Early antibiotic exposure and adverse outcomes in very preterm infants at low risk of early-onset sepsis: the EPIPAGE-2 cohort study

Abstract Objective There is a dilemma of ibuprofen treatment with patent ductus arteriosus (PDA) as to how and when to treat. We aimed to clarify this issue in very preterm infants (VPIs; < 32 weeks). Methods This retrospective study included 1 659 VPIs who were diagnosed with PDA according to echocardiographic examinations and cardiovascular dysfunction scoring system (the CVD scoring). The VPIs were classified into six groups (A1, A2, A3, B1, B2, and B3) based on CVD scores (A, < 3, and B, ≥ 3), and treatment with ibuprofen for PDA (1, conservational management; 2, early ibuprofen treatment; and 3, late ibuprofen treatment). Treatment was stopped when PDA was closed, CVD score was zero or PDA needed ligation. Results VPIs with CVD scores < 3 had most PDA closure without surgery, and early ibuprofen treatment did not significantly affect PDA closure. VPIs with CVD scores ≥ 3 had some PDA closure after 2 courses of treatment, but closure rates decreased linearly with ibuprofen course (1st 75.2%, 2nd 62.3%, 3rd 50.0%, P < 0.0001), and early ibuprofen treatment (group B2) did not increase PDA closure compared to late ibuprofen treatment (group B3). In these same infants, the longer they were in CVD scores ≥ 3, the more the complications of preterm were increased (retinopathy of prematurity ROP 1st 16.5%, 2nd 23.8%, 3rd 29.6%, P = 0.016; bronchopulmonary dysplasia BPD 1st 15.5%, 2nd 26.7%, 3rd 33.8%, P < 0.0001; intraventricular hemorrhage IVH 1st 20.4%, 2nd 32.4%, 3rd 23.8%, P = 0.015). Conclusion Ibuprofen is suggested for PDA closure when the PDA reopens or has developed into the stage when the CVD score ≥ 3.

Download Full-text

Longitudinal Cognitive Assessment in Low-Risk Very Preterm Infants

Medicina ◽

10.3390/medicina58010133 ◽

2022 ◽

Vol 58 (1) ◽

pp. 133

Author(s):

Domenico M. Romeo ◽

Martina Ricci ◽

Federica Mirra ◽

Ilaria Venezia ◽

Maria Mallardi ◽

...

Keyword(s):

Preterm Infants ◽

Preschool Age ◽

Cognitive Outcomes ◽

Low Risk ◽

Neurological Deficits ◽

Cognitive Assessments ◽

Very Preterm Infants ◽

Very Preterm ◽

Normal Ranges ◽

Neurodevelopmental Impairment

Background and Objectives: Preterm infants are at higher risk of neurodevelopmental impairment both at preschool and school ages, even in the absence of major neurological deficits. The early identification of children at risk is essential for early intervention with rehabilitation to optimize potential outcomes during school years. The aim of our study is to assess cognitive outcomes at preschool age in a cohort of low-risk very preterm infants, previously studied at 12 and 24 months using the Griffiths scales. Materials and Methods: Sixty-six low-risk very preterm infants born at a gestational age of <32 weeks were assessed at 12 and 24 months corrected age using the Griffiths Mental Development Scales (second edition) and at preschool age with the Wechsler Preschool and Primary Scales of Intelligence (third edition) (WPPSI-III). Results: At 12 and 24 months and at preschool age, low-risk very preterm infants showed scores within normal ranges with similar scores in males and females. A statistically significant correlation was observed in the general developmental quotient between 12 and 24 months; a further significant correlation was observed between the early cognitive assessments and those performed at preschool age, with a better correlation using the assessments at 24 months. Conclusion: The present study showed a favourable trajectory of cognitive development in low-risk very preterm infants, from 12 months to preschool age.

Download Full-text

Growth and neurodevelopment in very preterm infants receiving a high enteral volume-feeding regimen – a population-based cohort study

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.1080/14767058.2017.1414796 ◽

2017 ◽

Vol 32 (10) ◽

pp. 1664-1672 ◽

Cited By ~ 4

Author(s):

Claus Klingenberg ◽

Fredrik Kragh Muraas ◽

Catherine Elde Isaksen ◽

Tina Nilsen ◽

Marte Torgersen ◽

...

Keyword(s):

Cohort Study ◽

Preterm Infants ◽

Population Based ◽

Very Preterm Infants ◽

Very Preterm ◽

Feeding Regimen

Download Full-text

Low breastfeeding continuation to 6 months for very preterm infants: A E uropean multiregional cohort study

Maternal and Child Nutrition ◽

10.1111/mcn.12657 ◽

2018 ◽

Vol 15 (1) ◽

Cited By ~ 9

Author(s):

Camille Bonnet ◽

Béatrice Blondel ◽

Aurélie Piedvache ◽

Emilija Wilson ◽

Anna‐Karin Edstedt Bonamy ◽

...

Keyword(s):

Cohort Study ◽

Preterm Infants ◽

Very Preterm Infants ◽

Very Preterm

Download Full-text

Neonatal care bundles are associated with a reduction in the incidence of intraventricular haemorrhage in preterm infants: a multicentre cohort study

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2018-316692 ◽

2019 ◽

Vol 105 (4) ◽

pp. 419-424 ◽

Cited By ~ 2

Author(s):

Karen de Bijl-Marcus ◽

Annemieke Johanna Brouwer ◽

Linda S De Vries ◽

Floris Groenendaal ◽

Gerda van Wezel-Meijler

Keyword(s):

Cohort Study ◽

Preterm Infants ◽

Periventricular Leukomalacia ◽

Intraventricular Haemorrhage ◽

Nursing Intervention ◽

Hospital Death ◽

Very Preterm Infants ◽

Very Preterm ◽

Multicentre Cohort Study ◽

Multicentre Cohort

ObjectiveTo investigate the effect of a nursing intervention bundle, applied during the first 72 hours of life, on the incidence of germinal matrix-intraventricular haemorrhage (GMH-IVH) in very preterm infants.DesignMulticentre cohort study.SettingTwo Dutch tertiary neonatal intensive care units.PatientsThe intervention group consisted of 281 neonates, whereas 280 infants served as historical controls (gestational age for both groups <30 weeks).InterventionsAfter a training period, the nursing intervention bundle was implemented and applied during the first 72 hours after birth. The bundle consisted of maintaining the head in the midline, tilting the head of the incubator and avoidance of flushing/rapid withdrawal of blood and sudden elevation of the legs.Main outcome measuresThe incidence of GMH-IVH occurring and/or increasing after the first ultrasound (but within 72 hours), cystic periventricular leukomalacia and/or in-hospital death was the primary composite outcome measure. Logistic regression analysis was used to explore differences between groups.ResultsThe nursing intervention bundle was associated with a lower risk of developing a GMH-IVH (any degree), cystic periventricular leukomalacia and/or mortality (adjusted OR 0.42, 95% CI 0.27 to 0.65). In the group receiving the bundle, also severe GMH-IVH, cystic periventricular leukomalacia and/or death were less often observed (adjusted OR 0.54, 95% CI 0.33 to 0.91).ConclusionsThe application of a bundle of nursing interventions is associated with reduced risk of developing a new/progressive (severe) GMH-IVH, cystic periventricular leukomalacia and/or mortality in very preterm infants when applied during the first 72 hours postnatally.

Download Full-text