Neurodevelopmental Follow-up of Very Preterm Infants after Proactive Treatment at a Gestational Age of ≥23 Weeks

Abstract Introduction/Background Bronchopulmonary dysplasia (BPD) is a common complication of extreme prematurity and may require prolonged home respiratory support. BPD is associated with worse neurodevelopmental outcomes but the impact of home respiratory support on neurodevelopmental outcomes, rehospitalization rates and association with caregiver sociodemographics is less well studied. Objectives This study examines the impact of home respiratory support on neurodevelopmental outcomes in very preterm infants at 18-24 months corrected gestational age. Design/Methods This linked Canadian Neonatal Network and Canadian Neonatal Follow-Up Network (CNFUN) multicenter cohort study of infants born April 1, 2009-December 31, 2016 at <29 weeks’ gestational age assessed at 18-24 months corrected age at a CNFUN site compared significant neurodevelopmental impairment rates, rehospitalization rates and sociodemographics in children with and without home respiratory support using Chi-square and student t-tests. Results Of the 3918 infants, 622 (15.9%) received home respiratory support. As expected, infants on home respiratory support had a lower gestational age (mean 25.5 vs 26.5 weeks, p < 0.01), lower birth weight (mean 781 vs 955 grams, p < 0.01), longer NICU stay (mean 118 vs 76 days, p < 0.01) and more comorbidities: late onset sepsis (35.1% vs 22.9%, p < 0.01), NEC ≥ stage 2 (8.9% vs 5.9%, p = 0.01), grade 3-4 IVH or PVL (12.7% vs 8.4%, p < 0.01) and ROP ≥ grade 3 (28% vs 10.8%, p < 0.01). Infants on home respiratory support had higher significant neurodevelopmental impairment rates defined as Bayley-III motor, cognitive, language scores <70, nonambulatory cerebral palsy (GMFCS ≥ 3), hearing and/or visual impairment rates (Table 1), rehospitalization rates (63.3% vs 29.2%, p < 0.01) and >3 rehospitalizations (19.8% vs 5.0%, p < 0.01). With home respiratory support, fewer families had paid employment and more were on social welfare. Conclusion Children born preterm who are discharged home on respiratory support, compared to those without home support, are more likely to experience neurodevelopmental impairment and rehospitalization, and may have an adverse impact on family income. This is important for discharge planning and follow-up care of these high risk children.

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Changes in Neonatology: Comparison of Two Cohorts of Very Preterm Infants (Gestational Age <32 Weeks): The Project on Preterm and Small for Gestational Age Infants 1983 and The Leiden Follow-Up Project on Prematurity 1996-1997

PEDIATRICS ◽

10.1542/peds.2004-1497 ◽

2005 ◽

Vol 115 (2) ◽

pp. 396-405 ◽

Cited By ~ 131

Author(s):

G. M. S. J. Stoelhorst

Keyword(s):

Preterm Infants ◽

Gestational Age ◽

Small For Gestational Age ◽

Very Preterm Infants ◽

Very Preterm

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Behaviour at 2 years of age in very preterm infants (gestational age <32 weeks)

Acta Paediatrica ◽

10.1080/08035350310011551 ◽

2003 ◽

Vol 92 (5) ◽

pp. 1-1 ◽

Cited By ~ 1

Author(s):

GMSJ Stoelhorst ◽

SE Martens ◽

M Rijken ◽

van Zwieten PHT ◽

AH Zwinderman ◽

...

Keyword(s):

Preterm Infants ◽

Gestational Age ◽

Very Preterm Infants ◽

Very Preterm

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Significance of low birthweight for gestational age among very preterm infants

BJOG An International Journal of Obstetrics & Gynaecology ◽

10.1111/j.1471-0528.1997.tb11976.x ◽

1997 ◽

Vol 104 (6) ◽

pp. 668-673 ◽

Cited By ~ 31

Author(s):

Arsenio Spinillo ◽

Ezio Capuzzo ◽

Gaia Piazzi ◽

Federica Baltaro ◽

Mauro Stronati ◽

...

Keyword(s):

Preterm Infants ◽

Gestational Age ◽

Low Birthweight ◽

Very Preterm Infants ◽

Very Preterm

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67 Are NICUs too busy?

Paediatrics & Child Health ◽

10.1093/pch/pxab061.052 ◽

2021 ◽

Vol 26 (Supplement_1) ◽

pp. e47-e48

Author(s):

Marc Beltempo ◽

Robert Platt ◽

Anne-Sophie Julien ◽

Regis Blais ◽

Bertelle Valerie ◽

...

Keyword(s):

Preterm Infants ◽

Patient Outcomes ◽

Gestational Age ◽

Late Onset ◽

Mode Of Delivery ◽

Random Effect ◽

Organizational Factors ◽

Neurological Injury ◽

Very Preterm Infants ◽

Very Preterm

Abstract Primary Subject area Neonatal-Perinatal Medicine Background In a health care system with limited resources, hospital organizational factors such as unit occupancy and nurse-to-patient ratios may contribute to patient outcomes. Objectives We aimed to assess the association of NICU occupancy and nurse staffing with outcomes of very preterm infants born < 33 weeks gestational age (GA). Design/Methods This was a multicenter retrospective cohort study of infants born 23-32 weeks GA without major congenital anomaly, admitted within 2 days after birth to one of four Level 3 NICUs in Quebec, Canada (2015-2018). For each 8 h shift, data on unit occupancy were obtained from a central provincial database (SiteNeo) and linked to the hospital nursing hours database (Logibec). Unit occupancy rates and nursing provision ratios (nursing hours/recommended nursing hours based on patient dependency categories) were pooled for the first shift, 24 h, and 7 days of admission for each infant. Patient data were obtained from the Canadian Neonatal Network database. Primary outcome was mortality and/or morbidity (severe neurological injury, bronchopulmonary dysplasia, necrotizing enterocolitis, and late-onset sepsis, severe retinopathy of prematurity). Adjusted odds ratios (AOR) for association of exposure with outcomes were estimated using generalized linear mixed models with a random effect for center, while adjusting for confounders (gestational age, small for gestational age, sex, outborn, Score for Neonatal Acute Physiology version 2, mode of delivery, and the other organizational variables). Results Among 1870 infants included in analyses, 796 (43%) had mortality/morbidity. Median occupancy was 89% (IQR 82-94) and median nursing provision was 1.13 (IQR 0.97-1.37). Overall higher NICU occupancy on shift of admission, first 24 h, and 7 days were associated with higher odds of mortality/morbidity (Figure 1) but nursing provision was not (Figure 2). Subgroup analysis by GA (< 29 and 29-32 weeks) yielded similar results (not shown). Generalized linear mixed model analyses showed that a 5% reduction in occupancy in the first 24 h of admission was associated with a 6% reduction in mortality/morbidity. Conclusion NICU occupancy is associated with mortality/morbidity among very preterm infants and may reflect lack of adequate resources in periods of high activity. Interventions aimed at reducing occupancy and maintaining adequate resources need to be considered as strategies to improve patient outcomes.

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Pulse Oximetry Values in Very Preterm infants Asymtomatic at 34-36 weeks post menstrual age.

10.22541/au.160726775.54268285/v1 ◽

2020 ◽

Author(s):

Ignacio Oyarzún ◽

Marcela Diaz ◽

Paulina Toso ◽

Alejandra Zamorano ◽

Soledad Montes ◽

...

Keyword(s):

Pulse Oximetry ◽

Preterm Infants ◽

Premature Infants ◽

Gestational Age ◽

Oxygen Therapy ◽

Healthy Children ◽

Multicentric Study ◽

Very Preterm Infants ◽

Very Preterm ◽

Postmenstrual Age

Background: Oxygen supplementation is an important component for preterm infants neonatal care. Pulse oximetry (SpO2) is essential to guide oxygen therapy. Evidence on SpO2 values in premature infants previous to discharge is limited. Objectives: To establish SpO2 values in asymptomatic premature infants at 34, 35, and 36 weeks postmenstrual age (PMA). Methods: Longitudinal, multicentric study. From May 2018 to May 2019 premature infants born ≤32 weeks gestational age, from three level III NICUs in Santiago, Chile (altitude 579mt), were enrolled. Healthy children without current apnea of prematurity were included. Continuous SpO2 was obtained with Masimo-Radical 7/8 (USA), averaging time 2-4 seconds. Results: 101 SpO2 recordings (n = 44, 33 and 24 at 34, 35 and 36 weeks PMA respectively) from 62 infants. Twenty eight (45%) male, median (range) gestational age at birth 30 (26-32) weeks, median (range) birth weight 1480 (785-2700) g. Oximetry variables for total recordings: mean SpO2, median (range) 96.9 (93.3-99.3); minimum SpO2, median (range) 74 (51-89); time of SpO2 <90%, median (range) 2% (0-10.6%); time of SpO2 <80%, median (range) 0.1% (0-1.3%); desaturation event by ≥4% (DI4) ≥ 0 and ≥ 10 seconds per sample hour, median (range) 45.2 (5.2-115) and median (range) 15 (3.5-62.5) respectively; desaturation event <80% (DI80), median (range) 0.58 (0-10.8). We found no differences between SpO2 values at different weeks PMA. Conclusions: We described SpO2 values in very preterm infants, asymptomatic at 34, 35 and 36 weeks PMA. These values could be used as a reference to guide oxygen therapy previous to discharge.

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Predictors of long-term outcome in very preterm infants: Gestational age versus neonatal cranial ultrasound.

Journal of Developmental & Behavioral Pediatrics ◽

10.1097/00004703-200402000-00029 ◽

2004 ◽

Vol 25 (1) ◽

pp. 74

Author(s):

M. M. M.

Keyword(s):

Preterm Infants ◽

Gestational Age ◽

Cranial Ultrasound ◽

Term Outcome ◽

Long Term Outcome ◽

Very Preterm Infants ◽

Very Preterm

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Necrotizing Enterocolitis in a Dutch Cohort of Very Preterm Infants: Prevalence, Mortality, and Long-Term Outcomes

European Journal of Pediatric Surgery ◽

10.1055/s-0041-1741544 ◽

2022 ◽

Author(s):

Ceren Imren ◽

Lotte E. Vlug ◽

Barbara A. E. de Koning ◽

Tessa Diertens ◽

Heleen E. Snel ◽

...

Keyword(s):

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Surgical Complication ◽

Intestinal Failure ◽

Very Preterm Infants ◽

Very Preterm ◽

Anastomotic Strictures ◽

Multidisciplinary Perspective

Abstract Introduction To improve counseling of parents and to guide care strategies, we studied the disease course and outcomes of necrotizing enterocolitis (NEC) up to 2 years of corrected age (CA) from a multidisciplinary perspective. Materials and Methods This was a retrospective cohort study in preterm infants (birth weight < 1,500 g, gestational age < 32 weeks), diagnosed with NEC (Bell's stage ≥ II) from 2008 through 2020. Data on prevalence, mortality, surgery, intestinal failure (IF), growth, and neurodevelopment at 2-year follow-up were separately analyzed for medically and surgically treated children. Results Of 3,456 preterm infants, 200 (6%) were diagnosed with NEC, of whom 135 developed an indication for surgery within 7 days after the diagnosis; 28/135 died before surgery, and 37/107 died after an open-and-close procedure. An enterostomy was constructed in 62 patients and an end-to-end anastomosis in 15. The postoperative course was described for 77 patients, of whom 23 developed surgical complications (12/23 incisional hernias, 9/23 anastomotic strictures), 13/77 a short bowel, and 25/77 IF. Sixty-day survival after birth for medical NEC patients was 88% (hazard ratio [HR]: 0.698; p = 0.318), and for surgically treated NEC patients was 40% (HR: 3.729; p < 0.001). At 2-year follow-up, one patient received parenteral nutrition. Severe delay in weight for age, motor, and cognitive development was seen in 3, 6, and 2%, respectively. Conclusion In this cohort, the mortality rate was high, especially in surgically treated NEC patients. The surgical complication rate is comparable to previous studies, but in surviving patients, persisting IF and severe delay in growth and neurodevelopment at 2 years CA were relatively rare.

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