Initiating delivery room stabilization/resuscitation in very low birth weight (VLBW) infants with an FiO2 less than 100% is feasible

Abstract Background Neonatal hypothermia, defined as a temperature < 36.5°C, is a major contributor to neonatal mortality and morbidity. Hypothermia in preterm infants remains a challenge in the neonatal intensive care unit (NICU) for many reasons.Objective To investigate the incidence of admission hypothermia (AH) in very low-birth weight (VLBW) infants in multiple NICUs in Shandong Province, China, and to provide clinical evidence for the implementation of quality improvement practices to reduce the incidence of AH in NICU.Methods This retrospective, observational study was carried out over a period of 12 months, from January 1, 2018 to December 31, 2018. The correlations between hypothermia preventive measures and the incidence of AH were analysed by descriptive statistical methods and a Spearman analysis. The associations between AH and maternal and neonatal variables were tested with bivariate analyses, followed by stepwise logistic regression. P <0.05 was considered statistically significant.Results A total of 1639 in-born infants who were born at a weight less than 1500 g were enrolled in the study on their day of birth. Among them, 1295 VLBW infants fulfilled the inclusion criteria. The incidence of AH was 87.9% in VLBW infants among the 28 NICUs. We investigated whether team training and education, such as monthly chart reporting on hypothermia in preterm infants on admission to the NICU, which was associated with 10.7% of all the cases, could decrease the rate of AH. Indeed, transport with a heated transport incubator was associated with 9.3% of the cases. here was a negative correlation between the incidence of AH and the number of quality improvement measures implemented to prevent hypothermia (r= -0.242, p <0.05). A low birth weight, intubation in the delivery room , and a low 5-min Apgar score were significantly associated with AH. Conclusion: The incidence of AH was high. There was a negative correlation between the incidence of AH and the number of quality improvement measures implemented to prevent hypothermia. It is important to monitor for AH in newborns who have a low birth weight, who have a low Apgar score at 5 min and who require intubation in the delivery room.

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Reduced Formula Intake with Donor Milk (DM) Impacts Necrotizing Enterocolitis (NEC) in Very Low Birth Weight (VLBW) Infants:

PEDIATRICS ◽

10.1542/peds.137.supplement_3.443a ◽

2016 ◽

Vol 137 (Supplement 3) ◽

pp. 443A-443A

Author(s):

Jennifer S. Wicks ◽

Anita L. Esquerra-Zwiers ◽

Laura M. Rogers ◽

Celina M. Scala ◽

Shirley Chen ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Necrotizing Enterocolitis ◽

Very Low Birth Weight ◽

Donor Milk ◽

Vlbw Infants

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Sex-Specific Long-Term Trends in Length of Hospital Stay, Postmenstrual Age at Discharge, and Survival in Very Low Birth Weight Infants

Neonatology ◽

10.1159/000515899 ◽

2021 ◽

pp. 1-9

Author(s):

Matthias Fröhlich ◽

Tatjana Tissen-Diabaté ◽

Christoph Bührer ◽

Stephanie Roll

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Hospital Stay ◽

Very Low Birth Weight ◽

Survival Rates ◽

Length Of Hospital Stay ◽

Mortality Rates ◽

Vlbw Infants ◽

Postmenstrual Age ◽

Over Time

Introduction: In very low birth weight (<1,500 g, VLBW) infants, morbidity and mortality have decreased substantially during the past decades, and both are known to be lower in girls than in boys. In this study, we assessed sex-specific changes over time in length of hospital stay (LOHS) and postmenstrual age at discharge (PAD), in addition to survival in VLBW infants. Methods: This is a single-center retrospective cohort analysis based on quality assurance data of VLBW infants born from 1978 to 2018. Estimation of sex-specific LOHS over time was based on infants discharged home from neonatal care or deceased. Estimation of sex-specific PAD over time was based on infants discharged home exclusively. Analysis of in-hospital survival was performed for all VLBW infants. Results: In 4,336 of 4,499 VLBW infants admitted from 1978 to 2018 with complete data (96.4%), survival rates improved between 1978–1982 and 1993–1997 (70.8 vs. 88.3%; hazard ratio (HR) 0.20, 95% confidence interval 0.14, 0.30) and remained stable thereafter. Boys had consistently higher mortality rates than girls (15 vs. 12%, HR 1.23 [1.05, 1.45]). Nonsurviving boys died later compared to nonsurviving girls (adjusted mean survival time 23.0 [18.0, 27.9] vs. 20.7 [15.0, 26.3] days). LOHS and PAD assessed in 3,166 survivors displayed a continuous decrease over time (1978–1982 vs. 2013–2018: LOHS days 82.9 [79.3, 86.5] vs. 60.3 [58.4, 62.1] days); PAD 40.4 (39.9, 40.9) vs. 37.4 [37.1, 37.6] weeks). Girls had shorter LOHS than boys (69.4 [68.0, 70.8] vs. 73.0 [71.6, 74.4] days) and were discharged with lower PAD (38.6 [38.4, 38.8] vs. 39.2 [39.0, 39.4] weeks). Discussion/Conclusions: LOHS and PAD decreased over the last 40 years, while survival rates improved. Male sex was associated with longer LOHS, higher PAD, and higher mortality rates.

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Predictors of Mortality Among Very Low Birth Weight Infants With Gastrointestinal Perforation

The American Surgeon ◽

10.1177/0003134820956928 ◽

2020 ◽

pp. 000313482095692

Author(s):

Marina L. Reppucci ◽

Eliza H. Hersh ◽

Prerna Khetan ◽

Brian A. Coakley

Keyword(s):

Metabolic Acidosis ◽

Birth Weight ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

Severe Metabolic Acidosis ◽

Related Factors ◽

Vlbw Infants ◽

Risk Of Death ◽

Portal Venous Gas ◽

Elevated Lactate

Background Gastrointestinal (GI) perforation is a risk factor for mortality in very low birth weight (VLBW) infants. Little data exist regarding pretreatment factors and patient characteristics known to independently correlate with risk of death. Materials and Methods A retrospective review of all VLBW infants who sustained GI perforation between 2011 and 2018 was conducted. Birth, laboratory, and disease-related factors of infants who died were compared to those who survived. Results 42 VLBW infants who sustained GI perforations were identified. Eleven (26.19%) died. There were no significant differences in birth-related factors, hematological lab levels at diagnosis, presence of pneumatosis, or bacteremia. Portal venous gas ( P = .03), severe metabolic acidosis ( P < .01), and elevated lactate at diagnosis ( P < .01) were statistically more likely to occur among infants who died. Discussion Portal venous gas, severe metabolic acidosis, and elevated lactate were associated with an increased risk of mortality among VLBW infants who develop a GI perforation. Further research is required to better identify risk factors.

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A Single-Center Experience with Very Low Birth Weight Infants and Focal Intestinal Perforation: Comparison of Primary Anastomosis versus Stoma Opening

European Journal of Pediatric Surgery ◽

10.1055/s-0037-1605348 ◽

2017 ◽

Vol 28 (05) ◽

pp. 426-432

Author(s):

Dario Consonni ◽

Francesco Macchini ◽

Giovanni Parente ◽

Andrea Zanini ◽

Stefania Franzini ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Intestinal Perforation ◽

Very Low Birth Weight ◽

Primary Anastomosis ◽

P Value ◽

Single Center ◽

Vlbw Infants ◽

Single Center Experience ◽

Focal Intestinal Perforation

Introduction We present a single-center experience with very low birth weight (VLBW) infants with focal intestinal perforation (FIP), comparing the results of primary anastomosis (PA) and stoma opening (SO). Materials and Methods Clinical records of VLBW infants with FIP who underwent surgery between 2006 and 2015 were reviewed. Patients were divided into two groups according to the procedure performed: limited bowel resection and PA or SO. Patients with gastric perforation or patients who underwent clip and drop were excluded. Information regarding birth weight (BW), gestational age (GA), weight at surgery (WS), number of abdominal reoperations, duration of parenteral nutrition (PN), and demise was recorded. Results In this study, 40 patients were included: 22 in PA group and 18 in SO group. BW was 865 g in PA and 778 in SO (p-value: 0.2). GA was 26.1 weeks in PA and 25.6 in SO (p-value: 0.3). WS was 1,014 g in PA and 842 in SO (p-value: 0.09). Duration of surgery was 115 minutes in PA and 122 in SO (p-value: 0.67). Five patients (23%) belonging to PA group developed complications and required SO. Five patients (23%) demised in PA group and six (33%) in SO (p-value: 0.2). Seventeen abdominal reoperations were performed in PA group and 22 in SO group (p-value: 0.08). Conclusion Both procedures appear to be safe. When possible, PA should be performed as it reduces the number of abdominal reinterventions.

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Epoprostenol for very low birth weight (VLBW) infants: a novel dilution protocol

La Pediatria Medica e Chirurgica ◽

10.4081/pmc.2013.31 ◽

2013 ◽

Vol 35 (5) ◽

Cited By ~ 1

Author(s):

S. Rugolotto ◽

R. Beghini ◽

I. Cogo ◽

G. Sidoti ◽

E.M. Padovani ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

Vlbw Infants

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Effect of red blood cell transfusion on short-term outcomes in very low birth weight infants

Clinical and Experimental Pediatrics ◽

10.3345/kjp.2019.00990 ◽

2020 ◽

Vol 63 (2) ◽

pp. 56-62

Author(s):

Eui Young Lee ◽

Sung Shin Kim ◽

Ga Young Park ◽

Sun Hyang Lee

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Blood Cell ◽

Red Blood Cell ◽

Very Low Birth Weight ◽

Short Term ◽

Vlbw Infants ◽

Early Onset Sepsis ◽

The Relationship ◽

Rbc Transfusion

Background: Red blood cell (RBC) transfusion improves cardiorespiratory status of preterm infants by increasing circulating hemoglobin, improving tissue oxygenation, and reducing cardiac output. However, RBC transfusion itself has also been suggested to negatively affect short-term outcomes such as intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and necrotizing enterocolitis (NEC) in premature infants.Purpose: This study aimed to analyze the relationship between RBC transfusion and short-term outcomes in very low birth weight (VLBW) infants (birth weight, <1,500 g).Methods: We retrospectively reviewed the medical records of VLBW infants admitted to the Soonchunhyang University Bucheon Hospital between October 2010 and December 2017. Infants who died during hospitalization were excluded. The infants were divided into 2 groups according to RBC transfusion status. We investigated the relationship between RBC transfusion and short-term outcomes including BPD, ROP, NEC, and IVH.Results: Of the 250 enrolled VLBW infants, 109 (43.6%) underwent transfusion. Univariate analysis revealed that all shortterm outcomes except early-onset sepsis and patent ductus arteriosus were associated with RBC transfusion. In multivariate analysis adjusted for gestational age, birth weight and Apgar score at 1 minute, RBC transfusion was significantly correlated with BPD (odds ratio [OR], 5.42; P<0.001) and NEC (OR, 3.40; P= 0.009).Conclusion: RBC transfusion is significantly associated with adverse clinical outcomes such as NEC and BPD in VLBW infants. Careful consideration of the patient’s clinical condition and appropriate guidelines is required before administration of RBC transfusions.

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