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Ikeda H, Watanabe S, Sato S, Fee EL, Carter SWD, Kumagai Y, Takahashi T, Kawamura S, Hanita T, Illanes SE, Choolani MA, Saito M, Kikuchi A, Kemp MW, Usuda H. Upregulation of hepatic nuclear receptors in extremely preterm ovine fetuses undergoing artificial placenta therapy. J Matern Fetal Neonatal Med 2024; 37:2301651. [PMID: 38195120 DOI: 10.1080/14767058.2023.2301651] [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: 09/28/2023] [Accepted: 12/30/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE Extremely preterm infants have low Nuclear Receptor (NR) expression in their developing hepatobiliary systems, as they rely on the placenta and maternal liver for compensation. NRs play a crucial role in detoxification and the elimination of both endogenous and xenobiotic substances by regulating key genes encoding specific proteins. In this study, we utilized an Artificial Placenta Therapy (APT) platform to examine the liver tissue expression of NRs of extremely preterm ovine fetuses. This fetal model, resembling a "knockout placenta," lacks placental and maternal support, while maintaining a healthy extrauterine survival. METHODS Six ovine fetuses at 95 ± 1 d gestational age (GA; term = ∼150 d)/∼600 g delivery weight were maintained on an APT platform for a period of 120 h (APT Group). Six age-matched, in utero control fetuses were delivered at 99-100 d GA (Control Group). Fetal liver tissue samples and blood samples were collected at delivery from both groups and assessed mRNA expression of NRs and target transporters involved in the hepatobiliary transport system using quantitative PCR. Data were tested for group differences with ANOVA (p < .05 deemed significant). RESULTS mRNA expression of NRs was identified in both the placenta and the extremely preterm ovine fetal liver. The expression of HNF4α, LRH1, LXR, ESR1, PXR, CAR, and PPARα/γ were significantly elevated in the liver of the APT Group compared to the Control Group. Moreover, target transporters NTCP, OATP1B3, BSEP, and MRP4 were upregulated, whereas MRP2 and MRP3 were unchanged. Although there was no evidence of liver necrosis or apoptotic changes histologically, there was an impact in the fetal liver of the ATP group at the tissue level with a significant increase in TNFα mRNA, a cytokine involved in liver inflammation, and blood elevation of transaminases. CONCLUSION A number of NRs in the fetal liver were significantly upregulated after loss of placental-maternal support. However, the expression of target transporter genes appeared to be insufficient to compensate role of the placenta and maternal liver and avoid fetal liver damage, potentially due to insufficient excretion of organic anions.
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Affiliation(s)
- Hideyuki Ikeda
- Division of Obstetrics and Gynecology, The University of Western Australia, Crawley, Australia
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Japan
| | - Shimpei Watanabe
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Japan
| | - Shinichi Sato
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Japan
| | - Erin L Fee
- Division of Obstetrics and Gynecology, The University of Western Australia, Crawley, Australia
| | - Sean W D Carter
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yusaku Kumagai
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Japan
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tsukasa Takahashi
- Division of Obstetrics and Gynecology, The University of Western Australia, Crawley, Australia
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Japan
| | | | - Takushi Hanita
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Japan
| | - Sebastian E Illanes
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universidad de Los Andes, Santiago, Chile
- IMPACT, Center of Interventional Medicine for Precision and Advanced Cellular Therapy, Santiago, Chile
| | - Mahesh A Choolani
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Masatoshi Saito
- Division of Obstetrics and Gynecology, The University of Western Australia, Crawley, Australia
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Japan
| | - Atsuo Kikuchi
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Japan
| | - Matthew W Kemp
- Division of Obstetrics and Gynecology, The University of Western Australia, Crawley, Australia
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Japan
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, Australia
- Women and Infants Research Foundation, King Edward Memorial Hospital, Subiaco, Australia
| | - Haruo Usuda
- Division of Obstetrics and Gynecology, The University of Western Australia, Crawley, Australia
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Japan
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Jeong J, Lee Y, Han J, Kang E, Kim D, Kim KS, Kim EAR, Lee BS, Jung E. Mitochondrial DNA mutations in extremely preterm infants with bronchopulmonary dysplasia. Gene 2024; 910:148337. [PMID: 38432533 DOI: 10.1016/j.gene.2024.148337] [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: 10/01/2023] [Revised: 02/21/2024] [Accepted: 02/29/2024] [Indexed: 03/05/2024]
Abstract
Bronchopulmonary dysplasia (BPD) is a serious chronic lung disease affecting extremely preterm infants. While mitochondrial dysfunction has been investigated in various medical conditions, limited research has explored mitochondrial DNA (mtDNA) gene mutations, specifically in BPD. This study aimed to evaluate mitochondrial mtDNA gene mutations in extremely preterm infants with BPD. In this prospective observational study, we enrolled a cohort of extremely preterm infants diagnosed with BPD. Clinical data were collected to provide comprehensive patient profiles. Peripheral blood mononuclear cells were isolated from whole-blood samples obtained within a defined timeframe. Subsequently, mtDNA extraction and sequencing using next-generation sequencing technology were performed to identify mtDNA gene mutations. Among the cohort of ten extremely preterm infants with BPD, mtDNA sequencing revealed the presence of mutations in seven patients, resulting in a total of twenty-one point mutations. Notably, many of these mutations were identified in loci associated with critical components of the respiratory chain complexes, vital for proper mitochondrial function and cellular energy production. This pilot study provides evidence of mtDNA point mutations in a subset of extremely preterm infants with BPD. These findings suggest a potential association between mitochondrial dysfunction and the pathogenesis of BPD. Further extensive investigations are warranted to unravel the mechanisms underlying mtDNA mutations in BPD.
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Affiliation(s)
- Jiyoon Jeong
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea.
| | - Yeonmi Lee
- Department of Convergence Medicine and Stem Cell Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea; Department of Biomedical Science, College of Life Science, CHA University, 335, Pangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
| | - Jongsuk Han
- Department of Convergence Medicine and Stem Cell Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea; Department of Biomedical Science, College of Life Science, CHA University, 335, Pangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
| | - Eunju Kang
- Department of Convergence Medicine and Stem Cell Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea; Department of Biomedical Science, College of Life Science, CHA University, 335, Pangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
| | - Deokhoon Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea.
| | - Ki-Soo Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea.
| | - Ellen Ai-Rhan Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea.
| | - Byong Sop Lee
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea.
| | - Euiseok Jung
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea.
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Borg K, Hansen BM, Klamer A, Zachariassen G. Very preterm studies remain a challenge because of limited cohort sizes. Acta Paediatr 2024; 113:1118. [PMID: 38413549 DOI: 10.1111/apa.17173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 02/29/2024]
Affiliation(s)
- Kristine Borg
- H. C. Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Bo Mølholm Hansen
- Department of Paediatrics, Nordsjaellands Hospital, Hilleroed, Denmark
| | - Anja Klamer
- H. C. Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Gitte Zachariassen
- H. C. Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
- OPEN Explorative Network, Odense University Hospital, Odense, Region of Southern Denmark, Denmark
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DeMauro SB, McDonald SA, Heyne RJ, Vohr BR, Duncan AF, Newman JE, Das A, Hintz SR. Increasing Prevalence of Cerebral Palsy Among Two-Year-Old Children Born at <27 Weeks of Gestation: A Cohort Study. J Pediatr 2024; 268:113944. [PMID: 38336201 PMCID: PMC11045323 DOI: 10.1016/j.jpeds.2024.113944] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/12/2024] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE To evaluate changes in prevalence and severity of cerebral palsy (CP) among surviving children born at <27 weeks of gestation over time and to determine associations between CP and other developmental domains, functional impairment, medical morbidities, and resource use among 2-year-old children who were born extremely preterm. STUDY DESIGN Retrospective cohort study using prospective registry data, conducted at 25 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Participants were children born at <27 weeks of gestation and followed at 18 through 26 months of corrected age from 2008 through 2019. Outcomes of interest were changes in prevalence of any CP and severity of CP over time and associations between CP and other neurodevelopmental outcomes, functional impairment, and medical comorbidities. Adjusted logistic, linear, multinomial logistic, and robust Poisson regression evaluated the relationships between child characteristics, CP severity, and outcomes. RESULTS Among 6927 surviving children with complete follow-up data, 3717 (53.7%) had normal neurologic examinations, 1303 (18.8%) had CP, and the remainder had abnormal neurologic examinations not classified as CP. Adjusted rates of any CP increased each year of the study period (aOR 1.11 per year, 95% CI 1.08-1.14). Cognitive development was significantly associated with severity of CP. Children with CP were more likely to have multiple medical comorbidities, neurosensory problems, and poor growth at follow-up. CONCLUSIONS The rate of CP among surviving children who were born extremely preterm increased from 2008 through 2019. At 18 to 26 months of corrected age, neurodevelopmental and medical comorbidities are strongly associated with all severity levels of CP.
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Affiliation(s)
- Sara B DeMauro
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
| | | | - Roy J Heyne
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX
| | - Betty R Vohr
- Department of Pediatrics, Alpert Medical School of Brown University and Women & Infants Hospital, Providence, RI
| | - Andrea F Duncan
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | - Abhik Das
- RTI International, Research Triangle Park, NC
| | - Susan R Hintz
- Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital Stanford, Palo Alto, CA
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Selvanathan T, Guo T, Ufkes S, Chau V, Branson H, Synnes A, Ly LG, Kelly EN, Grunau RE, Miller SP. Size and Location of Preterm Brain Injury and Associations With Neurodevelopmental Outcomes. Neurology 2024; 102:e209264. [PMID: 38527245 DOI: 10.1212/wnl.0000000000209264] [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] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/05/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND AND OBJECTIVES We examined associations of white matter injury (WMI) and periventricular hemorrhagic infarction (PVHI) volume and location with 18-month neurodevelopment in very preterm infants. METHODS A total of 254 infants born <32 weeks' gestational age were prospectively recruited across 3 tertiary neonatal intensive care units (NICUs). Infants underwent early-life (median 33.1 weeks) and/or term-equivalent-age (median 41.9 weeks) MRI. WMI and PVHI were manually segmented for quantification in 92 infants. Highest maternal education level was included as a marker of socioeconomic status and was defined as group 1 = primary/secondary school; group 2 = undergraduate degree; and group 3 = postgraduate degree. Eighteen-month neurodevelopmental assessments were completed with Bayley Scales of Infant and Toddler Development, Third Edition. Adverse outcomes were defined as a score of less than 85 points. Multivariable linear regression models were used to examine associations of brain injury (WMI and PVHI) volume with neurodevelopmental outcomes. Voxel-wise lesion symptom maps were developed to assess relationships between brain injury location and neurodevelopmental outcomes. RESULTS Greater brain injury volume was associated with lower 18-month Motor scores (β = -5.7, 95% CI -9.2 to -2.2, p = 0.002) while higher maternal education level was significantly associated with higher Cognitive scores (group 3 compared 1: β = 14.5, 95% CI -2.1 to 26.9, p = 0.03). In voxel-wise lesion symptom maps, brain injury involving the central and parietal white matter was associated with an increased risk of poorer motor outcomes. DISCUSSION We found that brain injury volume and location were significant predictors of motor, but not cognitive outcomes, suggesting that different pathways may mediate outcomes across domains of neurodevelopment in preterm infants. Specifically, assessing lesion size and location may allow for more accurate identification of infants with brain injury at highest risk of poorer motor outcomes. These data also highlight the importance of socioeconomic status in cognitive outcomes, even in preterm infants with brain injury.
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Affiliation(s)
- Thiviya Selvanathan
- From Pediatrics (T.S., S.U., R.E.G., S.P.M.), BC Children's Hospital Research Institute and the University of British Columbia, Vancouver; Pediatrics (T.S., T.G., V.C., L.G.L., S.P.M.), The Hospital for Sick Children and University of Toronto; Diagnostic Imaging (H.B.), The Hospital for Sick Children and the University of Toronto, Ontario; Pediatrics (A.S., R.E.G.), BC Women's Hospital and the University of British Columbia, Vancouver; and Pediatrics (E.N.K.), Mount Sinai Hospital, The Hospital for Sick Children and the University of Toronto, Ontario, Canada
| | - Ting Guo
- From Pediatrics (T.S., S.U., R.E.G., S.P.M.), BC Children's Hospital Research Institute and the University of British Columbia, Vancouver; Pediatrics (T.S., T.G., V.C., L.G.L., S.P.M.), The Hospital for Sick Children and University of Toronto; Diagnostic Imaging (H.B.), The Hospital for Sick Children and the University of Toronto, Ontario; Pediatrics (A.S., R.E.G.), BC Women's Hospital and the University of British Columbia, Vancouver; and Pediatrics (E.N.K.), Mount Sinai Hospital, The Hospital for Sick Children and the University of Toronto, Ontario, Canada
| | - Steven Ufkes
- From Pediatrics (T.S., S.U., R.E.G., S.P.M.), BC Children's Hospital Research Institute and the University of British Columbia, Vancouver; Pediatrics (T.S., T.G., V.C., L.G.L., S.P.M.), The Hospital for Sick Children and University of Toronto; Diagnostic Imaging (H.B.), The Hospital for Sick Children and the University of Toronto, Ontario; Pediatrics (A.S., R.E.G.), BC Women's Hospital and the University of British Columbia, Vancouver; and Pediatrics (E.N.K.), Mount Sinai Hospital, The Hospital for Sick Children and the University of Toronto, Ontario, Canada
| | - Vann Chau
- From Pediatrics (T.S., S.U., R.E.G., S.P.M.), BC Children's Hospital Research Institute and the University of British Columbia, Vancouver; Pediatrics (T.S., T.G., V.C., L.G.L., S.P.M.), The Hospital for Sick Children and University of Toronto; Diagnostic Imaging (H.B.), The Hospital for Sick Children and the University of Toronto, Ontario; Pediatrics (A.S., R.E.G.), BC Women's Hospital and the University of British Columbia, Vancouver; and Pediatrics (E.N.K.), Mount Sinai Hospital, The Hospital for Sick Children and the University of Toronto, Ontario, Canada
| | - Helen Branson
- From Pediatrics (T.S., S.U., R.E.G., S.P.M.), BC Children's Hospital Research Institute and the University of British Columbia, Vancouver; Pediatrics (T.S., T.G., V.C., L.G.L., S.P.M.), The Hospital for Sick Children and University of Toronto; Diagnostic Imaging (H.B.), The Hospital for Sick Children and the University of Toronto, Ontario; Pediatrics (A.S., R.E.G.), BC Women's Hospital and the University of British Columbia, Vancouver; and Pediatrics (E.N.K.), Mount Sinai Hospital, The Hospital for Sick Children and the University of Toronto, Ontario, Canada
| | - Anne Synnes
- From Pediatrics (T.S., S.U., R.E.G., S.P.M.), BC Children's Hospital Research Institute and the University of British Columbia, Vancouver; Pediatrics (T.S., T.G., V.C., L.G.L., S.P.M.), The Hospital for Sick Children and University of Toronto; Diagnostic Imaging (H.B.), The Hospital for Sick Children and the University of Toronto, Ontario; Pediatrics (A.S., R.E.G.), BC Women's Hospital and the University of British Columbia, Vancouver; and Pediatrics (E.N.K.), Mount Sinai Hospital, The Hospital for Sick Children and the University of Toronto, Ontario, Canada
| | - Linh G Ly
- From Pediatrics (T.S., S.U., R.E.G., S.P.M.), BC Children's Hospital Research Institute and the University of British Columbia, Vancouver; Pediatrics (T.S., T.G., V.C., L.G.L., S.P.M.), The Hospital for Sick Children and University of Toronto; Diagnostic Imaging (H.B.), The Hospital for Sick Children and the University of Toronto, Ontario; Pediatrics (A.S., R.E.G.), BC Women's Hospital and the University of British Columbia, Vancouver; and Pediatrics (E.N.K.), Mount Sinai Hospital, The Hospital for Sick Children and the University of Toronto, Ontario, Canada
| | - Edmond N Kelly
- From Pediatrics (T.S., S.U., R.E.G., S.P.M.), BC Children's Hospital Research Institute and the University of British Columbia, Vancouver; Pediatrics (T.S., T.G., V.C., L.G.L., S.P.M.), The Hospital for Sick Children and University of Toronto; Diagnostic Imaging (H.B.), The Hospital for Sick Children and the University of Toronto, Ontario; Pediatrics (A.S., R.E.G.), BC Women's Hospital and the University of British Columbia, Vancouver; and Pediatrics (E.N.K.), Mount Sinai Hospital, The Hospital for Sick Children and the University of Toronto, Ontario, Canada
| | - Ruth E Grunau
- From Pediatrics (T.S., S.U., R.E.G., S.P.M.), BC Children's Hospital Research Institute and the University of British Columbia, Vancouver; Pediatrics (T.S., T.G., V.C., L.G.L., S.P.M.), The Hospital for Sick Children and University of Toronto; Diagnostic Imaging (H.B.), The Hospital for Sick Children and the University of Toronto, Ontario; Pediatrics (A.S., R.E.G.), BC Women's Hospital and the University of British Columbia, Vancouver; and Pediatrics (E.N.K.), Mount Sinai Hospital, The Hospital for Sick Children and the University of Toronto, Ontario, Canada
| | - Steven P Miller
- From Pediatrics (T.S., S.U., R.E.G., S.P.M.), BC Children's Hospital Research Institute and the University of British Columbia, Vancouver; Pediatrics (T.S., T.G., V.C., L.G.L., S.P.M.), The Hospital for Sick Children and University of Toronto; Diagnostic Imaging (H.B.), The Hospital for Sick Children and the University of Toronto, Ontario; Pediatrics (A.S., R.E.G.), BC Women's Hospital and the University of British Columbia, Vancouver; and Pediatrics (E.N.K.), Mount Sinai Hospital, The Hospital for Sick Children and the University of Toronto, Ontario, Canada
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Suonpera E, Lanceley A, Ni Y, Marlow N. Parenting stress and health-related quality of life among parents of extremely preterm born early adolescents in England: a cross-sectional study. Arch Dis Child Fetal Neonatal Ed 2024; 109:253-260. [PMID: 37879883 DOI: 10.1136/archdischild-2023-325429] [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: 02/07/2023] [Accepted: 09/27/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To determine whether extremely preterm (EP) birth exerts persisting effects on parents in early adolescence. DESIGN Cross-sectional survey conducted between March 2017 and October 2018. SETTING Evaluation of a longitudinal population-based birth cohort in England at 11 years of age (EPICure2@11 Study). PARTICIPANTS Parents of EP (<27 weeks of gestation) adolescents and control parents of term born (≥37 weeks of gestation) classmates of similar age and sex. MAIN OUTCOME MEASURES The Parenting Stress Index Short Form (PSI-4-SF) and the Short Form Health Survey (SF-12v1). RESULTS The 163 EP and 125 comparison respondents were most commonly mothers in their mid-40s. EP parents reported higher total parenting stress scores compared with controls, overall (adjusted difference in means: 14 (95% CI 9 to 20)) and after exclusion of moderate and severe child disability and multiples (9 (95% CI 3 to 15). Average physical and mental health-related quality of life scores were similar in the two groups (adjusted difference in means physical health: -2 (95% CI -4 to 1) and mental health: -1 (95% CI -4 to 1)). Among EP parents, 12% (20/164) reported the combination of high parenting stress and low mental health scores. With increasing child age, parenting stress scores for preterm parents were lower in contrast to controls who reported increasing parenting stress. CONCLUSIONS In early adolescence, compared with parents of term-born children, EP parents experience increased levels of parenting stress that are particularly high among a proportion of parents and associated with lower mental health-related quality of life. Practitioner awareness of this continuing risk throughout childhood is important to support parental abilities and well-being.
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Affiliation(s)
- Emmi Suonpera
- EGA UCL Institute for Women's Health, University College London, London, UK
| | - Anne Lanceley
- EGA UCL Institute for Women's Health, University College London, London, UK
| | - Yanyan Ni
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Neil Marlow
- EGA UCL Institute for Women's Health, University College London, London, UK
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Mitra S, Whitehead L, Smith K, Maclean B, Nixon R, Veysey A, Campbell-Yeo M, Kuhle S, Gale C, Soll R, Dorling J, Johnston BC. Prophylactic cyclo-oxygenase inhibitor drugs for the prevention of morbidity and mortality in extremely preterm infants: a clinical practice guideline incorporating family values and preferences. Arch Dis Child Fetal Neonatal Ed 2024; 109:232-238. [PMID: 37419686 DOI: 10.1136/archdischild-2023-325445] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/23/2023] [Indexed: 07/09/2023]
Abstract
ImportanceProphylactic cyclo-oxygenase inhibitors (COX-Is) such as indomethacin, ibuprofen and acetaminophen may prevent morbidity and mortality in extremely preterm infants (born ≤28 weeks' gestation). However, there is controversy around which COX-I, if any, is the most effective and safest, which has resulted in considerable variability in clinical practice. Our objective was to develop rigorous and transparent clinical practice guideline recommendations for the prophylactic use of COX-I drugs for the prevention of mortality and morbidity in extremely preterm infants. The Grading of Recommendations Assessment, Development and Evaluation evidence-to-decision framework for multiple comparisons was used to develop the guideline recommendations. A 12-member panel, including 5 experienced neonatal care providers, 2 methods experts, 1 pharmacist, 2 parents of former extremely preterm infants and 2 adults born extremely preterm, was convened. A rating of the most important clinical outcomes was established a priori. Evidence from a Cochrane network meta-analysis and a cross-sectional mixed-methods study exploring family values and preferences were used as the primary sources of evidence. The panel recommended that prophylaxis with intravenous indomethacin may be considered in extremely preterm infants (conditional recommendation, moderate certainty in estimate of effects). Shared decision making with parents was encouraged to evaluate their values and preferences prior to therapy. The panel recommended against routine use of ibuprofen prophylaxis in this gestational age group (conditional recommendation, low certainty in the estimate of effects). The panel strongly recommended against use of prophylactic acetaminophen (strong recommendation, very low certainty in estimate of effects) until further research evidence is available.
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Affiliation(s)
- Souvik Mitra
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Neonatal Perinatal Medicine, IWK Health, Halifax, Nova Scotia, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Leah Whitehead
- Division of Neonatal Perinatal Medicine, IWK Health, Halifax, Nova Scotia, Canada
| | - Katie Smith
- School of Access, Education and Language, Nova Scotia Community College, Halifax, Nova Scotia, Canada
| | - Breagh Maclean
- Department of Service Nova Scotia, Government of Nova Scotia, Halifax, Nova Scotia, Canada
| | - Rebekah Nixon
- Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andrew Veysey
- Division of Neonatal Perinatal Medicine, IWK Health, Halifax, Nova Scotia, Canada
| | - Marsha Campbell-Yeo
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Neonatal Perinatal Medicine, IWK Health, Halifax, Nova Scotia, Canada
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stefan Kuhle
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Chris Gale
- School of Public Health, Imperial College London, London, UK
| | - Roger Soll
- Department of Pediatrics, University of Vermont, Burlington, New Jersey, USA
| | - Jon Dorling
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Bradley C Johnston
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Nutrition, College of Agriculture and Life Sciences, Texas A&M University, College Station, Texas, USA
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, Texas, USA
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van Beek PE, Rijken M, Broeders L, Ter Horst HJ, Koopman-Esseboom C, de Kort E, Laarman ARC, Mulder-de Tollenaer SM, Steiner K, Swarte RMC, van Westering-Kroon E, Oei G, Leemhuis AG, Andriessen P. Neurodevelopmental outcome at 5.5 years in Dutch preterm infants born at 24-26 weeks' gestational age: the EPI-DAF study. Arch Dis Child Fetal Neonatal Ed 2024; 109:272-278. [PMID: 38071564 DOI: 10.1136/archdischild-2023-325732] [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: 04/24/2023] [Accepted: 10/20/2023] [Indexed: 04/20/2024]
Abstract
OBJECTIVE After lowering the Dutch threshold for active treatment from 25 to 24 completed weeks' gestation, survival to discharge increased by 10% in extremely preterm live born infants. Now that this guideline has been implemented, an accurate description of neurodevelopmental outcome at school age is needed. DESIGN Population-based cohort study. SETTING All neonatal intensive care units in the Netherlands. PATIENTS All infants born between 240/7 and 266/7 weeks' gestation who were 5.5 years' corrected age (CA) in 2018-2020 were included. MAIN OUTCOME MEASURES Main outcome measure was neurodevelopmental outcome at 5.5 years. Neurodevelopmental outcome was a composite outcome defined as none, mild or moderate-to-severe impairment (further defined as neurodevelopmental impairment (NDI)), using corrected cognitive score (Wechsler Preschool and Primary Scale of Intelligence Scale-III-NL), neurological examination and neurosensory function. Additionally, motor score (Movement Assessment Battery for Children-2-NL) was assessed. All assessments were done as part of the nationwide, standardised follow-up programme. RESULTS In the 3-year period, a total of 632 infants survived to 5.5 years' CA. Data were available for 484 infants (77%). At 5.5 years' CA, most cognitive and motor (sub)scales were significantly lower compared with the normative mean. Overall, 46% had no impairment, 36% had mild impairment and 18% had NDI. NDI-free survival was 30%, 49% and 67% in live born children at 24, 25 and 26 weeks' gestation, respectively (p<0.001). CONCLUSIONS After lowering the threshold for supporting active treatment from 25 to 24 completed weeks' gestation, a considerable proportion of the surviving extremely preterm children did not have any impairment at 5.5 years' CA.
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Affiliation(s)
- Pauline E van Beek
- Department of Neonatology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Monique Rijken
- Department of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Lisa Broeders
- The Netherlands Perinatal Registry, Utrecht, The Netherlands
| | - Hendrik J Ter Horst
- Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Corine Koopman-Esseboom
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ellen de Kort
- Department of Neonatology, Máxima Medical Center, Veldhoven, The Netherlands
| | - A R C Laarman
- Department of Neonatology, Amsterdam University Medical Center location VUMC, Amsterdam, The Netherlands
| | | | - Katerina Steiner
- Department of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Renate M C Swarte
- Department of Neonatology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Guid Oei
- Department of Obstetrics and Gynaecology, Máxima Medical Center, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Aleid G Leemhuis
- Department of Neonatology, Emma Childrens' Hospital, Amsterdam University Medical Center location AMC, Amsterdam, The Netherlands
| | - Peter Andriessen
- Department of Neonatology, Máxima Medical Center, Veldhoven, The Netherlands
- Department of Applied Physics, School of Medical Physics and Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Pristner M, Wasinger D, Seki D, Klebermaß-Schrehof K, Berger A, Berry D, Wisgrill L, Warth B. Neuroactive metabolites and bile acids are altered in extremely premature infants with brain injury. Cell Rep Med 2024; 5:101480. [PMID: 38518769 PMCID: PMC11031385 DOI: 10.1016/j.xcrm.2024.101480] [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: 05/22/2023] [Revised: 10/02/2023] [Accepted: 02/27/2024] [Indexed: 03/24/2024]
Abstract
The gut microbiome is associated with pathological neurophysiological evolvement in extremely premature infants suffering from brain injury. The exact underlying mechanism and its associated metabolic signatures in infants are not fully understood. To decipher metabolite profiles linked to neonatal brain injury, we investigate the fecal and plasma metabolome of samples obtained from a cohort of 51 extremely premature infants at several time points, using liquid chromatography (LC)-high-resolution mass spectrometry (MS)-based untargeted metabolomics and LC-MS/MS-based targeted analysis for investigating bile acids and amidated bile acid conjugates. The data are integrated with 16S rRNA gene amplicon gut microbiome profiles as well as patient cytokine, growth factor, and T cell profiles. We find an early onset of differentiation in neuroactive metabolites between infants with and without brain injury. We detect several bacterially derived bile acid amino acid conjugates in plasma and feces. These results provide insights into the early-life metabolome of extremely premature infants.
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Affiliation(s)
- Manuel Pristner
- Department of Food Chemistry and Toxicology, University of Vienna, 1090 Vienna, Austria
| | - Daniel Wasinger
- Department of Food Chemistry and Toxicology, University of Vienna, 1090 Vienna, Austria
| | - David Seki
- Center for Microbiology and Environmental Systems Science, Department of Microbiology and Ecosystem Science, Division of Microbial Ecology, University of Vienna, 1090 Vienna, Austria; Joint Microbiome Facility of the Medical University of Vienna and the University of Vienna, 1090 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, 1090 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, 1090 Vienna, Austria
| | - David Berry
- Center for Microbiology and Environmental Systems Science, Department of Microbiology and Ecosystem Science, Division of Microbial Ecology, University of Vienna, 1090 Vienna, Austria; Joint Microbiome Facility of the Medical University of Vienna and the University of Vienna, 1090 Vienna, Austria
| | - Lukas Wisgrill
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria
| | - Benedikt Warth
- Department of Food Chemistry and Toxicology, University of Vienna, 1090 Vienna, Austria.
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Song S, Zhu Z, Mao W, Zhu Y, Zhang R, Bu X, Li H, Han Y, Cao Y, Gao Y, Qiu YP, Wei G, Zhang P, Xie J, Wang M, Chen C, Zhu L. Comparison of singleton and twin birth weight reference percentile curves by gestational age and sex in extremely preterm infants: a population-based study. BMJ Paediatr Open 2024; 8:e002502. [PMID: 38627060 PMCID: PMC11029334 DOI: 10.1136/bmjpo-2024-002502] [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: 01/08/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND With the increasing survival rate of smaller newborns and twins, previous growth curves may not accurately assess the growth of extremely preterm infants (EPIs). Our study aimed to establish birth weight percentile curves for singletons and twins in EPIs from China and the USA and compare the differences between them. METHODS In China, EPIs were from 31 provinces, from 2010 to 2021. The collected information was sex, gestational age, birth weight, singletons and twins. We used the generalised additive models for location scale and shape method to construct the birth weight percentile curves by gestational age and sex for EPIs. The National Vital Statistics System database from 2016 to 2021 was also analysed. We compared the differences between the 50th birth weight percentile curves of the two databases. RESULTS We identified 8768 neonates in China (5536 singletons and 3232 twins) and 121 933 neonates in the USA (97 329 singletons and 24 604 twins). We established the 3rd, 10th, 25th, 50th, 75th, 90th and 97th birth weight reference curves for China and the USA. The results showed that males had higher birth weights than females. In China, for the same gestational age and sex, birth weights in singletons and twins were found to be similar, though singleton males born in China had slightly higher birth weights than male twins. In the USA, birth weights were also similar for females and males, with the same gestational age in singletons and twins. CONCLUSION We established birth weight reference percentile curves by gestational age and sex for singletons and twins among EPIs in China and the USA.
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Affiliation(s)
- Shuting Song
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Zhicheng Zhu
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Weiying Mao
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Yan Zhu
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Rong Zhang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Xinghe Bu
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Heqin Li
- Department of Neonatology, Baoji Maternity and Child Care Hospital, Shanxi, China
| | - Yanqing Han
- Department of Neonatology, Sichuan Provincial Maternal and Child Health Hospital, Sichuan, China
| | - Yuntao Cao
- Department of Neonatology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yuan Gao
- Department of Neonatalogy, Jinhua Woman's and Children's Hospital, zhejiang, China
| | - Yin-Ping Qiu
- Department of Neonatology, General hospital of Ningxia medical University, Yinchuan, China
| | - Guangyou Wei
- Department of Neonatology, The People's Hospital of Bozhou, Anhui, China
| | - Pingping Zhang
- Department of Neonatology, Tianjin First Central Hospital, Tianjin, China
| | - Jijian Xie
- Department of Neonatology, Affiliated Taihe Hospital of Hubei University of Medicine, Hubei, China
| | - Min Wang
- Department of Neonatology, Yichang Central Hospital, Hubei, China
| | - Chao Chen
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Li Zhu
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
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11
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Kim C, Kim S, Kim H, Hwang J, Kim SH, Yang M, Ahn SY, Sung SI, Chang YS. Long-term impact of late pulmonary hypertension requiring medication in extremely preterm infants with severe bronchopulmonary dysplasia. Sci Rep 2024; 14:8705. [PMID: 38622180 PMCID: PMC11018761 DOI: 10.1038/s41598-024-58977-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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/05/2024] [Indexed: 04/17/2024] Open
Abstract
This study investigated whether late pulmonary hypertension (LPH) independently increases the risk of long-term mortality or neurodevelopmental delay (NDD) in extremely preterm infants (EPIs) with severe bronchopulmonary dysplasia (BPD). Using prospectively collected data from the Korean Neonatal Network, we included EPIs with severe BPD born at 22-27 weeks' gestation between 2013 and 2021. EPIs having severe BPD with LPH (LPH, n = 124) were matched 1:3 with those without pulmonary hypertension (PH) as controls (CON, n = 372), via propensity score matching. LPH was defined as PH with the initiation of medication after 36 weeks' corrected age (CA). Long-term mortality after 36 weeks' CA or NDD at 18-24 months' CA was analyzed. NDD was assessed using composite scores based on various neurodevelopmental assessment modalities. LPH had significantly higher long-term mortality or NDD (45.2% vs. 23.1%, P < 0.001), mortality (24.2% vs. 4.84%, P < 0.001), and NDD (68.4% vs. 37.8%, P = 0.001), respectively than CON, even after adjusting for different demographic factors. Multivariable regression demonstrated that LPH independently increased the risk of mortality or NDD (adjusted odds ratio, 1.95; 95% confidence intervals, 1.17-3.25). When LPH occurs in EPIs with severe BPD, special monitoring and meticulous care for long-term survival and neurodevelopment are continuously needed.
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Affiliation(s)
- Chan Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-ku, Seoul, 06351, Republic of Korea
| | - Sumin Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-ku, Seoul, 06351, Republic of Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
| | - Hanna Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-ku, Seoul, 06351, Republic of Korea
| | - Jieun Hwang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-ku, Seoul, 06351, Republic of Korea
| | - Seung Hyun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-ku, Seoul, 06351, Republic of Korea
| | - Misun Yang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-ku, Seoul, 06351, Republic of Korea
- Cell and Gene Therapy Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - So Yoon Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-ku, Seoul, 06351, Republic of Korea
- Cell and Gene Therapy Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Se In Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-ku, Seoul, 06351, Republic of Korea
- Cell and Gene Therapy Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-ku, Seoul, 06351, Republic of Korea.
- Cell and Gene Therapy Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea.
- Department of Health Science and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea.
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12
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Mao WY, Lan JE, Gan MY, Zhang XJ, Yu H, Hu LY, Zhang R, Cao Y, Xiao ML. [Moxifloxacin treatment for Mycoplasma hominis meningitis in an extremely preterm infant]. Zhongguo Dang Dai Er Ke Za Zhi 2024; 26:432-436. [PMID: 38660910 DOI: 10.7499/j.issn.1008-8830.2312016] [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] [Indexed: 04/26/2024]
Abstract
The patient, a male newborn, was admitted to the hospital 2 hours after birth due to prematurity (gestational age 27+5 weeks) and respiratory distress occurring 2 hours postnatally. After admission, the infant developed fever and elevated C-reactive protein levels. On the fourth day after birth, metagenomic next-generation sequencing of cerebrospinal fluid indicated a positive result for Mycoplasma hominis (9 898 reads). On the eighth day, a retest of cerebrospinal fluid metagenomics confirmed Mycoplasma hominis (56 806 reads). The diagnosis of purulent meningitis caused by Mycoplasma hominis was established, and the antibiotic treatment was switched to moxifloxacin [5 mg/(kg·day)] administered intravenously for a total of 4 weeks. After treatment, the patient's cerebrospinal fluid tests returned to normal, and he was discharged as cured on the 76th day after birth. This article focuses on the diagnosis and treatment of neonatal Mycoplasma hominis purulent meningitis, introducing the multidisciplinary diagnosis and treatment of the condition in extremely preterm infants.
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Affiliation(s)
- Wei-Ying Mao
- Department of Neonatology, Children's Hospital of Fudan University/National Children's Medical Center, Shanghai 201102, China
| | | | | | | | | | - Li-Yuan Hu
- Department of Neonatology, Children's Hospital of Fudan University/National Children's Medical Center, Shanghai 201102, China
| | - Rong Zhang
- Department of Neonatology, Children's Hospital of Fudan University/National Children's Medical Center, Shanghai 201102, China
| | - Yun Cao
- Department of Neonatology, Children's Hospital of Fudan University/National Children's Medical Center, Shanghai 201102, China
| | - Mi-Li Xiao
- Department of Neonatology, Children's Hospital of Fudan University/National Children's Medical Center, Shanghai 201102, China
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Kruth SS, Willers C, Persad E, Sjöström ES, Lagerström SR, Rakow A. Probiotic supplementation and risk of necrotizing enterocolitis and mortality among extremely preterm infants-the Probiotics in Extreme Prematurity in Scandinavia (PEPS) trial: study protocol for a multicenter, double-blinded, placebo-controlled, and registry-based randomized controlled trial. Trials 2024; 25:259. [PMID: 38610034 PMCID: PMC11015611 DOI: 10.1186/s13063-024-08088-8] [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] [Received: 07/06/2023] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Extremely preterm infants, defined as those born before 28 weeks' gestational age, are a very vulnerable patient group at high risk for adverse outcomes, such as necrotizing enterocolitis and death. Necrotizing enterocolitis is an inflammatory gastrointestinal disease with high incidence in this cohort and has severe implications on morbidity and mortality. Previous randomized controlled trials have shown reduced incidence of necrotizing enterocolitis among older preterm infants following probiotic supplementation. However, these trials were underpowered for extremely preterm infants, rendering evidence for probiotic supplementation in this population insufficient to date. METHODS The Probiotics in Extreme Prematurity in Scandinavia (PEPS) trial is a multicenter, double-blinded, placebo-controlled and registry-based randomized controlled trial conducted among extremely preterm infants (n = 1620) born at six tertiary neonatal units in Sweden and four units in Denmark. Enrolled infants will be allocated to receive either probiotic supplementation with ProPrems® (Bifidobacterium infantis, Bifidobacterium lactis, and Streptococcus thermophilus) diluted in 3 mL breastmilk or placebo (0.5 g maltodextrin powder) diluted in 3 mL breastmilk per day until gestational week 34. The primary composite outcome is incidence of necrotizing enterocolitis and/or mortality. Secondary outcomes include incidence of late-onset sepsis, length of hospitalization, use of antibiotics, feeding tolerance, growth, and body composition at age of full-term and 3 months corrected age after hospital discharge. DISCUSSION Current recommendations for probiotic supplementation in Sweden and Denmark do not include extremely preterm infants due to lack of evidence in this population. However, this young subgroup is notably the most at risk for experiencing adverse outcomes. This trial aims to investigate the effects of probiotic supplementation on necrotizing enterocolitis, death, and other relevant outcomes to provide sufficiently powered, high-quality evidence to inform probiotic supplementation guidelines in this population. The results could have implications for clinical practice both in Sweden and Denmark and worldwide. TRIAL REGISTRATION ( Clinicaltrials.gov ): NCT05604846.
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Affiliation(s)
- Sofia Söderquist Kruth
- Women's Health and Allied Health Professional Theme, Karolinska University Hospital, Solna, 17176, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, 17177, Stockholm, Sweden
| | - Carl Willers
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 14152, Huddinge, Sweden
| | - Emma Persad
- Department of Women's and Children's Health, Karolinska Institutet, 17177, Stockholm, Sweden
| | | | - Susanne Rautiainen Lagerström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- K2 Medicin, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Alexander Rakow
- Department of Women's and Children's Health, Karolinska Institutet, 17177, Stockholm, Sweden.
- Department of Neonatology, Karolinska University Hospital, Solna, 17176, Stockholm, Sweden.
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Vestager ML, Hansen ML, Greisen G. Alternative consent methods used in the multinational, pragmatic, randomised clinical trial SafeBoosC-III. Trials 2024; 25:236. [PMID: 38575977 PMCID: PMC10996265 DOI: 10.1186/s13063-024-08074-0] [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: 12/19/2023] [Accepted: 03/25/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The process of obtaining prior informed consent for experimental treatment does not fit well into the clinical reality of acute and intensive care. The therapeutic window of interventions is often short, which may reduce the validity of the consent and the rate of enrolled participants, to delay trial completion and reduce the external validity of the results. Deferred consent and 'opt-out' are alternative consent methods. The SafeBoosC-III trial was a randomised clinical trial investigating the benefits and harms of cerebral oximetry monitoring in extremely preterm infants during the first 3 days after birth, starting within the first 6 h after birth. Prior, deferred and opt-out consent were all allowed by protocol. This study aimed to evaluate the use of different consent methods in the SafeBoosC-III trial, Furthermore, we aimed to describe and analyse concerns or complaints that arose during the first 6 months of trial conduct. METHODS All 70 principal investigators were invited to join this descriptive ancillary study. Each principal investigator received a questionnaire on the use of consent methods in their centre during the SafeBoosC-III trial, including the possibility to describe any concerns related to the consent methods used during the first 6 months of the trial, as raised by the parents or the clinical staff. RESULTS Data from 61 centres were available. In 43 centres, only prior informed consent was used: in seven, only deferred consent. No centres used the opt-out method only, but five centres used prior and deferred, five used prior, deferred and opt-out (all possibilities) and one used both deferred and opt-out. Six centres applied to use the opt-out method by their local research ethics committee but were denied using it. One centre applied to use deferred consent but was denied. There were only 23 registered concerns during the execution of the trial. CONCLUSIONS Consent by opt-out was allowed by the protocol in this multinational trial but only a few investigators opted for it and some research ethics boards did not accept its use. It is likely to need promotion by the clinical research community to unfold its potential.
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Affiliation(s)
- Maria Linander Vestager
- Department of Neonatology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | - Mathias Lühr Hansen
- Department of Neonatology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Gorm Greisen
- Department of Neonatology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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15
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Schmölzer GM, Asztalos EV, Beltempo M, Boix H, Dempsey E, El-Naggar W, Finer NN, Hudson JA, Mukerji A, Law BHY, Yaskina M, Shah PS, Sheta A, Soraisham A, Tarnow-Mordi W, Vento M. Does the use of higher versus lower oxygen concentration improve neurodevelopmental outcomes at 18-24 months in very low birthweight infants? Trials 2024; 25:237. [PMID: 38576007 PMCID: PMC10996184 DOI: 10.1186/s13063-024-08080-2] [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] [Received: 12/29/2023] [Accepted: 03/29/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Immediately after birth, the oxygen saturation is between 30 and 50%, which then increases to 85-95% within the first 10 min. Over the last 10 years, recommendations regarding the ideal level of the initial fraction of inspired oxygen (FiO2) for resuscitation in preterm infants have changed from 1.0, to room air to low levels of oxygen (< 0.3), up to moderate concentrations (0.3-0.65). This leaves clinicians in a challenging position, and a large multi-center international trial of sufficient sample size that is powered to look at safety outcomes such as mortality and adverse neurodevelopmental outcomes is required to provide the necessary evidence to guide clinical practice with confidence. METHODS An international cluster, cross-over randomized trial of initial FiO2 of 0.3 or 0.6 during neonatal resuscitation in preterm infants at birth to increase survival free of major neurodevelopmental outcomes at 18 and 24 months corrected age will be conducted. Preterm infants born between 230/7 and 286/7 weeks' gestation will be eligible. Each participating hospital will be randomized to either an initial FiO2 concentration of either 0.3 or 0.6 to recruit for up to 12 months' and then crossed over to the other concentration for up to 12 months. The intervention will be initial FiO2 of 0.6, and the comparator will be initial FiO2 of 0.3 during respiratory support in the delivery room. The sample size will be 1200 preterm infants. This will yield 80% power, assuming a type 1 error of 5% to detect a 25% reduction in relative risk of the primary outcome from 35 to 26.5%. The primary outcome will be a composite of all-cause mortality or the presence of a major neurodevelopmental outcome between 18 and 24 months corrected age. Secondary outcomes will include the components of the primary outcome (death, cerebral palsy, major developmental delay involving cognition, speech, visual, or hearing impairment) in addition to neonatal morbidities (severe brain injury, bronchopulmonary dysplasia; and severe retinopathy of prematurity). DISCUSSION The use of supplementary oxygen may be crucial but also potentially detrimental to preterm infants at birth. The HiLo trial is powered for the primary outcome and will address gaps in the evidence due to its pragmatic and inclusive design, targeting all extremely preterm infants. Should 60% initial oxygen concertation increase survival free of major neurodevelopmental outcomes at 18-24 months corrected age, without severe adverse effects, this readily available intervention could be introduced immediately into clinical practice. TRIAL REGISTRATION The trial was registered on January 31, 2019, at ClinicalTrials.gov with the Identifier: NCT03825835.
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Affiliation(s)
- Georg M Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, 10240 Kingsway Avenue NW, Edmonton, AB, T5H 3V9, Canada.
- Dept. of Pediatrics, University of Alberta, Edmonton, Canada.
| | - Elizabeth V Asztalos
- Department of Newborn & Developmental Paediatrics, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, ON, Canada
| | - Marc Beltempo
- Departement of Pediatrics, Montreal Children's HospitalMcGill University Health CenterMcGill University, Montreal, QC, Canada
| | - Hector Boix
- Division of Neonatology, Dexeus Quironsalud University Hospital, Barcelona, Spain
| | - Eugene Dempsey
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - Walid El-Naggar
- Department of Paediatrics, Dalhousie University, Halifax, Canada
| | - Neil N Finer
- School of Medicine, University of California, San Diego, CA, USA
- Sharp Mary Birch Hospital for Women and Newborns, San Diego, USA
| | - Jo-Anna Hudson
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NF, Canada
| | - Amit Mukerji
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Brenda H Y Law
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, 10240 Kingsway Avenue NW, Edmonton, AB, T5H 3V9, Canada
- Dept. of Pediatrics, University of Alberta, Edmonton, Canada
| | - Maryna Yaskina
- Women and Children's Health Research Institute (WCHRI), University of Alberta, Edmonton, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - Ayman Sheta
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Amuchou Soraisham
- Department of Pediatrics, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
- Alberta Childrens Hospital Research Institute, University of Calgary, Alberta, Canada
| | - William Tarnow-Mordi
- Trials Centre, National Health and Medical Research Council Clinical, University of Sydney, Camperdown, Australia
| | - Max Vento
- Department of Pediatrics, La Fe University and Polytechnic Hospital, Valencia, Spain
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Debay A, Shah P, Lodha A, Shivananda S, Redpath S, Seshia M, Dorling J, Lapointe A, Canning R, Strueby L, Beltempo M. Association of 24-Hour In-house Neonatologist Coverage with Outcomes of Extremely Preterm Infants. Am J Perinatol 2024; 41:747-755. [PMID: 35170012 DOI: 10.1055/a-1772-4637] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This study aimed to assess if 24-hour in-house neonatologist (NN) coverage is associated with delivery room (DR) resuscitation/stabilization and outcomes among inborn infants <29 weeks' gestational age (GA). STUDY DESIGN Survey-linked cohort study of 2,476 inborn infants of 23 to 28 weeks' gestation, admitted between 2014 and 2015 to Canadian Neonatal Network Level-3 neonatal intensive care units (NICUs) with a maternity unit. Exposures were classified using survey responses based on the most senior provider offering 24-hour in-house coverage: NN, fellow, and no NN/fellow. Primary outcome was death and/or major morbidity (bronchopulmonary dysplasia, severe neurological injury, late-onset sepsis, necrotizing enterocolitis, and retinopathy of prematurity). Multivariable logistic regression analysis was used to assess the association between exposures and outcomes and adjust for confounders. RESULTS Among the 28 participating NICUs, most senior providers ensuring 24-hour in-house coverage were NN (32%, 9/28), fellows (39%, 11/28), and no NN/fellow (29%, 8/28). No NN/fellow coverage and 24-hour fellow coverage were associated with higher odds of infants receiving DR chest compressions/epinephrine compared with 24-hour NN coverage (adjusted odds ratio [aOR] = 4.72, 95% confidence interval [CI]: 2.12-10.6 and aOR = 3.33, 95% CI: 1.44-7.70, respectively). Rates of mortality/major morbidity did not differ significantly among the three groups: NN, 63% (249/395 infants); fellow, 64% (1092/1700 infants); no NN/fellow, 70% (266/381 infants). CONCLUSION 24-hour in-house NN coverage was associated with lower rates of DR chest compressions/epinephrine. There was no difference in neonatal outcomes based on type of coverage; however, further studies are needed as ecological fallacy cannot be ruled out. KEY POINTS · Lower rates of DR cardiopulmonary resuscitation with 24h in-house NN coverage. · The type of 24h in-house coverage was not associated with mortality and/or major morbidity.. · High-volume centers more often have 24h in-house neonatal fellow coverage.
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Affiliation(s)
- Anthony Debay
- Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Prakesh Shah
- Departement of Pediatrics, Toronto University, Toronto, Ontario, Canada
| | - Abhay Lodha
- Departement of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Sandesh Shivananda
- Departement of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie Redpath
- Departement of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Mary Seshia
- Departement of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jon Dorling
- Departement of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anie Lapointe
- Departement of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Rody Canning
- Departement of Pediatrics, Moncton Hospital, Moncton, Alberta, Canada
| | - Lannae Strueby
- Departement of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Marc Beltempo
- Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
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Schwarz CE, O'Toole JM, Healy DB, Panaviene J, Livingstone V, Dempsey EM. Electrical Cardiometry during transition and short-term outcome in very preterm infants: a prospective observational study. Eur J Pediatr 2024; 183:1629-1636. [PMID: 38189914 PMCID: PMC11001706 DOI: 10.1007/s00431-023-05387-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 01/09/2024]
Abstract
The purpose of this study is to evaluate the association of Electrical Cardiometry (EC)-derived cardiac output indexed to weight (CO) and its changes during the first 48 h in relation to adverse short-term outcome in very preterm infants. In this prospective observational study of preterm infants < 32 weeks gestational age (GA), the combined adverse outcome was defined as mortality or abnormal cranial ultrasound (any grade intracranial hemorrhage (ICH) or periventricular leukomalacia) within the first 2 weeks postnatally. Logistic regression models were used to investigate the association between median CO and outcome and mixed-effects models for the time trajectory of CO. In the absence of device-specific thresholds for low or high CO, no thresholds were used in our analysis. Fifty-three infants (median (IQR) GA 29.0 (25.4-30.6) weeks, birthweight 1020 (745-1505) g) were included in the analysis. Median CO was 241 (197-275) mL/kg/min for the adverse outcome and 198 (175-227) mL/kg/min for normal outcome (odds ratio (OR) (95% confidence interval (95% CI)), 1.01 (1.00 to 1.03); p = 0.028). After adjustment for GA, the difference was not significant (adjusted OR (95% CI), 1.01 (0.99 to 1.02); p = 0.373). CO trajectory did not differ by outcome (p = 0.352). A post hoc analysis revealed an association between CO time trajectory and ICH ≥ grade 2. Conclusions: EC-derived CO estimates within 48 h postnatally were not independently associated with brain injury (any grade) or mortality in the first 14 days of life. CO time trajectory was found to be associated with ICH ≥ grade 2. What is Known: • Bioreactance-derived cardiac output indexed to bodyweight (CO) in the transitional period has been associated with adverse short-term outcome in preterm infants. What is New: • Electrical Cardiometry (EC)-derived CO measurements in very preterm infants during the transitional period are not independently associated with adverse outcome (death or ultrasound detected brain damage) within 2 weeks postnatally. • In the first 48 h EC-derived CO increases over time and is higher in extremely preterm infants compared to very preterm and differs from previously reported bioreactance-derived CO values.
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Affiliation(s)
- C E Schwarz
- Department of Paediatrics & Child Health, University College Cork, Cork, Ireland.
- INFANT Research Centre, University College Cork, Cork, Ireland.
- Department of Neonatology, Center for Pediatric and Adolescent Medicine, University of Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.
| | - J M O'Toole
- Department of Paediatrics & Child Health, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - D B Healy
- Department of Paediatrics & Child Health, University College Cork, Cork, Ireland
| | - J Panaviene
- Department of Paediatrics & Child Health, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - V Livingstone
- Department of Paediatrics & Child Health, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - E M Dempsey
- Department of Paediatrics & Child Health, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
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Söderström F, Sindelar R, Olsson KW, Yousef S, Todorova D, Pestalozzi J, Mellander M, Raaijmakers R. Active versus restrictive ligation strategy for patent ductus arteriosus - A retrospective two-center study of extremely preterm infants born between 22 + 0 and 25 + 6 weeks of gestational age. Early Hum Dev 2024; 191:105976. [PMID: 38452632 DOI: 10.1016/j.earlhumdev.2024.105976] [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: 12/22/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Patent ductus arteriosus (PDA) in premature infants is associated with adverse clinical outcomes. Mode and timing of treatment are still controversial. Data are limited in the most extremely premature infants <26 weeks of gestational age (GA), where clinical problems are most significant and patients are most vulnerable. AIMS To investigate whether different approaches to surgical closure of PDA in two large Swedish centers has an impact on clinical outcomes including mortality in extremely preterm infants born <26 weeks GA. STUDY DESIGN Retrospective, two-center, cohort study. SUBJECTS Infants born at 22+0-25+6 weeks GA between 2010 and 2016 at Uppsala University Children's Hospital (UUCH; n = 228) and Queen Silvia Children's Hospital Gothenburg (QSCHG; n = 220). MAIN OUTCOME MEASURES Survival, bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP). RESULTS Surgical closure of PDA was more common and performed earlier at QSCHG (50 % vs 16 %; median age 11 vs 44 days; p < 0.01). Survival was similar in both centres. There was a higher incidence of severe BPD and longer duration of mechanical ventilation at UUCH (p < 0.01). There was a higher incidence of ROP, IVH and sepsis at QSCH (p < 0.05, p < 0.01 and p < 0.01). A sub-group analysis matching all surgically treated infants at QSCHG with infants at UUCH with the same GA showed similar results as the total cohort. CONCLUSION Earlier and higher rate of surgical PDA closure in this cohort of extremely preterms born <26 weeks GA did not impact mortality but was associated with lower rates of severe BPD and higher rates of severe ROP.
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Affiliation(s)
- Fanny Söderström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Neonatal Intensive Care Unit, Uppsala University Children's Hospital, Uppsala, Sweden
| | - Richard Sindelar
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Neonatal Intensive Care Unit, Uppsala University Children's Hospital, Uppsala, Sweden
| | | | - Sawin Yousef
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Daniela Todorova
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Neonatal Intensive Care Unit, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Joanna Pestalozzi
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Mats Mellander
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Children's Heart Center, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Renske Raaijmakers
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Neonatal Intensive Care Unit, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
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19
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Winkler P, Cloppenburg E, Heep A, Malik E, Lüdders D, Lange M. [Influence of Fetomaternal Risk Factors on Mortality and Morbidity in Extremely Preterm Infants]. Z Geburtshilfe Neonatol 2024; 228:166-173. [PMID: 38081217 DOI: 10.1055/a-2198-9124] [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] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
INTRODUCTION The management of pregnant women at risk of preterm delivery poses a challenge to the interdisciplinary team. At the edge of viability, it is crucial to take into consideration maternal and fetal risk factors when determining individual counseling and therapeutic approaches. METHODS At a level 4 perinatal center, all preterm infants (PI) born in the years 2017 to 2020 who had a gestational age between 230/7 and 246/7 weeks and were cared for with a curative therapeutic approach were enrolled in a retrospective observational study. Divided into two groups (230/7-236/7 and 240/7-246/7 weeks of gestation), the PI were compared in terms of mortality and morbidity based on maternal and fetal risk factors. Thirteen risk factors and their prognostic relevance for survival were analyzed. RESULTS 41 mothers with 48 PI were included. 9 neonates received primary palliative treatment and were excluded from the analyses. The survival rates between the two groups (n=21, n=27) showed no significant difference (66.7% versus 74.1%, p=0.750). A significantly higher mortality was observed in PI with an increased number of risk factors (p=0.004), the most severe of which were hypertensive disorders of pregnancy and preterm premature rupture of membranes. Data regarding morbidity showed no significant difference. CONCLUSION Data regarding mortality correlate with national findings. Observed morbidity in the study population was recorded. The prediction of probability of survival is more precise when risk factors are taken into consideration.
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Affiliation(s)
- Paula Winkler
- Universitätsklinik für Gynäkologie und Geburtshilfe, Klinikum Oldenburg AoR, Oldenburg, Germany
| | - Eva Cloppenburg
- Universitätsklinik für Kinder- und Jugendmedizin, Elisabeth-Kinderkrankenhaus, Klinik für Neonatologie, Pädiatrische Intensivmedizin, Kinderkardiologie, Pädiatrische Pneumologie und Allergologie, Klinikum Oldenburg AoR, Oldenburg, Germany
| | - Axel Heep
- Universitätsklinik für Kinder- und Jugendmedizin, Elisabeth-Kinderkrankenhaus, Klinik für Neonatologie, Pädiatrische Intensivmedizin, Kinderkardiologie, Pädiatrische Pneumologie und Allergologie, Klinikum Oldenburg AoR, Oldenburg, Germany
| | - Eduard Malik
- Universitätsklinik für Gynäkologie und Geburtshilfe, Klinikum Oldenburg AoR, Oldenburg, Germany
| | - Dörte Lüdders
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Starnberg, Starnberg, Germany
| | - Matthias Lange
- Universitätsklinik für Kinder- und Jugendmedizin, Elisabeth-Kinderkrankenhaus, Klinik für Neonatologie, Pädiatrische Intensivmedizin, Kinderkardiologie, Pädiatrische Pneumologie und Allergologie, Klinikum Oldenburg AoR, Oldenburg, Germany
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20
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Dassios T, Harris C, Williams EE, Greenough A. Sex differences in preterm respiratory morbidity: A recent whole-population study. Acta Paediatr 2024; 113:745-750. [PMID: 38126241 DOI: 10.1111/apa.17071] [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: 11/07/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
AIM To determine whether there were differences between male and female infants in respiratory morbidity in a whole population of extremely preterm infants, including infants born below 24 weeks of gestation. METHODS Retrospective whole-population study of all infants <28 weeks of gestation admitted to a neonatal unit in England from 2014 to 2019. Bronchopulmonary dysplasia (BPD) development was defined as any respiratory support at 36 weeks postmenstrual age. RESULTS The 11 844 infants had a median (IQR) gestational age of 26.0 (24.9-27.1) weeks and a birth weight of 0.81 (0.67-0.96) kg. The duration of invasive ventilation was longer in male compared to female infants who were born at 24-27 completed weeks of gestation (p < 0.001), but not significantly different between male and female infants born at 22 and 23 weeks of gestation (p = 0.446). The incidence of BPD was higher in male compared to female infants born at 24-27 weeks of gestation (p < 0.001) but not different between male and female infants born at 22 and 23 weeks of gestation (p = 0.148). CONCLUSION Respiratory morbidity was more pronounced in male compared to female extremely preterms, only in gestations 24-27 completed weeks. Male predominance was absent in infants born below 24 weeks of gestation.
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Affiliation(s)
- Theodore Dassios
- Faculty of Life Science and Medicine, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Patras, Patras, Greece
| | - Christopher Harris
- Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Emma E Williams
- Faculty of Life Science and Medicine, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Anne Greenough
- Faculty of Life Science and Medicine, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
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21
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Abdelmageed WA, Lapointe A, Brown R, Gorgos A, Luu TM, Beltempo M, Altit G, Dayan N. Association between maternal hypertension and infant neurodevelopment in extremely preterm infants. J Perinatol 2024; 44:539-547. [PMID: 38287138 DOI: 10.1038/s41372-024-01886-7] [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: 08/29/2023] [Revised: 12/04/2023] [Accepted: 01/16/2024] [Indexed: 01/31/2024]
Abstract
OBJECTIVE To examine the association between maternal hypertension during pregnancy and neurodevelopmental impairment (NDI) at 24 months post-menstrual age in extremely preterm infants. STUDY DESIGN Using data from two tertiary neonatal units (2011-2017) for infants born at 23 + 0 to 28 + 6 weeks, we investigated outcomes of NDI related to maternal hypertension and small-for-gestational-age (SGA) status. RESULTS Of 1019 pre-term infants, 647 had complete data and were included in the analysis. Ninety-six (15%) had maternal hypertension exposure; 25 (4%) were also SGA. Infants with maternal hypertension showed a higher odds of any NDI (aOR: 2.29, 95% CI = 1.36-3.87) and significant NDI (aOR: 2.01, 95% CI = 1.02-3.95). The combination of hypertension and SGA further elevated this risk (aOR for any NDI: 4.88, 95% CI = 1.80-13.22; significant NDI: 6.91, 95% CI = 2.50-19.12). CONCLUSION Maternal hypertension during pregnancy elevates the risk of NDI in extremely preterm infants, more so when combined with SGA.
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Affiliation(s)
- Wael A Abdelmageed
- Department of Medicine, Division of Experimental Medicine, McGill University Health Center, Montreal, QC, Canada
| | - Anie Lapointe
- Division of Neonatology, Department of Paediatrics, Sainte-Justine University Hospital Center, Montréal, QC, Canada
| | - Richard Brown
- Research Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Andreea Gorgos
- Neonatal Follow-Up, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Thuy Mai Luu
- Neonatal Follow-Up, Department of Paediatrics, Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Marc Beltempo
- Division of Neonatology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Gabriel Altit
- Division of Neonatology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Natalie Dayan
- Research Institute, McGill University Health Centre, Montreal, QC, Canada.
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Jenni F, Konzett K, Gang S, Sparr V, Simma B. Psychomotor and Cognitive Outcome in Very Preterm Infants in Vorarlberg, Austria, 2007-2019. Neuropediatrics 2024; 55:90-96. [PMID: 38158208 DOI: 10.1055/a-2236-4003] [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] [Indexed: 01/03/2024]
Abstract
AIM The aim of this study was to analyze neurodevelopmental outcome of very and extremely preterm infants in Vorarlberg, Austria, accessed with neurodevelopmental testing, at the corrected age of 24 months. This article also compared these results with (inter)national data and analyzed the impact of perinatal parameters. METHODS Population-based, retrospective multicenter study with data on very and extremely preterm infants born in Vorarlberg from 2007 to 2019 assessed with Bayley Scales of Infant Development (BSID-II/Bayley-III). RESULTS Included were 264 infants with a mean age of 29.0 (± 2.1) weeks of gestational age and a mean birth weight of 1177 (± 328.26) g; 172 infants underwent a BSID-II, 92 a Bayley-III assessment. The psychomotor developmental index (PDI) and mental developmental index (MDI) showed mean scores of 99.6 (± 14.4) and 91 (± 20.4), respectively. Adverse outcomes (scores <70) were assessed in 4.2% for PDI and 15.5% for MDI. In the extremely preterm group (n = 79), results for mean PDI were 100.1 (± 16.8) and for mean MDI 88.4 (± 22.4). Accordingly, adverse outcomes were assessed in 5.1% for PDI and in 20.3% for MDI. In addition to bronchopulmonary dysplasia and intraventricular hemorrhage Grade 3-4, head circumference at birth and patent ductus arteriosus were also identified as risk factors for poor outcome. CONCLUSION This study showed a remarkably good neurodevelopmental outcome in preterm infants with low rates of adverse outcome, similar to (inter)national reports, especially in the group of extremely preterm infants. Research is needed to explore the role of social factors and infants' environment, especially cognitive outcome and language skills.
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Affiliation(s)
- Fabio Jenni
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Karin Konzett
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Stefanie Gang
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Verena Sparr
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Burkhard Simma
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
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Valentine GC, Perez KM, Wood TR, Mayock DE, Law JB, Kolnik S, Strobel KM, Brandon OC, Comstock BA, Heagerty PJ, Juul SE. Time to regain birthweight and association with neurodevelopmental outcomes among extremely preterm newborns. J Perinatol 2024; 44:554-560. [PMID: 38195922 DOI: 10.1038/s41372-024-01869-8] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/16/2023] [Accepted: 01/02/2024] [Indexed: 01/11/2024]
Abstract
OBJECTIVE Determine association between time to regain birthweight and 2-year neurodevelopment among extremely preterm (EP) newborns. STUDY DESIGN Secondary analysis of the Preterm Erythropoietin Neuroprotection Trial evaluating time to regain birthweight, time from birth to weight nadir, time from nadir to regain birthweight, and cumulative weight loss with 2-year corrected Bayley Scales of Infant and Toddler Development 3rd edition. RESULTS Among n = 654 EP neonates, those with shorter nadir-to-regain had lower cognitive scores (≤1 day versus ≥8 days: -5.0 points, [CI -9.5, -0.6]) and lower motor scores (≤1 day versus ≥8 days: -4.6 points [CI -9.2, -0.03]) in adjusted stepwise forward regression modeling. Increasingly cumulative weight loss was associated with lower cognitive scores (≤-50 percent-days: -5.6, [CI -9.4, -1.8]), motor scores (≤-50 percent-days: -4.2, [CI -8.2, -0.2]); and language scores (≤-50 percent-days: -6.0, [CI -10.1, -1.9]). CONCLUSION Faster nadir-to-regain and excessive cumulative weight loss are associated with adverse 2-year neurodevelopmental outcomes. TRIAL REGISTRATION PENUT Trial Registration: NCT01378273. https://clinicaltrials.gov/ct2/show/NCT01378273 . CLINICAL TRIAL REGISTRATION This study is a post-hoc secondary analysis of pre-existing data from the PENUT Trial (NCT #01378273).
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Affiliation(s)
- Gregory C Valentine
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA.
- Division of Maternal-Fetal Medicine at Baylor College of Medicine, Department of Obstetrics & Gynecology, Houston, TX, USA.
| | - Krystle M Perez
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA
| | - Thomas R Wood
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA
| | - Dennis E Mayock
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA
| | - Janessa B Law
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA
| | - Sarah Kolnik
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA
| | - Katie M Strobel
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA
| | - Olivia C Brandon
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA
| | - Bryan A Comstock
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - Sandra E Juul
- Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, WA, USA
- Institute on Human Development and Disability, University of Washington, Seattle, WA, USA
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24
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Chen J, Zhu Y, Li L, Lv J, Li Z, Chen X, Chen X, Huang S, Xie R, Zhang Y, Ye G, Luo R, Shen X, Fu M, Zhuo Y. Visual impairment burden in retinopathy of prematurity: trends, inequalities, and improvement gaps. Eur J Pediatr 2024; 183:1891-1900. [PMID: 38319404 DOI: 10.1007/s00431-024-05450-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/10/2024] [Accepted: 01/22/2024] [Indexed: 02/07/2024]
Abstract
Retinopathy of prematurity (ROP) is an important cause of avoidable childhood visual impairment, and the increase in number and survival of premature infants may inflate its burden globally. We aimed to comprehensively assess the trends and inequalities in the burden of ROP-related visual impairment and to identify improvement gaps to facilitate appropriate actions in neonatal care systems. We obtained ROP data from the Global Burden of Disease 2019 study. We employed joinpoint regression analysis to assess the trends of the burden of ROP-related visual impairment, measured by age-standardised prevalence rates, health equity analysis methods to evaluate cross-country burden inequalities, and data envelopment and stochastic frontier analyses to identify improvement gaps based on the development status, i.e., sociodemographic index (SDI). Between 1990 and 2019, the age-standardised prevalence rates of ROP-related visual impairment significantly increased worldwide (average annual percentage change: 0.23 [95% confidence interval, 0.21-0.26] among males and 0.26 [0.25-0.27] among females), primarily in developed regions. Although significant SDI-related cross-country inequalities were identified, these reduced over time (slope index of inequality: -57.74 [-66.22 to -49.25] in 1990 to -29.68 [-38.39 to -20.97] in 2019; health concentration index: -0.11 [-0.13 to -0.09] in 1990 to -0.07 [-0.09 to -0.06] in 2019). Notably, some less-developed countries exhibited superior performance despite limited resources, whereas others with a higher SDI delivered lagging performance. Conclusion: The global burden of ROP-related visual impairment has steadily increased between 1990 and 2019, with disproportionate burden concentration among less-developed countries, requiring appropriate preventive and intervention measures. What is Known: • Retinopathy of prematurity (ROP) is an important cause of avoidable childhood visual impairment. • The prevalence of ROP is anticipated to increase due to the growing number of extremely premature infants. What is New: • The prevalence of ROP-related visual impairment has increased worldwide, primarily in developed regions, with declining but persisting cross-country inequalities. • The increasing burden of ROP-related visual impairment should be considered as part of global and national health agendas, requiring interventions with proven efficacy.
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Affiliation(s)
- Jianqi Chen
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Yingting Zhu
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Linling Li
- Shenzhen Maternal and Child Health Care Hospital, Shenzhen, 518000, China
| | - Juan Lv
- Shenzhen Maternal and Child Health Care Hospital, Shenzhen, 518000, China
| | - Zhidong Li
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Xuhao Chen
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Xiaohong Chen
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Shaofen Huang
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Rui Xie
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Yuan Zhang
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Guitong Ye
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Ruiyu Luo
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Xinyue Shen
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China
| | - Min Fu
- Shenzhen Maternal and Child Health Care Hospital, Shenzhen, 518000, China.
| | - Yehong Zhuo
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China.
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25
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Jung JK, Kim EY, Heo JS, Park KH, Choi BM. Analysis of perinatal risk factors for massive pulmonary hemorrhage in very low birth weight infant: A nationwide large cohort database. Early Hum Dev 2024; 191:105977. [PMID: 38460343 DOI: 10.1016/j.earlhumdev.2024.105977] [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: 12/28/2023] [Revised: 02/28/2024] [Accepted: 02/28/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVE To determine perinatal risk factors for Massive pulmonary hemorrhage (MPH) and MPH-caused mortality to guide clinicians in implementing preventive measures at the beginning of life for improving the survival of very low birth weight infant (VLBWIs). STUDY DESIGN A total of 13,826 VLBWIs born between 2013 and 2020 in the Korean Neonatal Network database were included. RESULTS MPH occurred in 870 (6.3 %) VLBWIs. Among infants with MPH, 162 (18.6 %) VLBWIs died due to MPH. In the multivariate logistic regression analysis, independent risk factors for MPH were identified as small for gestational age, multiple gestation, high CRIB-II score, use of surfactant, and symptomatic patent ductus arteriosus (sPDA) in VLBIWs. Independent risk factors for MPH-caused mortality were identified as multiple gestation in VLBWIs. Receiving a complete course of antenatal corticosteroids (ACS) was found to be a significant independent protective factor for MPH-caused mortality in VLBWIs. CONCLUSION Proactive managements for reducing unnecessary use of pulmonary surfactant and for decreasing the risk of sPDA at the beginning of life could be recommended as preventive strategies to reduce the risk of MPH in extremely preterm infants. ACS therapy is highly recommended for women with a high likelihood of giving birth preterm to reduce the risk of mortality caused by MPH.
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Affiliation(s)
- Jong Ki Jung
- Department of Pediatrics, Korea University Ansan Hospital, Ansan-si, Republic of Korea; Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eun Yeob Kim
- Medical Science Research Center, Korea University Ansan Hospital, Ansan-si, Republic of Korea
| | - Ju Sun Heo
- Department of Pediatrics, Korea University Anam Hospital, Seoul, Republic of Korea; Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyu Hee Park
- Department of Pediatrics, Korea University Ansan Hospital, Ansan-si, Republic of Korea
| | - Byung Min Choi
- Department of Pediatrics, Korea University Ansan Hospital, Ansan-si, Republic of Korea; Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea.
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26
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Valcarce V, Salas AA, Ambalavanan N. Body composition of very preterm infants in mid-adulthood. Pediatr Res 2024; 95:1177-1178. [PMID: 38160219 DOI: 10.1038/s41390-023-03012-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Vivian Valcarce
- Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ariel A Salas
- Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Namasivayam Ambalavanan
- Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA.
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27
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Shemesh R, Strauss T, Zaslavsky-Paltiel I, Lerner-Geva L, Reichman B, Wygnanski-Jaffe T. Perinatal and neonatal risk factors for retinopathy of prematurity in very low birthweight, very preterm twins: a population-based study. Eye (Lond) 2024; 38:902-909. [PMID: 37925560 PMCID: PMC10965998 DOI: 10.1038/s41433-023-02801-8] [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: 02/11/2023] [Revised: 09/28/2023] [Accepted: 10/17/2023] [Indexed: 11/06/2023] Open
Abstract
OBJECTIVE To determine the effect of perinatal and neonatal risk factors on retinopathy of prematurity (ROP) and to examine the association of fertility treatments on the risk for ROP in very low birth weight (VLBW) preterm twins. METHODS The population-based observational study consisted of VLBW twins born at 24-29 weeks gestational age (GA). Data from the Israel national database (1995-2020) were applied. Univariate and multivariable logistic regression using the General Estimating Equation were used for assessment of risk factors. RESULTS The study population comprised 4092 infants of whom 2374 (58%) were conceived following fertility treatments. ROP was diagnosed in 851 (20.8%) infants. The odds for ROP approximately doubled with each week decrease in GA: at 24 weeks, Odds Ratio (OR) 58.00 (95% confidence interval (CI) 31.83-105.68); 25 weeks, OR 25.88 (95% CI 16.76-39.96); 26 weeks, OR 12.69 (95% CI 8.84-18.22) compared to 29 weeks GA. Each decrease in one birthweight z-score was associated with 1.82-fold increased risk for ROP (OR, 1.82, 95% CI 1.59-2.08). Infertility treatments were not associated with ROP. Neonatal morbidities significantly associated with ROP were surgical necrotizing enterocolitis (NEC) (OR, 2.04, 95% CI 1.31-3.19); surgically treated patent ductus arteriosus (PDA) (OR, 1.63, 95% CI 1.12-2.37); sepsis (OR, 1.43, 95% CI 1.20-1.71) and bronchopulmonary dysplasia (OR, 1.52, 95% CI 1.22-1.90). CONCLUSION Among preterm VLBW twins, poor intrauterine growth and surgical interventions for NEC and PDA were associated with high odds for ROP. This study does not support an association of fertility treatments with increased risk for ROP.
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Affiliation(s)
- Rachel Shemesh
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | - Tzipi Strauss
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Neonatology, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Inna Zaslavsky-Paltiel
- Women and Children's Health Research Unit, Gertner Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Liat Lerner-Geva
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Women and Children's Health Research Unit, Gertner Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Brian Reichman
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Women and Children's Health Research Unit, Gertner Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Tamara Wygnanski-Jaffe
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.
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28
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Chen X, Yuan L, Jiang S, Gu X, Lei X, Hu L, Xiao T, Zhu Y, Dang D, Li W, Cao Y, Du L, Lee SK, Chen C, Zhou W, Zhou J. Synergistic effects of achieving perinatal interventions on bronchopulmonary dysplasia in preterm infants. Eur J Pediatr 2024; 183:1711-1721. [PMID: 38231237 DOI: 10.1007/s00431-023-05355-9] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 01/18/2024]
Abstract
To investigate the effect of perinatal interventions on the risk of severe BPD (sBPD) and death in extremely preterm infants (EPIs) and their synergistic effects. This was a secondary analysis of the prospective cohort Chinese Neonatal Network (CHNN). Infants with a birth weight of 500 to 1250 g or 24-28 weeks completed gestational age were recruited. The impacts and the synergistic effects of six evidence-based perinatal interventions on the primary outcomes of sBPD and death were assessed by univariate and multivariable logistic regression modeling. Totally, 6568 EPIs were finally enrolled. Antenatal corticosteroid (adjusted OR, aOR, 0.74; 95%CI, 0.65-083), birth in centers with tertiary NICU (aOR, 0.64; 95%CI, 0.57-0.72), preventing intubation in the delivery room (aOR, 0.65; 95%CI, 0.58-0.73), early caffeine therapy (aOR, 0.59; 95%CI, 0.52-0.66), and early extubating (aOR, 0.42; 95%CI 0.37-0.47), were strongly associated with a lower risk of sBPD and death while early surfactant administration was associated with a lower risk of death (aOR, 0.84; 95%CI, 0.72, 0.98). Compared with achieving 0/1 perinatal interventions, achieving more than one intervention was associated with decreased rates (46.6% in 0/1 groups while 38.5%, 29.6%, 22.2%, 16.2%, and 11.7% in 2/3/4/5/6-intervention groups respectively) and reduced risks of sBPD/death with aORs of 0.76(0.60, 0.96), 0.55(0.43, 0.69), 0.38(0.30, 0.48), 0.28(0.22, 0.36), and 0.20(0.15, 0.27) in 2, 3, 4, 5, and 6 intervention groups respectively. Subgroup analyses showed consistent results. CONCLUSION Six perinatal interventions can effectively reduce the risk of sBPD and death in a synergistic form. WHAT IS KNOWN • Bronchopulmonary dysplasia (BPD) is a multifactorial chronic lung disease associated with prematurity. The effective management of BPD requires a comprehensive set of interventions. However, the extent to which these interventions can mitigate the risk of severe outcomes, such as severe BPD or mortality, or if they possess synergistic effects remains unknown. WHAT IS NEW • The implementation of various perinatal interventions, such as prenatal steroids, birth in centers with tertiary NICU, early non-Invasive respiratory support, surfactant administration within 2 hours after birth, early caffeine initiation within 3 days, and early extubation within 7 days after birth has shown promising results in the prevention of severe bronchopulmonary dysplasia (BPD) or mortality in extremely preterm infants. Moreover, these interventions have demonstrated synergistic effects when implemented in combination.
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Affiliation(s)
- Xiang Chen
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, China
| | - Lin Yuan
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, China
| | - Siyuan Jiang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, China
| | - Xinyue Gu
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, China
| | - Xiaoping Lei
- Division of Neonatology, Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Liyuan Hu
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, China
| | - Tiantian Xiao
- Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yanping Zhu
- Department of Neonatology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Dan Dang
- Department of Neonatology, The First Hospital of Jilin University, Changchun, China
| | - Wenli Li
- Department of Neonatology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yun Cao
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, China
| | - Lizhong Du
- Neonatal Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Shoo K Lee
- Maternal-Infant Care Research Centre and Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - Chao Chen
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, China
| | - Wenhao Zhou
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, China.
| | - Jianguo Zhou
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, China.
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29
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Huang J, Shen W, Wu F, Mao J, Liu L, Chang Y, Zhang R, Ye X, Qiu Y, Ma L, Cheng R, Wu H, Chen D, Chen L, Xu P, Mei H, Wang S, Xu F, Ju R, Zheng Z, Lin X, Tong X. Risk factors for severe bronchopulmonary dysplasia in a Chinese cohort of very preterm infants. Saudi Med J 2024; 45:369-378. [PMID: 38657990 DOI: 10.15537/smj.2024.45.4.20230741] [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: 01/08/2024] [Accepted: 02/16/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVES To examine the risk factors for severe bronchopulmonary dysplasia (BPD) in a cohort of very preterm infants (VPIs) in China, as BPD is common among VPIs and associated with a high mortality rate. METHODS In this multicenter retrospective study, medical records from infants with BPD born at gestation age (GA) of <32 weeks with birth weight (BW) of <1,500 grams (g) in 7 regions of China were included. The cohort was stratified into different BPD severity groups based on their fraction of inspired oxygen requirement at a modified GA of 36 weeks or post discharge. Risk factors were identified using logistic regression analysis. RESULTS A significant inverse correlation was revealed between BPD severity and both GA and BW (p<0.001). Independent risk factors for severe BPD (sBPD) were identified as invasive mechanical ventilation (≥7d), multiple blood transfusion (≥3), nosocomial infection (NI), hemodynamically significant patent ductus arteriosus (hsPDA), delayed initiation of enteral nutrition, and longer time to achieve total caloric intake of 110 kcal/kg. Conversely, administration of antenatal steroids was associated with reduced risk of sBPD. CONCLUSION Our study not only reaffirmed the established risk factors of low GA and BW for sBPD in VPIs, but also identified additional, potentially modifiable risk factors. Further research is warranted to explore whether intervention in these modifiable factors might reduce the risk of sBPD.Clinical Trial Reg. No.: ChiCTR1900023418.
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Affiliation(s)
- Jing Huang
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children's Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children's Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children's Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children's Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children's Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children's Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children's Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People's Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women' and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wei Shen
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children's Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children's Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children's Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children's Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children's Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children's Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children's Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People's Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women' and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | | | - Jian Mao
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children's Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children's Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children's Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children's Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children's Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children's Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children's Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People's Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women' and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | | | - Yanmei Chang
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children's Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children's Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children's Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children's Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children's Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children's Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children's Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People's Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women' and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Rong Zhang
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children's Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children's Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children's Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children's Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children's Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children's Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children's Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People's Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women' and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiuzhen Ye
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children's Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children's Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children's Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children's Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children's Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children's Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children's Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People's Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women' and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | | | - Li Ma
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children's Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children's Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children's Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children's Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children's Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children's Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children's Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People's Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women' and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Rui Cheng
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children's Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children's Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children's Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children's Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children's Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children's Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children's Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People's Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women' and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | | | - Dongmei Chen
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children's Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children's Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children's Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children's Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children's Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children's Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children's Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People's Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women' and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ling Chen
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children's Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children's Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children's Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children's Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children's Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children's Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children's Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People's Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women' and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ping Xu
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children's Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children's Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children's Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children's Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children's Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children's Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children's Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People's Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women' and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hua Mei
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children's Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children's Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children's Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children's Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children's Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children's Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children's Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People's Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women' and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Sannan Wang
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children's Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children's Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children's Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children's Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children's Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children's Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children's Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People's Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women' and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Falin Xu
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children's Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children's Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children's Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children's Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children's Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children's Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children's Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People's Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women' and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Rong Ju
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children's Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children's Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children's Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children's Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children's Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children's Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children's Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People's Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women' and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhi Zheng
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children's Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children's Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children's Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children's Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children's Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children's Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children's Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People's Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women' and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xinzhu Lin
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children's Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children's Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children's Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children's Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children's Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children's Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children's Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People's Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women' and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaomei Tong
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children's Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children's Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children's Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children's Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children's Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children's Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children's Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People's Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women' and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Zhuxiao R, Jiangxue H, Yongsheng L, Jingjun P, Shuo Y, Fang X, Qi Z, Shandan Z, Chuan N, Jie Y. Umbilical cord blood cell characteristics in very preterm neonates for autologous cell therapy of preterm-associated complications. BMC Pediatr 2024; 24:214. [PMID: 38528484 DOI: 10.1186/s12887-024-04678-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/01/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND There are emerging clinical evidence for umbilical cord blood mononuclear cells (UCBMNCs) intervention to improve preterm complications. The first critical step in cell therapy is to obtain high-quality cells. This retrospective study aimed to investigate the quantity and quality of UCBMNCs from very preterm infants (VPIs) for the purpose of autologous cell therapy in prevention and treatment of preterm complications. METHODS Very preterm infants (VPIs) born in Guangdong Women and Children Hospital from January 1, 2017, to December 8, 2022, from whom cord blood was successfully collected and separated for public or private banking, were enrolled. The UCBMNCs characters from route cord blood tests performed in cord blood bank, impact of perinatal factors on UCBMNCs, the relationship between UCBMNCs characteristics and preterm outcomes, and the correlation of UCBMNCs characteristics and peripheral blood cells in VPIs were analyzed. RESULTS Totally, 89 VPIs underwent UCB collection and processing successfully. The median cell number post processing was 2.6 × 108. To infuse a dose of 5 × 107 cells/kg, only 3.4% of infants required a volume of more than 20 mL/kg, which exceeded the maximum safe volume limit for VPIs. However, when infusing 10 × 107 cells/kg, 25.8% of infants required a volume of more than 20 ml/kg volume. Antenatal glucocorticoids use and preeclampsia was associated with lower original UCBMNCs concentration. Both CD34+ hematopoietic stem cells (HSC) frequency and colony forming unit - granulocyte and macrophage (CFU-GM) number correlated negatively with gestational age (GA). UCBMNCs characters had no significant effect on preterm outcomes, whereas a significant positive correlation was observed between UCBMNCs concentration and total white blood cell, neutrophil, lymphocyte and PLT counts in peripheral blood. CONCLUSION UCBMNCs collected from VPIs was feasible for autologous cell therapy in improving preterm complications. Setting the infusion dose of 5 × 107 cells/kg guaranteed a safe infusion volume in more than 95% of the targeted infants. UCBMNCs characters did not affect preterm complications; however, the effect of UCBMNCs concentration on peripheral blood classification count should be considered when evaluating the immunomodulation of UCBMNCs transfusion.
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Affiliation(s)
- Ren Zhuxiao
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, 511442, China
- Guangdong Neonatal ICU Medical Quality Control CenterNational Key Clinical Specialty Construction Unit, Guangzhou, 511442, China
| | - Han Jiangxue
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, 511442, China
| | - Li Yongsheng
- Guangdong Cord Blood Bank, Guangzhou, 511440, China
| | - Pei Jingjun
- Department of Neonatology, Nanfang Hospital, Southern Medical University, Guangzhou, 511400, China
| | - Yang Shuo
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Xu Fang
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, 511442, China
- Guangdong Neonatal ICU Medical Quality Control CenterNational Key Clinical Specialty Construction Unit, Guangzhou, 511442, China
| | - Zhang Qi
- Department of Clinic Genetic Center, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, 511442, China
| | - Zhang Shandan
- Department of Neonatology, The Maternal and Child Health Care Hospital of HuaDu District, GuangZhou City, Guangdong Medical University, Guangzhou, 510800, China
| | - Nie Chuan
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, 511442, China.
- Guangdong Neonatal ICU Medical Quality Control CenterNational Key Clinical Specialty Construction Unit, Guangzhou, 511442, China.
- Department of Clinic Genetic Center, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, 511442, China.
| | - Yang Jie
- Department of Neonatology, Nanfang Hospital, Southern Medical University, Guangzhou, 511400, China.
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Matlock DN, Ratcliffe SJ, Courtney SE, Kirpalani H, Firestone K, Stein H, Dysart K, Warren K, Goldstein MR, Lund KC, Natarajan A, Demissie E, Foglia EE. The Diaphragmatic Initiated Ventilatory Assist (DIVA) trial: study protocol for a randomized controlled trial comparing rates of extubation failure in extremely premature infants undergoing extubation to non-invasive neurally adjusted ventilatory assist versus non-synchronized nasal intermittent positive pressure ventilation. Trials 2024; 25:201. [PMID: 38509583 PMCID: PMC10953115 DOI: 10.1186/s13063-024-08038-4] [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] [Received: 11/07/2023] [Accepted: 03/06/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Invasive mechanical ventilation contributes to bronchopulmonary dysplasia (BPD), the most common complication of prematurity and the leading respiratory cause of childhood morbidity. Non-invasive ventilation (NIV) may limit invasive ventilation exposure and can be either synchronized or non-synchronized (NS). Pooled data suggest synchronized forms may be superior. Non-invasive neurally adjusted ventilatory assist (NIV-NAVA) delivers NIV synchronized to the neural signal for breathing, which is detected with a specialized catheter. The DIVA (Diaphragmatic Initiated Ventilatory Assist) trial aims to determine in infants born 240/7-276/7 weeks' gestation undergoing extubation whether NIV-NAVA compared to non-synchronized nasal intermittent positive pressure ventilation (NS-NIPPV) reduces the incidence of extubation failure within 5 days of extubation. METHODS This is a prospective, unblinded, pragmatic, multicenter phase III randomized clinical trial. Inclusion criteria are preterm infants 24-276/7 weeks gestational age who were intubated within the first 7 days of life for at least 12 h and are undergoing extubation in the first 28 postnatal days. All sites will enter an initial run-in phase, where all infants are allocated to NIV-NAVA, and an independent technical committee assesses site performance. Subsequently, all enrolled infants are randomized to NIV-NAVA or NS-NIPPV at extubation. The primary outcome is extubation failure within 5 days of extubation, defined as any of the following: (1) rise in FiO2 at least 20% from pre-extubation for > 2 h, (2) pH ≤ 7.20 or pCO2 ≥ 70 mmHg; (3) > 1 apnea requiring positive pressure ventilation (PPV) or ≥ 6 apneas requiring stimulation within 6 h; (4) emergent intubation for cardiovascular instability or surgery. Our sample size of 478 provides 90% power to detect a 15% absolute reduction in the primary outcome. Enrolled infants will be followed for safety and secondary outcomes through 36 weeks' postmenstrual age, discharge, death, or transfer. DISCUSSION The DIVA trial is the first large multicenter trial designed to assess the impact of NIV-NAVA on relevant clinical outcomes for preterm infants. The DIVA trial design incorporates input from clinical NAVA experts and includes innovative features, such as a run-in phase, to ensure consistent technical performance across sites. TRIAL REGISTRATION www. CLINICALTRIALS gov , trial identifier NCT05446272 , registered July 6, 2022.
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Affiliation(s)
- David N Matlock
- University of Arkansas for Medical Sciences, 4301 W. Markham St., Slot 512-5B, Little Rock, AR, 72205, USA.
- University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | | | | | - Haresh Kirpalani
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- McMaster University, Hamilton, ON, Canada
| | | | | | - Kevin Dysart
- Nemours Children's Health Wilmington, Philadelphia, PA, USA
| | - Karen Warren
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Aruna Natarajan
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ejigayehu Demissie
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth E Foglia
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Shenzhen Neonatal Data Network. [A cross-sectional survey of delivery room transitional care management for very/extremely preterm infants in 24 hospitals in Shenzhen City]. Zhongguo Dang Dai Er Ke Za Zhi 2024; 26:250-7. [PMID: 38557376 DOI: 10.7499/j.issn.1008-8830.2308017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 01/02/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES To investigate the current status of delivery room transitional care management for very/extremely preterm infants in Shenzhen City. METHODS A cross-sectional survey was conducted in November 2022, involving 24 tertiary hospitals participating in the Shenzhen Neonatal Data Network. The survey assessed the implementation of transitional care management in the delivery room, including prenatal preparation, delivery room resuscitation, and post-resuscitation management in the neonatal intensive care unit. Very/extremely preterm infants were divided into four groups based on gestational age: <26 weeks, 26-28+6 weeks, 29-30+6 weeks, and 31-31+6 weeks. Descriptive analysis was performed on the results. RESULTS A total of 140 very/extremely preterm infants were included, with 10 cases in the <26 weeks group, 45 cases in the 26-28+6 weeks group, 49 cases in the 29-30+6 weeks group, and 36 cases in the 31-31+6 weeks group. Among these infants, 99 (70.7%) received prenatal counseling, predominantly provided by obstetricians (79.8%). The main personnel involved in resuscitation during delivery were midwives (96.4%) and neonatal resident physicians (62.1%). Delayed cord clamping was performed in 52 cases (37.1%), with an average delay time of (45±17) seconds. Postnatal radiant warmer was used in 137 cases (97.9%) for thermoregulation. Positive pressure ventilation was required in 110 cases (78.6%), with 67 cases (60.9%) using T-piece resuscitators and 42 cases (38.2%) using a blended oxygen device. Blood oxygen saturation was monitored during resuscitation in 119 cases (85.0%). The median time from initiating transitional care measures to closing the incubator door was 87 minutes. CONCLUSIONS The implementation of delivery room transitional care management for very/extremely preterm infants in the hospitals participating in the Shenzhen Neonatal Data Network shows varying degrees of deviation from the corresponding expert consensus in China. It is necessary to bridge the gap through continuous quality improvement and multicenter collaboration to improve the quality of the transitional care management and outcomes in very/extremely preterm infants.
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Legge N, Popat H, Fitzgerald D. Improved survival at the cost of more chronic lung disease? Current management and outcomes in extremely preterm infants born in New South Wales and the Australian Capital Territory: 2010-2020. World J Pediatr 2024; 20:230-238. [PMID: 37902946 PMCID: PMC10957579 DOI: 10.1007/s12519-023-00761-3] [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: 04/26/2023] [Accepted: 09/10/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Since 2010, most tertiary care hospitals in Australia have changed how they care for extremely premature infants. However, in-hospital and longer-term outcome data have suggested unchanged or even worse health outcomes in later epochs, especially respiratory outcomes. This study examined the trend in outcomes since these changes were introduced, particularly the prevalence of chronic neonatal lung disease (CLD). METHODS This is a retrospective cross-sectional analysis of data from the Neonatal Intensive Care Units' (NICUS) database of all perinatal intensive care units in New South Wales and the Australian Capital Territory, including infants born at ≥ 24 and ≤ 28 weeks of gestational age in tertiary perinatal units between January 1, 2010, and December 31, 2020. Temporal trends and changes in primary outcome were examined by linear and adjusted multivariable logistic regression models. RESULTS This study included 3258 infants. We saw significant changes in antenatal magnesium sulfate (75% increase), delayed cord clamping (66% increase), delivery room intubations (30% decrease), any time (20% decrease), duration on mechanical ventilation (100-hour decrease), and hours on noninvasive ventilation (200-hour increase). Mortality decreased from 17% to 6%. The incidence of CLD increased significantly even when adjusted for confounders (15% increase). Any time and mean hours spent on mechanical ventilation significantly increased the odds of CLD. This study could not find a significant association of any of the protective antenatal treatments on CLD. CONCLUSIONS The last decade saw a significant improvement in survival and survival to discharge without major morbidity. There was increased use of magnesium sulfate, delayed cord clamping, and less invasive respiratory management of extremely preterm infants. The avoidance of mechanical ventilation may impact the incidence of CLD.
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Affiliation(s)
- Nele Legge
- Liverpool Hospital, Corner Elizabeth and Goulburn Streets, Liverpool, NSW, Australia.
- University of Sydney, Camperdown, Australia.
| | - Himanshu Popat
- University of Sydney, Camperdown, Australia
- Children's Hospital Westmead, Westmead, Australia
| | - Dominic Fitzgerald
- University of Sydney, Camperdown, Australia
- Children's Hospital Westmead, Westmead, Australia
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Kulmaganbetov M, Leung M, Alsweiler JM, Black J, Bloomfield FH, Gamble GD, Harding JE, Jiang Y, Poppe T, Tottman AC, Wouldes TA, Thompson B. Associations between neonatal nutrition and visual outcomes in 7-year-old children born very preterm. Ophthalmic Physiol Opt 2024; 44:347-355. [PMID: 38069619 DOI: 10.1111/opo.13260] [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: 05/25/2023] [Revised: 11/10/2023] [Accepted: 11/25/2023] [Indexed: 02/08/2024]
Abstract
PURPOSE There is uncertainty about the effect of increased neonatal protein intake on neurodevelopmental outcomes following preterm birth. The aim of this study was to assess the effect of a change in neonatal nutrition protocol at a major tertiary neonatal intensive care unit intended to increase protein intake on ophthalmic and visual development in school-age children born very preterm. METHODS The study cohort comprised children (n = 128) with birthweight <1500 g or gestational age < 30 weeks born at Auckland City Hospital before (OldPro group, n = 55) and after (NewPro group, n = 73) a reformulation of parenteral nutrition that resulted in increased total protein intake during the first postnatal week and decreased carbohydrate, total parenteral fluid and sodium intake. Clinical and psychophysical vision assessments were completed at 7 years' corrected age, including visual acuity, global motion perception (a measure of dorsal stream function), stereoacuity, ocular motility and ocular health. Composite measures of favourable overall visual, binocular and functional visual outcomes along with individual vision measures were compared between the groups using logistic and linear regression models. RESULTS Favourable overall visual outcome did not differ between the two groups. However, global motion perception was better in the NewPro group (p = 0.04), whereas the OldPro group were more likely to have favourable binocular visual outcomes (60% vs. 36%, p = 0.02) and passing stereoacuity (p = 0.02). CONCLUSIONS These results indicate subtle but complex associations between early neonatal nutrition after very preterm birth and visual development at school age.
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Affiliation(s)
- Mukhit Kulmaganbetov
- Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong, Hong Kong
- Kazakh Eye Research Institute, Almaty, Kazakhstan
| | - Myra Leung
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
- Discipline of Optometry and Vision Science, University of Canberra, Canberra, Australian Capital Territory, Australia
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane M Alsweiler
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
- Newborn Services, National Women's Health, Auckland City Hospital, Auckland, New Zealand
| | - Joanna Black
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | | | - Greg D Gamble
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- Department of Statistics, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Tanya Poppe
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Anna C Tottman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Trecia A Wouldes
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Benjamin Thompson
- Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong, Hong Kong
- Liggins Institute, University of Auckland, Auckland, New Zealand
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
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Abstract
Despite strong evidence of important benefits of volume-targeted ventilation, many high-risk extremely preterm infants continue to receive traditional pressure-controlled ventilation in the United States and elesewhere. Reluctance to abandon one's comfort zone, lack of suitable equipment and a lack of understanding of the subtleties of volume-targeted ventilation appear to contribute to the relatively slow uptake of volume-targeted ventilation. This review will underscore the benefits of using tidal volume as the primary control variable, to improve clinicians' understanding of the way volume-targeted ventilation interacts with the awake, breathing infant and to provide information about evidence-based tidal volume targets in various circmstances. Focus on underlying lung pathophysiology, individualized ventilator settings and tidal volume targets are essential to successful use of this approach thereby improving important clinical outcomes.
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Affiliation(s)
- Martin Keszler
- Emeritus Professor of Pediatrics, Alpert Medical School of Brown University, Department of Pediatrics, Women & Infants Hospital of Rhode Island, 101 Dudley Street, Providence RI 02905, USA.
| | - M Kabir Abubakar
- Professor of Clinical Pediatrics, Georgetown University School of Medicine, Chief of Neonatology, MedStar Medical Group, Chief, Division of Neonatal Perinal Medicine, MedStar Georgetown University Hospital, 3800 Reservoir Road, Washington DC, 20007, USA.
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36
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How HS, Malhotra A, Martin C. EBNEO commentary: Early human milk fortification in infants born extremely preterm: A randomised trial. Acta Paediatr 2024; 113:625-626. [PMID: 38235608 DOI: 10.1111/apa.17110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/18/2023] [Accepted: 01/05/2024] [Indexed: 01/19/2024]
Affiliation(s)
- Hee Siong How
- Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Atul Malhotra
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Camilia Martin
- Department of Pediatrics, Weill Cornell Medicine, New York City, New York, USA
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Siljehav V, Gudmundsdottir A, Tjerkaski J, Aubert AM, Cuttini M, Koopman C, Maier RF, Zeitlin J, Åden U. Treating very preterm European infants with inhaled nitric oxide increased in-hospital mortality but did not affect neurodevelopment at 5 years of age. Acta Paediatr 2024; 113:461-470. [PMID: 38140833 DOI: 10.1111/apa.17075] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
AIM We examined the outcomes of using inhaled nitric oxide (iNO) to treat very preterm born (VPT) infants across Europe. METHODS This was a sub-study of the Screening to Improve Health in Very Preterm Infants in Europe research. It focused on all infants born between 22 + 0 and 31 + 6 weeks/days of gestation from 2011 to 2012, in 19 regions in 11 European countries. We studied 7268 infants admitted to neonatal care and 5 years later, we followed up the outcomes of 103 who had received iNO treatment. They were compared with 3502 propensity score-matched controls of the same age who did not receive treatment. RESULTS All countries used iNO and 292/7268 (4.0%) infants received this treatment, ranging from 1.2% in the UK to 10.5% in France. There were also large regional variations within some countries. Infants treated with iNO faced higher in-hospital mortality than matched controls (odds ratio 2.03, 95% confidence interval 1.33-3.09). The 5-year follow-up analysis of 103 survivors showed no increased risk of neurodevelopmental impairment after iNO treatment. CONCLUSION iNO was used for VPT patients in all 11 countries. In-hospital mortality was increased in infants treated with iNO, but long-term neurodevelopmental outcomes were not affected in 103 5-year-old survivors.
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Affiliation(s)
- Veronica Siljehav
- Department of Women's & Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Anna Gudmundsdottir
- Department of Women's & Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Jonathan Tjerkaski
- Department of Women's & Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Adrien M Aubert
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Corine Koopman
- Division of Perinatology and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Rolf F Maier
- Children's Hospital, University Hospital, Philipps University Marburg, Marburg, Germany
| | - Jennifer Zeitlin
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - Ulrika Åden
- Department of Women's & Children's Health, Karolinska Institutet, Stockholm, Sweden
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Azman Z, Vidinopoulos K, Somers A, Hooper SB, Zahra VA, Thiel AM, Galinsky R, Tran NT, Allison BJ, Polglase GR. In utero ventilation induces lung parenchymal and vascular alterations in extremely preterm fetal sheep. Am J Physiol Lung Cell Mol Physiol 2024; 326:L330-L343. [PMID: 38252635 DOI: 10.1152/ajplung.00249.2023] [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] [Received: 08/04/2023] [Revised: 12/19/2023] [Accepted: 01/17/2024] [Indexed: 01/24/2024] Open
Abstract
Extremely preterm infants are often exposed to long durations of mechanical ventilation to facilitate gas exchange, resulting in ventilation-induced lung injury (VILI). New lung protective strategies utilizing noninvasive ventilation or low tidal volumes are now common but have not reduced rates of bronchopulmonary dysplasia. We aimed to determine the effect of 24 h of low tidal volume ventilation on the immature lung by ventilating preterm fetal sheep in utero. Preterm fetal sheep at 110 ± 1(SD) days' gestation underwent sterile surgery for instrumentation with a tracheal loop to enable in utero mechanical ventilation (IUV). At 112 ± 1 days' gestation, fetuses received either in utero mechanical ventilation (IUV, n = 10) targeting 3-5 mL/kg for 24 h, or no ventilation (CONT, n = 9). At necropsy, fetal lungs were collected to assess molecular and histological markers of lung inflammation and injury. IUV significantly increased lung mRNA expression of interleukin (IL)-1β, IL-6, IL-8, IL-10, and tumor necrosis factor (TNF) compared with CONT, and increased surfactant protein (SP)-A1, SP-B, and SP-C mRNA expression compared with CONT. IUV produced modest structural changes to the airways, including reduced parenchymal collagen and myofibroblast density. IUV increased pulmonary arteriole thickness compared with CONT but did not alter overall elastin or collagen content within the vasculature. In utero ventilation of an extremely preterm lung, even at low tidal volumes, induces lung inflammation and injury to the airways and vasculature. In utero ventilation may be an important model to isolate the confounding mechanisms of VILI to develop effective therapies for preterm infants requiring prolonged respiratory support.NEW & NOTEWORTHY Preterm infants often require prolonged respiratory support, but the relative contribution of ventilation to the development of lung injury is difficult to isolate. In utero mechanical ventilation allows for mechanistic investigations into ventilation-induced lung injury without confounding factors associated with sustaining extremely preterm lambs ex utero. Twenty-four hours of in utero ventilation, even at low tidal volumes, increased lung inflammation and surfactant protein expression and produced structural changes to the lung parenchyma and vasculature.
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Affiliation(s)
- Zahrah Azman
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Kayla Vidinopoulos
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Ainsley Somers
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Valerie A Zahra
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Alison M Thiel
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Robert Galinsky
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Nhi T Tran
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Beth J Allison
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Graeme R Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
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Yeung T, Ahmed A, Wong J, Toye J, Abou Mehrem A, Mukerji A, Lapointe A, Ng E, Beltempo M, Pechlivanoglou P, Lee S, Shah PS. Variations in Site-Specific Costs for Infants Born Extremely Preterm in Canadian Neonatal Intensive Care Units. J Pediatr 2024; 266:113863. [PMID: 38096975 DOI: 10.1016/j.jpeds.2023.113863] [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: 08/22/2023] [Revised: 11/19/2023] [Accepted: 11/29/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVE To quantify site-specific costs and their association with survival without major morbidity (SWMM) in Canada for neonates <28 weeks of gestation admitted to large tertiary neonatal intensive care units. METHODS We conducted a retrospective analysis of infants born at <28 weeks of gestation and admitted to Canadian Neonatal Network sites from 2010 through 2021. Sites that cared for at least 50 eligible infants by gestational age in weeks over the study period were included. Using a validated costing algorithm that assessed physician, nursing, respiratory therapy, diagnostic imaging, transfusions, procedural, medication, and certain indirect costs, we calculated site and resource-specific costs in 2017 Canadian dollars (CAD) and evaluated their relationship with SWMM. RESULTS Seven sites with 8180 (range 841-1605) eligible neonates with a mean (SD) gestation of 25.4 [1.3] weeks were included. Survival to discharge or transfer was 85.3% with a mean (SD) length of stay of 75 (46) days. The mean (SD) total and daily costs per neonate varied between $94 992 ($60 283) and $174 438 ($130 501) CAD and $1833 ($916) to $2307 ($1281) CAD, respectively. Between sites, there was no relationship between costs and SWMM. CONCLUSIONS There was marked variation in costs and SWMM between sites in Canada with universal health care. The lack of concordance between both outcomes and costs among sites may provide possibilities for outcomes improvement and cost containment.
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Affiliation(s)
- Telford Yeung
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Section of Neonatology, Windsor Regional Hospital Metropolitan Campus, Windsor, Ontario, Canada
| | - Asma Ahmed
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jonathan Wong
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Jennifer Toye
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Ayman Abou Mehrem
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Amit Mukerji
- McMaster Children's Hospital, Hamilton, Ontario, Canada
| | | | - Eugene Ng
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Marc Beltempo
- Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Petros Pechlivanoglou
- Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Shoo Lee
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Mother-Infant Care Research Center, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada; Mother-Infant Care Research Center, Toronto, Ontario, Canada.
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Goupille P, Rollet Q, Prime L, Alexandre C, Dolley P, Dreyfus M. Extreme prematurity: Factors associated with perinatal management and morbi-mortality in western Normandy, France. J Gynecol Obstet Hum Reprod 2024; 53:102735. [PMID: 38280456 DOI: 10.1016/j.jogoh.2024.102735] [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: 08/30/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Extreme prematurity (birth before 26 weeks of gestation), presents complex challenges and can lead to various complications. Survival rates of extremely preterm infants are lower in France than in other countries. The choice between active and palliative care is decisive in managing these births. OBJECTIVE To conduct an observational study focused on factors associated with perinatal management, mortality, and morbidity outcomes among extremely preterm births in a regional perinatal network. METHODS We undertook a retrospective, multicenter study within the western Normandy perinatal network, encompassing live births between 230/6 and 256/6 weeks from 2015 to 2019. Data were extracted from the perinatal network database and medical records. RESULTS One hundred and seven infants born from 94 women were included. In the antenatal period, 79 were exposed to corticosteroids, 66 to magnesium sulfate, and 67 to antibiotics. Active care at birth was provided to 84 neonates of whom 42 survived. In total, 65 infants died. Among the 42 surviving neonates, 9 experienced no severe morbidity, 29 displayed one and 4 exhibited two criteria of severe morbidity. Active care was associated with gestational age. Neonatal survival was correlated with antenatal exposure to antibiotics and magnesium sulfate as well as with postnatal corticosteroids. We found no significant association between mortality and gestational age at birth. CONCLUSION Prognostic factors must be weighed to discuss active antenatal care which is crucial for survival of extremely preterm neonates. Cooperation between obstetricians and neonatal caregivers is a cornerstone on a regional perinatal network scale.
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Affiliation(s)
- Pauline Goupille
- Department of Obstetrics, Gynaecology and Reproduction Medicine, Caen University Hospital, Avenue de la Côte de Nacre, 14033 Caen, France.
| | - Quentin Rollet
- U1086 "ANTICIPE" INSERM, University of Caen Normandy, Centre François Baclesse: 3, Avenue du Général Harris, 14000 Caen, France
| | - Ludovic Prime
- Perinatal Network, Caen University Hospital, Avenue de la Côte de Nacre, 14033 Caen, France
| | - Cénéric Alexandre
- Department of Neonatology, Caen University Hospital, Avenue de la Côte de Nacre, 14033 Caen, France
| | - Patricia Dolley
- Department of Obstetrics, Gynaecology and Reproduction Medicine, Caen University Hospital, Avenue de la Côte de Nacre, 14033 Caen, France
| | - Michel Dreyfus
- Department of Obstetrics, Gynaecology and Reproduction Medicine, Caen University Hospital, Avenue de la Côte de Nacre, 14033 Caen, France; University of Caen Normandy, Esplanade de la Paix - CS 14032 Cedex 05, Caen, France
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Veldhuis MS, Dix LML, Breur JMPJ, de Vries WB, Koopman C, Eijsermans MJC, Swanenburg de Veye HFN, Molenschot MC, Lemmers PMA, van Bel F, Vijlbrief DC. Role of patent ductus arteriosus in preterms in long-term outcome. Early Hum Dev 2024; 190:105953. [PMID: 38330542 DOI: 10.1016/j.earlhumdev.2024.105953] [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: 11/08/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE This study aimed to determine long-term neurodevelopmental outcome and cerebral oxygenation in extremely preterm infants, comparing those with a hemodynamic significant patent ductus arteriosus (hsPDA) to those without. STUDY DESIGN We included infants born before 28 weeks of gestation from 2008 to 2010 with routine echocardiography. Prior to echocardiography, regional cerebral oxygen saturation was measured. At 5 years of age, we evaluated neurodevelopmental outcomes using the Movement Assessment Battery for Children 2nd Dutch edition for motor skills and the Wechsler Preschool and Primary Scale of Intelligence 3rd Dutch edition for cognition. RESULTS A total of 66 infants (gestational age 26.6 ± 0.9 weeks, birth weight 912 ± 176 g) were included, 34 infants with a hsPDA (including treatment). The group infants with hsPDA showed lower pre-closure cerebral saturation levels (58.2 % ±7.8 % versus 62.8 % ±7.0 %; p = 0.01). At 5 years, impaired motor outcome occurred more often in infants with hsPDA (17 (53 %) vs. 7 (23 %); p = 0.01). In multivariate analysis existence of hsPDA remained unfavourably related to the motor subdomain "aiming and catching". There were no potential effects of hsPDA on cognitive performance at 5 years of age. CONCLUSION Treatment-receiving infants with hsPDA appear to exhibit motor deficits, specifically in "aiming and catching", by the age 5. Persistent ductal patency could be a contributing factor.
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Affiliation(s)
- Moniek S Veldhuis
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Laura M L Dix
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Johannes M P J Breur
- Department of Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Willem B de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Corine Koopman
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Maria J C Eijsermans
- Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Mirella C Molenschot
- Department of Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Petra M A Lemmers
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Daniel C Vijlbrief
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
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Sant'Anna G, Shalish W. Weaning from mechanical ventilation and assessment of extubation readiness. Semin Perinatol 2024; 48:151890. [PMID: 38553331 DOI: 10.1016/j.semperi.2024.151890] [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: 04/14/2024]
Abstract
Tremendous advancements in neonatal respiratory care have contributed to the improved survival of extremely preterm infants (gestational age ≤ 28 weeks). While mechanical ventilation is often considered one of the most important breakthroughs in neonatology, it is also associated with numerous short and long-term complications. For those reasons, clinical research has focused on strategies to avoid or reduce exposure to mechanical ventilation. Nonetheless, in the extreme preterm population, 70-100% of infants born 22-28 weeks of gestation are exposed to mechanical ventilation, with nearly 50% being ventilated for ≥ 3 weeks. As contemporary practices have shifted towards selectively reserving mechanical ventilation for those patients, mechanical ventilation weaning and extubation remain a priority yet offer a heightened challenge for clinicians. In this review, we will summarize the evidence for different strategies to expedite weaning and assess extubation readiness in preterm infants, with a particular focus on extremely preterm infants.
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Affiliation(s)
- Guilherme Sant'Anna
- Professor of Pediatrics, Division of Neonatology, Montreal Children's Hospital Departments of Pediatrics and Experimental Medicine, Senior Scientist of the Research Institute of the McGill University Health Center, McGill University Health Center, 1001 Boulevard Decarie, Room B05.2711, Montreal, Quebec H4A3J1, Canada.
| | - Wissam Shalish
- Assistant Professor of Pediatrics, Division of Neonatology, Montreal Children's Hospital Departments of Pediatrics and Experimental Medicine, Junior Scientist of FRQS, McGill University Health Center, Montreal, Quebec, Canada
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Ponnapakkam A, Carr NR, Comstock BA, Perez K, O'Shea TM, Tolia VN, Clark RH, Heagerty PJ, Juul SE, Ahmad KA. Factors Associated with Outpatient Therapy Utilization in Extremely Preterm Infants. Am J Perinatol 2024; 41:458-469. [PMID: 34753183 DOI: 10.1055/a-1692-0544] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Factors influencing utilization of outpatient interventional therapies for extremely low gestational age newborns (ELGANs) after discharge remain poorly characterized, despite a significant risk of neurodevelopmental impairment. We sought to assess the effects of maternal, infant, and environmental characteristics on outpatient therapy utilization in the first 2 years after discharge using data from the Preterm Erythropoietin Neuroprotection (PENUT) Trial. STUDY DESIGN This is a secondary analysis of 818, 24 to 27 weeks gestation infants enrolled in the PENUT trial who survived through discharge and completed at least one follow-up call or in-person visit between 4 and 24 months of age. Utilization of a state early intervention (EI) program, physical therapy (PT), occupational therapy (OT), and speech therapy (ST) was recorded. Odds ratios and cumulative frequency curves for resource utilization were calculated for patient characteristics adjusting for gestational age, treatment group, and birth weight. RESULTS EI was not accessed by 37% of infants, and 18% did not use any service (PT/OT/ST/EI). Infants diagnosed with severe morbidities (intraventricular hemorrhage, retinopathy of prematurity, bronchopulmonary dysplasia, necrotizing enterocolitis), discharged with home oxygen, or with gastrostomy placement experienced increased utilization of PT, OT, and ST compared with peers. However, substantial variation in service utilization occurred by the state of enrollment and selected maternal characteristics. CONCLUSIONS ELGANs with severe medical comorbidities are more likely to utilize services after discharge. Therapy utilization may be impacted by maternal characteristics and state of enrollment. Outpatient therapy services remain significantly underutilized in this high-risk cohort. Further research is required to characterize and optimize the utilization of therapy services following NICU discharge of ELGANs. KEY POINTS · Outpatient therapy is underutilized in ELGANs.. · Medical comorbidities may impact therapy use.. · Maternal characteristics may impact therapy use.. · State of enrollment may impact therapy use..
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Affiliation(s)
- Adharsh Ponnapakkam
- Department of Pediatrics, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | - Nicholas R Carr
- Department of Pediatrics, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Bryan A Comstock
- Center for Biomedical Statistics, University of Washington, Seattle, Washington
| | - Krystle Perez
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - T Michael O'Shea
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | - Veeral N Tolia
- Pediatrix Medical Group, Dallas TX
- MEDNAX Center for Research, Education, Quality, and Safety, Sunrise, FL
| | - Reese H Clark
- MEDNAX Center for Research, Education, Quality, and Safety, Sunrise, FL
| | - Patrick J Heagerty
- Center for Biomedical Statistics, University of Washington, Seattle, Washington
| | - Sandra E Juul
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Kaashif A Ahmad
- MEDNAX Center for Research, Education, Quality, and Safety, Sunrise, FL
- Pediatrix Medical Group of San Antonio, San Antonio, TX
- Department of Pediatrics, Baylor College of Medicine, San Antonio, TX
- Pediatrix and Obstetrix Specialists of Houston, Houston, TX
- Department of Clinical Sciences, University of Houston, Houston, TX
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Cervera SB, Saeed S, Luu TM, Gorgos A, Beltempo M, Claveau M, Basso O, Lapointe A, Tremblay S, Altit G. Evaluation of the association between patent ductus arteriosus approach and neurodevelopment in extremely preterm infants. J Perinatol 2024; 44:388-395. [PMID: 38278962 DOI: 10.1038/s41372-024-01877-8] [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: 10/02/2023] [Revised: 12/28/2023] [Accepted: 01/05/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE Assess if unit-level PDA management correlates with neurodevelopmental impairment (NDI) at 18-24 months corrected postnatal age (CPA) in extremely preterm infants. STUDY DESIGN Retrospective analysis of infants born at <29 weeks (2014-2017) across two units having distinct PDA strategies. Site 1 utilized an echocardiography-based treatment strategy aiming for accelerated closure (control). Site 2 followed a conservative approach. PRIMARY ENDPOINT NDI, characterized by cerebral palsy, any Bayley-III composite score <85, sensorineural/mixed hearing loss, or at least unilateral visual impairment. RESULTS 377 infants were evaluated. PDA treatment rates remained unchanged in Site 1 but eventually reached 0% in Site 2. Comparable rates of any/significant NDI were seen across both sites (any NDI: 38% vs 36%; significant NDI: 13% vs 10% for Site 1 and 2, respectively). After adjustments, NDI rates remained similar. CONCLUSION PDA management strategies in extremely preterm newborns showed no significant impact on neurodevelopment outcomes at 18-24 months CPA.
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Affiliation(s)
- Soledad Belén Cervera
- Division of Neonatology, Department of Paediatrics, Sainte-Justine University Health Center, Montréal, QC, Canada
| | - Sahar Saeed
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Thuy Mai Luu
- Neonatal Follow-Up, Department of Paediatrics, Université de Montréal, Montreal, QC, Canada
| | - Andrea Gorgos
- Neonatal Follow-Up, Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Marc Beltempo
- Division of Neonatology, Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Martine Claveau
- Division of Neonatology, Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Olga Basso
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Anie Lapointe
- Division of Neonatology, Department of Paediatrics, Sainte-Justine University Health Center, Montréal, QC, Canada
| | - Sophie Tremblay
- Division of Neonatology, Department of Paediatrics, Sainte-Justine University Health Center, Montréal, QC, Canada
| | - Gabriel Altit
- Division of Neonatology, Department of Paediatrics, Sainte-Justine University Health Center, Montréal, QC, Canada.
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Kvanta H, Bolk J, Broström L, Nosko D, Fernández de Gamarra-Oca L, Padilla N, Ådén U. Language performance and brain volumes, asymmetry, and cortical thickness in children born extremely preterm. Pediatr Res 2024; 95:1070-1079. [PMID: 37923870 PMCID: PMC10920199 DOI: 10.1038/s41390-023-02871-0] [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: 07/06/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Children born preterm are more prone to have language difficulties. Few studies focus on children born extremely preterm (EPT) and the structural differences in language-related regions between these children and children born at term. METHODS Our study used T1-weighted magnetic resonance imaging (MRI) scans to calculate the brain volumetry, brain asymmetry, and cortical thickness of language-related regions in 50 children born EPT and 37 term-born controls at 10 years of age. The language abilities of 41 of the children born EPT and 29 term-born controls were then assessed at 12 years of age, using the Wechsler Intelligence Scale for Children, Fifth Edition and the Clinical Evaluations of Language Fundamentals, Fourth Edition. The differences between MRI parameters and their associations with language outcomes were compared in the two groups. RESULTS Brain volume and cortical thickness of language-related regions were reduced in children born EPT, but volumetric asymmetry was not different between children born EPT and at term. In children born EPT the brain volume was related to language outcomes, prior to adjustments for full-scale IQ. CONCLUSIONS These findings expand our understanding of the structural correlates underlying impaired language performance in children born with EPT. IMPACT The article expands understanding of the structure-function relationship between magnetic resonance imaging measurements of language-related regions and language outcomes for children born extremely preterm beyond infancy. Most literature to date has focused on very preterm children, but the focus in this paper is on extreme prematurity and language outcomes. While the brain volume and cortical thickness of language-related regions were reduced in children born EPT only the volume, prior to adjustment for full-scale IQ, was associated with language outcomes. We found no differences in volumetric asymmetry between children born EPT and at term.
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Affiliation(s)
- Hedvig Kvanta
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Stockholm, Sweden.
| | - Jenny Bolk
- Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Lina Broström
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Daniela Nosko
- Department of Paediatrics, Örebro University Hospital, Örebro, Sweden
| | | | - Nelly Padilla
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Ulrika Ådén
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Stockholm, Sweden
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Weese-Mayer DE, Di Fiore JM, Lake DE, Hibbs AM, Claure N, Qiu J, Ambalavanan N, Bancalari E, Kemp JS, Zimmet AM, Carroll JL, Martin RJ, Krahn KN, Hamvas A, Ratcliffe SJ, Krishnamurthi N, Indic P, Dormishian A, Dennery PA, Moorman JR. Maturation of cardioventilatory physiological trajectories in extremely preterm infants. Pediatr Res 2024; 95:1060-1069. [PMID: 37857848 DOI: 10.1038/s41390-023-02839-0] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/14/2023] [Accepted: 09/27/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND In extremely preterm infants, persistence of cardioventilatory events is associated with long-term morbidity. Therefore, the objective was to characterize physiologic growth curves of apnea, periodic breathing, intermittent hypoxemia, and bradycardia in extremely preterm infants during the first few months of life. METHODS The Prematurity-Related Ventilatory Control study included 717 preterm infants <29 weeks gestation. Waveforms were downloaded from bedside monitors with a novel sharing analytics strategy utilized to run software locally, with summary data sent to the Data Coordinating Center for compilation. RESULTS Apnea, periodic breathing, and intermittent hypoxemia events rose from day 3 of life then fell to near-resolution by 8-12 weeks of age. Apnea/intermittent hypoxemia were inversely correlated with gestational age, peaking at 3-4 weeks of age. Periodic breathing was positively correlated with gestational age peaking at 31-33 weeks postmenstrual age. Females had more periodic breathing but less intermittent hypoxemia/bradycardia. White infants had more apnea/periodic breathing/intermittent hypoxemia. Infants never receiving mechanical ventilation followed similar postnatal trajectories but with less apnea and intermittent hypoxemia, and more periodic breathing. CONCLUSIONS Cardioventilatory events peak during the first month of life but the actual postnatal trajectory is dependent on the type of event, race, sex and use of mechanical ventilation. IMPACT Physiologic curves of cardiorespiratory events in extremely preterm-born infants offer (1) objective measures to assess individual patient courses and (2) guides for research into control of ventilation, biomarkers and outcomes. Presented are updated maturational trajectories of apnea, periodic breathing, intermittent hypoxemia, and bradycardia in 717 infants born <29 weeks gestation from the multi-site NHLBI-funded Pre-Vent study. Cardioventilatory events peak during the first month of life but the actual postnatal trajectory is dependent on the type of event, race, sex and use of mechanical ventilation. Different time courses for apnea and periodic breathing suggest different maturational mechanisms.
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Affiliation(s)
- Debra E Weese-Mayer
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Division of Autonomic Medicine, Department of Pediatrics, Ann & Robert H Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, IL, USA.
| | - Juliann M Di Fiore
- Department of Pediatrics, Case Western Reserve University, School of Medicine, Cleveland, OH, USA.
- Department of Pediatrics, Division of Neonatology, UH Rainbow Babies & Children's Hospital, Cleveland, OH, USA.
| | - Douglas E Lake
- Division of Cardiovascular Medicine, Center for Advanced Medical Analytics and Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Anna Maria Hibbs
- Department of Pediatrics, Case Western Reserve University, School of Medicine, Cleveland, OH, USA
- Department of Pediatrics, Division of Neonatology, UH Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | - Nelson Claure
- Division of Neonatology, Department of Pediatrics, Holtz Children's Hospital - Jackson Memorial Medical Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jiaxing Qiu
- Division of Cardiovascular Medicine, Center for Advanced Medical Analytics and Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Namasivayam Ambalavanan
- Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Eduardo Bancalari
- Division of Neonatology, Department of Pediatrics, Holtz Children's Hospital - Jackson Memorial Medical Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - James S Kemp
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Amanda M Zimmet
- Division of Cardiovascular Medicine, Center for Advanced Medical Analytics and Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - John L Carroll
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Richard J Martin
- Department of Pediatrics, Case Western Reserve University, School of Medicine, Cleveland, OH, USA
- Department of Pediatrics, Division of Neonatology, UH Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | - Katy N Krahn
- Division of Cardiovascular Medicine, Center for Advanced Medical Analytics and Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Aaron Hamvas
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Neonatology, Department of Pediatrics, Ann & Robert H Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, IL, USA
| | - Sarah J Ratcliffe
- Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Narayanan Krishnamurthi
- Division of Autonomic Medicine, Department of Pediatrics, Ann & Robert H Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, IL, USA
| | - Premananda Indic
- Department of Electrical Engineering, University of Texas Tyler, Tyler, TX, USA
| | - Alaleh Dormishian
- Division of Neonatology, Department of Pediatrics, Holtz Children's Hospital - Jackson Memorial Medical Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Phyllis A Dennery
- Hasbro Children's Hospital, Brown University, Warren Alpert School of Medicine, Providence, RI, USA
| | - J Randall Moorman
- Division of Cardiovascular Medicine, Center for Advanced Medical Analytics and Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
- Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
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Bamat NA, Huber M, Shults J, Li Y, Zong Z, Zuppa A, Eichenwald EC, Laughon MM, DeMauro SB, McKenna KJ, Laskin B, Lorch SA. Diuretic Tolerance to Repeated-Dose Furosemide in Infants Born Very Preterm with Bronchopulmonary Dysplasia. J Pediatr 2024; 266:113813. [PMID: 37918519 PMCID: PMC10922280 DOI: 10.1016/j.jpeds.2023.113813] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/27/2023] [Accepted: 10/29/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVES To assess the presence and timing of furosemide diuretic tolerance in infants with bronchopulmonary dysplasia (BPD), and to determine if tolerance is modified by thiazide co-administration. STUDY DESIGN We performed a retrospective cohort study among infants born very preterm with BPD exposed to repeated-dose furosemide for 72 hours, measuring net fluid balance (total intake minus total output) as a surrogate of diuresis in the 3 days before and after exposure. The primary comparison was the difference in fluid balance between the first and third 24 hours of furosemide exposure. We fit a general linear model for within-subject repeated measures of fluid balance over time, with thiazide co-administration as an interaction variable. Secondary analyses included an evaluation of weight trajectories over time. RESULTS In 83 infants, median fluid balance ranged between + 43.6 and + 52.7 ml/kg/d in the 3 days prior to furosemide exposure. Fluid balance decreased to a median of + 29.1 ml/kg/d in the first 24 hours after furosemide, but then increased to +47.5 ml/kg/d by the third 24-hour interval, consistent with tolerance (P < .001). Thiazides did not modify the change in fluid balance during furosemide exposure for any time-period. Weight decreased significantly in the first 24 hours after furosemide and increased thereafter (P < .001). CONCLUSIONS The net fluid balance response to furosemide decreases rapidly during repeated-dose exposures in infants with BPD, consistent with diuretic tolerance. Clinicians should consider this finding in the context of an infant's therapeutic goals. Further research efforts to identify safe and effective furosemide dosage strategies are needed.
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Affiliation(s)
- Nicolas A Bamat
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
| | - Matthew Huber
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Justine Shults
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Yun Li
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Zili Zong
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - Athena Zuppa
- Adjunct Professor of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Eric C Eichenwald
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Matthew M Laughon
- Division of Neonatology, Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Sara B DeMauro
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Kristin J McKenna
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Benjamin Laskin
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Scott A Lorch
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Dubner SE, Rickerich L, Bruckert L, Poblaciones RV, Sproul D, Scala M, Feldman HM, Travis KE. Early, low-dose hydrocortisone and near-term brain connectivity in extremely preterm infants. Pediatr Res 2024; 95:1028-1034. [PMID: 38030826 DOI: 10.1038/s41390-023-02903-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Postnatal steroids are used to prevent bronchopulmonary dysplasia in extremely preterm infants but may have adverse effects on brain development. We assessed connectivity metrics of major cerebral and cerebellar white matter pathways at near-term gestational age among infants who did or did not receive a standardized regimen of hydrocortisone during the first 10 days of life. METHODS Retrospective cohort study. PARTICIPANTS Infants born <28 weeks: Protocol group (n = 33) received at least 50% and not more than 150% of an intended standard dose of 0.5 mg/kg hydrocortisone twice daily for 7 days, then 0.5 mg/kg per day for 3 days; Non-Protocol group (n = 22), did not receive protocol hydrocortisone or completed <50% of the protocol dose. We assessed group differences in near-term diffusion MRI mean fractional anisotropy (FA) and mean diffusivity (MD) across the corticospinal tract, inferior longitudinal fasciculus, corpus callosum and superior cerebellar peduncle. RESULTS Groups were comparable in gestational age, post-menstrual age at scan, medical complications, bronchopulmonary dysplasia, and necrotizing enterocolitis. No significant large effect group differences were identified in mean FA or MD in any cerebral or cerebellar tract. CONCLUSION(S) Low dose, early, postnatal hydrocortisone was not associated with significant differences in white matter tract microstructure at near-term gestational age. IMPACT This study compared brain microstructural connectivity as a primary outcome among extremely preterm infants who did or did not receive early postnatal hydrocortisone. Low dose hydrocortisone in the first 10 days of life was not associated with significant differences in white matter microstructure in major cerebral and cerebellar pathways. Hydrocortisone did not have a significant effect on early brain white matter circuits.
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Affiliation(s)
- Sarah E Dubner
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Lucy Rickerich
- Program in Human Biology, Stanford University, Stanford, CA, USA
| | - Lisa Bruckert
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Rocío Velasco Poblaciones
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Dawson Sproul
- Program in Human Biology, Stanford University, Stanford, CA, USA
| | - Melissa Scala
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Heidi M Feldman
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Katherine E Travis
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University, Stanford, CA, USA.
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Eberhard R, Paquette K, Garfinkle J, Myers KA. Response to Hydrocortisone in an Extremely Preterm Neonate With Late-Onset Sepsis, Meningoencephalitis, and Drug-Resistant Seizures. Clin EEG Neurosci 2024; 55:252-256. [PMID: 36567490 DOI: 10.1177/15500594221147138] [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: 12/27/2022]
Abstract
Corticosteroids are commonly used in children with bacterial meningitis; however, there are very few data regarding possible utility in neonates, particularly those born premature. We describe our experience using hydrocortisone in the treatment of a girl born at 26 weeks, 6 days gestation. She had suffered profound brain injury following late onset group B streptococcus sepsis and meningitis, and developed drug-resistant seizures. Because seizures continued despite treatment with phenobarbital, phenytoin, levetiracetam, lacosamide, and midazolam, intravenous hydrocortisone was added. We observed a marked decrease in focal electrographic seizures within 2 days of initiation of hydrocortisone. This experience suggests that corticosteroids could be a treatment option for drug-resistant seizures and status epilepticus in preterm neonates, particularly those with bacterial meningitis.
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Affiliation(s)
- Ralf Eberhard
- Division of Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Katryn Paquette
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jarred Garfinkle
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kenneth A Myers
- Division of Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
- Child Health and Human Development Program, Research Institute of the McGill University Medical Centre, Montreal, Quebec, Canada
- Department of Neurology and Neurosurgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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Mani S, Mirza H, Ziegler J, Chandrasekharan P. Early Pulmonary Hypertension in Preterm Infants. Clin Perinatol 2024; 51:171-193. [PMID: 38325940 PMCID: PMC10850766 DOI: 10.1016/j.clp.2023.11.005] [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: 02/09/2024]
Abstract
Pulmonary hypertension (PH) in preterm neonates has multifactorial pathogenesis with unique characteristics. Premature surfactant-deficient lungs are injured following exposure to positive pressure ventilation and high oxygen concentrations resulting in variable phenotypes of PH. The prevalence of early PH is variable and reported to be between 8% and 55% of extremely preterm infants. Disruption of the lung development and vascular signaling pathway could lead to abnormal pulmonary vascular transition. The management of early PH and the off-label use of selective pulmonary vasodilators continue to be controversial.
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Affiliation(s)
- Srinivasan Mani
- Section of Neonatology, Department of Pediatrics, The University of Toledo/ ProMedica Russell J. Ebeid Children's Hospital, Toledo, OH 43606, USA
| | - Hussnain Mirza
- Section of Neonatology, Department of Pediatrics, Advent Health for Children/ UCF College of Medicine, Orlando, FL 32408, USA
| | - James Ziegler
- Division of Cardiovascular Diseases, Department of Pediatrics, Hasbro Children's Hospital/ Brown University, Providence, RI 02903, USA
| | - Praveen Chandrasekharan
- Division of Neonatology, Department of Pediatrics, Jacobs School of Medicine & Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY 32408, USA; Oishei Children's Hospital, 818 Ellicott Street, Buffalo, NY 14203, USA.
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