scholarly journals B.02 Long-term neurodevelopmental outcomes in preterm twins

2019 ◽  
Vol 46 (s1) ◽  
pp. S10
Author(s):  
R Christensen ◽  
V Chau ◽  
A Synnes ◽  
R Grunau ◽  
S Miller
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Retinopathy Of Prematurity ◽  
Positive Impact ◽  
Preterm Neonates ◽  
Language Outcomes ◽  
Neurodevelopmental Outcomes ◽  
Movement Assessment ◽  
Discordant Twins ◽  
Over Time

Background: Preterm infants are at risk for adverse neurodevelopmental outcomes, however studies examining preterm twins are limited. The aim of this study was to examine whether preterm monozygotic (MZ) and dizygotic (DZ) twins have similar morbidities and long-term neurodevelopmental outcomes. Methods: From a cohort of 225 preterm neonates studied with MRI, 24 MZ and 52 DZ twins were included. Outcomes at 1.5-years, 3-years and 4.5-years were assessed with the Bayley-III, Movement Assessment Battery for Children and Wechsler Preschool and Primary Scale of Intelligence. Results: Twin pairs had substantial concordance for retinopathy of prematurity but only moderate-fair concordance for bronchopulmonary dysplasia, infection and brain injury. Differences in cognitive and language scores were stable over time, while motor differences increased. Discordant twins had significantly lower gestational age [Mean1(SD)=26.7(1.38); Mean2(SD)=29.1(2.1); P<0.001] and birth weight [Mean1(SD)=892.2(291.2); Mean2(SD)=1208.0(289.4); P=0.001] and a higher incidence of bronchopulmonary dysplasia and retinopathy of prematurity. In discordant twins, cognitive and language score differences decreased over time while motor differences increased. Conclusions: Preterm twin pairs have similar neurodevelopmental outcomes through early childhood despite poor concordance for perinatal illness. Discordant twins were born earlier and had more morbidities. Increasing concordance in cognitive and language outcomes over time may reflect the positive impact of early intervention programs.

Head circumference, total cerebral volume and neurodevelopment in preterm neonates

2021 ◽  
pp. fetalneonatal-2020-321397
Author(s):  
Thiviya Selvanathan ◽  
Ting Guo ◽  
Eddie Kwan ◽  
Vann Chau ◽  
Rollin Brant ◽  
...  
Keyword(s):  
Gestational Age ◽  
Head Circumference ◽  
Neonatal Intensive Care ◽  
Adverse Outcomes ◽  
White Matter Injury ◽  
Preterm Neonates ◽  
Strongly Correlated ◽  
Language Outcomes ◽  
Neurodevelopmental Outcomes ◽  
Movement Assessment

ObjectivesTo assess the association of head circumference (HC) <10th percentile at birth and discharge from the neonatal intensive care unit (NICU) with neurodevelopment in very preterm (24–32 weeks’ gestational age) neonates, and to compare the association of HC and total cerebral volume (TCV) with neurodevelopmental outcomes.DesignIn a prospective cohort, semiautomatically segmented TCV and manually segmented white matter injury (WMI) volumes were obtained. Multivariable regressions were used to study the association of HC and TCV with neurodevelopmental outcomes, accounting for birth gestational age, WMI and postnatal illness.SettingParticipants born in 2006–2013 at British Columbia Women’s Hospital were recruited.Patients168 neonates had HC measurements at birth and discharge and MRI at term-equivalent age (TEA). 143 children were assessed at 4.5 years.Main outcome measuresMotor, cognitive and language outcomes at 4.5 years were assessed using the Movement Assessment Battery for Children Second Edition (M-ABC) and Wechsler Preschool and Primary Scale of Intelligence Third Edition Full Scale IQ (FSIQ) and Verbal IQ (VIQ).ResultsSmall birth HC was associated with lower M-ABC and FSIQ scores. In children with small birth HC, small discharge HC was associated with lower M-ABC, FSIQ and VIQ scores, while normal HC at discharge was no longer associated with adverse outcomes. HC strongly correlated with TCV at TEA. TCV did not correlate with outcomes.ConclusionsSmall birth HC is associated with poorer neurodevelopment, independent of postnatal illness and WMI. Normalisation of HC during NICU care appears to moderate this risk.

Antenatal corticosteroids and neurodevelopmental outcomes in late preterm births

2021 ◽  
pp. fetalneonatal-2021-322152
Author(s):  
Amir Aviram ◽  
Kellie Murphy ◽  
Sarah McDonald ◽  
Elizabeth Asztalos ◽  
Arthur Zaltz ◽  
...  
Keyword(s):  
Birth Weight ◽  
Neonatal Resuscitation ◽  
Late Preterm ◽  
Preterm Neonates ◽  
Neurocognitive Disorder ◽  
Antenatal Corticosteroids ◽  
Neurodevelopmental Outcomes ◽  
Increased Risk ◽  
Visual Testing

ObjectivesAntenatal corticosteroids (ACS) decrease neonatal mortality and morbidity among preterm neonates, yet there has been concern regarding their long-term safety. We hypothesised that potential long-term adverse effects of ACS may be observed among infants born during the late preterm period (LPT, 340/7–366/7 weeks of gestation), when the benefits of ACS are subtle.DesignPopulation-based, retrospective cohort.SettingOntario, Canada, between 2006 and 2011.PatientsAll live singleton infants born during the LPT period with a minimum 5-year follow-up.InterventionsExposure to ACS prior to 340/7 weeks of gestation.Main outcome measuresSuspected neurocognitive disorder, audiometry testing or visual testing.ResultsOverall, 25 668 infants were eligible for analysis, of whom 2689 (10.5%) received ACS. Infants in the ACS group had lower mean birth weight and higher rates of birth weight <10th percentile, neonatal resuscitation and neonatal intensive care unit admission. At 5 years of age, ACS exposure was associated with an increased risk of suspected neurocognitive disorder (adjusted HR (aHR) 1.12, 95% CI 1.05 to 1.20), audiometry testing (aHR 1.20, 95% CI 1.10 to 1.31) and visual testing (aHR 1.06, 95% CI 1.01 to 1.11).ConclusionIn children born during the LPT period, exposure to ACS prior to 340/7 weeks of gestation is associated with an increased utilisation of the healthcare system related to audiometry and visual testing and suspected neurocognitive disorders by 5 years of age.

scholarly journals Severe Retinopathy of Prematurity Is Not Independently Associated With Worse Neurodevelopmental Outcomes in Preterm Neonates

2021 ◽  
Vol 9 ◽  
Author(s):  
Marie Altendahl ◽  
Myung Shin Sim ◽  
Artemiy Kokhanov ◽  
Bradley Gundlach ◽  
Irena Tsui ◽  
...  
Keyword(s):  
Health Insurance ◽  
Retinopathy Of Prematurity ◽  
Preterm Neonates ◽  
Neurodevelopmental Outcomes ◽  
Age Cohort ◽  
Male Sex ◽  
The Relationship ◽  
Type 1 Rop

Purpose: To evaluate the relationship between retinopathy of prematurity (ROP) severity and neurodevelopmental outcomes in premature neonates at 0–36 months corrected age.Methods: A retrospective chart review was performed on 228 neonates screened for ROP at the UCLA Mattel Children's Hospital between 2011 and 2018. Demographic information, clinical outcomes, ROP severity (no ROP, type 1 ROP, type 2 ROP), and Bayley-III neurodevelopmental scores were collected. Infants were grouped into corrected age cohorts (0–12, 12–24, and 24–36 months) to assess neurodevelopmental outcomes with increasing age. Within each age cohort, ANOVA and Chi-Square testing were used to detect differences in birth characteristics and neurodevelopmental scores between infants with type 1 ROP, type 2 ROP, or no ROP. Univariable analyses assessed the relationship between ROP severity and neurodevelopmental outcomes within each age cohort. A multivariable analysis was then performed to determine if ROP severity remained significantly associated with worse neurodevelopmental scores after controlling for birth weight (BW), intraventricular hemorrhage grade (IVH), health insurance type, male sex, and age at Bayley testing.Results: Without controlling for factors associated with prematurity, neonates with type 1 ROP had poorer cognition (p = 0.001) and motor (p = 0.006) scores at ages 0–12 months and poorer cognition (p = 0.01), language (p = 0.04) and motor (p = 0.04) scores at ages 12–24 months than infants without ROP, but no significant differences were detected at ages 24–36 months. After adjusting for BW, IVH, insurance type, male sex, and age at Bayley testing, ROP severity was no longer associated with worse neurodevelopmental scores in any domain.Conclusion: This study emphasizes that poorer neurodevelopmental outcomes in preterm neonates are most likely related to lower birthweight, associated co-morbidities of prematurity, and socioeconomic factors such as health insurance, not severity of ROP itself.

scholarly journals Cranial Ultrasound in Preterm Neonates: Screening of at Risk Infants for Long Term Neurodevelopmental Impairments

2016 ◽  
Vol 6 (1) ◽  
pp. 28-32 ◽  
Author(s):  
Mirza Md Ziaul Islam ◽  
Md Atiqul Islam ◽  
M Monir Hossain ◽  
Naila Zaman Khan
Keyword(s):  
At Risk ◽  
Preterm Neonates ◽  
Ultrasound Finding ◽  
Cranial Ultrasound ◽  
Variable Degree ◽  
Ultrasound Scanning ◽  
Inclusion Criteria ◽  
Neurodevelopmental Outcomes ◽  
Neurodevelopmental Abnormalities

Background: Preterm birth is associated with variable degree of brain injury and adverse neurodevelopmental outcomes. Therefore, screening of these infants is required to assess further neurodevelopmental abnormalities. Cranial ultrasound finding has been a predictor of outcome in this population.Objective: The present study was carried out to find cranial ultrasound abnormalities in preterm neonates to aid in screening at risk infants for long term neurodevelopmenal impairment.Materials and Methods: This observational study was conducted in Dhaka Shishu (Children) Hospital from October 2011 to March 2012. Total 103 preterm neonates who met the inclusion criteria were enrolled in the study. The neonates underwent cranial ultrasound (cUS) scan just after admission and before discharge for screening at risk infants.Results: Total 103 neonates were enrolled with mean age of 7.67 days in neonates with normal cUS findings and 7.23 days in neonates with abnormal cUS findings. Mean gestational age was 31.94 weeks in neonates with normal cUS and 31.85 weeks in neonates with abnormal cUS findings with mean weight 1.83 and 1.81 kg respectively. Among the neonates, 64 (62.1%) were males and 39 (37.9%) were females. Before discharge, out of 103 preterm neonates, 56 (54.3%) had normal cUS and 47 (45.7%) had abnormal cUS findings of which 22 (21.4%) had cerebral edema, 17 (16.5%) IVH and 8 (7.8%) had ventricular dilatation.Conclusion: Routine cranial ultrasound scanning of preterm neonates may aid in identifying at risk infants for long term neurodevelopmental impairments.J Enam Med Col 2016; 6(1): 28-32

scholarly journals Reference: The role of corticosteroids in a preterm infant with lung pathology in the first three months of life.

2021 ◽  
Author(s):  
Femi Adeniyi
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Scientific Evidence ◽  
Extensive Study ◽  
Preterm Neonates ◽  
Lung Pathology ◽  
Selective Treatment ◽  
Term Outcome ◽  
Long Term Outcome

Corticosteroids are helpful in the treatment of preterm neonates at risk of bronchopulmonary dysplasia (BPD). However, its usefulness depends on patient selection, the timing of intervention with a corticosteroid, and choice of corticosteroid. In making these clinical choices, one must consider both short and long-term outcomes. Although corticosteroid use has been available for decades in preterm neonatal care, many aspects of corticosteroid use are unresolved due to limited research. Corticosteroids cause upregulation of anti-inflammatory, inhibiting pro-inflammatory mediators at the genomic level. Furthermore, the benefits of using corticosteroids should outweigh the known risks. Here we will discuss the current literature to guide clinical practice—a literature search for evidence through the clinical database on EMBASE, Medline, PubMed, and Cochrane. The keywords are bronchopulmonary dysplasia, corticosteroids, and prematurity.Limitations.There is bias due to limited research available to provide a high level of scientific evidence on the use of different modes of administration, other agents compared to the systemic use of dexamethasone. Conclusion.The consensus in the prevention of BPD is selective treatment after one week of life with dexamethasone. There is limited evidence to suggest the role of prophylaxis hydrocortisone in preventing BPD and advise to be considered in centers with a high risk of BPD. An extensive study into prophylaxis hydrocortisone for prevention of BDP and long-term outcome appears to be promising.The role of instilled steroids with surfactants at birth appears promising in the single-center study. A multicentre double-blinded randomized intratracheal budesonide use at delivery will be valuable.

scholarly journals Predicting long-term neurodevelopmental outcomes in very preterm neonates by umbilical cord gas parameters

2020 ◽  
pp. 100248
Author(s):  
Sima H. Baalbaki ◽  
S. Lindsay Wood ◽  
Alan T. Tita ◽  
Jeff M. Szychowski ◽  
William W. Andrews ◽  
...  
Keyword(s):  
Umbilical Cord ◽  
Preterm Neonates ◽  
Neurodevelopmental Outcomes ◽  
Very Preterm

PREDICTORS OF BRONCHOPULMONARY DYSPLASIA DEVELOPMENT AND COMORBIDITIES OF PREMATURITY ASSOCIATED WITH RESPIRATORY SUPPORT TECHNIQUES IN PREMATURE NEONATES

2021 ◽  
Vol 74 (7) ◽  
pp. 1699-1706
Author(s):  
Olena Yu. Sorokina ◽  
Anna V. Bolonska
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Necrotizing Enterocolitis ◽  
Bronchopulmonary Dysplasia ◽  
Retinopathy Of Prematurity ◽  
Cox Regression ◽  
Respiratory Support ◽  
Preterm Neonates ◽  
Support Materials ◽  
Clinical Variables

The aim of the study was to analyze and identify risk factors for the development of moderate and severe bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis in preterm neonates in intensive care unit and during any kind of respiratory support. Materials and methods: A simple retrospective-prospective blind controlled non-randomised study included 28-32 weeks of gestational age 122 newborns with respiratory distress syndrom, who were treated in the neonatal intensive care units of two medical institutions of Dnipro from 2016 to 2020. Among 122 children neonates were divided into two groups according to particularities of respiratory support, prior type of noinvasive ventilation and infusion volume per day. The uni-variate Cox regressions using clinical variables identified specific clinical variables associated with development of moderate and severe BPD, retinopathy of prematurity, necrotizing enterocolitis, mortality rate (based on odds ratio and 95% confidence interval (95% CI). Then, significant clinical variables were used to build a multivariate Cox regression models. by backwards elimination of non-significant clinical variables. To estimate discriminative ability of comorbidities predictors we conducted ROC-analysis. Results: The patients with moderate and severe BPD significantly longer were mechanically ventilated and received О2 more than 30% in inhaled gas mixture, therefore every day of MV and/or additional oxygen >30% led to increase in probability of BPD development by 15% (p=0,01), АUC=0,78 (95% CI 0,66-0,89). Significant predictors of moderate and severe retinopathy of prematurity were body weight (AUC 0,64 (95% CI 0,51-0,77) (p=0.03), duration of non-invasive ventilation by NIV PC (AUC 0,68 (95% CI 0,54-0,83) (p <0.01), CPAP (AUC 0.63) (95% CI 0.49-0.76) (p = 0,04) and caffeine administration (AUC 0,68 (95% CI 0,59-0,77) (p=0.01). Patients who developed NEC had a statistically significantly lower daily infusion volume AUC 0,68 (0,59-0,77) p <0.01, later onset of enteral nutrition AUC 0,68 (95% CI 0,59-0,77) p <0.01, lower hemoglobin levels on the first, third and seventh days of life AUC 0,67 (95% CI 0,57-0,77) p <0.01, as well as the level of leukocytes AUC 0,65 (95% CI 0,56-0,75) p = 0,01 and platelet count AUC 0,67 (0,58-0,77) (p <0.01) during the first 7 days of life. Conclusions: The results of the study revealed risk factors for intensive care in general and respiratory support in particular, which significantly increase the risk of developing comorbidities of prematurity. Among them are relatively controlled, it is the duration of mechanical ventilation and NIV, which increase the risk of BPD and retinopathy of prematurity. Other risk factors which we can manage include nutrition state, anemia and supplemental oxygen.

Outcomes of a uniformly active approach to infants born at 22–24 weeks of gestation

2021 ◽  
pp. fetalneonatal-2020-320486
Author(s):  
Fanny Söderström ◽  
Erik Normann ◽  
Maria Jonsson ◽  
Johan Ågren
Keyword(s):  
Visual Impairment ◽  
Developmental Delay ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Retinopathy Of Prematurity ◽  
Ductus Arteriosus ◽  
Neurodevelopmental Outcomes ◽  
Active Approach ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

ObjectiveTo determine survival and outcomes in infants born at 22–24 weeks of gestation in a centre with a uniformly active approach to management of extremely preterm infants.Study designSingle-centre retrospective cohort study including infants born 2006–2015. Short-term morbidities assessed included retinopathy of prematurity, necrotising enterocolitis, patent ductus arteriosus, intraventricular haemorrhage, periventricular malacia and bronchopulmonary dysplasia. Neurodevelopmental outcomes assessed included cerebral palsy, visual impairment, hearing impairment and developmental delay.ResultsTotal survival was 64% (143/222), ranging from 52% at 22 weeks to 70% at 24 weeks. Of 133 (93%) children available for follow-up at 2.5 years corrected age, 34% had neurodevelopmental impairment with 11% classified as moderately to severely impaired. Treatment-requiring retinopathy of prematurity, severe bronchopulmonary dysplasia, visual impairment and developmental delay correlated with lower gestational age.ConclusionsA uniformly active approach to all extremely preterm infants results in survival rates that are not distinctly different across the gestational ages of 22–24 weeks and more than 50% survival even in infants at 22 weeks. The majority were unimpaired at 2.5 years, suggesting that such an approach does not result in higher rates of long-term adverse neurological outcome.

scholarly journals HIGH SYSTEMIC BLOOD PRESSURE IN PRETERM INFANTS WITH BRONCHOPULMONARY DYSPLASIA AND LONG-TERM OUTCOMES

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e20-e20
Author(s):  
Florence Cayouette ◽  
Sarah Spénard ◽  
Anie Lapointe ◽  
Véronique Dorval ◽  
Julie Sommer ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Neurodevelopmental Outcome ◽  
Systemic Blood Pressure ◽  
Control Group ◽  
Neurodevelopmental Outcomes ◽  
Systemic Blood ◽  
Neurodevelopmental Impairment

Abstract BACKGROUND Bronchopulmonary dysplasia (BPD) is a known risk factor for neurodevelopmental impairment in preterm infants. BPD is also associated with an increased incidence of high systemic blood pressure (HBP). However, it is not known if a diagnosis of HBP in BPD patients relates to later neurodevelopmental outcomes. OBJECTIVES We aimed to determine the incidence of neonatal HBP diagnosis in a cohort of preterm infants born <29 weeks of gestational age (GA) with BPD. The secondary objective was to assess if a concomitant diagnosis of BPD and HBP influences neurodevelopmental outcomes at 18 months. DESIGN/METHODS We performed a single center retrospective study using data from medical charts. All infants born <29 weeks GA admitted to our level-IV neonatal intensive care unit between January 2010 and December 2012 diagnosed with BPD at 36 weeks of corrected GA were included. Patients transferred before 36 weeks of corrected GA, that died before 18 months or had congenital anomalies were excluded. Patients were classified in the HBP group if HBP was a documented diagnosis in the chart. The control group was the remaining patients with BPD at 36 weeks corrected GA but without HBP. Severe neurodevelopmental impairment at 18 months was defined as either any Bailey-III score <70, cerebral palsy or severe hearing or visual impairment. Descriptive statistics for prenatal and postnatal patients’ characteristics were analyzed. Logistic regression was performed for factors associated with long-term disability. Level of significance was determined as a p value <0.05. RESULTS During the study period, 337 preterm infants <29 weeks of GA were identified and after exclusions, 98 newborns met the criteria of BPD at 36 weeks corrected GA. Mean GA and mean birth weight were 26.7 ± 1.7 weeks and 882 ± 199 g respectively. The majority were males (57%) and received antenatal steroids (87.8%). We identified twenty-five newborns (25.5%) with a diagnosis of HBP. Demographic data was similar between the 2 groups. 56% of the HBP group received a post-natal course of steroids, compared to 36% for the control group (p 0.07). The neurodevelopmental outcome at 18 months was similar between the two groups (p 0.54) and was not influenced by the presence of a HBP diagnosis after regression analysis (p 0.8). CONCLUSION The diagnosis of HBP was frequent in our cohort of preterm infants born <29 weeks GA with BPD but did not seem to be related to long-term neurodevelopmental outcomes.

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