scholarly journals Treatment status of extremely premature infants with gestational age < 28 weeks in a Chinese perinatal center from 2010 to 2019

2021 ◽  
Author(s):  
Wen-Wen Zhang ◽  
Yong-Hui Yu ◽  
Xiao-Yu Dong ◽  
Simmy Reddy
Keyword(s):  
Survival Time ◽  
Premature Infants ◽  
Active Treatment ◽  
Gestational Age ◽  
Real World ◽  
Neonatal Intensive Care ◽  
Total Mortality ◽  
Delivery Room ◽  
Real World Data ◽  
Perinatal Medicine

Abstract Background There is a paucity of studies conducted in China on the outcomes of all live-birth extremely premature infants (EPIs) and there is no unified recommendation on the active treatment of the minimum gestational age in the field of perinatal medicine in China. We aimed to investigate the current treatment situation of EPIs and to provide evidence for formulating reasonable treatment recommendations. Methods We established a real-world ambispective cohort study of all live births in delivery rooms with gestational age (GA) between 24+0 and 27+6 weeks from 2010 to 2019. Results Of the 1163 EPIs included in our study, 241 (20.7%) survived, while 849 (73.0%) died in the delivery room and 73 (6.3%) died in the neonatal intensive care unit. Among all included EPIs, 862 (74.1%) died from withholding or withdrawal of care. Regardless of stratification according to GA or birth weight, the proportion of total mortality attributable to withdrawal of care is high. For infants with the GA of 24 weeks, active treatment did not extend their survival time (P = 0.224). The survival time without severe morbidity of the active treatment was significantly longer than that of withdrawing care for infants older than 25 weeks (P < 0.001). Over time, the survival rate improved, and the withdrawal of care caused by socioeconomic factors and primary nonintervention were reduced significantly (P < 0.001). Conclusions The mortality rate of EPIs is still high. Withdrawal of care is common for EPIs with smaller GA, especially in the delivery room. It is necessary to use a multi-center, large sample of real-world data to find the survival limit of active treatment based on our treatment capabilities.

Tracheostomy in the Extremely Premature Neonate: A Multi-Institutional Study

2020 ◽  
Vol 162 (4) ◽  
pp. 559-565
Author(s):  
Kevin D. Pereira ◽  
Kevin Shaigany ◽  
Karen B. Zur ◽  
Carolyn M. Jenks ◽  
Diego A. Preciado ◽  
...  
Keyword(s):  
Lung Disease ◽  
Premature Infants ◽  
Gestational Age ◽  
Chronic Lung Disease ◽  
Neonatal Intensive Care ◽  
Premature Neonate ◽  
Neurodevelopmental Outcomes ◽  
Children's Hospitals ◽  
Children’S Hospitals ◽  
The Mean

Objective (1) To describe characteristics associated with tracheostomy placement and (2) to describe associated in-hospital morbidity in extremely premature infants. Study Design Pooled retrospective analysis of charts. Setting Academic children’s hospitals. Subjects and Methods The patient records of premature infants (23-28 weeks gestational age) who underwent tracheostomy between January 1, 2012, and December 31, 2017, were reviewed from 4 academic children’s hospitals. Demographics, procedural morbidity, feeding, respiratory, and neurodevelopmental outcomes at the time of transfer from the neonatal intensive care unit (NICU) were obtained. The contribution of baseline characteristics to mortality, neurodevelopmental, and feeding outcomes was also assessed. Results: The charts of 119 infants were included. The mean gestational age was 25.5 (95% confidence interval, 25.2-25.7) weeks. The mean birth weight was 712 (671-752) g. Approximately 50% was African American. The principal comorbidity was chronic lung disease (92.4%). Overall, 60.5% of the infants had at least 1 complication. At the time of transfer, most remained mechanically ventilated (94%) and dependent on a feeding tube (90%). Necrotizing enterocolitis increased the risk of feeding impairment ( P = .002) and death ( P = .03). Conclusions Tracheostomy in the extremely premature neonate is primarily performed for chronic lung disease. Complications occur frequently, with skin breakdown being the most common. Placement of a tracheostomy does not seem to mitigate the systemic morbidity associated with extreme prematurity.

scholarly journals Vertically transmitted infections and extrauterine growth restriction in preterm neonates: a new risk factor

2021 ◽  
Vol 21 (1) ◽  
pp. 107-115
Author(s):  
Verônica Cheles Vieira ◽  
Raquel Cristina Gomes Lima ◽  
Daiane Borges Queiroz ◽  
Danielle Souto de Medeiros
Keyword(s):  
Premature Infants ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Positive Association ◽  
Final Analysis ◽  
Growth Restriction ◽  
Preterm Neonates ◽  
Clinical Practices ◽  
Increased Risk ◽  
Extrauterine Growth Restriction

Abstract Objectives: to investigate the association between Vertically Transmitted Infections (VTI) and Extrauterine Growth Restriction (EUGR) among premature infants in Neonatal Intensive Care Units (NICU). Methods: part of a large non-concurrent cohort study with medical records analysis. We evaluated EUGR in premature infants at a gestational age at birth of > 32 weeks and <36 weeks and presented a corrected gestational age of 36 completed weeks during a 27-day birth follow-up. Premature infants with major congenital anomalies were excluded. We analyzed associations among EUGR, VTI and covariables related to maternal disease, birth characteristics, perinatal morbidities and clinical practices. Results: out of the 91 premature infants, 59.3% (CI95%=48.9-69.0%) developed EUGR. VTI were observed in 4.4%o of the population; all premature infants affected by VTI had EUGR. The VTI found were syphilis, cytomegalovirus disease and toxoplasmosis. The final analysis has showed a positive association between VTI and EUGR (RR=1.57; CI95%o=1.07-2.30); the female covariables (RR=1.50; CI95%=1.11-2.02), moderate premature classification (RR=1.41; CI95%=1.06-1.87) and small for gestational age (RR=2.69; CI95% 1.853.90) have also influenced this outcome. Conclusion: this study revealed VTI as an important morbidity factor, with impact on the increased risk of EUGR between premature infants affected by these diseases.

scholarly journals Accuracy of Transcutaneous Carbon Dioxide Measurement in Premature Infants

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Marie Janaillac ◽  
Sonia Labarinas ◽  
Riccardo E. Pfister ◽  
Oliver Karam
Keyword(s):  
Carbon Dioxide ◽  
Partial Pressure ◽  
Premature Infants ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Wide Limit ◽  
Cerebral Lesions ◽  
Carbon Dioxide Measurement

Background.In premature infants, maintaining blood partial pressure of carbon dioxide (pCO2) value within a narrow range is important to avoid cerebral lesions. The aim of this study was to assess the accuracy of a noninvasive transcutaneous method (TcpCO2), compared to blood partial pressure of carbon dioxide (pCO2).Methods.Retrospective observational study in a tertiary neonatal intensive care unit. We analyzed the correlation between blood pCO2and transcutaneous values and the accuracy between the trends of blood pCO2and TcpCO2in all consecutive premature infants born at <33 weeks’ gestational age.Results.248 infants were included (median gestational age: 29 + 5 weeks and median birth weight: 1250 g), providing 1365 pairs of TcpCO2and blood pCO2values. Pearson’sRcorrelation between these values was 0.58. The mean bias was −0.93 kPa with a 95% confidence limit of agreement of −4.05 to +2.16 kPa. Correlation between the trends of TcpCO2and blood pCO2values was good in only 39.6%.Conclusions.In premature infants, TcpCO2was poorly correlated to blood pCO2, with a wide limit of agreement. Furthermore, concordance between trends was equally low. We warn about clinical decision-making on TcpCO2alone when used as continuous monitoring.

scholarly journals O1-4 Survival time of nivolumab treatment in advanced gastric cancer from real-world data of the DELIVER trial (JACCRO GC-08)

2021 ◽  
Vol 32 ◽  
pp. S285
Author(s):  
Atsushi Ishiguro ◽  
Eisuke Inoue ◽  
Yasuhiro Sakamoto ◽  
Ryohei Kawabata ◽  
Yusuke Akamaru ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Survival Time ◽  
Advanced Gastric Cancer ◽  
Real World ◽  
Real World Data ◽  
World Data

10 High spontaneous ductal closure even at the extreme of prematurity

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e7-e7
Author(s):  
Gabriela de Carvalho Nunes ◽  
Punnanee Wutthigate ◽  
Jessica Simoneau ◽  
Marc Beltempo ◽  
Guilherme Sant'Anna ◽  
...  
Keyword(s):  
Premature Infants ◽  
Gestational Age ◽  
Ductus Arteriosus ◽  
Subject Area ◽  
Outpatient Setting ◽  
Perinatal Medicine ◽  
Extremely Preterm ◽  
Ductal Closure ◽  
Catheter Closure ◽  
Preterm Newborns

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Extremely preterm newborns are at risk of prolonged patency of the ductus arteriosus (PDA). Current literature has failed to indicate improvement in outcomes after exposure to strategies promoting ductal closure. As such, our center abandoned these practices in 2013. Objectives Describe the spontaneous PDA closure in premature infants, including those infants born at the extreme of gestational age (&lt; 26 weeks). Design/Methods Retrospective study of newborns &lt; 29 weeks, admitted within 24 hours after birth between 2015 and 2019 and without genetic or congenital anomalies. Newborns who were last known to be alive, with an available echocardiography, and who were not exposed to any intervention to accelerate PDA closure were included. Images were reviewed by experts blinded to the outcomes. Results 296 infants were analyzed. 37 (12%) did not survive their hospitalization, and 16 were exposed to interventions to accelerate ductal closure at some point during their lifetime (4 ligations, 4 catheter-closure, 5 ibuprofen and 3 acetaminophen). Out of the 243 remaining newborns, 214 had at least one echocardiography to ascertain ductal patency or closure (100% of those &lt;26 weeks). The average gestational age was 26.3±1.5 weeks, with 84 (39%) being &lt;26 weeks. PDA closed spontaneously in 194 (91%), with 60 having closure ascertainment after discharge (average age at closure ascertainment of 36.4 [IQR: 34.4 – 40.1] weeks). Of the 84 &lt;26 weeks, 76 (90%) had confirmation of ductal closure. The 20 infants with an open PDA at the last evaluation were followed in an outpatient setting and considered small/restrictive. In our cohort, 92/243 (38%) were exposed to post-natal steroids. In the &lt;26 weeks group, 74% were exposed to steroids, at a cumulative dose of 1.64 [0.89 – 2.44] mg/kg. BPD was found in 57% of the overall cohort and in 79% of &lt;26 weeks. Conclusion The majority of newborns &lt; 29 weeks, and even those at the extreme of gestational age (&lt; 26 weeks) spontaneously closed their PDA before term-corrected age. While BPD rate was similar to previous cohorts, post-natal steroids use was high.

Survival analysis by tumor response from real-world data in advanced gastric cancer treated with nivolumab: The DELIVER trial (JACCRO GC-08).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 4044-4044
Author(s):  
Yosuke Kito ◽  
Eisuke Inoue ◽  
Yusuke Akamaru ◽  
Masazumi Takahashi ◽  
Jin Matsuyama ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Clinical Trial ◽  
Survival Time ◽  
Advanced Gastric Cancer ◽  
Real World ◽  
Tumor Response ◽  
Phase Iii ◽  
Clinical Factors ◽  
Real World Data ◽  
World Data

4044 Background: The phase III ATTRACTION-2 trial demonstrated survival benefit of nivolumab (Nivo) as third- or later-line treatment in previously treated advanced gastric or gastroesophageal junction (GEJ) cancer, with response rate (RR) of 11% (Kang YK, et al. Lancet 2017). It has been shown that some tumors grow rapidly after Nivo treatment, but the proportion and survival are still uncertain. We therefore prospectively investigated clinical outcomes from real-world data of Nivo treatment in advanced gastric cancer (GC). Methods: The DELIVER trial was a prospective, multicenter, observational study which assessed patients (pts) with advanced gastric or GEJ adenocarcinoma treated with Nivo alone and ECOG PS 0-2 (UMIN000030850). The aims were to evaluate the efficacy and safety of Nivo treatment in real world. Primary endpoint was overall survival (OS), secondary endpoints were RR, disease control rate (DCR), progression-free survival (PFS), tumor growth rate (TGR) at 1st evaluation, and safety. The sub-group analyses were performed for survival according to tumor response and clinical factors. The survival data was fixed at the timepoint of 1 year after the last enrollment. Results: In 501 pts enrolled from Mar 2018 to Aug 2019, 487 pts were evaluable (median age 70y, 71% male, ECOG PS0/1/2 42/44/14%, no. of prior regimen 1/2/≥3 2/39/59%, 21% HER2-pos, 42% pts with ascites). Median OS was 5.8 months (m) (95%CI 5.3-7.0) with 1y-survival rate of 30%, and median PFS was 1.8 m (95%CI 1.7-2.0), at 454 events for PFS and 389 events for OS. The DCR were 39.4%, and RR was 14.2% in 282 pts with measurable lesions. Median OS and PFS by tumor response (CR/PR/SD/PD) were Not Reached (NR)/NR/11.3/4.1m and NR/11.7/3.8/1.4m, respectively. A sub-group analysis of OS by clinical factors is the following: male/female; 6.5/5.0m ( p= 0.002), tub/por/sig; 8.1/5.4/4.1m ( p< 0.0001), albumin < 3.5/≥3.5; 4.2/8.9m ( p< 0.0001), w/peritoneal mets/w/o; 4.9/8.4m ( p< 0.0001), and w/ascites/w/o; 3.7/8.9m ( p< 0.0001). These findings were also observed in PFS. In 219 evaluable pts for TGR, 20.5% pts were identified as hyper-progressive disease (HPD). An exploratory approach by logistic regression analysis indicated that level of free-T3 in blood before Nivo treatment was higher in the HPD compared to the non-HPD group (2.5 vs. 2.2 pg/ml, p= 0.005). Survival time was comparable between the HPD group and PD without HPD group. Median period from 1st evaluation to death was 2.8 m for HPD, 5.7 m for non-HPD, and 2.4 m for PD at 1st evaluation without HPD. Conclusions: The real-world data of Nivo treatment in advanced GC indicated comparable survival to previous result in a clinical trial. Differences in survival time by tumor response or some clinical factors were observed in Nivo treatment. In addition, our study revealed the rate of HPD and the prognosis in advanced GC pts treated with Nivo. Clinical trial information: UMIN000030850.

scholarly journals Premature: growth and its relation to oral skills

CoDAS ◽  
2015 ◽  
Vol 27 (4) ◽  
pp. 378-383
Author(s):  
Camila Lehnhart Vargas ◽  
Luana Cristina Berwig ◽  
Eduardo Matias dos Santos Steidl ◽  
Leila Sauer Prade ◽  
Geovana Bolzan ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Premature Infant ◽  
Premature Infants ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Tube Feeding ◽  
Oral Feeding ◽  
Feeding Performance ◽  
Time Of Feeding ◽  
Oral Skills

OBJECTIVE: To evaluate the influence of oral motor skills of premature infants on their oral feeding performance and growth, during neonatal hospitalization.METHODS: Fifty-one newborns hospitalized in the neonatal intensive care unit of a hospital in Southern Brazil, between July 2012 and March 2013, were evaluated. The evaluation of oral feeding skills, according to Lau and Smith, was applied after prescription for starting oral feeding. The oral feeding performance was analyzed using the following variables: days taken to start independent oral feeding and hospital discharge. Growth was measured by weight, length, and head circumference, using the curves of Fenton, at birth, first and independent oral feeding, and hospital discharge.RESULTS: At birth, 71% preterm infants were proper for gestational age, most of them were males (53%), with average of 33.6 (±1.5) weeks of gestational age. The gestational age in the assessment did not influence the oral feeding performance of the premature infant and did not differ between levels. Time of transition from tube feeding to oral feeding and hospital stay was shorter when the oral skills were higher. At birth, there was a tendency of low weight and low oral feeding performance. Level IV premature infants in the release of oral feeding presented higher weights.CONCLUSION: The level of oral skills of the premature infant interfered positively on time of feeding transition from tube to independent oral feeding and hospital stay. Growth, represented by weight gain, was not affected by the level of oral skill.

scholarly journals Low plasma concentrations of arginine and asymmetric dimethylarginine in premature infants with necrotizing enterocolitis

2007 ◽  
Vol 97 (5) ◽  
pp. 906-911 ◽  
Author(s):  
Milan C. Richir ◽  
Michiel P. C. Siroen ◽  
Ruurd M. van Elburg ◽  
Willem P. F. Fetter ◽  
Freeke Quik ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Birth Weight ◽  
Necrotizing Enterocolitis ◽  
Premature Infants ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Asymmetric Dimethylarginine ◽  
Plasma Concentrations ◽  
Nos Inhibitor ◽  
Oxide Synthase

Several studies have described reduced plasma concentrations of arginine, the substrate for nitric oxide synthase (NOS) in infants with necrotizing enterocolitis (NEC). No information on the plasma concentrations of the endogenous NOS inhibitor asymmetric dimethylarginine (ADMA) in patients with NEC is currently available. We investigated whether plasma concentrations of arginine, ADMA, and their ratio differ between premature infants with and without NEC, and between survivors and non-survivors within the NEC group. In a prospective case–control study, arginine and ADMA concentrations were measured in ten premature infants with NEC (median gestational age 193 d, birth weight 968 g), and ten matched control infants (median gestational age 201 d, birth weight 1102 g), who were admitted to the Neonatal Intensive Care Unit. In the premature infants with NEC, median arginine and ADMA concentrations (μmol/l), and the arginine:ADMA ratio were lower compared to the infants without NEC: 21·4 v. 55·9, P = 0·001; 0·59 v. 0·85, P = 0·009 and 36·6 v. 72·3, P = 0·023 respectively. In the NEC group, median arginine (μmol/l) and the arginine:ADMA ratio were lower in non-surviving infants than in surviving infants: 14·7 v. 33·8, P = 0·01 and 32·0 v. 47·5, P = 0·038 respectively. In premature infants with NEC not only the NOS substrate arginine, but also the endogenous NOS inhibitor ADMA and the arginine:ADMA ratio were lower than in infants without NEC. In addition, low arginine and arginine:ADMA were associated with mortality in infants with NEC. Overall, these data suggest that a diminished nitric oxide production may be involved in the pathophysiology of NEC, but this needs further investigation.

scholarly journals Analysis of Characteristics of Peripheral Arterial Ischemia in Premature Babies and Effects of Nitroglycerin Patch Application

2020 ◽  
Vol 26 (4) ◽  
pp. 434-444
Author(s):  
Jeongeun Kim ◽  
Jin Won Lee ◽  
Dong Yeon Kim
Keyword(s):  
Premature Infants ◽  
Gestational Age ◽  
Skin Color ◽  
Neonatal Intensive Care ◽  
Umbilical Artery ◽  
Clinical Information ◽  
Patch Application ◽  
Premature Babies ◽  
Lower Blood ◽  
Peripheral Arterial

Purpose: The aim of this retrospective study was to analyze the characteristics of peripheral arterial ischemia and tissue necrosis in premature babies, as well as the effects of nitroglycerin.Methods: In total, 513 newborns were enrolled who were admitted to the neonatal intensive care unit with a gestational age of 34 weeks or younger. Data were collected on general personal and clinical information, peripheral arterial ischemia, and nitroglycerin patch application in the premature infants. The collected data were analyzed using the x<sup>2</sup> test, t-test, Mann-Whitney U test, logistic regression.Results: Thirty-six (7.0%) infants had peripheral arterial ischemia, while 477 (93.0%) infants did not. Lower gestational age (x<sup>2</sup>=35.97, p<.001), lower birth weight (x<sup>2</sup>=29.40, p<.001), lower blood pressure (x<sup>2</sup>=23.10, p<.001), and insertion of an umbilical artery catheter (p<.001) were significantly associated with the occurrence of peripheral arterial ischemia. Among the preterm infants in whom nitroglycerin patches were applied, 30 (83.3%) premature infants without necrosis improved without complications, 4 (11.1%) showed hypotension, and 2 (5.6%) showed skin damage.Conclusion: Based on a review of our experiences with nitroglycerin patches, we recommend closely observing skin color and using nitroglycerin patches on the skin to help improve flow in premature infants with peripheral arterial ischemia.

Abstract 14970: Normative Echocardiographic Data for Premature Infants Between 23 to 26- and 6/7-weeks Gestational Age

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nikola Dragisic ◽  
Benjamin E REINKING ◽  
Griffin geick ◽  
Amy Hahn ◽  
Jennifer Maldonado ◽  
...  
Keyword(s):  
Premature Infants ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Normative Data ◽  
Ductus Arteriosus ◽  
Time Interval ◽  
Structural Development ◽  
Cardiac Structure ◽  
Data Set ◽  
And Function

Background: Echocardiography is utilized to assess cardiac structure and function. In infants, children, and adolescents, a normative data set can be utilized to evaluate cardiac size relative to patient body size and provides the clinician with a quantified z-score based on body surface area. A complete normative data set for premature infants is not yet available. The aim of this study was to develop a normative data set for commonly measured cardiac structures in a cohort of premature infants. Methods and Results: Single center retrospective echocardiographic study in a cohort of premature infants without congenital heart disease. A total of 184 infants admitted at the University of Iowa’s Neonatal Intensive Care Unit between 2009-2019 were included in the study. All infants were between 23 to 26- and 6/7-weeks gestational age. We considered patients with a patent ductus arteriosus and/or a patent foramen ovale as having normal intra-cardiac anatomy given their prematurity. Some infants had numerous echocardiograms during this time interval which resulted in 439 utilized echocardiogram. Each echocardiogram used was interpreted individually regardless if the patient had multiple between the gestational ages of 23 and 26- and 6/7-weeks. Commonly examined cardiac structures were assessed via 2-dimensional and M-mode echocardiography. The mean and standard deviations were obtained for each cardiac structure and grouped by week of gestational age ( Table 1 ). Conclusions: We present normative data for commonly measured cardiac structures based on gestational age in a premature patient population. This information is valuable for clinicians to assess for appropriate cardiac structural development and may be utilized to guide clinical management and need for possible intervention as the child continues to develop and grow.

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