Early energy restriction in premature infants and bronchopulmonary dysplasia: a cohort study

2020 ◽  
Vol 123 (9) ◽  
pp. 1024-1031
Author(s):  
Jose Uberos ◽  
Sara Jimenez-Montilla ◽  
Manuel Molina-Oya ◽  
Jose Luis García-Serrano
Keyword(s):  
Cohort Study ◽  
Energy Intake ◽  
Bronchopulmonary Dysplasia ◽  
Neonatal Intensive Care ◽  
Animal Studies ◽  
Very Low Birth Weight ◽  
Fold Increase ◽  
Clinical History ◽  
Energy Restriction ◽  
Adjusted Risk

AbstractBronchopulmonary dysplasia (BPD) is a multifactor pathology. Animal studies and cohort studies suggest that poor nutrient intake after birth increases the risk of BPD. The objective of the present study was to determine the existence of association between BPD in very low birth weight (VLBW) and energy intake during the first week of life. We recorded in a retrospective cohort study the intake of enteral and parenteral macronutrients during this period by examining the nutritional and clinical history of 450 VLBW newborns admitted to the neonatal intensive care unit. After applying the relevant exclusion criteria, data for 389 VLBW infants were analysed, of whom 159 developed some degree of BPD. Among the newborns with BPD, energy and lipid intake was significantly lower and fluid intake was significantly higher. The energy intake for the 25th percentile in the group without BPD was 1778·2 kJ/kg during the first week of life. An energy intake <1778·2 kJ/kg in this period was associated with a 2-fold increase in the adjusted risk of BPD (OR 2·63, 95 % CI 1·30, 5·34). The early nutrition and the increase of energy intake in the first week of life are associated in our sample with a lower risk of BPD developing.

The Use of Dexamethasone in Premature Infants at Risk for Bronchopulmonary Dysplasia or Who Already Have Developed Chronic Lung Disease: A Cautionary Note

PEDIATRICS ◽  
1991 ◽  
Vol 88 (2) ◽  
pp. 413-414
Author(s):  
LEE FRANK
Keyword(s):  
Risk Factors ◽  
Bronchopulmonary Dysplasia ◽  
Animal Studies ◽  
Very Low Birth Weight ◽  
Double Blind Study ◽  
Dexamethasone Treatment ◽  
Double Blind ◽  
High Incidence ◽  
Potential Risk Factors ◽  
Clinical Problems

To the Editor.— The distressingly high incidence of bronchopulmonary dysplasia (BPD) in today's very low birth weight premature infant population and the prolonged morbidity and tumultuous clinical problems associated with BPD in these tiny infants have led to a trial usage of dexamethasone treatment to try to assuage these problems in this patient population. The report of Kazzi et al1 is noteworthy because the authors not only indicate in clear fashion the failure of relatively prolonged dexamethasone treatment to ameliorate the hospital course of infants with BPD (in a randomized prospective double-blind study), but they also clearly identify potential risk factors associated with dexamethasone treatment that are of concern to them as clinical investigators, risk factors based both on clinical and experimental animal studies.

scholarly journals Assessment of Safety, Immunogenicity and Preventive Efficacy of Prevenar-13 in Children with Bronchopulmonary Dysplasia

2018 ◽  
Vol 17 (2) ◽  
pp. 65-69
Author(s):  
E. S. Zubova ◽  
V. V. Semerikov ◽  
L. V. Sofronova ◽  
M. P. Kostinov
Keyword(s):  
Adverse Event ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Very Low Birth Weight ◽  
Fold Increase ◽  
Adverse Event Following Immunization ◽  
Age Related ◽  
Preventive Efficacy ◽  
The Central Nervous System ◽  
First Year Of Life

Relevance. Bronchopulmonary dysplasia (BPD) is the most frequent chronic pathology of the lungs in children of the first year of life, especially among children born with extremely low and very low  birth weight.Goal. The safety, immunogenicity and preventive efficacy of Prevenar 13 in preterm infants with bronchopulmonary dysplasia were assessedMaterials and methods.There were 29 children under observation, as well as 29 non-vaccinated children as a comparison group. Oxygen support was not needed by any child with BPD. Children in both groups had consequences of perinatal involvement of the central nervous system. Prevenar 13 vaccine was used for immunization.Results. The level vaccine adverse event following immunization in the group of vaccinated children was 16.7 ± 0.07%. One child had a  high body temperature up to 39.5 °C, it was required to prescribe  antipyretic drugs in the age-related dosage. All vaccine adverse event following immunization disappeared on 2 day. Local reactions were not recorded.Conclusions.The use of the Prevenar13 vaccine has established high preventive efficacy among preterm infants with BPD, a decrease in the incidence of otitis media by 3.5 times. Evaluation of  the immunogenicity of the Prevenar 13 vaccine among children with  BPD showed good immunological efficacy (a 4-fold increase in the mean geometric titer of antibodies at 28 days after vaccination).

Improved Survival Accounts for Most, but Not All, of the Increase in Bronchopulmonary Dysplasia

PEDIATRICS ◽  
1992 ◽  
Vol 90 (5) ◽  
pp. 663-668 ◽  
Author(s):  
Robert A. Parker ◽  
Daniel P. Lindstrom ◽  
Robert B. Cotton
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Bronchopulmonary Dysplasia ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Hyaline Membrane Disease ◽  
Logistic Regression Models ◽  
Changes In Risk ◽  
Adjusted Incidence ◽  
Minute Apgar Score

The incidence of bronchopulmonary dysplasia (BPD) increased from 10.6% in 1976 through 1980, to 21.7% (1981 through 1985), and to 32.9% (1986 through 1990) in very low birth weight neonates (1500 g or less) admitted to the Vanderbilt Neonatal Intensive Care Unit, while there was a concurrent decline in incidence of neonatal death (NEOD) during the same periods (26.4%, 18.3%, and 15.9%, respectively). Population changes in risk factors (birth weight, sex, race, location of birth, gestational age, diagnosis of hyaline membrane disease, and 5-minute Apgar score) over time do not account for this increase. To estimate the proportion of the increase in BPD attributable to the concurrent decline in NEOD during these periods, separate logistic regression models for NEOD and BPD were calculated from patients born during 1976 through 1985. These results were used to predict the expected number of cases of NEOD and BPD during 1986 through 1990, assuming that the adjusted incidence of NEOD and BPD remained constant from 1976 through 1985, to 1986 through 1990. The increase in the combined outcome, NEOD/BPD, over the three time periods (34.2%, 36.1%, and 43.5%) remained statistically significant after adjustment for the risk factors listed above. During 1986 through 1990, the predicted number of NEOD was 83 more than the number observed, while the predicted number with BPD was 115 less than the number observed. If all 83 averted cases of NEOD during 1986 through 1990 had developed BPD, then 83 (72%) of the 115 excess cases of BPD could be attributed to averted NEOD. The approximate 95% confidence interval for this estimate was 58% to 87%. These results indicate that while most of the excess cases of BPD in 1986 through 1990 could be explained by neonates who previously would have died, there were still additional cases of BPD that were not explained by the risk factors included in this analysis.

scholarly journals Maternal and neonatal outcomes in COVID-19 infected pregnancies: a prospective cohort study

2020 ◽  
Vol 27 (7) ◽  
Author(s):  
Reihaneh Pirjani ◽  
Reihaneh Hosseini ◽  
Tahereh Soori ◽  
Maryam Rabiei ◽  
Ladan Hosseini ◽  
...  
Keyword(s):  
Cohort Study ◽  
Pregnant Women ◽  
Neonatal Intensive Care ◽  
Neonatal Outcomes ◽  
Control Group ◽  
Adjusted Risk ◽  
Adjusted Risk Ratio ◽  
Significant Difference ◽  
Maternal And Neonatal Outcomes ◽  
Delivery Type

Abstract Background Despite the large number of pregnant women with the coronavirus disease 2019 (COVID-19), there is not enough analytical study to compare maternal and fetal consequences of COVID-19 infected with non-infected pregnancies. This cohort study aimed to compare maternal and fetal consequences of COVID-19 infected with non-infected pregnancies. Methods We included pregnant women with and without COVID-19 who were admitted to Arash Hospital in Tehran, Iran, from 1 March to 1 September 2020. Clinical features, treatments, and maternal and fetal outcomes were assessed. Results A total of 199 women enrolled, including 66 COVID-19 infected and 133 non-infected pregnant women prospectively. Caesarean section was carried out in total 105 women (52.76%). A significant difference was found in term of delivery type between COVID-19 infected and non-infected pregnant women [adjusted risk ratio (aRR): 1.31, 95% confidence interval (CI): 1.04, 1.65, P = 0.024]. No significant association was found between COVID-19 infection and preterm birth (aRR: 1.16, 95% CI: 0.54, 2.48, P = 0.689), low birth weight (aRR: 1.13, 95% CI: 0.55, 2.31, P = 0.723), gestational diabetes (aRR: 1.67, 95% CI: 0.81, 3.42, P = 0.160), pre-eclampsia (aRR: 2.02, 95% CI: 0.42, 6.78, P = 0.315), intrauterine growth restriction (aRR: 0.16, 95% CI: 0.02, 1.86, P = 0.145), preterm rupture of membrane (aRR: 0.19, 95% CI: 0.02, 2.20, P = 0.186), stillbirth (aRR: 1.41, 95% CI: 0.08, 18.37, P = 0.614), postpartum haemorrhage (aRR: 1.84, 95% CI: 0.39, 8.63, P = 0.185), neonatal intensive care unit (ICU) admission (aRR: 1.84, 95% CI: 0.77, 4.39, P = 0.168) and neonatal sepsis (aRR: 0.84, 95% CI: 0.48, 1.48, P = 0.568). The percentage of patients (4/66, 6.06%) being admitted to the ICU was significantly higher than the control group (0%) (P &lt; 0.001). Conclusion Basically, although pregnancy and neonatal outcomes were not significantly different, the need for ICU care for pregnant women with COVID-19 was significantly higher compared with those without COVID-19.

scholarly journals Neurodesenvolvimento de Grandes Prematuros ou Recém-Nascidos com Muito Baixo Peso: Comparação de Gémeos Monocoriónicos e Bicoriónicos com Recém-Nascidos de Gestação Unifetal

2016 ◽  
Vol 29 (11) ◽  
pp. 702 ◽  
Author(s):  
Adelaide Taborda ◽  
Guiomar Oliveira
Keyword(s):  
Cerebral Palsy ◽  
Developmental Delay ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Monochorionic Twins ◽  
Logistic Regression Models ◽  
Adjusted Risk ◽  
Neurodevelopmental Delay ◽  
Very Preterm ◽  
Increased Risk

Introduction: Twins are associated with a delayed development and cerebral palsy. The purpose of this work was to compare the neurologic morbidity in very preterm or very low birth weight dichorionic and monochorionic twins with singletons.Material and Methods: We conducted a retrospective cohort study of livebirths lowest through 32 weeks of gestation or very low weight infants admitted to Neonatal Intensive Care Unit of a level III hospital, between 2006 and 2010. Development was evaluated with the Growing Skills II Scale at 24 months of age. Cerebral palsy was defined by predetermined criteria by Surveillance of Cerebral Palsy in Europe. Infants were analyzed as twins and singletons cohort. Within the twin category the infants were further separated as dichorionic and monochorionic and were compared with singletons infants. Logistic regression models were used to control for demographic and clinical factors.Results: The cohort of infants who were assessed for neurodevelopmental impaired, consisted of 194 singletons infants and 89twins (50 dichorionic; 39 monochorionic). Monochorionic twins, when compared with the singletons, showed an increased risk of severe developmental delay in these areas: locomotion (adjusted OR 12.2) language (adjusted OR 6.5) and autonomy (adjusted OR 7.2). Cerebral palsy was diagnosed in 4.1% of singleton infants and 15.4% of monochorionic twins. The adjusted risk of severe developmental delay and cerebral palsy in monochorionic twins was 3.6 and 4.2, respectively.Discussion: This work showed higher rate of moderate and severe neurodevelopment delay including cerebral palsy in monochorionic twins compared to singletons infants. Analysis by groups stratified according to gestational age and comparison of monochorionic and dichorionic twins displayed the role of chorionicity for these neurodevelopmental disorders.Conclusions: In our sample the monochorionic twins are associated with an independent risk of neurodevelopmental delay.

Individualized Behavioral and Environmental Care for the Very Low Birth Weight Preterm Infant at High Risk for Bronchopulmonary Dysplasia: Neonatal Intensive Care Unit and Developmental Outcome

PEDIATRICS ◽  
1986 ◽  
Vol 78 (6) ◽  
pp. 1123-1132 ◽  
Author(s):  
Heidelise Als ◽  
Gretchen Lawhon ◽  
Elizabeth Brown ◽  
Rita Gibes ◽  
Frank H. Duffy ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Intensive Care Unit ◽  
Bronchopulmonary Dysplasia ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Behavioral Regulation ◽  
Care Giving

We hypothesize that the respiratory and functional states of the very low birth weight infant with bronchopulmonary dysplasia can be improved in the neonatal intensive care unit by prevention of inappropriate sensory input. To test this hypothesis, we developed for preterm newborns a behavior observation method that catalogues specific reaction patterns according to putative stress and relaxation behaviors. We then collected behavioral information and heart rate, respiratory rate, and transcutaneous PO2 readings before, during, and after routine care-giving interventions. Eight control and eight experimental infants were selected for study based on the following criteria: birth weight &lt;1,250 g, gestational age &lt;28 weeks, on the respirator &gt;24 hours in first 48 hours of life at ≥0.6O FiO2 for more than two hours during first 48 hours of life. Additionally, the two groups were comparable on other medical and demographic variables, including severity of respiratory status for the first ten days and incidence of intraventricular hemorrhage, patent ductus arteriosus, and socioeconomic status. Systematic observations were conducted on days 10, 20, and 30 after birth and at 36 and 40 weeks postconception. For the intervention infants, our observations were discussed with the infants' primary nurses, and individualized modifications for each infant's care plan were implemented based on these observations. Experimental infants showed significantly briefer stays on the respirator (P &lt; .01) and in increased FiO2 (P &lt; .05). Their feeding behavior was normalized significantly earlier (P &lt; .01). Experimental infants also showed significantly better behavioral regulation scores at 1 month after their mothers' estimated dates of confinement (post-EDC), as measured with the Assessment of Preterm Infants' Behavior, significantly better Mental and Psychomotor Developmental Indices at 3, 6, and 9 months post-EDC, as measured with the Bayley Scales of Infant Development, and significantly better behavioral regulation scores at 9 months post-EDC, as measured in a videotaped play observation. Measurements of weight, height, and head circumference at 3, 6, and 9 months post-EDC showed no differences. All assessments were performed by one of two trained testers not familiar with the goals of the study or the group status of the infant. These results support the hypothesis that very low birth weight preterm babies profit significantly both medically and developmentally from individualized behavioral care in the neonatal intensive care unit.

Optimised retinopathy of prematurity screening guideline in China based on a 5-year cohort study

2020 ◽  
pp. bjophthalmol-2020-316401
Author(s):  
Qian Yang ◽  
Xiaohong Zhou ◽  
Yingqin Ni ◽  
Haidong Shan ◽  
Wenjing Shi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retinopathy Of Prematurity ◽  
Neonatal Intensive Care ◽  
Predictive Performance ◽  
Screening Guideline ◽  
Postmenstrual Age ◽  
The Mean ◽  
Type 1 Rop ◽  
Rop Screening

PurposesTo develop an optimised retinopathy of prematurity (ROP) screening guideline by adjusting the screening schedule and thresholds of gestational age (GA) and birth weight (BW).MethodsA multicentre retrospective cohort study was conducted based on data from four tertiary neonatal intensive care units in Shanghai, China. The medical records of enrolled infants, born from 2012 to 2016 who underwent ROP examinations, were collected and analysed. The incidence and risk factors for ROP were analysed in all infants. Postnatal age (PNA) and postmenstrual age (PMA) of infants, detected to diagnose ROP for the first time, were compared with the present examination schedule. The predictive performance of screening models was evaluated by internally validating sensitivity and specificity.ResultsOf the 5606 eligible infants, ROP was diagnosed in 892 (15.9%) infants; 63 (1.1%) of them received treatment. The mean GA of ROP patients was 29.4±2.4 weeks, and the mean BW was 1260±330 g. Greater prematurity was associated with an older PNA at which ROP developed. The minimum PMA and PNA at which diagnosis of treatable ROP occurred were 32.43 and 3 weeks, respectively. The optimised criteria (GA <32 weeks or BW <1600 g) correctly predicted 98.4% type 1 ROP infants, reducing the infants requiring examinations by 43.2% when internally validated.ConclusionsThe incidence of type 1 ROP and the mean GA and BW of ROP infants have decreased in China. The suggested screening threshold and schedule may be reliably used to guide the modification of ROP screening guideline and decrease medical costs.

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