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Yu J, Lu H, Zhang X, Tang J, Liu Z, Jin Q, Wei W, Wang X. The triacylglycerol structures are key factors influencing lipid digestion in preterm formulas during in vitro digestion. Food Chem 2024; 443:138546. [PMID: 38301557 DOI: 10.1016/j.foodchem.2024.138546] [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: 07/11/2023] [Revised: 01/16/2024] [Accepted: 01/21/2024] [Indexed: 02/03/2024]
Abstract
Preterm formulas are usually supplemented with medium-chain triacylglycerols (MCT) whereas breast milk contains more medium and long-chain triacylglycerols (MLCT). Different types of triacylglycerol (TAG) containing medium-chain fatty acids may influence lipid digestion. In this study, the digestive characteristics of breast milk and preterm formulas with different MCT contents were evaluated using a dynamic in vitro system simulating the gastrointestinal tract of preterm infants. The lipolysis products, including diacylglycerols, monoacylglycerols (MAGs), free fatty acids, and undigested TAGs, were analyzed. Formulas with MCT addition has significantly (P < 0.05) lower lipolysis degree (LD, 69.35%-71.28%) than breast milk (76.93%). Higher amounts of C8:0 and C10:0 were released in the formulas with MCT addition. Breast milk released more C18:1n-9, C18:2n-6, and MAG containing C16:0, whereas formulas released more free C16:0. The Pearson correlation heatmap showed that the LD value was significantly and positively (P < 0.05) related to the MLCT and sn-2 C16:0 content.
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Affiliation(s)
- Jiahui Yu
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, China; Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, School of Food Science and Technology, Jiangnan University, Wuxi, China
| | - Huijia Lu
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, China; Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, School of Food Science and Technology, Jiangnan University, Wuxi, China
| | - Xinghe Zhang
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, China; Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, School of Food Science and Technology, Jiangnan University, Wuxi, China
| | - Juncheng Tang
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, China; Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, School of Food Science and Technology, Jiangnan University, Wuxi, China
| | - Zuoliang Liu
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, China; Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, School of Food Science and Technology, Jiangnan University, Wuxi, China
| | - Qingzhe Jin
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, China; Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, School of Food Science and Technology, Jiangnan University, Wuxi, China
| | - Wei Wei
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, China; Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, School of Food Science and Technology, Jiangnan University, Wuxi, China.
| | - Xingguo Wang
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, China; Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, School of Food Science and Technology, Jiangnan University, Wuxi, China.
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Phillips R, VanNatta D, Chu J, Best A, Ruiz P, Oswalt T, Wooldridge D, Fayard E. Breastfeeding Practice Before Bottle-Feeding: An Initiative to Increase the Rate of Breastfeeding for Preterm Infants at the Time of Neonatal Intensive Care Unit Discharge. Crit Care Nurs Clin North Am 2024; 36:251-260. [PMID: 38705692 DOI: 10.1016/j.cnc.2023.12.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Preterm babies who received 72 hours of breastfeeding practice before introducing a bottle had significantly higher rates of breastfeeding at the time of neonatal intensive care unit (NICU) discharge than did babies who were introduced to bottle-feeding with or before breastfeeding during the first 72 hours of oral feeding or babies who were primarily bottle-fed. There were no statistical differences in corrected gestational age (CGA) at birth, first oral feeding, or full oral feeds, in days from first to full oral feeds, or in CGA or days of life at NICU discharge.
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Affiliation(s)
- Raylene Phillips
- Loma Linda University Children's Hospital, Neonatology Division, 11175 Campus Street, CP 11121, Loma Linda, CA 92350, USA; Loma Linda University School of Medicine, Department of Pediatrics, Division of Neonatology, 11175 Campus Street, Loma Linda, CA 92350, USA; Loma Linda University Children's Hospital, Unit 3700, 11234 Anderson Street, Loma Linda, CA, 92354, USA.
| | - Dawn VanNatta
- Loma Linda University Children's Hospital, Unit 3700, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Jenny Chu
- Loma Linda University Children's Hospital, Unit 3700, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Allison Best
- Loma Linda University Children's Hospital, Unit 3700, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Pamela Ruiz
- Loma Linda University Children's Hospital, Unit 3700, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Tonya Oswalt
- Loma Linda University Children's Hospital, Unit 3700, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Dianne Wooldridge
- Loma Linda University Children's Hospital, Unit 3700, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Elba Fayard
- Loma Linda University Children's Hospital, Neonatology Division, 11175 Campus Street, CP 11121, Loma Linda, CA 92350, USA; Loma Linda University School of Medicine, Department of Pediatrics, Division of Neonatology, 11175 Campus Street, Loma Linda, CA 92350, USA; Loma Linda University Children's Hospital, Unit 3700, 11234 Anderson Street, Loma Linda, CA, 92354, USA
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Ikeda N, Shepherd E, Makrides M, McPhee AJ, Gibson RA, Gould JF. The effects of parenteral fish oil on neurodevelopment in preterm infants: A narrative review. Prostaglandins Leukot Essent Fatty Acids 2024; 201:102620. [PMID: 38763084 DOI: 10.1016/j.plefa.2024.102620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVE This narrative review aimed to summarize studies assessing the effects of parenteral fish oil on neurodevelopment in preterm infants. METHODS PubMed was searched (July 1985 to October 2023). We reviewed randomized controlled trials, and observational studies assessing intravenous lipid emulsion with fish oil in preterm infants (born less than 37 weeks' gestation), that reported long-term neurodevelopmental outcomes. RESULTS We identified four publications relating to three randomized controlled trials in addition to four cohort studies. Study designs and outcomes were heterogenous and precluded meta-analyses. Results of trials were null for a selection of neurodevelopmental outcomes, however possible benefits of parenteral fish oil supplementation for neurodevelopment was reported in three cohort studies. Certainty of the evidence is hindered by methodological limitations of available trials and observational studies. CONCLUSIONS Further research is required to firmly establish the effects of parenteral fish oil on preterm neurodevelopment.
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Affiliation(s)
- N Ikeda
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.
| | - E Shepherd
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - M Makrides
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - A J McPhee
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Neonatal Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - R A Gibson
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - J F Gould
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia; School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
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Cho H, Lee Y, Oh S, Heo JS. Risk factors and outcomes of vitamin D deficiency in very preterm infants. Pediatr Neonatol 2024:S1875-9572(24)00073-1. [PMID: 38769030 DOI: 10.1016/j.pedneo.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/17/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Vitamin D is essential for bone health and immune system. Vitamin D deficiency (VDD) poses a high-risk to very preterm (VP) infants. This study aimed to evaluate the risk factors associated with VDD in VP infants and its potential clinical outcomes. METHODS A retrospective cohort study was conducted on VP infants admitted to the neonatal intensive care unit of a specialized tertiary hospital in Seoul, Republic of Korea, between January 2018 and June 2022. Serum 25-hydroxyvitamin D (25(OH)D) levels and other biochemical parameters were measured between 4 and 6 weeks of age. VDD was defined as a serum 25(OH)D level <20 ng/mL. Prenatal and postnatal risk factors and clinical outcomes were compared between the VDD and non-VDD groups. RESULTS Of the 82 VP infants analyzed, 27 (32.9%) were diagnosed with VDD. The VDD group exhibited a significantly longer duration of parenteral nutrition (PN) compared to the non-VDD group (adjusted odds ratio [OR] = 1.12; 95% confidence interval [CI]: 1.008-1.245). Breast milk intake was lower in the VDD group than in the non-VDD group (adjusted OR = 0.976, 95% CI, 0.955-0.999). Notably, calcium levels were significantly lower in the VDD group, while parathyroid hormone levels were significantly higher, compared with the non-VDD group. Additionally, the rickets severity score was higher in the VDD group than in the non-VDD, although the difference was not statistically significant. CONCLUSIONS Prolonged PN duration and low breast milk intake significantly increased the risk of VDD in VP infants.
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Affiliation(s)
- Hannah Cho
- Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea; Department of Pediatrics, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Yoon Lee
- Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea; Department of Pediatrics, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Saelin Oh
- Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Ju Sun Heo
- Department of Pediatrics, Korea University Anam Hospital, Seoul, Republic of Korea; Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.
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Méio MDBB, de Miranda Salgado GG, Villela LD, da Costa ACC, Lima PAT, Milanesi BG, Moreira MEL. Influence of morbidity, early nutritional intake, and total energy: protein ratio on longitudinal extrauterine growth restriction of very preterm newborns at term-equivalent age: an observational study. Eur J Pediatr 2024:10.1007/s00431-024-05595-3. [PMID: 38730194 DOI: 10.1007/s00431-024-05595-3] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/13/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024]
Abstract
To evaluate the influence of early nutritional intake on the growth pattern of very preterm infants. This was an observational study including 109 newborns (< 32 weeks gestational age). Perinatal morbidities, nutritional therapy (first four weeks of life), and weight, length, and head circumference (HC) growth at term-equivalent age were evaluated. Growth restriction was defined as a difference > 1.2 SD between the birth and term age measurements. Growth restriction at term-equivalent age: 52.3% (weight), 42.9% (length), and 22% (HC). Morbidities were positively correlated with nutrition therapy and negatively correlated with the total energy provision: protein ratio. The duration of parenteral nutrition, the time to reach full enteral feedings, and the total energy provision: protein ratio were significantly correlated. Nutrient intake influenced weight, length, and HC growth, and cumulative energy deficit was significantly associated with HC growth restriction. Conclusion: Perinatal morbidities interfere with nutritional therapy and early nutrient intake, leading to insufficient energy and energy provision: protein ratio for growth. What is Known: • The intake of macronutrients early in life, mainly protein, is important for the optimal growth of pretem infants. • The severity of morbidities and low gestational ages impact the nutritional management of preterm infants. What is New: • The number of morbidities, reflecting the severity of the neonatal clinical course, had a detrimental effect on the nutritional therapy and nutrients intake. • The inadequate energy provision per gram of protein ratio was significantly associated with growth restriction in all growth measures at the second week of life, persisting for head circumference up to the fourth week, highlighting the importance of its measurement, as it could be a precocious sign of development risk.
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Affiliation(s)
- Maria Dalva Barbosa Baker Méio
- Neonatology, Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Oswaldo Cruz Foundation, FIOCRUZ, Av. Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, Brasil, CEP 22250-020.
- Postgraduation on Applied Clinical Research, Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Oswaldo Cruz Foundation, FIOCRUZ, Av. Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, Brasil, CEP 22250-020.
| | - Giovana Gleysse de Miranda Salgado
- Neonatology, Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Oswaldo Cruz Foundation, FIOCRUZ, Av. Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, Brasil, CEP 22250-020
| | - Letícia Duarte Villela
- Neonatology, Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Oswaldo Cruz Foundation, FIOCRUZ, Av. Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, Brasil, CEP 22250-020
- Postgraduation on Applied Clinical Research, Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Oswaldo Cruz Foundation, FIOCRUZ, Av. Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, Brasil, CEP 22250-020
| | - Ana Carolina Carioca da Costa
- Neonatology, Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Oswaldo Cruz Foundation, FIOCRUZ, Av. Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, Brasil, CEP 22250-020
- Postgraduation on Applied Clinical Research, Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Oswaldo Cruz Foundation, FIOCRUZ, Av. Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, Brasil, CEP 22250-020
| | - Paola Azara Tabicas Lima
- Neonatology, Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Oswaldo Cruz Foundation, FIOCRUZ, Av. Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, Brasil, CEP 22250-020
| | - Brunna Grazziotti Milanesi
- Neonatology, Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Oswaldo Cruz Foundation, FIOCRUZ, Av. Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, Brasil, CEP 22250-020
| | - Maria Elisabeth Lopes Moreira
- Neonatology, Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Oswaldo Cruz Foundation, FIOCRUZ, Av. Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, Brasil, CEP 22250-020
- Postgraduation on Applied Clinical Research, Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Oswaldo Cruz Foundation, FIOCRUZ, Av. Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, Brasil, CEP 22250-020
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Wu X, Guo R, Fan Y, Chen S, Zheng W, Shu X, Chen B, Li X, Xu T, Shi L, Chen L, Shan L, Zhu Z, Tao E, Jiang M. Dynamic impact of delivery modes on gut microbiota in preterm infants hospitalized during the initial 4 weeks of life. Int J Med Microbiol 2024; 315:151621. [PMID: 38759506 DOI: 10.1016/j.ijmm.2024.151621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 03/05/2024] [Accepted: 05/05/2024] [Indexed: 05/19/2024] Open
Abstract
Preterm infants face a high risk of various complications, and their gut microbiota plays a pivotal role in health. Delivery modes have been reported to affect the development of gut microbiota in term infants, but its impact on preterm infants remains unclear. Here, we collected fecal samples from 30 preterm infants at five-time points within the first four weeks of life. Employing 16 S rRNA sequencing, principal coordinates analysis, the analysis of similarities, and the Wilcoxon rank-sum test, we examined the top dominant phyla and genera, the temporal changes in specific taxa abundance, and their relationship with delivery modes, such as Escherichia-Shigella and Enterococcus based on vaginal delivery and Pluralibacter related to cesarean section. Moreover, we identified particular bacteria, such as Taonella, Patulibacter, and others, whose proportions fluctuated among preterm infants born via different delivery modes at varying time points, as well as the microbiota types and functions. These results indicated the influence of delivery mode on the composition and function of the preterm infant gut microbiota. Importantly, these effects are time-dependent during the early stages of life. These insights shed light on the pivotal role of delivery mode in shaping the gut microbiota of preterm infants and have significant clinical implications for their care and management.
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Affiliation(s)
- Xin Wu
- Department of Pediatrics, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Rui Guo
- Gastrointestinal Laboratory and Pediatric Endoscopy Center, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, China
| | - Yijia Fan
- Gastrointestinal Laboratory and Pediatric Endoscopy Center, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, China
| | - Shuang Chen
- Gastrointestinal Laboratory and Pediatric Endoscopy Center, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, China
| | - Wei Zheng
- Gastrointestinal Laboratory and Pediatric Endoscopy Center, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, China
| | - Xiaoli Shu
- Gastrointestinal Laboratory and Pediatric Endoscopy Center, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, China
| | - Bo Chen
- Gastrointestinal Laboratory and Pediatric Endoscopy Center, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, China
| | - Xing Li
- Department of Pediatrics, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Tingting Xu
- Department of Pediatrics, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Lingbing Shi
- Department of Pediatrics, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Li Chen
- Department of Pediatrics, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Lichun Shan
- Department of Pediatrics, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Zhenya Zhu
- Gastrointestinal Laboratory and Pediatric Endoscopy Center, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, China
| | - Enfu Tao
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang Province, China
| | - Mizu Jiang
- Gastrointestinal Laboratory and Pediatric Endoscopy Center, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, China; Department of Gastroenterology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, China.
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Greve S, Bruns N, Dathe AK, Schuendeln MM, Felderhoff-Mueser U, Stein A. Effects of an early transfer from incubator to a warming crib in very low birthweight preterm infants. BMC Pediatr 2024; 24:319. [PMID: 38724933 PMCID: PMC11080167 DOI: 10.1186/s12887-024-04795-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
PURPOSE Very low birth weight infants are cared for postnatally in the incubator because of adverse consequences of hypothermia. Data on the optimal weight of transfer to a warming crib are rare. The aim of this study was to determine the course of temperature and body weight during a standardized transfer to a warming crib at a set weight. METHODS Prospective intervention study in very low birthweight infants who were transferred from the incubator to a warming crib at a current weight between 1500 g and 1650 g. RESULTS No infant had to be transferred back to an incubator. Length of hospital stay was equal compared to a historical cohort from the two years directly before the intervention. The intervention group showed an increase in the volume fed orally on the day after transfer to the warming crib, although this did not translate into an earlier discontinuation of gavage feedings. Compared to the historical group, infants in the intervention group could be transferred to an unheated crib at an earlier postmenstrual age and weight. CONCLUSIONS Early transfer from the incubator to a warming crib between 1500 g and 1650 g is feasible and not associated with adverse short-term events or outcomes. TRIAL REGISTRATION DRKS-IDDRKS00031832.
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Affiliation(s)
- Sandra Greve
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, Universitätsmedizin Essen, University of Duisburg-Essen, North-Rhine Westphalia, 45122, Essen, Germany.
| | - Nora Bruns
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, Universitätsmedizin Essen, University of Duisburg-Essen, North-Rhine Westphalia, 45122, Essen, Germany
| | - Anne-Kathrin Dathe
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, Universitätsmedizin Essen, University of Duisburg-Essen, North-Rhine Westphalia, 45122, Essen, Germany
- Department of Health and Nursing, Occupational Therapy, Ernst-Abbe-University of Applied Sciences, Jena, Germany
| | - Michael M Schuendeln
- Department of Paediatrics III, Department of Pediatric Hematology and Oncology, Universitätsmedizin Essen, University of Duisburg-Essen, North-Rhine Westphalia, 45122, Essen, Germany
| | - Ursula Felderhoff-Mueser
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, Universitätsmedizin Essen, University of Duisburg-Essen, North-Rhine Westphalia, 45122, Essen, Germany
| | - Anja Stein
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, Universitätsmedizin Essen, University of Duisburg-Essen, North-Rhine Westphalia, 45122, Essen, Germany
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8
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Li Y, Hu Y, Li Y, Li X, Huang X, Shi Z, Yang R, Zhang X, Chen Q. The effect of oral motor intervention with different initiation times to improve feeding outcomes in preterm infants: protocol for a single-blind, randomized controlled trial. Trials 2024; 25:306. [PMID: 38715042 PMCID: PMC11075240 DOI: 10.1186/s13063-024-08131-8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/22/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Premature infants commonly encounter difficulties with oral feeding, a complication that extends hospital stays, affects infants' quality of life, and imposes substantial burdens on families and society. Enhancing preterm infants' oral feeding skills and facilitating their transition from parenteral or nasal feeding to full oral feeding pose challenges for neonatal intensive care unit (NICU) healthcare professionals. Research indicates that oral motor interventions (OMIs) can enhance preterm infants' oral feeding capabilities and expedite the transition from feeding initiation to full oral feeding. Nonetheless, the most suitable timing for commencing these interventions remains uncertain. METHODS This is a single-blind, randomized controlled trial. Preterm with a gestational age between 29+0 to 34+6 weeks will be eligible for the study. These infants will be randomized and allocated to one of two groups, both of which will receive the OMIs. The intervention commences once the infant begins milk intake during the early OMIs. Additionally, in the late OMIs group, the intervention will initiate 48 h after discontinuing nasal continuous positive airway pressure. DISCUSSION OMIs encompass non-nutritive sucking and artificial oral stimulation techniques. These techniques target the lips, jaw, muscles, or tongue of premature infants, aiming to facilitate the shift from tube feeding to oral feeding. The primary objective is to determine the ideal intervention timing that fosters the development of oral feeding skills and ensures a seamless transition from parenteral or nasal feeding to full oral feeding among preterm infants. Furthermore, this study might yield insights into the long-term effects of OMIs on the growth and neurodevelopmental outcomes of preterm infants. Such insights could bear substantial significance for the quality of survival among preterm infants and the societal burden imposed by preterm birth. TRIAL REGISTRATION chictr.org.cn ChiCTR2300076721. Registered on October 17, 2023.
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Affiliation(s)
- Yingxin Li
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, No. 20, Section 3, South Renmin Road, Chengdu, Sichuan, 610041, China
| | - Yanlin Hu
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, No. 20, Section 3, South Renmin Road, Chengdu, Sichuan, 610041, China
| | - Yuan Li
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, No. 20, Section 3, South Renmin Road, Chengdu, Sichuan, 610041, China
| | - Xia Li
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, No. 20, Section 3, South Renmin Road, Chengdu, Sichuan, 610041, China
| | - Xi Huang
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, No. 20, Section 3, South Renmin Road, Chengdu, Sichuan, 610041, China
| | - Zeyao Shi
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, No. 20, Section 3, South Renmin Road, Chengdu, Sichuan, 610041, China
| | - Ru Yang
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, No. 20, Section 3, South Renmin Road, Chengdu, Sichuan, 610041, China
| | - Xiujuan Zhang
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, No. 20, Section 3, South Renmin Road, Chengdu, Sichuan, 610041, China
| | - Qiong Chen
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Sichuan, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, No. 20, Section 3, South Renmin Road, Chengdu, Sichuan, 610041, China.
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9
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Düken ME, Yayan EH. The effects of massage therapy and white noise application on premature infants' sleep. Explore (NY) 2024; 20:319-327. [PMID: 37806925 DOI: 10.1016/j.explore.2023.09.002] [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: 02/03/2023] [Revised: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 10/10/2023]
Abstract
AIM Sleep is vital to premature infants' physical, social and emotional development. The significance of sleep duration, efficiency, and function in premature infants regarding growth development, behavior and neurological development has been increasing. MATERIALS AND METHODS This study was conducted in a randomized controlled experimental design with three groups. Premature infants at 28-37 weeks of gestation who were admitted to the Neonatal Intensive Care Unit of Şanlıurfa Mehmet Akif İnan Training and Research Hospital Haliliye Annex Building were the research population. The sample of the present study consisted of 120 premature infants in the massage therapy group (40), white noise group (40), and control group (40). RESULTS The sleep duration and sleep efficiency of the premature infants in the massage group increased compared to before the application, whereas the number of awakenings and WASO values decreased. The sleep duration of premature infants in the massaged group increased by some five hours. In the white noise group, the sleep duration increased by about two hours than the pre-treatment, and there was an increase in sleep efficiency. White noise application provided a significant decrease in the number of awakenings and WASO values in premature infants. CONCLUSION In this experimental study, which was designed with three groups, it was revealed that massage and white noise application in premature infants were significant non-pharmacological methods to increase sleep duration and sleep efficiency. It was concluded that massage therapy and white noise application is one of the considerable interventions regarding sleep duration, efficiency and functions in premature infants who left the intrauterine period early.
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Affiliation(s)
- Mehmet Emin Düken
- Health Sciences of Faculty, Department of Child Health and Diseases Nursing, Harran University, Şanlıurfa 63000, Turkey.
| | - Emriye Hilal Yayan
- Faculty of Nursing, Department of Child Health and Diseases Nursing, Inönü University, Malatya 44280, Turkey.
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Ghanem M, Zozaya C, Ibrahim J, Lee S, Mohsen N, Nasef N, Mohamed A. Correlation between early postnatal body weight changes and lung ultrasound scores as predictors of bronchopulmonary dysplasia in preterm infants: A secondary analysis of a prospective study. Eur J Pediatr 2024; 183:2123-2130. [PMID: 38363393 DOI: 10.1007/s00431-024-05464-z] [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: 12/31/2023] [Revised: 01/20/2024] [Accepted: 01/31/2024] [Indexed: 02/17/2024]
Abstract
Recent research links early weight changes (EWC) with bronchopulmonary dysplasia (BPD) in preterm neonates, while lung ultrasound score (LUS) has shown promise in predicting BPD. We aimed to explore the correlation between LUS and EWC as markers of extravascular lung edema and to investigate the correlation between LUS and EWC in preterm infants with respiratory distress syndrome regarding future BPD development. This secondary analysis of a prospective study involved infants ≤ 28 weeks gestation. Enrolled infants underwent lung ultrasound assessment on postnatal days 3, 7 and 14, measuring LUS. EWC was computed on the same time points. Infants were classified as either having BPD or not. Descriptive statistics, correlation coefficient, and area under the receiver operating characteristic (AUROC) curve analysis were utilized. Of 132 infants, 70 (53%) had BPD. Univariate analysis revealed statistically significant differences in LUS and EWC at days 3, 7, and 14 between BPD and no-BPD groups (p < 0.001). A statistically significant but weak positive correlation existed between LUS and EWC (r0.37, r0.29, r0.24, and p < 0.01) at postnatal days 3, 7, and 14, respectively. AUROC analysis indicated LUS having superior predictive capacity for the need for invasive mechanical ventilation at day 14 as well as the later BPD development compared to EWC (p < 0.0001). CONCLUSION In a cohort of extreme preterm infants, our study revealed a positive yet weak correlation between LUS and EWC, suggesting that EWC was not the major contributing to the evolving chronic lung disease. WHAT IS KNOWN • Recent evidence links Early Weight-Changes with bronchopulmonary dysplasia in preterm neonates. • Lung ultrasound score has shown promise in early prediction of the subsequent development of bronchopulmonary dysplasia in preterm infants. No studies have examined the correlation between Early Weight-Changes and Lung ultrasound score in preterm infants during first 2 weeks after birth. WHAT IS NEW • Our study demonstrated a positive and statistically significant correlation between early LUS and EWC, indicating their potential role as early predictors for the subsequent development of BPD in extreme preterm infants. • The weak correlation between the two parameters may stem from the possible restricted influence of EWC, given that it may not be the primary factor contributing to the evolving chronic lung disease.
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Affiliation(s)
- Mohab Ghanem
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, ON, M5G 1X5, Canada
| | - Carlos Zozaya
- Department of Neonatology, Hospital Universitario La Paz, Madrid, Spain
| | - Jenna Ibrahim
- Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, ON, M5G 1X5, Canada
| | - Seungwoo Lee
- Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, ON, M5G 1X5, Canada
| | - Nada Mohsen
- Department of Pediatrics, Mansoura University, Mansoura, Egypt
| | - Nehad Nasef
- Department of Pediatrics, Mansoura University, Mansoura, Egypt
| | - Adel Mohamed
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
- Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, ON, M5G 1X5, Canada.
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11
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Tajalli S, Ebadi A, Parvizy S, Kenner C. Development and psychometric evaluation of "Caring Ability of Mother with Preterm Infant Scale" (CAMPIS): a sequential exploratory mixed-method study. BMC Nurs 2024; 23:297. [PMID: 38685021 PMCID: PMC11057165 DOI: 10.1186/s12912-024-01960-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 04/22/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Caring ability is one of the most important indicators regarding care outcomes. A valid and reliable scale for the evaluation of caring ability in mothers with preterm infants is lacking. OBJECTIVE The present study was conducted with the aim of designing and psychometric evaluation of the tool for assessing caring ability in mothers with preterm infants. METHOD A mixed-method exploratory design was conducted from 2021 to 2023. First the concept of caring ability of mothers with preterm infants was clarified using literature review and comparative content analysis, and a pool of items was created. Then, in the quantitative study, the psychometric properties of the scale were evaluated using validity and reliability tests. A maximum likelihood extraction with promax rotation was performed on 401 mothers with the mean age of 31.67 ± 6.14 years to assess the construct validity. RESULT Initial caring ability of mother with preterm infant scale (CAMPIS) was developed with 64 items by findings of the literature review, comparative content analysis, and other related questionnaire items, on a 5-point Likert scale to be psychometrically evaluated. Face, content, and construct validity, as well as reliability, were measured to evaluate the psychometric properties of CAMPIS. So, the initial survey yielded 201 valid responses. The three components: 'cognitive ability'; knowledge and skills abilities'; and 'psychological ability'; explained 47.44% of the total observed variance for CAMPIS with 21 items. A subsequent survey garnered 200 valid responses. The confirmatory factor analysis results indicated: χ2/df = 1.972, comparative fit index (CFI) = 0.933, and incremental fit index (IFI) = 0.933. These results demonstrate good structural, convergent, discriminant validity and reliability. OMEGA, average inter-item correlation (AIC), intraclass correlation coefficients (ICC) for the entire scale were at 0.900, 0.27 and 0.91 respectively. CONCLUSION Based on the results of the psychometric evaluation of CAMPIS, it was found that the concept of caring ability in the Iranian mothers with preterm infants is a multi-dimensional concept, which mainly focuses on cognitive ability, technical ability, and psychological ability. The designed scale has acceptable validity and reliability characteristics that can be used in future studies to assess this concept in the mothers of preterm infants.
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Affiliation(s)
- Saleheh Tajalli
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Soroor Parvizy
- Nursing and Midwifery Care Research Center, Pediatric Nursing Department, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
- Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Carole Kenner
- School of Nursing and Health Sciences, The College of New Jersey, Ewing, NJ, USA
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12
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Schmid SV, Arnold C, Jaisli S, Bubl B, Harju E, Kidszun A. Parents' and neonatal healthcare professionals' views on barriers and facilitators to parental presence in the neonatal unit: a qualitative study. BMC Pediatr 2024; 24:268. [PMID: 38658901 PMCID: PMC11040849 DOI: 10.1186/s12887-024-04758-3] [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: 12/01/2023] [Accepted: 04/11/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Parent and infant separation in the neonatal unit is associated with adverse health outcomes. Family-integrated care has several advantages and the potential to reduce these adverse outcomes but requires parental presence. This study aimed to explore the views of parents and neonatal healthcare professionals (nHCPs) on barriers and facilitators to parental presence in a Swiss neonatal unit and to identify possible differences between nHCPs and parents, and between mothers and fathers. METHODS Data were collected through semi-structured interviews with parents and focus group discussions with nHCPs. Inductive content analysis was used to identify barriers and facilitators to parental presence in the neonatal unit. RESULTS Twenty parents (10 mothers and 10 fathers) and 21 nHCPs (10 nurses and 11 physicians) participated in the study. Parents and nHCPs experienced barriers and facilitators related to: (1) Structural factors of the institution, such as infrastructure or travel and distance to the neonatal unit. (2) Organization and time management of parental presence, daily activities, and work. (3) Resources, which include factors related to the legal situation, support services, family, and friends. (4) Physical and psychological aspects, such as pain, which mainly affected mothers, and aspects of emotional distress, which affected both parents. Self-care was an important physical and psychological facilitator. (5) Parent-professional interaction. Parental presence was influenced by communication, relationship, and interaction in infant care; and (6) Cultural aspects and language. Some perspectives differed between mothers and fathers, while the overall views of parents and nHCPs provided complementary rather than conflicting insights. Using visit plans to support the organization, educating nHCPs in knowledge skills and available resources to improve encouragement and information to parents, strengthening parent self-care, and improving nHCPs' attitudes towards parental presence were seen as possible improvements. CONCLUSIONS Multifactorial barriers and facilitators determine parental presence and experience in the neonatal unit. Parents and nHCPs made specific recommendations to improve parental presence.
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Affiliation(s)
- Stephanie Vanessa Schmid
- Division of Neonatology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Friedbühlstrasse 19, Bern, 3010, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Alpenquai 4, Lucerne, 6002, Switzerland
| | - Christine Arnold
- Division of Neonatology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Friedbühlstrasse 19, Bern, 3010, Switzerland.
| | - Sophie Jaisli
- Division of Neonatology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Friedbühlstrasse 19, Bern, 3010, Switzerland
| | - Benedikt Bubl
- Division of Neonatology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Friedbühlstrasse 19, Bern, 3010, Switzerland
| | - Erika Harju
- Faculty of Health Sciences and Medicine, University of Lucerne, Alpenquai 4, Lucerne, 6002, Switzerland
- School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, Winterthur, 8401, Switzerland
| | - André Kidszun
- Division of Neonatology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Friedbühlstrasse 19, Bern, 3010, Switzerland
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Zores C, Gibier C, Haumesser L, Meyer N, Poirot S, Briot C, Langlet C, Dillenseger L, Kuhn P. Evaluation of a new tool - "Step by step with my baby" - to support parental involvement in the care of preterm infants. Arch Pediatr 2024:S0929-693X(24)00057-5. [PMID: 38653616 DOI: 10.1016/j.arcped.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/24/2023] [Accepted: 11/26/2023] [Indexed: 04/25/2024]
Abstract
BACKGROUND AND AIMS Parental guidance is essential for supporting parental involvement, maintaining the quality and safety of infant care, and limiting parental stress. The efficiency of a new tool to support parental empowerment - "Step by step with my baby" - was evaluated. The perception of this tool by parents and nurses was studied. METHODS This was a prospective, observational study conducted from September 2019 to December 2020 at a level-3 neonatal center. A total of 79 newborns (<33 weeks of gestational age or small for gestational age), 84 parents, and 94 nurses were included. The new tool that was evaluated is in the form of a drawing of flowers to be colored according to the parents' ability to care for their newborn. Six domains were explored and given a score (total of 35 points) according to the parents' ability to care for each item: behavior, skin-to-skin contact, carrying, oral and tube feeding, and routine care. The use and relevance of this tool were evaluated by parents and caregivers. RESULTS At a mean of 19 days of life, parents required caregiver support regardless of the skill domain (6/35). After 26 days, the mean score increased to 19.4 (p < 0.05). Parents felt autonomous in changing diapers and monitoring temperature but always required help for skin-to-skin contact, carrying, and feeding with or without a tube. The progression was not affected by the presence of siblings, the distance from home, and staying in the parental hospital room. For 67 % of the parents, the tool gave them a better understanding of their newborn and helped them be more confident (69 %) without feeling judged (81 %). These feelings were upheld by nurses. CONCLUSIONS This tool was efficient for evaluating parents' autonomy and helped them take ownership of the care provided.
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Affiliation(s)
- Claire Zores
- CHU Strasbourg, Médecine et Réanimation du nouveau-né, Service de Pédiatrie 2, Pôle médico chirurgical Pédiatrique de Hautepierre, Avenue Molière, 67091 Strasbourg, France; INCI, UPR 3231, CNRS/ université de Strasbourg, 67000 Strasbourg, Alsace, France.
| | - Corisande Gibier
- CHU Strasbourg, Médecine et Réanimation du nouveau-né, Service de Pédiatrie 2, Pôle médico chirurgical Pédiatrique de Hautepierre, Avenue Molière, 67091 Strasbourg, France
| | - Lucile Haumesser
- CHU Strasbourg, Service d'information médicale-biostatistique - Santé Publique 67000 Strasbourg, Alsace, France
| | - Nicolas Meyer
- CHU Strasbourg, Service d'information médicale-biostatistique - Santé Publique 67000 Strasbourg, Alsace, France
| | - Stéphanie Poirot
- CHU Strasbourg, Médecine et Réanimation du nouveau-né, Service de Pédiatrie 2, Pôle médico chirurgical Pédiatrique de Hautepierre, Avenue Molière, 67091 Strasbourg, France
| | - Caroline Briot
- CHU Strasbourg, Médecine et Réanimation du nouveau-né, Service de Pédiatrie 2, Pôle médico chirurgical Pédiatrique de Hautepierre, Avenue Molière, 67091 Strasbourg, France
| | - Claire Langlet
- CHU Strasbourg, Médecine et Réanimation du nouveau-né, Service de Pédiatrie 2, Pôle médico chirurgical Pédiatrique de Hautepierre, Avenue Molière, 67091 Strasbourg, France
| | - Laurence Dillenseger
- CHU Strasbourg, Médecine et Réanimation du nouveau-né, Service de Pédiatrie 2, Pôle médico chirurgical Pédiatrique de Hautepierre, Avenue Molière, 67091 Strasbourg, France
| | - Pierre Kuhn
- CHU Strasbourg, Médecine et Réanimation du nouveau-né, Service de Pédiatrie 2, Pôle médico chirurgical Pédiatrique de Hautepierre, Avenue Molière, 67091 Strasbourg, France; INCI, UPR 3231, CNRS/ université de Strasbourg, 67000 Strasbourg, Alsace, France
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Shimotsuma T, Tomotaki S, Akita M, Araki R, Tomotaki H, Iwanaga K, Kobayashi A, Saitoh A, Fushimi Y, Takita J, Kawai M. Severe Bronchopulmonary Dysplasia Adversely Affects Brain Growth in Preterm Infants. Neonatology 2024:1-9. [PMID: 38648742 DOI: 10.1159/000538527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/19/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Bronchopulmonary dysplasia (BPD) is associated with neurodevelopmental outcomes of preterm infants, but its effect on brain growth in preterm infants after the neonatal period is unknown. This study aimed to evaluate the effect of severe BPD on brain growth of preterm infants from term to 18 months of corrected age (CA). METHODS Sixty-three preterm infants (42 with severe BPD and 21 without severe BPD) who underwent magnetic resonance imaging at term equivalent age (TEA) and 18 months of CA were studied by using the Infant Brain Extraction and Analysis Toolbox (iBEAT). We measured segmented brain volumes and compared brain volume and brain growth velocity between the severe BPD group and the non-severe BPD group. RESULTS There was no significant difference in brain volumes at TEA between the groups. However, the brain volumes of the total brain and cerebral white matter in the severe BPD group were significantly smaller than those in the non-severe BPD group at 18 months of CA. The brain growth velocities from TEA to 18 months of CA in the total brain, cerebral cortex, and cerebral white matter in the severe BPD group were lower than those in the non-severe BPD group. CONCLUSION Brain growth in preterm infants with severe BPD from TEA age to 18 months of CA is less than that in preterm infants without severe BPD.
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Affiliation(s)
- Taiki Shimotsuma
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Pediatrics, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, Japan
| | - Seiichi Tomotaki
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mitsuyo Akita
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryosuke Araki
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroko Tomotaki
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kougoro Iwanaga
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akira Kobayashi
- Department of Pediatrics, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, Japan
| | - Akihiko Saitoh
- Department of Pediatrics, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, Japan
| | - Yasutaka Fushimi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Junko Takita
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahiko Kawai
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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吴 梓, 张 漪, 周 茜, 刘 沁, 程 实, 夏 世. [Risk factors for the failure of ibuprofen treatment in preterm infants with hemodynamically significant patent ductus arteriosus]. Zhongguo Dang Dai Er Ke Za Zhi 2024; 26:343-349. [PMID: 38660897 PMCID: PMC11057302 DOI: 10.7499/j.issn.1008-8830.2310145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/27/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES To investigate the risk factors for the failure of ibuprofen treatment in preterm infants with hemodynamically significant patent ductus arteriosus (hsPDA). METHODS A retrospective collection of clinical data was conducted on preterm infants with a gestational age of <34 weeks who were diagnosed with hsPDA and treated at the Department of Neonatology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, from January 2018 to June 2023. The subjects were divided into two groups based on the treatment approach: the ibuprofen group (95 cases) and the ibuprofen plus surgery group (44 cases). The risk factors for the failure of ibuprofen treatment in preterm infants with hsPDA were identified by binary logistic regression analysis. RESULTS The binary logistic regression analysis revealed that an increased diameter of the ductus arteriosus, a resistance index (RI) value of the middle cerebral artery ≥0.80, and prolonged total invasive mechanical ventilation time were risk factors for the failure of ibuprofen treatment in preterm infants with hsPDA (P<0.05). Receiver operating characteristic curve analysis showed that a ductus arteriosus diameter >2.85 mm, a middle cerebral artery RI value ≥0.80, and a total invasive mechanical ventilation time >16 days had significant predictive value for the failure of ibuprofen treatment in preterm infants with hsPDA (P<0.05). The combined predictive value of these three factors was the highest, with an area under the curve of 0.843, a sensitivity of 86.5%, and a specificity of 75.0% (P<0.05). CONCLUSIONS A ductus arteriosus diameter >2.85 mm, a middle cerebral artery RI value ≥0.80, and a total invasive mechanical ventilation time >16 days are risk factors for the failure of ibuprofen treatment in preterm infants with hsPDA, and they are of significant predictive value for the necessity of surgical treatment following the failure of ibuprofen treatment.
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Affiliation(s)
| | | | | | - 沁 刘
- 华中科技大学同济医学院附属湖北妇幼保健院超声科,湖北武汉430070
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戴 雪, 朱 昂, 谢 婷, 熊 玉, 孟 伦, 陈 名. [Impact of different angles of pulmonary surfactant administration on bronchopulmonaryplasia and intracranial hemorrhage in preterm infants: a prospective randomized controlled study]. Zhongguo Dang Dai Er Ke Za Zhi 2024; 26:337-342. [PMID: 38660896 PMCID: PMC11057306 DOI: 10.7499/j.issn.1008-8830.2311066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/27/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES To investigate the effects of different angles of pulmonary surfactant (PS) administration on the incidence of bronchopulmonary dysplasia and intracranial hemorrhage in preterm infants. METHODS A prospective study was conducted on 146 preterm infants (gestational age <32 weeks) admitted to the Department of Neonatology, Provincial Hospital Affiliated to Anhui Medical University from January 2019 to May 2023. The infants were randomly assigned to different angles for injection of pulmonary surfactant groups: 0° group (34 cases), 30° group (36 cases), 45° group (38 cases), and 60° group (38 cases). Clinical indicators and outcomes were compared among the groups. RESULTS The oxygenation index was lower in the 60° group compared with the other three groups, with shorter invasive ventilation time and oxygen use time, and a lower incidence of bronchopulmonary dysplasia than the other three groups (P<0.05). The incidence of intracranial hemorrhage was lower in the 60° group compared to the 0° group (P<0.05). The cure rate in the 60° group was higher than that in the 0° group and the 30° group (P<0.05). CONCLUSIONS The clinical efficacy of injection of pulmonary surfactant at a 60° angle is higher than other angles, reducing the incidence of intracranial hemorrhage and bronchopulmonary dysplasia in preterm infants.
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Affiliation(s)
| | | | - 婷婷 谢
- 中国科学技术大学附属第一医院新生儿科,安徽合肥230001
| | - 玉红 熊
- 中国科学技术大学附属第一医院新生儿科,安徽合肥230001
| | - 伦 孟
- 中国科学技术大学附属第一医院新生儿科,安徽合肥230001
| | - 名武 陈
- 中国科学技术大学附属第一医院新生儿科,安徽合肥230001
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Langanky LO, Kreutzer KB, Poets CF, Franz AR, Schwarz CE. Pulse oximetry signal loss during hypoxic episodes in preterm infants receiving automated oxygen control. Eur J Pediatr 2024:10.1007/s00431-024-05549-9. [PMID: 38592485 DOI: 10.1007/s00431-024-05549-9] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/10/2024]
Abstract
The aim of this study was to analyze signal loss (SL) resulting from low signal quality of pulse oximetry-derived hemoglobin oxygen saturation (SpO2) measurements during prolonged hypoxemic episodes (pHE) in very preterm infants receiving automatic oxygen control (AOC). We did a post hoc analysis of a randomized crossover study of AOC, programmed to set FiO2 to "back-up FiO2" during SL. In 24 preterm infants (median (interquartile range)) gestational age 25.3 (24.6 to 25.6) weeks, recording time 12.7 h (12.2 to 13.6 h) per infant, we identified 76 pHEs (median duration 119 s (86 to 180 s)). In 50 (66%) pHEs, SL occurred for a median duration of 51 s (33 to 85 s) and at a median frequency of 2 (1 to 2) SL-periods per pHE. SpO2 before and after SL was similar (82% (76 to 88%) vs 82% (76 to 87%), p = 0.3)). Conclusion: SL is common during pHE and must hence be considered in AOC-algorithm designs. Administering a "backup FiO2" (which reflects FiO2-requirements during normoxemia) during SL may prolong pHE with SL. Trial registration: The study was registered at www. CLINICALTRIALS gov under the registration no. NCT03785899. WHAT IS KNOWN • Previous studies examined SpO2 signal loss (SL) during routine manual oxygen control being rare, but pronounced in lower SpO2 states. • Oxygen titration during SL is unlikely to be beneficial as SpO2 may recover to a normoxic range. WHAT IS NEW • Periods of low signal quality of SpO2 are common during pHEs and while supported with automated oxygen control (SPOC), FiO2 is set to a back-up value reflecting FiO2 requirements during normoxemia in response to SL, although SpO2 remained below target until signal recovery. • FiO2 overshoots following pHEs were rare during AOC and occurred with a delayed onset; therefore, increased FiO2 during SL does not necessarily lead to overshoots.
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Affiliation(s)
- Lukas O Langanky
- Department of Neonatology, University Children's Hospital, Tübingen University Hospital, Tübingen, Germany
| | - Karen B Kreutzer
- Department of Neonatology, University Children's Hospital, Tübingen University Hospital, Tübingen, Germany
| | - Christian F Poets
- Department of Neonatology, University Children's Hospital, Tübingen University Hospital, Tübingen, Germany
| | - Axel R Franz
- Department of Neonatology, University Children's Hospital, Tübingen University Hospital, Tübingen, Germany
- Center for Pediatric Clinical Studies, University Children's Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Christoph E Schwarz
- Department of Neonatology, University Children's Hospital, Tübingen University Hospital, Tübingen, Germany.
- Department of Neonatology, Center for Pediatric and Adolescent Medicine, University of Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.
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Tomotaki S, Isayama T, Kobayashi T, Masutani S, Kawasaki H, Nakayama A, Ikeda T, Toyoshima K. Proactive Diagnosis and Tailor-Made Treatment of Patent Ductus Arteriosus in Very Preterm Infants with Routine Echocardiography in Japan: A post hoc Analysis of the PLASE Study. Neonatology 2024:1-9. [PMID: 38593757 DOI: 10.1159/000538363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/12/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION A feature of the management of extremely preterm infants in Japan is proactive circulatory management using early routine echocardiography performed by neonatologists. METHODS This study was a post hoc analysis of the Patent ductus arteriosus and Left Atrial Size Evaluation in preterm infants (PLASE) study, which is a prospective cohort study including preterm infants admitted to 34 tertiary neonatal intensive care units in Japan between October 2015 and December 2016. We described the details of the treatment strategy of patent ductus arteriosus (PDA) based on early routine echocardiography. RESULTS In total, 613 preterm infants were included into the analysis. Twenty percent of infants with prophylactic indomethacin were switched to therapeutic cyclooxygenase inhibitor (COX-I) before the completion of the full prophylactic indomethacin course. Therapeutic COX-I was mostly administered based on echocardiographic findings before PDA became symptomatic or hemodynamically significant. Therapeutic COX-I was frequently discontinued after one or two doses before the full course (three doses) was completed. The proportion of infants requiring additional treatment (additional therapeutic COX-I course or surgical PDA closure) after discontinued COX-I courses (<3 doses) compared to infants after completed 3 doses course was significantly lower (after the first therapeutic COX-I course 46% vs. 68%, p < 0.001) or without a significant difference (after the second or third course). CONCLUSIONS The clinical management of PDA in Japan featured (1) COX-I administration based on echocardiographic findings before symptomatic or hemodynamically significant PDA appeared and (2) frequent discontinuation of therapeutic COX-I before completing the standard three doses course.
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Affiliation(s)
- Seiichi Tomotaki
- Department of Neonatology, Kanagawa Children's Medical Center, Yokohama, Japan
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tetsuya Isayama
- Department of Neonatology, National Center for Child Health and Development, Setagaya, Japan
| | - Tohru Kobayashi
- Department of Data Science, Clinical Research Center, National Center for Child Health and Development, Setagaya, Japan
| | - Satoshi Masutani
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Hidenori Kawasaki
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Atsushi Nakayama
- Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | | | - Katsuaki Toyoshima
- Department of Neonatology, Kanagawa Children's Medical Center, Yokohama, Japan
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Lin H, Bai G, Ge J, Chen X, He X, Ma X, Shi L, Du L, Chen Z. Nutritional support during the first week for infants with bronchopulmonary dysplasia and respiratory distress: a multicenter cohort study in China. BMC Pediatr 2024; 24:238. [PMID: 38570780 PMCID: PMC10988891 DOI: 10.1186/s12887-024-04675-5] [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: 08/26/2023] [Accepted: 02/27/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD) is a major complication affecting the survival rate and long-term outcomes of preterm infants. A large, prospective, multicenter cohort study was conducted to evaluate early nutritional support during the first week of life for preterm infants with a gestational age < 32 weeks and to verify nutritional risk factors related to BPD development. METHODS A prospective multicenter cohort study of very preterm infants was conducted in 40 tertiary neonatal intensive care units across mainland China between January 1, 2020, and December 31, 2021. Preterm infants who were born at a gestational age < 32 weeks, < 72 h after birth and had a respiratory score > 4 were enrolled. Antenatal and postnatal information focusing on nutritional parameters was collected through medical systems. Statistical analyses were also performed to identify BPD risk factors. RESULTS The primary outcomes were BPD and severity at 36 weeks postmenstrual age. A total of 1410 preterm infants were enrolled in this study. After applying the exclusion criteria, the remaining 1286 infants were included in this analysis; 614 (47.7%) infants were in the BPD group, and 672 (52.3%) were in the non-BPD group. In multivariate logistic regression model, the following six factors were identified of BPD: birth weight (OR 0.99, 95% CI 0.99-0.99; p = 0.039), day of full enteral nutrition (OR 1.03, 95% CI 1.02-1.04; p < 0.001), parenteral protein > 3.5 g/kg/d during the first week (OR 1.65, 95% CI 1.25-2.17; p < 0.001), feeding type (formula: OR 3.48, 95% CI 2.21-5.49; p < 0.001, mixed feed: OR 1.92, 95% CI 1.36-2.70; p < 0.001; breast milk as reference), hsPDA (OR 1.98, 95% CI 1.44-2.73; p < 0.001), and EUGR ats 36 weeks (OR 1.40, 95% CI 1.02-1.91; p = 0.035). CONCLUSIONS A longer duration to achieve full enteral nutrition in very preterm infants was associated with increased BPD development. Breastfeeding was demonstrated to have a protective effect against BPD. Early and rapidly progressive enteral nutrition and breastfeeding should be promoted in very preterm infants. TRIAL REGISTRATION The trial was registered in the Chinese Clinical Trial Registry (No. ChiCTR2000030125 on 24/02/2020) and in www.ncrcch.org (No. ISRCTN84167642 on 25/02/2020).
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Affiliation(s)
- Huijia Lin
- Department of NICU, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Guannan Bai
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jiajing Ge
- Department of NICU, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xuefeng Chen
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xinyu He
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xiaolu Ma
- Department of NICU, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Liping Shi
- Department of NICU, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Lizhong Du
- Department of NICU, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zheng Chen
- Department of NICU, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
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Burgmaier K, Zeiher M, Weber A, Cosgun ZC, Aydin A, Kuehne B, Burgmaier M, Hellmich M, Mehler K, Kribs A, Habbig S. Low incidence of acute kidney injury in VLBW infants with restrictive use of mechanical ventilation. Pediatr Nephrol 2024; 39:1279-1288. [PMID: 37955704 PMCID: PMC10899311 DOI: 10.1007/s00467-023-06182-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND We assessed the incidence of and risk factors for acute kidney injury (AKI) in very low birthweight infants (VLBW) in a center with a specific neonatal management protocol focusing on avoidance of early mechanical ventilation (MV). METHODS This retrospective single center analysis includes 128 infants born in 2020 with a gestational age ≥ 22 weeks who were screened for AKI using the nKDIGO criteria. RESULTS AKI was identified in 25/128 patients (19.5%) with eight of them (6.3%) presenting with severe AKI. Low gestational age, birthweight and 10-minute Apgar score as well as high CRIB-1 score were all associated with incidence of AKI. Forty-five percent of the infants with MV developed AKI vs. 8.9% of those without MV (p < 0.001). Early onset of MV and administration of more than 3 dosages of NSAIDs for patent duct were identified as independent risk factors for AKI in a logistic regression analysis. CONCLUSIONS We report a substantially lower frequency of AKI in VLBW infants as compared to previous studies, along with a very low rate of MV. A neonatal protocol focusing on avoidance of MV within the first days of life may be a key factor to decrease the risk of AKI in immature infants.
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Affiliation(s)
- Kathrin Burgmaier
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Faculty of Applied Healthcare Science, Deggendorf Institute of Technology, Deggendorf, Germany
| | - Melanie Zeiher
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Anna Weber
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Zülfü C Cosgun
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Aynur Aydin
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Benjamin Kuehne
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Mathias Burgmaier
- Faculty of Applied Healthcare Science, Deggendorf Institute of Technology, Deggendorf, Germany
- Department of Internal Medicine I, University Hospital RWTH Aachen, Aachen, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Katrin Mehler
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Angela Kribs
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Sandra Habbig
- Department of Pediatrics, University Hospital Cologne and Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
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21
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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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Bajaber A, Ali MH, Bazuhair AO, Bajaber O, Alsaiady M, Rabie S, BinMahmoud L, Alfaki D. Successful retrieval of deep intracardiac migrated broken umbilical venous catheter in a preterm infant: Case report. Radiol Case Rep 2024; 19:1235-1238. [PMID: 38292783 PMCID: PMC10825532 DOI: 10.1016/j.radcr.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/09/2023] [Accepted: 12/12/2023] [Indexed: 02/01/2024] Open
Abstract
Umbilical catheters serve as indispensable tools in the realm of neonatal intensive care, contributing significantly to the well-being of premature infants. While rare, it is essential to approach their handling with utmost caution, as it can lead to fatal complications. We report a case of a preterm 9-day-old male infant, who was referred to our center for specialized treatment following an unsuccessful surgical attempt to address a fractured umbilical venous catheter (UVC). This case underscores the value of employing imaging techniques for prompt identification of such complications. Furthermore, the utilization of endovascular therapy emerges as a promising intervention in managing such complexities, thereby expanding the horizons of interventional radiology in elevating the standard of patient care.
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Affiliation(s)
- Abubakr Bajaber
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Magda Hag Ali
- Department of Pediatric Cardiology, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Adeeb Omar Bazuhair
- Medical Imaging Department, Interventional Radiology Section, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Omar Bajaber
- Medical Imaging Department, Pediatric Radiology Section, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Moath Alsaiady
- Medical Imaging Department, Pediatric Radiology Section, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Samy Rabie
- Department of Pediatric Cardiology, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Latifa BinMahmoud
- Neonatal Critical Care Department, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Doaa Alfaki
- Neonatal Critical Care Department, King Saud Medical City, Riyadh 12746, Saudi Arabia
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Campanha PDPA, de Magalhães-Barbosa MC, Prata-Barbosa A, Rodrigues-Santos G, da Cunha AJLA. Exclusive breastfeeding and length of hospital stay in premature infants at a Brazilian reference center for kangaroo mother care. J Pediatr (Rio J) 2024:S0021-7557(24)00028-7. [PMID: 38522479 DOI: 10.1016/j.jped.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 03/26/2024] Open
Abstract
OBJECTIVE To evaluate exclusive breastfeeding at discharge and hospital length-of-stay in preterm infants undergoing or not the Kangaroo-Mother Care Method (KMC). METHODS A retrospective cohort study was conducted including preterm infants < 1800 g admitted to the neonatal unit of a KMC reference center. The infants were grouped into the KMC group and the non-KMC group. Multiple logistic and Poisson regressions were performed to evaluate the association between the KMC and two outcomes, exclusive breastfeeding at discharge, and hospital length-of-stay, adjusted for potential confounders. RESULTS 115 mother-infant dyads were included, 78 in the KMC group and 37 in the non-KMC group. In the bivariate analysis, the KMC group had a lower prevalence of maternal adverse conditions (6% vs. 32%, p < 0.001), a higher number of prenatal visits (median 6 vs. 3.5, p < 0.001), higher gestational ages (median 32 vs. 31 weeks, p < 0.05), higher birth weights (median 1530 vs. 1365 g, p < 0.01), a lower prevalence of necrotizing enterocolitis (3.8% vs. 16.2%, p < 0.05), parenteral nutrition (50% vs. 73%, p < 0.05), and deep vascular access (49.7% vs. 78.4%, p < 0.01), a higher prevalence of exclusive breastfeeding (65% vs. 8%, p < 0.001) and a shorter length of hospital stay (median 28 vs. 42 days, p < 0.001). In the multiple regression analysis, the KMC group was 23 times more likely to be exclusively breastfed at discharge (OR = 23.1; 95% CI = 4,85-109,93) and had a 19% reduction in the hospital length-of-stay (IDR = 0.81; 95% CI = 0.76-0.86) compared to the non-KMC group. CONCLUSIONS The KMC is associated with better short-term neonatal outcomes and should be encouraged in all Brazilian maternity hospitals.
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Affiliation(s)
- Patrícia de Padua Andrade Campanha
- Universidade Federal do Rio de Janeiro (UFRJ), Faculdade de Medicina, Rio de Janeiro, RJ, Brazil; Secretaria Municipal de Saúde do Rio de Janeiro - Maternidade Leila Diniz, Rio de Janeiro, RJ, Brazil.
| | - Maria Clara de Magalhães-Barbosa
- Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ, Brazil; Universidade Federal do Rio de Janeiro (UFRJ), Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro, RJ, Brazil
| | - Arnaldo Prata-Barbosa
- Universidade Federal do Rio de Janeiro (UFRJ), Faculdade de Medicina, Rio de Janeiro, RJ, Brazil; Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ, Brazil
| | | | - Antônio José Ledo Alves da Cunha
- Universidade Federal do Rio de Janeiro (UFRJ), Faculdade de Medicina, Rio de Janeiro, RJ, Brazil; Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ, Brazil
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24
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吴 迪, 鞠 俊, 常 贺. [Effects of antenatal corticosteroid therapy in pregnant women on the brain development of preterm infants as assessed by amplitude-integrated electroencephalography]. Zhongguo Dang Dai Er Ke Za Zhi 2024; 26:244-249. [PMID: 38557375 PMCID: PMC10986380 DOI: 10.7499/j.issn.1008-8830.2309148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/02/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES To investigate the effects of antenatal corticosteroid (ACS) therapy in pregnant women on the brain development of preterm infants using amplitude-integrated electroencephalography (aEEG). METHODS A retrospective analysis was conducted on 211 preterm infants with a gestational age of 28 to 34+6 weeks. The infants were divided into an ACS group (131 cases) and a control group (80 cases) based on whether antenatal dexamethasone was given for promoting fetal lung maturity. The first aEEG monitoring (referred to as aEEG1) was performed within 24 hours after birth, and the second aEEG monitoring (referred to as aEEG2) was performed between 5 to 7 days after birth. The aEEG results were compared between the two groups. RESULTS In preterm infants with a gestational age of 28 to 31+6 weeks, the ACS group showed a more mature periodic pattern and higher lower amplitude boundary in aEEG1 compared to the control group (P<0.05). In preterm infants with a gestational age of 32 to 33+6 weeks and 34 to 34+6 weeks, the ACS group showed a higher proportion of continuous patterns, more mature periodic patterns and higher Burdjalov scores in aEEG1 (P<0.05). And the ACS group exhibited a higher proportion of continuous patterns, more mature periodic patterns, higher lower amplitude boundaries, narrower bandwidths, and higher Burdjalov scores in aEEG2 (P<0.05). CONCLUSIONS ACS-treated preterm infants have more mature aEEG patterns compared to those not treated with ACS, suggesting a beneficial effect of ACS on the brain development of preterm infants.
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MacFarlane PM, Chen Z, Minich N, Mayer CA, Martin RJ, Di Fiore JM, Raffay TM, Hibbs AM. Elevated Urine Hyaluronan Concentrations Are Associated with an Unfavorable Respiratory Outcome in Preterm Neonates at 40 Weeks Postmenstrual Age. Neonatology 2024:1-10. [PMID: 38484718 DOI: 10.1159/000535185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/06/2023] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Hyaluronan (HA) is a major component of the extracellular matrix. Increased pulmonary HA concentrations are associated with several respiratory disorders and is a pathophysiological feature of lung disease. We investigated whether elevated urine HA is a biomarker of an unfavorable 40-week respiratory outcome in preterm infants. METHODS Infants comprised a cohort of preterm neonates <31 weeks gestational age (GA) from the Prematurity-Related Ventilatory Control (Pre-Vent) multicenter study. HA was quantified in urine obtained at 1 week and 1 month of age. Respiratory status at 40 weeks post-menstrual age (PMA) was classified as unfavorable [either (1) deceased at or before 40 weeks PMA, (2) an inpatient on respiratory medication, O2 or other respiratory support at 40 weeks, or (3) discharged prior to 40 weeks on medications/O2/other respiratory support], or favorable (alive and previously discharged, or inpatient and off respiratory medications, off O2, and off other respiratory support at 40 weeks PMA). The association between urine HA and the unfavorable 40 week PMA outcome was examined using a multivariate logistic generalized estimation equation model. RESULTS Infants with higher HA at 1 week (but not 1 month) showed increased odds of unfavorable respiratory outcome at 40 weeks PMA (OR [95% CI] = 1.87 per 0.01 mg [1.27, 2.73]). DISCUSSION AND CONCLUSION Neonatal urine screening for HA could identify infants at risk for death or need for respiratory support at term-corrected age (40 weeks PMA). The relationship between elevated HA at 1 week and an unfavorable 40 week outcome was stronger in infants with lower GA.
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Affiliation(s)
- Peter Mathew MacFarlane
- Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
| | - Zhengyi Chen
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nori Minich
- Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
| | - Catherine Ann Mayer
- Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
| | - Richard John Martin
- Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
| | - Juliann Marie Di Fiore
- Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
| | - Thomas Michael Raffay
- Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
| | - Anna Maria Hibbs
- Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
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Palleri E, Svenningsson A, Markasz L, Engstrand Lilja H. The Incidence of Necrotizing Enterocolitis and Late-Onset Sepsis during the COVID-19 Pandemic in Sweden: A Population-Based Cohort Study. Neonatology 2024:1-6. [PMID: 38442693 DOI: 10.1159/000536570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/29/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION The effect of the pandemic restrictions in the NICUs is not well studied. Necrotizing enterocolitis (NEC) is characterized by intestinal inflammation and bacterial invasion. This study aimed to investigate whether the incidence of NEC has changed during the COVID-19 pandemic in Sweden and whether it was associated with a change in the frequency of extremely preterm births. METHODS Data were retrieved from the Swedish Neonatal Quality Register (SNQ) for infants registered between January 2017 and December 2021 born below a gestational age of 35 weeks. The registry completeness is 98-99%. The diagnosis of NEC was the primary outcome. Generalized linear model analysis was used to calculate the risk ratio for NEC. RESULTS Totally 13,239 infants were included. 235 (1.8%) infants developed NEC, out of which 91 required surgical treatment. 8,967 infants were born before COVID-19 pandemic and 4,272 during. Median gestational age at birth was 32.8 weeks in both periods. The incidence of NEC was significantly lower during COVID-19 pandemic compared to the prior period (1.43 vs. 1.94%, p 0.037), but not the incidence of surgical NEC. The crude risk ratio of developing NEC during COVID-19 pandemic was 0.74 (95% CI: 0.55-0.98). The incidence of late-onset sepsis with positive culture was also declined during COVID-19 (3.21 vs. 4.15%, p value 0.008). CONCLUSION While we found significant reduction in the incidence of NEC and culture-positive late-onset sepsis during the COVID-19 pandemic, the number of extremely preterm births was unchanged.
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Affiliation(s)
- Elena Palleri
- Department of Women's and Children's Health, Karolinska Institutet Stockholm, Stockholm, Sweden
- Department of Neonatology, Karolinska University Hospital Stockholm, Stockholm, Sweden
| | - Anna Svenningsson
- Department of Women's and Children's Health, Karolinska Institutet Stockholm, Stockholm, Sweden
- Department of Pediatric Surgery, Karolinska University Hospital, Solna, Sweden
| | - Laszlo Markasz
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Neonatology, Uppsala University Children's Hospital, Uppsala, Sweden
| | - Helene Engstrand Lilja
- Department of Women's and Children's Health, Karolinska Institutet Stockholm, Stockholm, Sweden
- Department of Pediatric Surgery, Karolinska University Hospital, Solna, Sweden
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Hibbs AM, Chen Z, Minich NM, Martin RJ, Raffay TM, MacFarlane PM, Di Fiore JM. Association between Intermittent Hypoxemia and NICU Length of Stay in Preterm Infants. Neonatology 2024:1-9. [PMID: 38437802 DOI: 10.1159/000535264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/14/2023] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Length of hospitalization varies widely in preterm infants and can be affected by multiple maternal and neonatal factors including respiratory instability. Therefore, we aimed to determine the association between postnatal intermittent hypoxemia (IH) and prolonged hospitalization. METHODS This prospective single-center cohort study followed infants born at <31 weeks of gestational age through 2 years corrected age with detailed oxygen saturation data captured from days 7 to 30 of age. RESULTS 51/164 (31%) of infants were discharged after 400/7 weeks of corrected gestational age (CGA). A greater average daily number of IH events (OR per 10 events/day 1.33 [95% CI 1.03-1.72]), duration of events (OR per minute 1.14 [1.07-1.21]), and percent time with oxygen saturation <80% (OR per percent 1.88 [1.25-2.85]) on days 7-30 of age were all significantly associated with prolonged hospitalization past 400/7 weeks CGA. In survival analyses, infants with a greater average daily number of IH events (HR per 10 events/day 0.89 [0.81-0.98]), percent time with oxygen saturation <80% (HR per percent 0.79 [0.67-0.94]), and duration of events (HR per minute 0.93 [0.91-0.95]) on days 7-30 of age all had significantly lower probability of earlier discharge. In addition, there was a significant interaction with gestational age; the association between IH and prolonged hospitalization was stronger in more mature infants (p = 0.024). CONCLUSIONS Physiological instability on days 7-30 of age, as manifested by IH, is significantly associated with prolonged hospitalization. IH likely represents both a marker of initial severity of illness and the beginning of biological cascades, leading to prematurity-associated morbidities.
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Affiliation(s)
- Anna Maria Hibbs
- Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
| | - Zhengyi Chen
- Department of Population and Quantitative Health Sciences, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nori M Minich
- Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
| | - Richard J Martin
- Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
| | - Thomas M Raffay
- Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
| | - Peter M MacFarlane
- Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
| | - Juliann M Di Fiore
- Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
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Dewi DJ, Rachmawati EZK, Wahyuni LK, Hsu WC, Tamin S, Yunizaf R, Prihartono J, Iskandar RATP. Risk of dysphagia in a population of infants born pre-term: characteristic risk factors in a tertiary NICU. J Pediatr (Rio J) 2024; 100:169-176. [PMID: 37848170 PMCID: PMC10943319 DOI: 10.1016/j.jped.2023.09.004] [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: 06/12/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE To examine the prevalence and characteristics of dysphagia and suck-swallow-breath incoordination as phenotypes of oral feeding difficulties. METHOD A cross-sectional study with secondary data collected consecutively over 2 years from October 2020 to October 2022 to measure the prevalence of swallowing and oral feeding difficulty in preterm infants using Flexible endoscopic evaluation of swallowing examination at the tertiary Integrated Dysphagia Clinic. RESULTS The prevalence of swallowing disorders was 25 % and the prevalence of suck-swallow-breath incoordination was 62.5 %. The significant risk factor that may show a possible correlation with oral feeding difficulty was mature post-menstrual age (p = 0.006) and longer length of stay (p = 0.004). The dominant percentage of upper airway abnormality and disorder were retropalatal collapse (40 %), laryngomalacia (42.5 %), paradoxical vocal cord movement (12.5 %), and gastroesophageal reflux disease (60 %). The dominant characteristic of oral motor examination and flexible endoscopic evaluation of swallowing examination was inadequate non-nutritive sucking (45 %), inadequate postural tone (35 %), and inadequate nutritive sucking (65 %). CONCLUSION Dysphagia in preterm infants is mostly observed in those with mature post-menstrual age, longer length of stay, and the presence of gastroesophageal reflux disease with inadequate non-nutritive sucking and nutritive sucking abilities. Suck-swallow-breath incoordination is primarily observed in those with immature post-menstrual age, a higher prevalence of cardiopulmonary comorbidity, and a higher prevalence of upper airway pathologies (laryngomalacia, paradoxical vocal cord movement) with inadequate nutritive sucking ability.
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Affiliation(s)
- Dwi Juliana Dewi
- Universitas Indonesia, Faculty of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Jakarta, Indonesia.
| | | | - Luh Karunia Wahyuni
- Universitas Indonesia, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Jakarta, Indonesia
| | - Wei-Chung Hsu
- National Taiwan University Hospital, Department of Otolaryngology, Head and Neck Surgery, Taipei, Taiwan
| | - Susyana Tamin
- Universitas Indonesia, Faculty of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Jakarta, Indonesia
| | - Rahmanofa Yunizaf
- Universitas Indonesia, Faculty of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Jakarta, Indonesia
| | - Joedo Prihartono
- Universitas Indonesia, Faculty of Medicine, Department of Community Medicine, Jakarta, Indonesia
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Quétin P, Leboucq N, Boyer C, Crozier F, Delachartre P, Grinand M, Masson P, Claris O. On punctate white matter lesions in preterm infants: Is ultrasound diagnosis feasible? Eur J Paediatr Neurol 2024; 49:120-128. [PMID: 38492551 DOI: 10.1016/j.ejpn.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 01/25/2024] [Accepted: 02/25/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVES To observe hyperechoic nodular or punctate white matter lesions (HNPL) in a population of preterm infants using routine cranial ultrasound (cUS), to describe the characteristics of HNPL, and to compare them with punctate white matter lesions (PWML) detected in magnetic resonance imaging (MRI). DESIGN Retrospective observational single-center cohort study. SETTING Level 2B neonatal unit in France. PATIENTS 307 infants born <33 weeks gestation undergoing routine cUS with a total of 961 cUS performed. MAIN OUTCOME MEASURES Description of lesions (HNPL/PWML): presence or absence, number, size, location, and structural distribution. RESULTS Among the 307 included infants, 63 (20.5%) had at least one cerebral lesion, with 453 HNPL for 63 infants. HNPL were numerous (more than three in 66.6% of cases), primarily grouped in clusters (76.2%), located near the lateral ventricles (96.8%), and measuring more than 2 mm (79%). HNPL were diagnosed on day 29 on average and persisted until term. Overall, 43 MRI were performed in 307 infants, on average 18.9 days after last cUS, in 21 of those the indication was presence of HPNL on cUS. Of these 21 MRI, 14/21 presented 118 PWML compared to 173 HNPL on cUS. In the remaining MRI (7/21), no PWML were detected compared to 47 HNPL on cUS. CONCLUSIONS In our population of 307 preterm infants, cUS allowed the diagnosis of HNPL, with a large similarity to PWML in MRI and a better sensitivity. But in the absence of data on inter-observer variability, we cannot exclude overdiagnosis of HNPL.
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Affiliation(s)
- Philippe Quétin
- Service de Néonatalogie, Centre Hospitalier Henri Duffaut, Avignon, France.
| | - Nicolas Leboucq
- Unité d'Imagerie Pédiatrique, CHU Arnaud de Villeneuve, Montpellier, France
| | - Charlotte Boyer
- Unité d'Imagerie Pédiatrique, CHU Arnaud de Villeneuve, Montpellier, France
| | - Françoise Crozier
- Service de Néonatalogie, Centre Hospitalier Henri Duffaut, Avignon, France
| | - Philippe Delachartre
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS, UMR 5220, U1294, Lyon, France
| | - Marilyne Grinand
- Unité de Recherche Clinique, Centre Hospitalier Henri Duffaut, Avignon, France
| | - Philippe Masson
- Service de Néonatalogie, Centre Hospitalier Henri Duffaut, Avignon, France
| | - Olivier Claris
- Service de Néonatalogie et Réanimation Néonatale de la Croix-rousse, Hôpitaux Civils de Lyon, Lyon, France; Service de Néonatalogie et Réanimation Néonatale, Hôpital Femme-Mère-Enfant, Bron, France; EA 4129, Université Claude Bernard Lyon 1, Villeurbanne, France
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Radicioni M, Pennoni S, Fantauzzi A, Bini V, Camerini P. Ultrasound evaluation of diaphragm kinetics after minimally invasive surfactant administration. J Ultrasound 2024; 27:87-96. [PMID: 37660325 PMCID: PMC10908957 DOI: 10.1007/s40477-023-00820-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/29/2023] [Indexed: 09/05/2023] Open
Abstract
PURPOSE Concerns remain on different alveolar deposition of surfactant between LISA and INSURE methods. Ultrasound evaluation of diaphragm kinetics may provide clinical evidence on this issue, as indirect representation of the respiratory system compliance. METHODS This was a prospective-observational pilot study. The inclusion criterion was CPAP-supported infants ≤ 32 weeks with RDS receiving surfactant via minimally invasive technique. 52 patients randomized for surfactant administration via LISA or INSURE methods were enrolled. Right diaphragm (RD) global mean peak velocity (MPV) by Pulsed-Wave Tissue Doppler Imaging (PTDI) was recorded before and two hours after surfactant administration with simultaneous measurements of oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) (SF ratio). Mechanical ventilation ≤ 72 h from birth represented treatment failure. RESULTS LISA infants had significantly higher gestational age (p = 0.029) and birth weight (p = 0.030) with lower CRIB-II scores (p = 0.030) than INSURE infants. LISA infants showed higher median MPV at baseline RD-PTDI US assessment (p = 0.024), but post-surfactant median MPV and other the investigated variables were similar at the adjusted analysis for gestational age and sedation. 8/52 (15%) infants who failed treatment had a significantly lower SF ratio (p = 0.002) and higher median MPV at RD-PTDI US (p = 0.004) after surfactant administration, despite the higher CPAP support level before (p = 0.007) and after (p = 0.001) surfactant administration. A full course of antenatal steroids was protective against mechanical ventilation (p = 0.038). CONCLUSIONS Different minimally invasive surfactant administration techniques do not appear to influence diaphragm kinetics evaluated by RD-PTDI US.
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Affiliation(s)
- Maurizio Radicioni
- Neonatal Intensive Care Unit and Neonatal Pathology, S. Maria Della Misericordia Hospital, Piazzale Giorgio Menghini 1, 06129, Perugia, Italy.
| | | | - Ambra Fantauzzi
- Neonatal Intensive Care Unit and Neonatal Pathology, S. Maria Della Misericordia Hospital, Piazzale Giorgio Menghini 1, 06129, Perugia, Italy
| | - Vittorio Bini
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Piergiorgio Camerini
- Neonatal Intensive Care Unit and Neonatal Pathology, S. Maria Della Misericordia Hospital, Piazzale Giorgio Menghini 1, 06129, Perugia, Italy
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Zhao C, Sun Z, Chen H, Li K, Sun H. The impact of blood lactic acid levels on retinopathy of prematurity morbidity. BMC Pediatr 2024; 24:152. [PMID: 38424517 PMCID: PMC10902957 DOI: 10.1186/s12887-024-04571-y] [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: 12/02/2023] [Accepted: 01/17/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is a common disease in premature infants. In recent years, most researchers have used lactic acid as poor prognosis marker in premature infants. This study aims to explore investigate the impact of blood lactic acid levels on ROP. METHODS A retrospective case-control study was conducted, and infants with severe ROP born with birth weight (BW) ≤ 1500 g and gestational age (GA) ≤ 32 weeks were enrolled from November 2016 to November 2021. Infants without any stage ROP were included as controls and were matched with ROP infants (1:2) by GA and BW. All selected preterm infants were tested for heel terminal trace blood gas analysis within two weeks of life. Changes in blood lactic acid levels in the two groups were compared and analyzed by using multivariate logistic regression analysis. Sensitivity and specificity were analyzed by receiver operating characteristic (ROC) curve. RESULTS There were 79 infants in ROP group, and 158 infants in control group. The levels of blood lactic acid were significantly higher in the ROP group on days 1, 3, 5, and 7 compared with control group (all p < 0.05). The blood lactic acid levels on day 5 was an independent risk factor for ROP (p = 0.017). The area under the curve (AUC), sensitivity and specificity were highest on day 5 (AUC 0.716, sensitivity 77.2% and specificity 62.0%, respectively, p < 0.001), and higher on days 1, 3, and 7. CONCLUSION A high blood lactic acid level in the first seven days of life may be associated with increases ROP occurrence in very preterm infants, and suggest blood lactic acid level may impact the occurrence of ROP.
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Affiliation(s)
- Congcong Zhao
- Department of Pediatrics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhihong Sun
- Department of Neonatology, Children's Hospital affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, 33 Longhuwaihuan Road, Zhengzhou, 450018, China
| | - Hongming Chen
- Department of Neonatology, Zhecheng People's Hospital, Henan, China
| | - Kaili Li
- Department of Neonatology, Zhecheng People's Hospital, Henan, China
| | - Huiqing Sun
- Department of Neonatology, Children's Hospital affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, 33 Longhuwaihuan Road, Zhengzhou, 450018, China.
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蔡 娜, 沈 蕾, 陈 盛. [Predictive value of hemoglobin decrease for necrotizing enterocolitis in preterm infants with late-onset sepsis]. Zhongguo Dang Dai Er Ke Za Zhi 2024; 26:145-150. [PMID: 38436311 PMCID: PMC10921880 DOI: 10.7499/j.issn.1008-8830.2307011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/12/2023] [Indexed: 03/05/2024]
Abstract
OBJECTIVES To study the predictive value of hemoglobin (Hb) decrease for the occurrence of necrotizing enterocolitis (NEC) in preterm infants with late-onset sepsis (LOS) . METHODS Clinical data of 93 LOS preterm infants were collected for retrospective analysis, among which 16 infants developed NEC while 77 infants did not. Based on the decrease in Hb levels from the most recent Hb measurement before LOS occurrence to the initial Hb levels during LOS, the infants were divided into three groups: no Hb decrease (n=15), mild Hb decrease (Hb decrease <15 g/L; n=35), and severe Hb decrease (Hb decrease ≥15 g/L; n=43). Multivariate logistic regression analysis was conducted to explore the predictive factors for NEC secondary to LOS, and the value of Hb decrease in predicting NEC secondary to LOS was evaluated through receiver operating characteristic curve analysis. RESULTS The incidence of NEC in the severe Hb decrease group, mild Hb decrease group, and no Hb decrease group were 26%, 14%, and 0% (P<0.05), respectively. Multivariate logistic regression analysis revealed that a larger Hb decrease was an independent predictive factor for NEC in LOS preterm infants (OR=1.141, 95%CI: 1.061-1.277, P<0.001). Receiver operating characteristic curve analysis showed that the area under the curve for predicting NEC in preterm infants with LOS using Hb decrease (with a cut-off value of 20 g/L) was 0.803, with sensitivity and specificity of 0.69 and 0.78, respectively. CONCLUSIONS Hb decrease can serve as an indicator for prediction of NEC in preterm infants with LOS.
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Yarahmadi S, Pouralizadeh M, Atrkarroushan Z, Shahroudi P. The effect of the simulated intrauterine sound on behavioral and physiological indices of pain during capillary blood sampling for screening preterm infants: a randomized clinical trial study. BMC Pediatr 2024; 24:110. [PMID: 38350923 PMCID: PMC10863201 DOI: 10.1186/s12887-024-04604-6] [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: 01/30/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Due to medical procedures, preterm infants are at high risk for side effects of pain. In this regard, heel lancing for capillary blood sampling is a common painful procedure. The present study was conducted to assess the effectiveness of a simulated intrauterine sound on behavioral and physiological indices of pain due to heel-prick blood sampling in preterm infants. METHODS A double‑blind randomized clinical trial (RCT) was conducted. The data were collected from September 23 to December 22, 2019. We measured the effect of a simulated intrauterine sound on changes in the behavioral and physiological parameters of pain (heart rate, SPO2) caused by heel lance that was measured 5 min before the intervention, during the sampling, and 5 min after the procedure. We measured behavioral pain by video recording the infants' faces and then the scoring neonatal infant pain scale (NIPS). Heart rate and SPO2 were measured using a pulse oximeter device. The data were analyzed using analysis of variance (ANOVA) and independent t‑test in SPSS software version 20.0. RESULTS Eighty infants were randomized (40 in each group). Mean scores NIPS during and after intervention were in the intervention group (3.55 ± 0.84, 95% CI: 3.30-3.80(, and (1.15 ± 0.84, 95%: 0.95-1.35) and in the control group (5.57 ± 0.95, 95% CI:5.30-5.85) and (3.00 ± 0.98) respectively. There were significant differences in scores of NIPS between the two study groups during (p < 0.001) and five min after heel lancing (p < 0.001). Mean scores of heart rate in the three phases of before, during, and five min after the intervention were respectively in the intervention group (127.57 ± 4.45, 95% CI:126.27-128.99), (131.07 ± 6.54, 95% CI:129.20-133.22), (128.45 ± 5.15, 95% CI:127.02-130.07) and in the control group (128.67 ± 4.57, 95% CI:127.32-130.07), (136.07 ± 7.24, 95% CI:133.90-138.37), and (132.42 ± 6.47, 95% CI:130.37-134.49). There were significant differences in heart rate between the intervention and the control group during (p = 0.002) and five min after the heel lance (p = 0.003). Mean scores of SPO2 in the three phases of baseline, during, and five min after the intervention were respectively in the intervention group (96.72 ± 0.93, 95% CI:96.42-97.00), (91.47 ± 1.46, 95% CI:91.05-91.92), (94.17 ± 1.03, 95% CI:93.22-94.00) and in the control group (96.6 ± 0.84, 95% CI:96.35-96.85), (91.5 ± 1.24, 95% CI:91.12-91.87), and (93.60 ± 1.27, 95% CI:93.85-94.50). CONCLUSION This study showed that the simulated intrauterine sound reduces the behavioral pain and heart rate in the intervention group during and after heel lance. These results suggest using the method during the painful heel lancing to reduce pain parameters in preterm infants.
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Affiliation(s)
- Shamimeh Yarahmadi
- Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Moluk Pouralizadeh
- Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran.
- Beheshti School of Nursing and Midwifery, Guilan university of Medical Sciences, Hamidyan Ave, Rasht, Iran.
| | - Zahra Atrkarroushan
- Department of Biostatistics, Medical School, Guilan University of Medical Sciences, Rasht, Iran
| | - Parichehr Shahroudi
- Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
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Van Mechelen K, Hundscheid TM, van Westering-Kroon E, Bartoš F, Villamor E. Association between Antenatal Antibiotic Exposure and Bronchopulmonary Dysplasia: A Systematic Review and Bayesian Model-Averaged Meta-Analysis. Neonatology 2024:1-10. [PMID: 38310865 DOI: 10.1159/000536220] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/08/2024] [Indexed: 02/06/2024]
Abstract
INTRODUCTION Antenatal antibiotic exposure has been suggested as a risk factor for bronchopulmonary dysplasia (BPD). We aimed to summarize the evidence from randomized controlled trials (RCTs) and observational studies on this potential association. METHODS PubMed/Medline and Embase databases were searched. BPD was classified as BPD28 (supplemental oxygen during 28 days or at postnatal day 28), BPD36 (supplemental oxygen at 36 weeks postmenstrual age), BPD36 or death, and BPD-associated pulmonary hypertension (BPD-PH). Bayesian model-averaged (BMA) meta-analysis was used to calculate Bayes factors (BFs). The BF10 is the ratio of the probability of the data under the alternative hypothesis (H1) over the probability of the data under the null hypothesis (H0). RESULTS We included 6 RCTs and 27 observational studies (126,614 infants). Regarding BPD28, BMA showed that the evidence in favor of H0 (lack of association with antenatal antibiotics) was weak for the RCTS (BF10 = 0.506, 6 studies) and moderate for the observational studies (BF10 = 0.286, 10 studies). Regarding BPD36, the evidence in favor of H0 was moderate for the RCTs (BF10 = 0.127, 2 studies) and weak for the observational studies (BF10 = 0.895, 14 studies). Evidence in favor of H0 was also weak for the associations with BPD36 or death (BF10 = 0.429, 2 studies) and BPD-PH (BF10 = 0.384, 2 studies). None of the meta-analyses showed evidence in favor of H1. CONCLUSIONS The currently available evidence suggests a lack of association between antenatal antibiotics and BPD. However, our results should not be interpreted as an argument for widespread use of antibiotics in the setting of preterm delivery.
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Affiliation(s)
- Karen Van Mechelen
- Department of Neonatology, School for Oncology and Reproduction (GROW), Maastricht University, MosaKids Children's Hospital, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands,
| | - Tamara M Hundscheid
- Department of Neonatology, School for Oncology and Reproduction (GROW), Maastricht University, MosaKids Children's Hospital, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Elke van Westering-Kroon
- Department of Neonatology, School for Oncology and Reproduction (GROW), Maastricht University, MosaKids Children's Hospital, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - František Bartoš
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Eduardo Villamor
- Department of Neonatology, School for Oncology and Reproduction (GROW), Maastricht University, MosaKids Children's Hospital, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
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Hübl N, Riebold B, Schramm D, Seidl RO. Differences in the swallowing process of newborns and healthy preterm infants: first results with a non-invasive bioimpedance and electromyography measurement system. Eur Arch Otorhinolaryngol 2024; 281:843-854. [PMID: 37996534 PMCID: PMC10796423 DOI: 10.1007/s00405-023-08344-8] [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: 09/26/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE Preterm infants (PI) have difficulty coordinating sucking, swallowing and breathing, and there is a risk of aspiration. The causes of this are not yet sufficiently understood. The aim of this study was to test a novel measurement device to measure breathing and pharyngeal processes involved in swallowing externally in everyday life to identify possible differences in neonates (NB) and PI. METHODS Forty healthy NB were studied at 4-8 weeks of age (mean: 6.7 weeks) and 20 healthy PI (mean gestational age 30.5 weeks) at postmenstrual age (PMA) 34/35 weeks (mean PMA 35.1 weeks) during a single feeding. Surface electrodes were used to measure bioimpedance and electromyography reflecting swallow-related changes in the pharynx and muscle activation of the tongue and submental muscles. A respiratory belt was combined with recording of the depth of chest movements and the occurrence of pauses in breathing. RESULTS Velocity and extent of pharyngeal closure did not differ significantly across the feeding period (velocity: p=0.09, closure: p=0.17), but during the first two suck-swallow bursts PI had greater velocity (p<0.001*) and extent of pharyngeal closure (p=0.004*) than NB. The duration of swallowing phases was significantly longer in PIs (p<0.001*), their muscle activation decreased faster (p<0.001*), and they had more pauses in breathing than NBs. CONCLUSIONS The novel measurement device allowed, for the first time in everyday life, the measurement of factors influencing swallowing and breath-swallow coordination in NBs and PIs. PIs showed differences from NBs most likely due to differences in muscle strength and condition.
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Affiliation(s)
- Nicole Hübl
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Germany, Moorenstrasse 5, 40225, Düsseldorf, Germany.
| | - Benjamin Riebold
- TU Berlin, Control Systems Group, Einsteinufer 17, 10587, Berlin, Germany
| | - Dirk Schramm
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Germany, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Rainer O Seidl
- Ear-Nose and Throat, Unfallkrankenhaus Berlin, UKB, Warener Str.7, 12683, Berlin, Germany
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Kim YJ, Shin SH, Kim EK, Kim HS. Short term effect of intravenous treprostinil in term and preterm infants with pulmonary hypertension. BMC Pediatr 2024; 24:83. [PMID: 38281939 PMCID: PMC10823739 DOI: 10.1186/s12887-023-04501-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/20/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) is a life-threatening condition in newborns. We aimed to assess the clinical and echocardiographic responses of term and preterm infants to treprostinil. METHODS This retrospective study included newborns diagnosed with PH and treated with treprostinil as additional therapy after inhaled nitric oxide administration in the neonatal intensive care unit of a tertiary center. Term and preterm infants were compared in terms of echocardiographic findings and clinical findings 4 weeks after treprostinil treatment. RESULTS During the study period, 11 term and 18 preterm infants were diagnosed with PH and received treprostinil. There were no differences in the echocardiographic findings of interventricular septal deviation, direction of shunt, and ratio of estimated pulmonary artery pressure over systolic blood pressure. Congenital diaphragmatic hernia was the most common condition occurring upon PH diagnosis among term infants, while severe bronchopulmonary dysplasia was the most common in preterm infants. Improvements in echocardiographic findings were more pronounced in term infants than in preterm infants (100% vs. 55.6%, P = 0.012). The inhaled nitric oxide dose was gradually tapered for term infants and was lower than that for preterm infants at 1, 2, and 3 weeks after treprostinil. CONCLUSION Intravenous treprostinil could be an adjuvant therapy option for term and preterm infants with PH, especially for those who cannot receive oral medication. The efficacy and safety of treprostinil in this population with PH should be investigated further.
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Affiliation(s)
- Yoo-Jin Kim
- Department of Pediatrics, Chung-buk National University Hospital, Cheongju-si, Republic of Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
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李 佳, 谢 群, 文 羽, 宋 燕, 梁 会, 胡 艳. [Longitudinal study on catch-up growth in preterm infants with small for gestational age at corrected ages 0-24 months]. Zhongguo Dang Dai Er Ke Za Zhi 2024; 26:72-80. [PMID: 38269463 PMCID: PMC10817744 DOI: 10.7499/j.issn.1008-8830.2307059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/21/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVES To understand the growth and development status and differences between small for gestational age (SGA) and appropriate for gestational age (AGA) preterm infants during corrected ages 0-24 months, and to provide a basis for early health interventions for preterm infants. METHODS A retrospective study was conducted, selecting 824 preterm infants who received regular health care at the Guangzhou Women and Children's Medical Center from July 2019 to July 2022, including 144 SGA and 680 AGA infants. The growth data of SGA and AGA groups at birth and corrected ages 0-24 months were analyzed and compared. RESULTS The SGA group had significantly lower weight and length than the AGA group at corrected ages 0-18 months (P<0.05), while there were no significant differences between the two groups at corrected age 24 months (P>0.05). At corrected age 24 months, 85% (34/40) of SGA and 79% (74/94) of AGA preterm infants achieved catch-up growth. Stratified analysis by gestational age showed that there were significant differences in weight and length at corrected ages 0-9 months between the SGA subgroup with gestational age <34 weeks and the AGA subgroups with gestational age <34 weeks and 34 weeks (P<0.05). In addition, the weight and length of the SGA subgroup with gestational age 34 weeks showed significant differences compared to the AGA subgroups with gestational age <34 weeks and 34 weeks at corrected ages 0-18 months and corrected ages 0-12 months, respectively (P<0.05). Catch-up growth for SGA infants with gestational age <34 weeks and 34 weeks mainly occurred at corrected ages 0-12 months and corrected ages 0-18 months, respectively. CONCLUSIONS SGA infants exhibit delayed early-life physical growth compared to AGA infants, but can achieve a higher proportion of catch-up growth by corrected age 24 months than AGA infants. Catch-up growth can be achieved earlier in SGA infants with a gestational age of <34 weeks compared to those with 34 weeks.
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Liu J. [Management of lung diseases under ultrasound monitoring: potential to make bronchopulmonary dysplasia in preterm infants as an avoidable disease]. Zhongguo Dang Dai Er Ke Za Zhi 2024; 26:14-18. [PMID: 38269453 PMCID: PMC10817729 DOI: 10.7499/j.issn.1008-8830.2309120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 11/14/2023] [Indexed: 01/26/2024]
Abstract
Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease in preterm infants. Despite significant progress in the understanding of its etiology, mechanisms, prevention, and treatment, the prognosis remains poor. BPD not only has a high mortality rate but also causes persistent respiratory, neurological, and cardiovascular impairments in survivors. The author's team has successfully prevented the occurrence of BPD by managing neonatal lung diseases under lung ultrasound monitoring for nearly 7 years, opening up a new approach in BPD prevention. This article provides a brief overview of the approach, aiming to facilitate further research and provide more scientifically sound management strategies to prevent or minimize the occurrence of BPD.
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Affiliation(s)
- Jing Liu
- Department of Neonatology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China (liujingbj@sina. com)
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Shiva S, Rezazadeh K, Amiraslanzadeh A, Mehramuz B, Yeganehdoost S, Mahallei M. Continuous versus intermittent bolus infusion of calcium in preterm infants receiving total parenteral nutrition: a randomized blind clinical trial. BMC Pediatr 2024; 24:35. [PMID: 38216920 PMCID: PMC10785396 DOI: 10.1186/s12887-023-04516-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/28/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Premature neonates need adequate nutritional support to provide sufficient essential nutrients for optimal growth. Calcium (Ca) is one of the important nutrients in parental nutrition support of premature infants. This study aimed to compare the effect of continuous and intermittent bolus infusion of Ca on the incidence of metabolic bone disease (MBD) in preterm infants. METHODS This randomized double-blind clinical trial was conducted on ninety preterm infants in the NICU of Al-Zahra Hospital in Tabriz, Iran. The preterm infants were randomly allocated to either a continuous infusion group (received 4-5 ml/kg/day of Ca gluconate 10% by PN solution in a 24-h period) or an intermittent bolus administration group (received 1-2 ml/kg/day Ca gluconate 10% three to four times per day). Serial serum levels of Ca, phosphorous, alkaline phosphatase (ALP), vitamin D and parathyroid hormone (PTH) were assessed on the 7th day, 30th day and 45th day of life. RESULTS A total of 78 infants completed the study. The serum ALP level on the 45th day after birth was 753.28 ± 304.59 IU/L and 988.2 ± 341.3 IU/L in the continuous infusion and intermittent bolus administration groups, respectively (P < 0.05). MBD in preterm infants with ALP levels above 900 IU/L on the 45th day of life was significantly lower in the continuous infusion group than in the intermittent bolus administration group (p < 0.05). The mean serum levels of calcium, phosphorus, vitamin D and PTH in 45-day-old infants were not significantly different between the two groups. CONCLUSION The MBD in preterm infants who received continuous infusion of Ca was lower than that in preterm infants who received intermittent bolus administration of Ca. TRIAL REGISTRATION The Iranian Registry of Clinical Trials ( http://www.irct.ir ) with the identification No. IRCT20210913052466N1.
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Affiliation(s)
- Siamak Shiva
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Khatereh Rezazadeh
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Asmar Amiraslanzadeh
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Bahareh Mehramuz
- Department of Pathology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sadollah Yeganehdoost
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Majid Mahallei
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Woodford S, Parmar T, Leong E, Zhong J, Oei JL, Suzuki K, Kumar K, Yeo KT, Ma L, De Luca D, Hummler H, Schmölzer G, Vento M, Schindler T. International Online Survey on the Management of Patent Ductus Arteriosus. Neonatology 2024:1-7. [PMID: 38211569 DOI: 10.1159/000535121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/31/2023] [Indexed: 01/13/2024]
Abstract
INTRODUCTION There is uncertainty and lack of consensus regarding optimal management of patent ductus arteriosus (PDA). We aimed to determine current clinical practice in PDA management across a range of different regions internationally. MATERIALS AND METHODS We surveyed PDA management practices in neonatal intensive care units using a pre-piloted web-based survey, which was distributed to perinatal societies in 31 countries. The survey was available online from March 2018 to March 2019. RESULTS There were 812 responses. The majority of clinicians (54%) did not have institutional protocols for PDA treatment, and 42% reported variable management within their own unit. Among infants <28 weeks (or <1,000 g), most clinicians (60%) treat symptomatically. Respondents in Australasia were more likely to treat PDA pre-symptomatically (44% vs. 18% all countries [OR 4.1; 95% CI 2.6-6.5; p < 0.001]), and respondents from North America were more likely to treat symptomatic PDA (67% vs. 60% all countries [OR 2.0; 95% CI 1.5-2.6; p < 0.001]). In infants ≥28 weeks (or ≥1,000 g), most clinicians (54%) treat symptomatically. Respondents in North America were more likely to treat PDAs in this group of infants conservatively (47% vs. 38% all countries [OR 2.3; 95% CI 1.7-3.2; p < 0.001]), and respondents from Asia were more likely to treat the PDA pre-symptomatically (21% vs. 7% all countries [OR 5.5; 95% CI 3.2-9.8; p < 0.001]). DISCUSSION/CONCLUSION There were marked international differences in clinical practice, highlighting ongoing uncertainty and a lack of consensus regarding PDA management. An international conglomeration to coordinate research that prioritises and addresses these areas of contention is indicated.
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Affiliation(s)
- Sarah Woodford
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Trisha Parmar
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Emily Leong
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Jiayue Zhong
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Ju Lee Oei
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Keiji Suzuki
- Department of Pediatrics, Nagoya City University West Medical Center, Nagoya, Japan
| | - Kishore Kumar
- Department of Neonatology and Pediatrics, Cloudnine Hospitals, Bangalore, India
| | - Kee Thai Yeo
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Li Ma
- Hebei Provincial Children's Hospital, Shijiazhuang, China
| | - Daniele De Luca
- Division of Paediatrics and Neonatal Critical Care, South "A. Beclere" Medical Center, South Paris University Hospitals, Paris, France
| | - Helmut Hummler
- Section Neonatology, Pediatric Intensive Care, Ulm University Children's Hospital, Ulm, Germany
| | - Georg Schmölzer
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Maximo Vento
- Spanish Neonatal Network, Health Research Institute La Fe, Valencia, Spain
| | - Timothy Schindler
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia
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Jiang X, Jiang H, Shan SS, Huang R. Breastfeeding experience of postnatal mothers separated from preterm infants after discharge: a phenomenology qualitative approach. BMC Pregnancy Childbirth 2024; 24:28. [PMID: 38178032 PMCID: PMC10765664 DOI: 10.1186/s12884-023-06230-z] [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: 03/02/2023] [Accepted: 12/27/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Breastfeeding practices are influenced by the maternal-infant bond relationship. Mothers of preterm infants in the puerperium face many challenges and support is needed to maintain breastfeeding after hospital discharge. This study explored the breastfeeding experiences among mothers of preterm infants and challenges that influenced their breastfeeding practices. METHODS A qualitative phenomenological approach was used involving the mothers of preterm infants during the puerperium in Shanghai who fulfilled the inclusion criteria and consented to participate in the study. The mothers were recruited using purposive sampling. Eighteen participants were interviewed using semi-structured in-depth interviews. All interviews were recorded in digital audio, transcribed verbatim, and analyzed using thematic analysis. FINDINGS The breastfeeding experience among mothers of preterm infants included four themes: breastfeeding motivation, breastfeeding challenges, breastfeeding support and education, and response to parental stress. Breastfeeding challenges included perceived insufficient milk, bottle preference, and maternal-infant separation. Two sub-themes of breastfeeding support included breastfeeding knowledge and approach. CONCLUSION To overcome breastfeeding challenges and improve the breastfeeding rate of preterm infants after discharge, medical professionals must develop individualized breastfeeding plans based on a comprehensive assessment of the needs of mothers who delivered a preterm infant.
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Affiliation(s)
- Xin Jiang
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Hui Jiang
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
| | - Shan Shan Shan
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Rong Huang
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
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Weng Y, Zhang J, Chen Z. Effect of non-pharmacological interventions on pain in preterm infants in the neonatal intensive care unit: a network meta-analysis of randomized controlled trials. BMC Pediatr 2024; 24:9. [PMID: 38172771 PMCID: PMC10765718 DOI: 10.1186/s12887-023-04488-y] [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: 06/03/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE To evaluate the effectiveness of different non-pharmacological interventions for pain management in preterm infants and provide high-quality clinical evidence. METHODS Randomized controlled trials (RCTs) of various non-pharmacological interventions for pain management in preterm infants were searched from PubMed, Web of Science, Embase, and the Cochrane Library from 2000 to the present (updated March 2023). The primary outcome was pain score reported as standardized mean difference (SMD). The secondary outcomes were oxygen saturation and heart rate reported as the same form. RESULTS Thirty five RCTs of 2134 preterm infants were included in the meta-analysis, involving 6 interventions: olfactory stimulation, combined oral sucrose and non-nutritive sucking (OS + NNS), facilitated tucking, auditory intervention, tactile relief, and mixed intervention. Based on moderate-quality evidence, OS + NNS (OR: 3.92, 95% CI: 1.72, 6.15, SUCRA score: 0.73), facilitated tucking (OR: 2.51, 95% CI: 1.15, 3.90, SUCRA score: 0.29), auditory intervention (OR: 2.48, 95% CI: 0.91, 4.10, SUCRA score: 0.27), olfactory stimulation (OR: 1.80, 95% CI: 0.51, 3.14, SUCRA score: 0.25), and mixed intervention (OR: 2.26, 95% CI: 0.10, 4.38, SUCRA score: 0.14) were all superior to the control group for pain relief. For oxygen saturation, facilitated tucking (OR: 1.94, 95% CI: 0.66, 3.35, SUCRA score: 0.64) and auditory intervention (OR: 1.04, 95% CI: 0.22, 2.04, SUCRA score: 0.36) were superior to the control. For heart rate, none of the comparisons between the various interventions were statistically significant. CONCLUSION This study showed that there are notable variations in the effectiveness of different non-pharmacological interventions in terms of pain scores and oxygen saturation. However, there was no evidence of any improvement in heart rate.
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Affiliation(s)
- Yuwei Weng
- Medical School of Nantong University, Nantong, 226001, China
| | - Jie Zhang
- Medical School of Nantong University, Nantong, 226001, China
| | - Zhifang Chen
- Obstetrical Department, Affiliated Maternity and Child Health Care Hospital of Nantong University, Nantong, 226001, China.
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Jubaer H, Thomas M, Farkas D, Kolanjiyil AV, Momin MA, Hindle M, Longest W. Development of an effective two-equation turbulence modeling approach for simulating aerosol deposition across a range of turbulence levels. J Aerosol Sci 2024; 175:106262. [PMID: 38164243 PMCID: PMC10698304 DOI: 10.1016/j.jaerosci.2023.106262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 01/03/2024]
Abstract
Pharmaceutical aerosol systems present a significant challenge to computational fluid dynamics (CFD) modeling based on the need to capture multiple levels of turbulence, frequent transition between laminar and turbulent flows, anisotropic turbulent particle dispersion, and near-wall particle transport phenomena often within geometrically complex systems over multiple time scales. Two-equation turbulence models, such as the k - ω family of approximations, offer a computationally efficient solution approach, but are known to require the use of near-wall (NW) corrections and eddy interaction model (EIM) modifications for accurate predictions of aerosol deposition. The objective of this study was to develop an efficient and effective two-equation turbulence modeling approach that enables accurate predictions of pharmaceutical aerosol deposition across a range of turbulence levels. Key systems considered were the traditional aerosol deposition benchmark cases of a 90-degree bend (R e = 6,000 ) and a vertical straight section of pipe (R e = 10,000 ), as well as a highly complex case of direct-to-infant (D2I) nose-to-lung pharmaceutical aerosol delivery from an air-jet dry powder inhaler (DPI) including a patient interface and infant nasal geometry through mid-trachea (500 < R e < 7,000 ). Of the k - ω family of models, the low Reynolds number (LRN) shear stress transport (SST) approach was determined to provide the best agreement with experimental aerosol deposition data in the D2I system, based on an improved simulation of turbulent jet flow that frequently occurs in DPIs. Considering NW corrections, a new correlation was developed to quantitatively predict best regional values of the y + l i m i t , within which anisotropic NW turbulence is approximated. Considering EIM modifications, a previously described drift correction approach was implemented in pharmaceutical aerosol simulations for the first time. Considering all model corrections and modifications applied to the D2I system, regional relative errors in deposition fractions between CFD predictions and new experimental data were improved from 19-207% (no modifications) to 2-15% (all modifications) with a notable decrease in computational time (up to ∼15%). In conclusion, the highly efficient two-equation k - ω models with physically realistic corrections and modifications provided a viable, efficient and accurate approach to simulate the transport and deposition of pharmaceutical aerosols in complex airway systems that include laminar, turbulent and transitional flows.
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Affiliation(s)
- Hasan Jubaer
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, 401 West Main Street, P.O. Box 843015, Richmond, VA, 23284-3015, USA
| | - Morgan Thomas
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, 401 West Main Street, P.O. Box 843015, Richmond, VA, 23284-3015, USA
| | - Dale Farkas
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, 401 West Main Street, P.O. Box 843015, Richmond, VA, 23284-3015, USA
| | - Arun V. Kolanjiyil
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, 401 West Main Street, P.O. Box 843015, Richmond, VA, 23284-3015, USA
| | - Mohammad A.M. Momin
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA, USA
| | - Michael Hindle
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA, USA
| | - Worth Longest
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, 401 West Main Street, P.O. Box 843015, Richmond, VA, 23284-3015, USA
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA, USA
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Heesters V, Dekker J, Panneflek TJ, Kuypers KL, Hooper SB, Visser R, Te Pas AB. The vocal cords are predominantly closed in preterm infants <30 weeks gestation during transition after birth; an observational study. Resuscitation 2024; 194:110053. [PMID: 37979668 DOI: 10.1016/j.resuscitation.2023.110053] [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: 10/11/2023] [Revised: 11/06/2023] [Accepted: 11/12/2023] [Indexed: 11/20/2023]
Abstract
AIM Studies in animals have shown that vocal cords (VCs) close during apnoea before and after birth, thereby impairing the effect of non-invasive ventilation. We tested the feasibility of visualising VCs using ultrasonography (US) and investigated the position and movement of the VCs during non-invasive respiratory support of preterm infants at birth. METHODS In an observational study, VCs were visualised using US in infants <30 weeks gestation during both stabilisation after birth and at one hour after birth. Respiratory efforts were simultaneously recorded. The percentage of time the VCs were closed in the first ten minutes was determined from videoframes acquired at 15 Hz and compared with respiratory flow patterns measured using a respiratory function monitor. RESULTS US of the VCs could be performed in 20/20 infants included (median (IQR) gestational age 27+6 (27+1-28+6) weeks) without interfering with stabilisation, of whom 60% (12/20) were initially breathing and 40% (8/20) were apnoeic at birth. In breathing infants, the VCs closed between breaths and during breath holds, which accounted for 57% (49-66) of the time. In apnoeic infants receiving positive pressure ventilation, the VCs were closed for 93% (81-99) of the time. US at one hour after birth could be performed in 14/20 infants, VCs were closed between breaths and during breath holds, accounting for 46% (27-52) of the time. CONCLUSION Visualising VCs in preterm infants at birth using US is feasible. The VCs were closed during apnoea, in between breaths and during breath holds, impairing the effect of ventilation given.
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Affiliation(s)
- Veerle Heesters
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, the Netherlands.
| | - Janneke Dekker
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, the Netherlands
| | - Timothy Jr Panneflek
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, the Netherlands
| | - Kristel Lam Kuypers
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, the Netherlands
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia; Department of Obstetrics and Gynecology, Monash University, Melbourne, VIC, Australia
| | - Remco Visser
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, the Netherlands
| | - Arjan B Te Pas
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, the Netherlands
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Bruno MA, Galletti MF, Brener Dik PH, Mariani GL, Gonzalez Á, Nieto R. Prevalence and risk factors associated with the need for surgical intervention due to necrotizing enterocolitis in very low birth weight infants. Early Hum Dev 2024; 188:105917. [PMID: 38096735 DOI: 10.1016/j.earlhumdev.2023.105917] [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: 10/21/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION Necrotizing enterocolitis (NEC) is one of the most common gastrointestinal emergencies affecting very low birth weight (VLBW) infants with an incidence of 6-15 %. Early recognition is crucial. Mortality is high and variable (30-50 %). Those requiring surgical intervention have a higher mortality rate than those who receive medical treatment. OBJECTIVES 1) To assess the prevalence of surgical NEC and associated risk factors 2) To compare outcomes based on the type of treatment required 3) To estimate the mortality associated with NEC and surgical NEC. METHODS A multicentre retrospective cohort study was designed (level II), including VLBW infants born between 2011 and 2020 in Centers of the Neocosur Network. A multivariate logistic regression analysis was performed to evaluate risk factors associated with the need for surgery. RESULTS NEC was diagnosed in 1679 (10.4 %) of 16,131 births in this period. The prevalence of surgery was 25 % (95 % CI 23-27 %). In multivariable analysis, variables associated with an increased risk of surgery requirement were birth weight <750 g (aOR 1.73-95%CI 1.2-2.5) and receiving antenatal antibiotics (aOR 1.54-95%CI 1.09-2.74). Those requiring surgery had significantly higher morbidity and mortality than the ones receiving medical treatment. CONCLUSION In VLBW infants with NEC, lower birth weight and antenatal antibiotics administration were independently associated with the need for surgical intervention.
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Affiliation(s)
- Maria Ailen Bruno
- Neonatology, Hospital Italiano de Buenos Aires, Perón 4190, Buenos Aires, Argentina.
| | - Maria Fernanda Galletti
- Magister in Clinical Research, Neonatology Division, Department of Pediatrics, Hospital Italiano de Buenos Aires, Argentina
| | - Pablo H Brener Dik
- Magister in Clinical Research, Neonatology Division, Department of Pediatrics, Hospital Italiano de Buenos Aires, Argentina
| | - Gonzalo L Mariani
- Magister in Bioethics, Neonatology Division, Department of Pediatrics, Hospital Italiano de Buenos Aires, Argentina
| | - Álvaro Gonzalez
- Neonatology Division, Department of Pediatrics, Pontificia Universidad Católica, Santiago de Chile, Chile
| | - Ricardo Nieto
- Neonatology Division, Maternidad Ramón Sardá, Buenos Aires, Argentina
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Huang L, Zhao BY, Li XT, Huang SX, Chen TT, Cheng X, Li SJ, Li H, Hu RF. Effects of an online family-focused parenting support intervention on preterm infants' physical development and parents' sense of competence and care ability: A randomized controlled trial. Int J Nurs Stud 2024; 149:104625. [PMID: 37952471 DOI: 10.1016/j.ijnurstu.2023.104625] [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: 06/10/2023] [Revised: 10/12/2023] [Accepted: 10/17/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Parenting of preterm infants presents unique challenges, particularly during their transition from hospital to home. Early discharge programs can assist parents during this critical period. However, the feasibility of delivering a family-focused online discharge program remains understudied. OBJECTIVES This study was conducted to investigate the impact of a family-focused online parenting support intervention on parents' sense of competence, depression, caregiving, social support, family functioning, and the weight and length of preterm infants. METHODS We conducted a single-blind, two-arm randomized controlled trial with a repeated-measures design. Participants were recruited from a specialized tertiary hospital in China between May and December 2022. Forty-five families were randomly assigned to the intervention group and 44 to the control group. The intervention included three components: (1) two one-hour group sessions and three 30-minute individual sessions of online parenting support; (2) two follow-up telephone calls (15-30 min each) post-discharge; and (3) access to online parenting resources. Primary outcomes included parenting sense of competence, parental care ability, and preterm infants' weight and length. Secondary outcomes included depression, social support, and family functioning. Measurements were taken at baseline, preterm infant discharge, one month post-discharge, and three months post-discharge. A generalized estimating equation model was employed based on the intention-to-treat principle for outcome comparison. RESULTS Parents in the intervention group showed significant improvements in parenting sense of competence (P < 0.001), parental care ability (P < 0.001), depression (P < 0.001), and social support (P = 0.002). However, no statistically significant differences were observed in preterm infants' weight and length, or in family functioning (P > 0.05). CONCLUSIONS Although the intervention did not affect preterm infants' outcomes, the positive enhancements in parenting sense of competence, care ability, depression, and social support indicate that online family-focused parenting support can effectively prepare parents for hospital discharge and the early transition period.
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Affiliation(s)
- Long Huang
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Bing-Yue Zhao
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Xiao-Ting Li
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Shui-Xiu Huang
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Ting-Ting Chen
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Xiao Cheng
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Si-Jia Li
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Hao Li
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Rong-Fang Hu
- The School of Nursing, Fujian Medical University, Fuzhou, China.
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Bao L, Du K, Gao J, Jiang R, Li B, Liu T. An analysis of the risk factors for invasive fungal infections in preterm infants and a discussion of prevention strategies. Technol Health Care 2024; 32:361-367. [PMID: 37302058 DOI: 10.3233/thc-230218] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Although the success rate of resuscitation in preterm infants is increasing, the long length of hospital stay in preterm infants and the need for more invasive operations, coupled with the widespread use of empirical antibiotics, have increased the prevalence of fungal infections in preterm infants in neonatal intensive care units (NICUs) year on year. OBJECTIVE The present study aims to explore the risk factors of invasive fungal infections (IFI) in preterm infants and to identify some prevention strategies. METHODS A total of 202 preterm infants with a gestational age of 26 weeks to 36+6 weeks and a birth weight of less than 2,000 g, admitted to our neonatal unit during the 5-year period from January 2014 to December 2018, were selected for the study. Among these preterm infants, six cases that developed fungal infections during hospitalization were enrolled as the study group, and the remaining 196 infants who did not develop fungal infections during hospitalization were the control group. The gestational age, length of hospital stay, duration of antibiotic therapy, duration of invasive mechanical ventilation, indwelling duration of the central venous catheter, and duration of intravenous nutrition of the two groups were compared and analyzed. RESULTS There were statistically significant differences between the two groups in the gestational age, length of hospital stay, and duration of antibiotic therapy. CONCLUSION A small gestational age, a lengthy hospital stay, and long-term use of broad-spectrum antibiotics are the high-risk factors for fungal infections in preterm infants. Medical and nursing measures to address the high-risk factors might reduce the incidence of fungal infections and improve the prognosis in preterm infants.
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包 梦, 乔 秀, 张 新, 张 子, 赵 菲, 陈 新. [Neuropsychological development of large for gestational age infants at the age of 12 months]. Zhongguo Dang Dai Er Ke Za Zhi 2023; 25:1246-1252. [PMID: 38112142 PMCID: PMC10731971 DOI: 10.7499/j.issn.1008-8830.2307040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/27/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVES To investigate the level of neuropsychological development in large for gestational age (LGA) infants at the age of 12 months. METHODS The infants, aged 12 to <13 months, who attended the Outpatient Service of Child Care in the First Affiliated Hospital of Shandong First Medical University from December 2021 to June 2023, were enrolled as subjects. According to the gestational age and birth weight, they were divided into preterm appropriate for gestational age (AGA) group, preterm LGA group, early term AGA group, early term LGA group, full-term AGA group, and full-term LGA group. A modified Poisson regression analysis was used to investigate the association between LGA and neuropsychological development outcome at 12 months of age. RESULTS After adjustment for confounding factors, compared with the full-term AGA group at the age of 12 months, the full-term LGA group had a significant increase in the risk of language deficit (RR=1.364, 95%CI: 1.063-1.750), the early term LGA group had significant increases in the risk of abnormal gross motor, fine motor, language, and the preterm LGA group had significant increases in the risk of abnormal language, social behavior, and total developmental quotient (P<0.05); also, the early term AGA group had higher risks of developmental delay across all five attributes and in total developmental quotient at the age of 12 months (P<0.05); except for the language attribute, the preterm AGA group had higher risks of developmental delay in the other 4 attributes (P<0.05). CONCLUSIONS The neuropsychological development of LGA infants with different gestational ages lags behind that of full-term AGA infants at 12 months of age, and follow-up and early intervention of such infants should be taken seriously in clinical practice.
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Affiliation(s)
| | - 秀芸 乔
- 山东第一医科大学第一附属医院/山东省千佛山医院护理部,山东济南250013
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Yu X, Gai L, Wang X, Kong C, Cao N, Fan L, Yang F, Yang X, Sun L. Effectiveness and safety of intracardiac electrocardiogram guidance for epicutaneo-cava catheters via the lower extremity in preterm infants: a retrospective study. BMC Pediatr 2023; 23:623. [PMID: 38071296 PMCID: PMC10709929 DOI: 10.1186/s12887-023-04444-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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/26/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION In recent years, intracardiac electrocardiogram (IC-ECG) technology has been widely used for epicutaneo-cava catheter (ECC) placement and has shown many potential advantages. However, evidence about the quantitative changes, effectiveness, and safety of IC-ECG for lower extremity ECC is sparse. This study aimed to explore the quantitative changes in IC-ECG for lower extremity ECC and determine its effectiveness and safety. METHODS A retrospective study was conducted on 303 premature infants who underwent successful IC-ECG-guided lower extremity ECC placement between January 2019 and December 2021. All patients underwent chest X-ray postoperatively to verify the position of the catheter tip. The amplitudes of the surface electrocardiogram and IC-ECG QRS waves and the difference between the two amplitudes were measured. The effectiveness (matching rate between IC-ECG and chest X-ray) and safety (incidence of catheter-related complications) of IC-ECG for lower extremity ECC were evaluated. RESULTS The matching rate between IC-ECG and chest X-ray was 95.0%. When the catheter tip was optimally positioned, the QRS amplitude of the IC-ECG was 0.85 ± 0.56 mv higher than that of the surface electrocardiogram. The overall incidence of catheter-related complications was 10.6%. The actual ECC insertion length was associated with a noticeably increased risk of catheter-related complications. CONCLUSIONS This study suggests that IC-ECG is an effective and safe method by observing the dynamic changes in both QRS complexes and P wave to locate the tip of lower extremity ECC in preterm infants. Our findings would facilitate the application of IC-ECG for ECC localization.
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Affiliation(s)
- Xinying Yu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang City, 110004, Liaoning Province, People's Republic of China
| | - Li Gai
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang City, 110004, Liaoning Province, People's Republic of China
| | - Xuejun Wang
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chaonan Kong
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang City, 110004, Liaoning Province, People's Republic of China
| | - Na Cao
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang City, 110004, Liaoning Province, People's Republic of China
| | - Ling Fan
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fan Yang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang City, 110004, Liaoning Province, People's Republic of China
| | - Xiaoyu Yang
- School of Nursing, China Medical University, Shenyang, China
| | - Le Sun
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang City, 110004, Liaoning Province, People's Republic of China.
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van Kaam AH, Niemarkt HJ, Onland W. Timing of surfactant treatment in respiratory distress syndrome. Semin Fetal Neonatal Med 2023; 28:101495. [PMID: 38012889 DOI: 10.1016/j.siny.2023.101495] [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] [Indexed: 11/29/2023]
Abstract
The introduction of exogenous surfactant in the 1980s has resulted in an improved survival of very preterm infants with respiratory distress syndrome (RDS). Randomized controlled trials conducted before 2000 have shown that the magnitude of this beneficial effect strongly depends on the timing of surfactant treatment, i.e. the earlier surfactant is administered after birth the better. However, the initial mode of respiratory support in infants with RDS has changed dramatically over the last decades, moving from invasive to non-invasive support. Furthermore, new, less invasive techniques to administer surfactant have been introduced to match this non-invasive approach. This review summarizes the evidence on how these practice changes impacted the effect of surfactant timing on mortality and morbidity in preterm infants with RDS.
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Affiliation(s)
- Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - Hendrik J Niemarkt
- Department of Neonatology, Maxima Medical Center, De Run 4600, 5504 DB, Veldhoven, the Netherlands.
| | - Wes Onland
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
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