 0.05). The LPT group had higher incidence rates of respiratory diseases, feeding intolerance, and hypoglycemia than the ETT group (P < 0.05). The 34-34+6 weeks group had a higher incidence rate of neonatal asphyxia than the 37-37+6 weeks and 38-38+6 weeks groups; and had a higher incidence rate of septicemia than 36-36+6 weeks group (P < 0.0045). The 34-34+6 weeks and 35-35+6 weeks groups had higher incidence rates of neonatal respiratory distress syndrome, neonatal apnea, and anemia than the other three groups; and had higher incidence rates of neonatal pneumonia, hypoglycemia and septicemia than the 37-37+6 weeks and 38-38+6 weeks groups (P < 0.0045). The 35-35+6 weeks group had a higher incidence rate of feeding intolerance than the 36-36+6 weeks, 37-37+6 weeks, and 38-38+6 weeks groups (P < 0.0045). The 36-36+6 weeks group had a lower incidence rate of hypoglycemia than the 34-34+6 weeks group and a higher incidence rate of hypoglycemia than the 37-37+6 weeks group (P < 0.0045). CONCLUSIONS Compared with ETTs, LPTs have an increased incidence of perinatal complications. The incidence of perinatal complications is associated with gestational ages in the LPTs and ETTs.
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张 懿, 邵 树, 张 晓, 刘 捷, 曾 超. [Perinatal conditions of late preterm twins versus early term twins]. Zhongguo Dang Dai Er Ke Za Zhi 2021; 23:242-247. [PMID: 33691916 PMCID: PMC7969193] [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] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/30/2020] [Indexed: 11/05/2023]
Abstract
OBJECTIVE To study the perinatal complications of late preterm twins (LPTs) versus early term twins (ETTs). METHODS A retrospective analysis was performed for the complications of 246 LPTs, 496 ETTs, and their mothers. The risk factors for late preterm birth were analyzed. According to gestational age, the twins were divided into five groups: 34-34+6 weeks (n=44), 35-35+6 weeks (n=70), 36-36+6 weeks (n=132), 37-37+6 weeks (n=390), and 38-38+6 weeks (n=106). The perinatal complications were compared between groups. RESULTS Maternal hypertension, maternal thrombocytopenia, placenta previa, and premature rupture of membranes were independent risk factors for late preterm birth in twins (P < 0.05). The LPT group had higher incidence rates of respiratory diseases, feeding intolerance, and hypoglycemia than the ETT group (P < 0.05). The 34-34+6 weeks group had a higher incidence rate of neonatal asphyxia than the 37-37+6 weeks and 38-38+6 weeks groups; and had a higher incidence rate of septicemia than 36-36+6 weeks group (P < 0.0045). The 34-34+6 weeks and 35-35+6 weeks groups had higher incidence rates of neonatal respiratory distress syndrome, neonatal apnea, and anemia than the other three groups; and had higher incidence rates of neonatal pneumonia, hypoglycemia and septicemia than the 37-37+6 weeks and 38-38+6 weeks groups (P < 0.0045). The 35-35+6 weeks group had a higher incidence rate of feeding intolerance than the 36-36+6 weeks, 37-37+6 weeks, and 38-38+6 weeks groups (P < 0.0045). The 36-36+6 weeks group had a lower incidence rate of hypoglycemia than the 34-34+6 weeks group and a higher incidence rate of hypoglycemia than the 37-37+6 weeks group (P < 0.0045). CONCLUSIONS Compared with ETTs, LPTs have an increased incidence of perinatal complications. The incidence of perinatal complications is associated with gestational ages in the LPTs and ETTs.
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Affiliation(s)
- 懿敏 张
- />北京大学人民医院儿科, 北京 100044Department of Pediatrics, Peking University People's Hospital, Beijing 100044, China
| | - 树铭 邵
- />北京大学人民医院儿科, 北京 100044Department of Pediatrics, Peking University People's Hospital, Beijing 100044, China
| | - 晓蕊 张
- />北京大学人民医院儿科, 北京 100044Department of Pediatrics, Peking University People's Hospital, Beijing 100044, China
| | - 捷 刘
- />北京大学人民医院儿科, 北京 100044Department of Pediatrics, Peking University People's Hospital, Beijing 100044, China
| | - 超美 曾
- />北京大学人民医院儿科, 北京 100044Department of Pediatrics, Peking University People's Hospital, Beijing 100044, China
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韩 露, 徐 小, 童 笑, 张 欣, 刘 捷, 杨 立, 刘 慧, 闫 菊, 宋 志, 梅 亚, 米 荣, 秦 选, 刘 玉, 齐 宇, 张 巍, 曾 慧, 崔 红, 龙 卉, 郭 果, 陈 旭, 杨 召, 孙 芳, 付 晓, 王 长, 李 正. [Effect of breastfeeding on the development of infection-related diseases during hospitalization in late preterm infants in 25 hospitals in Beijing, China]. Zhongguo Dang Dai Er Ke Za Zhi 2020; 22:1245-1250. [PMID: 33327992 PMCID: PMC7735928 DOI: 10.7499/j.issn.1008-8830.2007065] [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] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/04/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the incidence rate of infectious diseases during hospitalization in late preterm infants in Beijing, China, as well as the risk factors for infectious diseases and the effect of breastfeeding on the development of infectious diseases. METHODS Related data were collected from the late preterm infants who were hospitalized in the neonatal wards of 25 hospitals in Beijing, China, from October 23, 2015 to October 30, 2017. According to the feeding pattern, they were divided into a breastfeeding group and a formula feeding group. The two groups were compared in terms of general status and incidence rate of infectious diseases. A multivariate logistic regression analysis was used to investigate the risk factors for infectious diseases. RESULTS A total of 1 576 late preterm infants were enrolled, with 153 infants in the breastfeeding group and 1 423 in the formula feeding group. Of all infants, 484 (30.71%) experienced infectious diseases. The breastfeeding group had a significantly lower incidence rate of infectious diseases than the formula feeding group (22.88% vs 31.55%, P=0.033). The multivariate logistic regression analysis showed that breastfeeding was an independent protective factor against infectious diseases (OR=0.534, P=0.004), while male sex, premature rupture of membranes, gestational diabetes mellitus, and asphyxia were risk factors for infectious diseases (OR=1.328, 5.386, 1.535, and 2.353 respectively, P < 0.05). CONCLUSIONS Breastfeeding can significantly reduce the incidence of infectious diseases and is a protective factor against infectious diseases in late preterm infants. Breastfeeding should therefore be actively promoted for late preterm infants during hospitalization.
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Affiliation(s)
- 露艳 韩
- 清华大学第一附属医院儿科, 北京 100016Department of Pediatrics, First Hospital of Tsinghua University, Beijing 100016, China
| | - 小静 徐
- 清华大学第一附属医院儿科, 北京 100016Department of Pediatrics, First Hospital of Tsinghua University, Beijing 100016, China
| | | | | | | | | | | | | | | | - 亚波 梅
- 中国人民解放军总医院第七医学中心儿科, 北京 100710
| | - 荣 米
- 首都儿科研究所附属儿童医院儿科, 北京 100191
| | - 选光 秦
- 首都医科大学附属北京朝阳医院儿科, 北京 100043
| | - 玉环 刘
- 首都医科大学附属北京地坛医院儿科, 北京 100015
| | - 宇洁 齐
- 首都医科大学附属北京儿童医院儿科, 北京 100045
| | - 巍 张
- 首都医科大学附属北京妇产医院儿科, 北京 100026
| | - 慧慧 曾
- 首都医科大学附属北京妇产医院儿科, 北京 100026
| | - 红 崔
- 首都医科大学附属北京友谊医院儿科, 北京 100050
| | - 卉 龙
- . 中国人民解放军总医院第一医学中心儿科, 北京 100853
| | - 果 郭
- 中国人民解放军总医院第五医学中心, 北京 100039
| | - 旭琳 陈
- 中国人民解放军总医院第三医学中心, 北京 100101
| | - 召意 杨
- 中国人民解放军总医院第六医学中心儿科, 北京 100048
| | | | | | - 长燕 王
- 中国医学科学院北京协和医学院北京协和医院儿科, 北京 100730
| | - 正红 李
- 中国医学科学院北京协和医学院北京协和医院儿科, 北京 100730
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10
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Liang JJ, Hu Y, Xing YF, Lin SF, Song YY. [Neuropsychological development of late preterm infants and early term infants at the age of 1 year: a follow-up study]. Zhongguo Dang Dai Er Ke Za Zhi 2020; 22:706-710. [PMID: 32669165 PMCID: PMC7389612] [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] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 05/19/2020] [Indexed: 11/04/2023]
Abstract
OBJECTIVE To study the level of neuropsychological development in late preterm infants and early term infants at the age of 1 year. METHODS A total of 1 257 children with a corrected age of 1 year were enrolled as subjects. According to gestational age at birth, they were divided into an early preterm group (28-33+6 weeks), a late preterm group (34-36+6 weeks), an early term group (37-38+6 weeks), and a full-term group (39-41+6 weeks). Gesell Developmental Schedules were used to assess the neuropsychological development of the children, and the groups were compared in terms of neuropsychological development at the age of 1 year. RESULTS There were significant differences in the developmental quotients of the five functional areas (adaptability, gross motor, fine motor, language and social ability) between the four groups at the age of 1 year (P<0.05), and the full-term infants had the highest development quotients, followed by the early term infants, the late preterm infants, and the early preterm infants (P<0.05). The full-term infants had the lowest rate of developmental delay in each functional area, while the early preterm infants had the highest rate (P<0.05). Compared with the full-term infants, the early term infants had a higher risk of developmental delay in adaptability (OR=1.796, P<0.05), and the late preterm infants had a higher risk of developmental delay in adaptability (OR=2.651, P<0.05) and fine motor (OR=2.679, P<0.05), while the early preterm infants had a higher risk of developmental delay in adaptability (OR=4.069, P<0.05), fine motor (OR=3.710, P<0.05), and social ability (OR=3.515, P<0.05). CONCLUSIONS The risk of neuropsychological developmental delay decreases with the increase in gestational age in children at the age of 1 year, with a dose-response effect. There are varying degrees of developmental delay in early term infants and late preterm infants, and health care follow-up for early term infants and late preterm infants should be taken seriously.
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Affiliation(s)
- Jing-Jing Liang
- Department of Child Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China.
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11
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Liang JJ, Hu Y, Xing YF, Lin SF, Song YY. [Neuropsychological development of late preterm infants and early term infants at the age of 1 year: a follow-up study]. Zhongguo Dang Dai Er Ke Za Zhi 2020; 22:706-710. [PMID: 32669165 PMCID: PMC7389612 DOI: 10.7499/j.issn.1008-8830.1912132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 05/19/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To study the level of neuropsychological development in late preterm infants and early term infants at the age of 1 year. METHODS A total of 1 257 children with a corrected age of 1 year were enrolled as subjects. According to gestational age at birth, they were divided into an early preterm group (28-33+6 weeks), a late preterm group (34-36+6 weeks), an early term group (37-38+6 weeks), and a full-term group (39-41+6 weeks). Gesell Developmental Schedules were used to assess the neuropsychological development of the children, and the groups were compared in terms of neuropsychological development at the age of 1 year. RESULTS There were significant differences in the developmental quotients of the five functional areas (adaptability, gross motor, fine motor, language and social ability) between the four groups at the age of 1 year (P<0.05), and the full-term infants had the highest development quotients, followed by the early term infants, the late preterm infants, and the early preterm infants (P<0.05). The full-term infants had the lowest rate of developmental delay in each functional area, while the early preterm infants had the highest rate (P<0.05). Compared with the full-term infants, the early term infants had a higher risk of developmental delay in adaptability (OR=1.796, P<0.05), and the late preterm infants had a higher risk of developmental delay in adaptability (OR=2.651, P<0.05) and fine motor (OR=2.679, P<0.05), while the early preterm infants had a higher risk of developmental delay in adaptability (OR=4.069, P<0.05), fine motor (OR=3.710, P<0.05), and social ability (OR=3.515, P<0.05). CONCLUSIONS The risk of neuropsychological developmental delay decreases with the increase in gestational age in children at the age of 1 year, with a dose-response effect. There are varying degrees of developmental delay in early term infants and late preterm infants, and health care follow-up for early term infants and late preterm infants should be taken seriously.
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Affiliation(s)
- Jing-Jing Liang
- Department of Child Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China.
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Chen D, Sun J, Li Q, Bai W, Mao J. An Important Finding of White Matter Injury in Late Preterm Infant: Deep Medullary Vein Involvement. Front Pediatr 2020; 8:597567. [PMID: 33392116 PMCID: PMC7773939 DOI: 10.3389/fped.2020.597567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/25/2020] [Indexed: 11/30/2022] Open
Abstract
Objective: To investigate high risk factors and magnetic resonance imaging (MRI) features in late preterm infants with severe white matter injury (WMI) associated with abnormal deep medullary veins (DMVs). Materials and Methods: Preterm infants with severe WMI, who were hospitalized in Shengjing Hospital from 1st January 2009 to 31st December 2018, were enrolled in this retrospective study. High risk factors and MRI characteristics of infants with abnormal DMVs were analyzed and compared with those of infants without DMV abnormalities. Results: A total of 2032 late preterm infants were examined by MRI; 71 cases (3.5%) had severe WMI and 15 of these (21.1%) had abnormal DMVs. The incidence of maternal diabetes was higher in infants with abnormal DMVs and neonatal convulsions were more likely (P < 0.05). The incidence of grade IV injury (P < 0.05), white matter periventricular cysts and thalamic injury (P < 0.01), cerebral venous sinus thrombus (P < 0.01) and germinal matrix/intraventricular hemorrhage (P < 0.05) were higher in infants with abnormal DMVs than in infants with normal DMVs. Conclusions: Congestion/thrombosis of DMVs may be an important cause of severe WMI in late preterm infants, especially in periventricular leukomalacia-like WMI. WMI with abnormal DMVs is more likely to lead to thalamic injury.
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Affiliation(s)
- Dan Chen
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jing Sun
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qiuyu Li
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wenjuan Bai
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jian Mao
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
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Abstract
The aim of this study was to compare the social competence, motor development, and cognition of late preterm infants (LPIs) with full-term infants. Several studies in the recent past indicated that LPIs are at high risk of social development problems. We compared the development of motor skills, cognition, and social competency of LPIs with full-term infants at between 2 and 2.5 years old. The Chinese versions of the Gesell Development Diagnosis scale and the Normal Development of Social Skills from Infants to Junior High School Children scale were used for the assessment. LPIs were not more socially competent than their full-term counterparts. Each skill-namely, adaptability, gross motor, fine motor, language, and personal-social responses-was separately associated with the total level of social skills. It was found that gross motor skills had a positive correlation with the self-help and locomotive abilities, and fine motor skills had a positive association with locomotion abilities. LPIs had risk factors due to their delayed social skills in areas including motor disorders and physiological and perinatal factors. LPIs under three were at a higher risk of impairment in social competency. Therefore, it is recommended that they be monitored regularly to identify the development of social and cognitive disorders at an early stage.
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Affiliation(s)
- Jia You
- Early Child Development Center, Xi'an Maternal and Child Health Care Hospital, Xi'an, China
| | - Hong-Juan Yang
- Early Child Development Center, Xi'an Maternal and Child Health Care Hospital, Xi'an, China
| | - Mei-Chen Hao
- Early Child Development Center, Xi'an Maternal and Child Health Care Hospital, Xi'an, China
| | - Jing-Jing Zheng
- Early Child Development Center, Xi'an Maternal and Child Health Care Hospital, Xi'an, China
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Baumert M, Surmiak P, Walencka Z, Mrowiec E, Sodowska P. Can neonates born at 34 weeks be classified as late preterm? Ginekol Pol 2018; 87:805-807. [PMID: 28098930 DOI: 10.5603/gp.2016.0092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 05/10/2016] [Accepted: 08/23/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES In recent years, much attention has been given to infants born prematurely, at 34 0/7 to 36 6/7 weeks of gestation (WG), which have been classified as 'late preterm'. Neonates from that subgroup are less physiologically and metabolically mature than term infants. The aim of the study was to determine whether infants born at 34WG can be classified as 'late preterm' or 'preterm' newborns. MATERIAL AND METHODS A total of 141 newborns were included in the study: 25 born ≤ 33WG, 53 late-preterm newborns, and 63 term infants. Cord-blood neutrophil gelatinase-associated lipocalin (NGAL) and creatinine concentrations were measured in all newborns. Also, the incidence of clinical complications in the early adaptive period during hospitalization was evaluated. RESULTS Higher NGAL concentration was noted among preterm newborns as compared to late-preterm neonates (p < 0.05), and term newborns (p < 0.05), especially in children born at 34WG as compared to 35WG (p < 0.001). However, no differences in NGAL concentration were found between neonates born at 35WG and 36WG, as well as children born at 36WG and term infants. A relationship between umbilical NGAL levels and gestational age was observed. Additionally, a statistically significant difference was found in the incidence of respiratory distress syndrome (p < 0.05) and infections (p < 0.05) among neonates born at 34WG as compared to 35WG. CONCLUSIONS Late preterm neonates should be defined as 'preterm' between 35 0/7 and 36 6/7 WG. Infants born at 34WG should be included in the preterm group.
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Affiliation(s)
| | - Piotr Surmiak
- Department of Neonatology, School of Medicine in Katowice, Medical University of Silesia in Katowice..
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Abstract
OBJECTIVE To assess whether type of milk supplementation provided to breastfeeding late preterm infants was associated with hospital length of stay (LOS) or breastfeeding status at discharge. DESIGN Retrospective chart review. SETTING Tertiary care teaching hospital in the southern United States. PARTICIPANTS Late preterm infants 35 0/7 to 36 6/7 weeks gestational age (N = 183) admitted to the mother-baby unit between November 1, 2014, and October 31, 2016. METHODS The exposure of interest was type of milk supplementation, for example, expressed human milk, pasteurized donor human milk, and formula. Outcomes measured were LOS and breastfeeding status at discharge. Generalized Poisson regression models were used to compare LOS by type of milk supplementation. Modified Poisson regression models were used to estimate risk ratios and 95% confidence intervals for associations with breastfeeding status at discharge. RESULTS The LOS for breastfed infants supplemented with expressed human milk and/or pasteurized donor human milk did not differ significantly from exclusively breastfed infants who received no supplement. Exclusively formula-fed infants had longer LOS of 3.2 days compared with 2.6 days for exclusively breastfed infants (p = .001). Breastfed infants who received any formula supplementation were 16% less likely to continue breastfeeding until day of discharge compared with breastfed infants who received human milk supplementation (risk ratio = .84, 95% confidence interval [.77, .92]). CONCLUSION The high prevalence of supplementation among breastfeeding late preterm infants underscores the potential effect of type of milk supplementation on LOS and breastfeeding outcomes. Our findings suggest that human milk supplementation discourages transition to formula feeding before hospital discharge without increasing LOS.
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Rodríguez-Camejo C, Puyol A, Fazio L, Rodríguez A, Villamil E, Andina E, Cordobez V, Díaz H, Lemos M, Siré G, Carroscia L, Castro M, Panizzolo L, Hernández A. Antibody Profile of Colostrum and the Effect of Processing in Human Milk Banks: Implications in Immunoregulatory Properties. J Hum Lact 2018; 34:137-147. [PMID: 28586632 DOI: 10.1177/0890334417706359] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND When feeding preterm infants, donor milk is preferred if the mother's own milk is unavailable. Pasteurization may have detrimental effects on bioactivity, but more information is needed about its effects on the immunological compounds. Research aim: This work has two main aims: evaluate the antibody profile of colostrum and study the quantitative variations in the antibodies' level and specific reactivity after undergoing Holder pasteurization. The authors focused on immunoregulatory components of colostrum (antidietary antibodies and TGF-β2) in the neonatal gut. METHODS This is a descriptive cross-sectional study of a convenience sample of 67 donated colostrum samples at different days after delivery, both raw and pasteurized. Antibody profiles were analyzed at different times during breastfeeding, and total and specific antibodies (IgM, IgA, and IgG subclasses) were compared with tetanus toxoid and ovalbumin using enzyme-linked immunosorbent assay. The processing effect on total and specific antibodies, as well as TGF-β2, was evaluated by paired analyses. RESULTS No variations in immunological compounds were observed throughout the colostrum stage. The TGF-β2, antibodies' concentrations, and antibodies' specific reactivity after pasteurization did not vary significantly as days of lactation varied. Changes in antibody levels were dependent on isotype and IgG subclass, and IgG4 showed remarkable resistance to heating. Moreover, the effect of the pasteurization on specific reactivity was antigen dependent. CONCLUSION The supply of relevant immunological components is stable throughout the colostrum stage. The effects of pasteurization on antibodies depend on isotype, subclass, and specificity. This information is relevant to improving the immunological quality of colostrum, especially for preterm newborns.
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Affiliation(s)
- Claudio Rodríguez-Camejo
- 1 Cátedra de Inmunología, Facultad de Ciencias-Facultad de Química, Universidad de la República, Montevideo, Uruguay
| | - Arturo Puyol
- 2 Banco de Leche "Ruben Panizza," Centro Hospitalario Pereira Rossell, Administración de los Servicios de Salud del Estado, Montevideo, Uruguay
| | - Laura Fazio
- 2 Banco de Leche "Ruben Panizza," Centro Hospitalario Pereira Rossell, Administración de los Servicios de Salud del Estado, Montevideo, Uruguay
| | - Analía Rodríguez
- 3 Departamento de Ciencia y Tecnología de los Alimentos, Facultad de Química, Universidad de la República, Montevideo, Uruguay
| | - Emilia Villamil
- 1 Cátedra de Inmunología, Facultad de Ciencias-Facultad de Química, Universidad de la República, Montevideo, Uruguay
| | - Eliana Andina
- 3 Departamento de Ciencia y Tecnología de los Alimentos, Facultad de Química, Universidad de la República, Montevideo, Uruguay
| | - Vanira Cordobez
- 3 Departamento de Ciencia y Tecnología de los Alimentos, Facultad de Química, Universidad de la República, Montevideo, Uruguay
| | - Hernán Díaz
- 3 Departamento de Ciencia y Tecnología de los Alimentos, Facultad de Química, Universidad de la República, Montevideo, Uruguay
| | - Mary Lemos
- 2 Banco de Leche "Ruben Panizza," Centro Hospitalario Pereira Rossell, Administración de los Servicios de Salud del Estado, Montevideo, Uruguay
| | - Gabriela Siré
- 2 Banco de Leche "Ruben Panizza," Centro Hospitalario Pereira Rossell, Administración de los Servicios de Salud del Estado, Montevideo, Uruguay
| | - Lilián Carroscia
- 2 Banco de Leche "Ruben Panizza," Centro Hospitalario Pereira Rossell, Administración de los Servicios de Salud del Estado, Montevideo, Uruguay
| | - Mara Castro
- 2 Banco de Leche "Ruben Panizza," Centro Hospitalario Pereira Rossell, Administración de los Servicios de Salud del Estado, Montevideo, Uruguay
| | - Luis Panizzolo
- 3 Departamento de Ciencia y Tecnología de los Alimentos, Facultad de Química, Universidad de la República, Montevideo, Uruguay
| | - Ana Hernández
- 1 Cátedra de Inmunología, Facultad de Ciencias-Facultad de Química, Universidad de la República, Montevideo, Uruguay
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Bennett CF, Galloway C, Grassley JS. Education for WIC Peer Counselors About Breastfeeding the Late Preterm Infant. J Nutr Educ Behav 2018; 50:198-202.e1. [PMID: 28818488 DOI: 10.1016/j.jneb.2017.05.364] [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] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 05/22/2017] [Accepted: 05/25/2017] [Indexed: 06/07/2023]
Abstract
Mothers of late preterm infants need ongoing support because they often find establishing breastfeeding (BF) to be complex and difficult. Special Supplemental Nutrition Program for Women, Infants and Children peer counselors provide BF information and emotional support to new mothers in many communities. However, their current training does not include education about BF for the late preterm infant. The purpose of this report is to present important information about BF and the late preterm infant that can enhance peer counselors' ability to offer appropriate support. The effect of this education on outcomes such as BF rates, maternal self-efficacy, infant hospital readmissions, and peer counselors' self-efficacy needs to be investigated.
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Affiliation(s)
- Cindi Faith Bennett
- Neonatal Intensive Care Unit, St Luke's Health System, Boise, ID; Neonatal Intensive Care Unit, St Luke's Children's Hospital, Boise, ID.
| | - Cynthia Galloway
- Special Supplemental Nutrition Program for Women, Infants, and Children Division of Preventive Health Services, Central District Health Department, Boise, ID
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Meredith-Dennis L, Xu G, Goonatilleke E, Lebrilla CB, Underwood MA, Smilowitz JT. Composition and Variation of Macronutrients, Immune Proteins, and Human Milk Oligosaccharides in Human Milk From Nonprofit and Commercial Milk Banks. J Hum Lact 2018; 34:120-129. [PMID: 28614672 DOI: 10.1177/0890334417710635] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND When human milk is unavailable, banked milk is recommended for feeding premature infants. Milk banks use processes to eliminate pathogens; however, variability among methods exists. Research aim: The aim of this study was to compare the macronutrient (protein, carbohydrate, fat, energy), immune-protective protein, and human milk oligosaccharide (HMO) content of human milk from three independent milk banks that use pasteurization (Holder vs. vat techniques) or retort sterilization. METHODS Randomly acquired human milk samples from three different milk banks ( n = 3 from each bank) were analyzed for macronutrient concentrations using a Fourier transform mid-infrared spectroscopy human milk analyzer. The concentrations of IgA, IgM, IgG, lactoferrin, lysozyme, α-lactalbumin, α antitrypsin, casein, and HMO were analyzed by mass spectrometry. RESULTS The concentrations of protein and fat were significantly ( p < .05) less in the retort sterilized compared with the Holder and vat pasteurized samples, respectively. The concentrations of all immune-modulating proteins were significantly ( p < .05) less in the retort sterilized samples compared with vat and/or Holder pasteurized samples. The total HMO concentration and HMOs containing fucose, sialic acid, and nonfucosylated neutral sugars were significantly ( p < .05) less in retort sterilized compared with Holder pasteurized samples. CONCLUSION Random milk samples that had undergone retort sterilization had significantly less immune-protective proteins and total and specific HMOs compared with samples that had undergone Holder and vat pasteurization. These data suggest that further analysis of the effect of retort sterilization on human milk components is needed prior to widespread adoption of this process.
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Affiliation(s)
| | - Gege Xu
- 2 Department of Chemistry, University of California Davis, Davis, CA, USA
| | | | - Carlito B Lebrilla
- 2 Department of Chemistry, University of California Davis, Davis, CA, USA
| | - Mark A Underwood
- 3 Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Jennifer T Smilowitz
- 4 Foods for Health Institute, University of California Davis, Davis, CA, USA.,5 Department of Food Science and Technology, University of California Davis, Davis, CA, USA
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Zhu Y, Zhang K, Hu L, Xiao ML, Li ZH, Chen C. [Clinical features and magnetic resonance imaging evaluation of encephalopathy in high-risk late preterm infants]. Zhongguo Dang Dai Er Ke Za Zhi 2017; 19:567-571. [PMID: 28506351 PMCID: PMC7389129 DOI: 10.7499/j.issn.1008-8830.2017.05.018] [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] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/06/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the risk factors, clinical features, and magnetic resonance imaging (MRI) changes of encephalopathy in high-risk late preterm infants. METHODS Head MRI scan was performed for late preterm infants with high-risk factors for brain injury who were hospitalized between January 2009 and December 2014. The risk factors, clinical features, and head MRI features of encephalopathy in late preterm infants were analyzed. RESULTS A total of 1 007 late preterm infants underwent MRI scan, among whom 313 (31.1%) had imaging features in accordance with the features of encephalopathy of prematurity. Of all infants, 76.7% had white matter damage. There was no association between the development of encephalopathy and gestational age in late preterm infants, but the detection rate of encephalopathy gradually increased with the increasing birth weight (P<0.05). The logistic regression analysis showed that a history of resuscitation was an independent risk factor for encephalopathy of prematurity (P<0.01). CONCLUSIONS Encephalopathy of prematurity is commonly seen in high-risk late preterm infants, especially white matter damage. A history of resuscitation is an independent risk factor for encephalopathy in late preterm infants.
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Affiliation(s)
- Yan Zhu
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai 201102, China.
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Cartwright J, Atz T, Newman S, Mueller M, Demirci JR. Integrative Review of Interventions to Promote Breastfeeding in the Late Preterm Infant. J Obstet Gynecol Neonatal Nurs 2017; 46:347-356. [PMID: 28390223 DOI: 10.1016/j.jogn.2017.01.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2017] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To define the different breastfeeding interventions that promote breastfeeding exclusivity and duration in the late preterm infant and to synthesize findings from the published empirical literature on late preterm infant breastfeeding interventions. DATA SOURCES The databases CINAHL, Scopus, and PubMed were searched for primary research articles on breastfeeding interventions for late preterm infants. Inclusion criteria included original research studies in which authors examined a breastfeeding intervention or second-line strategy in a sample inclusive of but not necessarily limited to the gestational age range of 34 to 3667 weeks gestation, written in English, and published between 2005 and 2015. STUDY SELECTION Thirteen articles were identified, including five randomized controlled trials, three quasi-experimental studies, four descriptive studies, and one case study. DATA EXTRACTION Whittemore and Knafl's methodology guided this integrative review. Data extraction and organization occurred under the following headings: author and year, study design, level of evidence, purpose, sample, setting, results, limitations, recommendations, and intervention. DATA SYNTHESIS Studies on breastfeeding interventions were synthesized under four concepts within the Late Preterm Conceptual Framework: Physiologic Functional Status, Care Practices, Family Role, and Care Environment. CONCLUSION Most breastfeeding interventions within this integrative review had positive effects on exclusivity and duration of breastfeeding in the late preterm infant. However, second-line strategies had equivocal effects on exclusivity but had positive effects on duration. The positive effects of breastfeeding interventions on breastfeeding exclusivity and duration are highlighted in our results, and we point to the need for a focus on breastfeeding after the transition home for late preterm infants.
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Zhang TW, Lin FT, Song YY, Wang LX, Cai YJ. [Early intellectual developmental outcome of late preterm infants]. Zhongguo Dang Dai Er Ke Za Zhi 2017; 19:142-146. [PMID: 28202109 PMCID: PMC7389466 DOI: 10.7499/j.issn.1008-8830.2017.02.003] [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] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 11/14/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To investigate the early intellectual developmental outcome of late preterm infants. METHODS A total of 106 late preterm infants with a gestational age of 34-36+6 weeks who were admitted to the neonatal ward between January 2012 and January 2015, cured, discharged, and regularly followed up at the outpatient service for high-risk children were enrolled as the preterm group. A total of 120 healthy full-term infants during the same period were randomly selected as the term group. Neonatal behavioral neurological assessment (NBNA) was performed for late preterm infants at a corrected gestational age of 40 weeks and full-term infants at a gestational age of 40 weeks. The Gesell Developmental Scale was used for late preterm infants at a corrected age of 3, 6, and 12 months and full-term infants at an age of 3, 6, and 12 months. RESULTS The preterm group had an NBNA score of <37 and a significantly lower NBNA score than the term group (P<0.05). At the corrected age of 3 months, the preterm group had significantly lower scores of gross motor, fine motor, and social competence than the term group (P<0.05). At the corrected age of 6 months, the preterm group had significantly lower scores of adaptability, gross motor, and fine motor than the term group (P<0.05). At the corrected age of 12 months, the preterm group had significantly lower scores of adaptability, gross motor, and social competence than the term group (P<0.05). CONCLUSIONS Late preterm infants have early intellectual developmental delay. It is necessary to perform neurodevelopmental monitoring for late preterm infants.
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Affiliation(s)
- Teng-Wei Zhang
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China.
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Yuan ZX, Wen XH, Huang JH, Liu Q, Huang HZ, Yu M, Ma L. [Association between maternal pre-pregnancy body mass index and adverse outcomes of late preterm infants]. Zhongguo Dang Dai Er Ke Za Zhi 2016; 18:1232-1236. [PMID: 27974113 PMCID: PMC7403075 DOI: 10.7499/j.issn.1008-8830.2016.12.007] [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] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 08/02/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To study the association between maternal pre-pregnancy body mass index (BMI) and adverse outcomes of late preterm infants (LPI). METHODS A total of 367 LPI who were born from January 2011 to December 2015 and admitted to the neonatal ward were enrolled. The BMI criteria for Chinese population were used to analyze the factors for maternal pre-pregnancy BMI and its association with adverse outcomes of LPI (1 minute Apgar score ≤7, delivery room resuscitation, hospitalization days after birth >7 days, and ventilation duration ≥6 hours). RESULTS Of all LPIs, there were 64 LPI (17.4%) in the low maternal pre-pregnancy BMI group, 243 LPI (66.2%) in the normal maternal pre-pregnancy BMI group, and 60 LPI (16.4%) in the high maternal pre-pregnancy BMI group. Low pre-pregnancy BMI was the risk factor for 1 minute Apgar score ≤7 (OR=3.243, 95% CI: 1.102-9.546) and need for delivery room resuscitation (OR=3.492, 95%CI: 1.090-11.190), and high pre-pregnancy BMI was the risk factor for hospitalization days after birth >7 days (OR=1.992, 95%CI: 1.024-3.874). CONCLUSIONS Abnormal maternal pre-pregnancy BMI has adverse effects on the outcomes of LPI. In order to reduce these adverse outcomes BMI should be controlled within the normal range in pregnant women.
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Affiliation(s)
- Zhi-Xuan Yuan
- Department of Pediatrics, Third Affiliated Hospital of Anhui Medical University, Hefei 230000, China.
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Kamath-Rayne BD, Rozance PJ, Goldenberg RL, Jobe AH. Antenatal corticosteroids beyond 34 weeks gestation: What do we do now? Am J Obstet Gynecol 2016; 215:423-30. [PMID: 27342043 DOI: 10.1016/j.ajog.2016.06.023] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 06/03/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
Abstract
The practice of antenatal corticosteroid administration in pregnancies of 24-34 weeks of gestation that are at risk of preterm delivery was adopted over 20 years after the first randomized clinical trial in humans. It is biologically plausible that antenatal corticosteroid in pregnancies beyond 34 weeks of gestation would reduce rates of respiratory morbidity and neonatal intensive care admission. Mostly guided by the results of a large multicenter randomized trial of antenatal corticosteroid in late preterm infants, the Antenatal Late Preterm Steroids Trial, the American Congress of Obstetricians and Gynecologists has released a practice advisory that the "administration of betamethasone may be considered in women with a singleton pregnancy between 34 0/7 and 36 6/7 weeks of gestation at imminent risk of preterm birth within 7 days." However, many unanswered questions about the risks and benefits of antenatal corticosteroids in this population remain and should be considered with the adoption of this treatment recommendation. This review of the literature indicates that the greatest effect is in the reduction of transient tachypnea of the newborn infant, which is a mostly self-limited condition. This benefit must be weighed against unanticipated outcomes, such as neonatal hypoglycemia, and unknowns about long-term neurodevelopmental follow up and metabolic risks. Amelioration of respiratory morbidity in late preterm infants does not preclude these infants from having other complications that are related to prematurity that require intensive care. Other possible morbidities of prematurity may be magnified if these babies no longer have respiratory symptoms. Conversely, if these late preterm babies no longer exhibit respiratory symptoms and "look good," they may be discharged before other morbidities of prematurity have resolved and be at risk for readmission. Furthermore, it is also important to ensure that unintended consequences are avoided to achieve a minor benefit. Some of these consequences may include treatment with multiple steroid courses or "treatment creep" in women at 34 to <37 weeks of gestation who do not meet the inclusion/exclusion criteria of the Antenatal Late Preterm Steroids Trial, particularly when a high percentage of women do not receive antenatal corticosteroid within 7 days of delivery. Finally, we believe that caution should be exercised before wide-scale universal adoption of antenatal corticosteroid for pregnancies that are at risk of preterm birth at 34 to <37 weeks of gestation, when it is unclear whether there are long-term effects. For a more balanced rationale for the decision to use antenatal corticosteroid treatment in pregnancies at >34 weeks of gestation, we urge for ongoing research into the risks and benefits of antenatal corticosteroid use in preterm infants overall, for better prediction of preterm birth so that antenatal corticosteroid can be administered within the ideal time frame, and for long-term neurodevelopmental follow-up of the participants in the large randomized Antenatal Late Preterm Steroids Trial.
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Affiliation(s)
- Magnus Domellöf
- Department of Clinical Sciences/Pediatrics, Umeå University, Umeå, Sweden
| | - Michael K Georgieff
- University of Minnesota Masonic Children's Hospital, Division of Neonatology, University of Minnesota School of Medicine, Minneapolis, MN.
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Escobar GJ, Puopolo KM, Wi S, Turk BJ, Kuzniewicz MW, Walsh EM, Newman TB, Zupancic J, Lieberman E, Draper D. Stratification of risk of early-onset sepsis in newborns ≥ 34 weeks' gestation. Pediatrics 2014; 133:30-6. [PMID: 24366992 PMCID: PMC4079292 DOI: 10.1542/peds.2013-1689] [Citation(s) in RCA: 252] [Impact Index Per Article: 25.2] [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] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To define a quantitative stratification algorithm for the risk of early-onset sepsis (EOS) in newborns ≥ 34 weeks' gestation. METHODS We conducted a retrospective nested case-control study that used split validation. Data collected on each infant included sepsis risk at birth based on objective maternal factors, demographics, specific clinical milestones, and vital signs during the first 24 hours after birth. Using a combination of recursive partitioning and logistic regression, we developed a risk classification scheme for EOS on the derivation dataset. This scheme was then applied to the validation dataset. RESULTS Using a base population of 608,014 live births ≥ 34 weeks' gestation at 14 hospitals between 1993 and 2007, we identified all 350 EOS cases <72 hours of age and frequency matched them by hospital and year of birth to 1063 controls. Using maternal and neonatal data, we defined a risk stratification scheme that divided the neonatal population into 3 groups: treat empirically (4.1% of all live births, 60.8% of all EOS cases, sepsis incidence of 8.4/1000 live births), observe and evaluate (11.1% of births, 23.4% of cases, 1.2/1000), and continued observation (84.8% of births, 15.7% of cases, incidence 0.11/1000). CONCLUSIONS It is possible to combine objective maternal data with evolving objective neonatal clinical findings to define more efficient strategies for the evaluation and treatment of EOS in term and late preterm infants. Judicious application of our scheme could result in decreased antibiotic treatment in 80,000 to 240,000 US newborns each year.
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Affiliation(s)
- Gabriel J. Escobar
- Kaiser Permanente Division of Research, and,Perinatal Research Unit, Kaiser Permanente Division of Research, Oakland, California;,Department of Inpatient Pediatrics, Kaiser Permanente Medical Center, Walnut Creek, California
| | - Karen M. Puopolo
- Division of Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Soora Wi
- Perinatal Research Unit, Kaiser Permanente Division of Research, Oakland, California
| | - Benjamin J. Turk
- Kaiser Permanente Division of Research, and,Perinatal Research Unit, Kaiser Permanente Division of Research, Oakland, California
| | - Michael W. Kuzniewicz
- Perinatal Research Unit, Kaiser Permanente Division of Research, Oakland, California
| | - Eileen M. Walsh
- Perinatal Research Unit, Kaiser Permanente Division of Research, Oakland, California
| | - Thomas B. Newman
- Division of Clinical Epidemiology, University of California, San Francisco, San Francisco, California
| | - John Zupancic
- Harvard Medical School, Boston, Massachusetts;,Beth Israel-Deaconess Medical Center, Boston, Massachusetts; and
| | - Ellice Lieberman
- Division of Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts;,Harvard Medical School, Boston, Massachusetts
| | - David Draper
- Baskin School of Engineering, University of California, Santa Cruz, Santa Cruz, California
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Ramachandrappa A, Rosenberg ES, Wagoner S, Jain L. Morbidity and mortality in late preterm infants with severe hypoxic respiratory failure on extra-corporeal membrane oxygenation. J Pediatr 2011; 159:192-8.e3. [PMID: 21459387 PMCID: PMC3134553 DOI: 10.1016/j.jpeds.2011.02.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 01/18/2011] [Accepted: 02/07/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate morbidity, mortality, and associated risk factors in late preterm term infants (34-0/7 to 36-6/7 weeks) requiring extra-corporeal membrane oxygenation (ECMO). STUDY DESIGN We reviewed 21,218 neonatal ECMO runs in Extra-corporeal Life Support Organization registry data from 1986-2006. Infants were divided in 3 groups: late preterm (34-0/7 to 36-6/7 weeks), early-term (37-0/7 to 38-6/7 weeks), and full-term (39-0/7 to 42-6/7 weeks). RESULTS There were 14,528 neonatal ECMO runs that met inclusion criteria. Late preterm infants experienced the highest mortality rate on ECMO (late preterm, 26.2%; early-term, 18%; full-term, 11.2%; P < .001) and had longer ECMO runs; they also had higher rates of serious complications. Gestational age was a highly significant predictor for mortality. Late preterm infants with a primary diagnosis of sepsis and persistent pulmonary hypertension had 3-fold higher risk of mortality on ECMO than infants with meconium aspiration. CONCLUSION Late preterm infants treated with ECMO have higher morbidity and mortality rates than term infants. This underscores the need for special consideration of this vulnerable population in the diagnosis and treatment of hypoxic respiratory failure.
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Affiliation(s)
- Ashwin Ramachandrappa
- Department of Pediatrics, Division of Neonatology, Emory University, Atlanta, GA 30322, USA
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