Mortality and neurological outcomes in extremely and very preterm infants born to mothers with hypertensive disorders of pregnancy

AbstractTo evaluate the impact of maternal hypertensive disorders of pregnancy (HDP) on mortality and neurological outcomes in extremely and very preterm infants using a nationwide neonatal database in Japan. This population-based retrospective study was based on an analysis of data collected by the Neonatal Research Network of Japan from 2003 to 2015 of neonates weighing 1,500 g or less at birth, between 22 and 31 weeks’ gestation. A total of 21,659 infants were randomly divided into two groups, HDP (n = 4,584) and non-HDP (n = 4,584), at a ratio of 1:1 after stratification by four factors including maternal age, parity, weeks of gestation, and year of delivery. Short-term (neonatal period) and medium-term (3 years of age) mortality and neurological outcomes were compared between the two groups by logistic regression analyses. In univariate analysis, HDP was associated with an increased risk for in-hospital death (crude odds ratio [OR], 1.31; 95% confidence interval, 1.04–1.63) and a decreased risk for severe intraventricular haemorrhage (0.68; 0.53–0.87) and periventricular leukomalacia (0.60; 0.48–0.77). In multivariate analysis, HDP was significantly associated with a lower risk for in-hospital death (adjusted OR, 0.61; 0.47–0.80), severe intraventricular haemorrhage (0.47; 0.35–0.63), periventricular leukomalacia (0.59; 0.45–0.78), neonatal seizures (0.40; 0.28–0.57) and cerebral palsy (0.70; 0.52–0.95) at 3 years after adjustment for covariates including birth weight. These results were consistent with those of additional analyses, which excluded cases with histological chorioamnionitis and which divided the infants into two subgroups (22–27 gestational weeks and 28–31 gestational weeks). Maternal HDP was associated with an increased risk for in-hospital death without adjusting for covariates, but it was also associated with a lower risk for mortality and adverse neurological outcomes in extremely and very preterm infants if all covariates except HDP were identical.

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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.

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24 Association of location of intubation procedure and number of tracheal intubation attempts with death or severe neurological injury among very preterm infants

Paediatrics & Child Health ◽

10.1093/pch/pxaa068.023 ◽

2020 ◽

Vol 25 (Supplement_2) ◽

pp. e9-e9

Author(s):

Anthony Debay ◽

Sharina Patel ◽

Pia Wintermark ◽

Martine Claveau ◽

François Olivier ◽

...

Keyword(s):

Tracheal Intubation ◽

Preterm Infants ◽

Physiological Stress ◽

Periventricular Leukomalacia ◽

Adverse Outcomes ◽

Neurological Injury ◽

Multivariable Logistic Regression Analysis ◽

Very Preterm Infants ◽

Very Preterm ◽

Increased Risk

Abstract Background The physiological stress induced by tracheal intubation (TI) is associated with increased risk of neurological injury among very preterm infants. The location of TI procedure and number of attempts required may contribute to adverse outcomes. Objectives We aimed to assess the association of location where TI is performed and the number of TI attempts with death and/or severe neurological injury (SNI) among very preterm infants born <33 weeks and intubated in the first 7 days of life. Design/Methods Retrospective cohort study of 442 infants born 23-32 weeks gestation, admitted to a Level 3 NICU 2015-2018 within the first 7 days of life. We excluded infants who were moribund and the ones with a major congenital anomaly. Data was collected from the Canadian Neonatal Network database and chart review. Exposures were location of TI (delivery room [DR] vs. NICU) and number of TI attempts (1 vs. >1) among infants intubated in the first 7 days of life. Primary outcome was death and/or SNI (intraventricular hemorrhage grade 3-4 and/or periventricular leukomalacia). Multivariable logistic regression analysis was used to assess the association between exposures and outcomes and adjust for confounders. Results Rate of intubation was 46% (202/442). Rate of death and/or SNI was 2.5% (6/240) among infants never intubated, 12% (13/105) among NICU TI, 32% (31/97) among DR TI, 20% (17/85) among infants with 1 TI attempt and 23% (27/117) among infants with >1 TI attempt. Rate of premedication use for NICU TI was 97% (102/105). Overall, median number of intubation attempts was 1 [IQR 1-2]. Compared to no TI, TI in the NICU (adjusted odds ratio [AOR] 3.39, 95% CI 1.20-10.53) and TI in the DR (AOR 9.28, 95% CI 3.33-29.43) were associated with higher odds of death and/or SNI. DR TI was associated with higher odds of death and/or SNI compared to NICU TI (AOR 2.73, 95% CI 1.23-6.35). Compared to no TI, 1 TI attempt (AOR 5.25, 95% CI 1.93-15.93) and >1 TI attempt (AOR 5.17, 95% CI 1.93-15.69) were associated with higher odds of death and/or SNI. The number of intubation attempts (1 vs. >1) was not associated with death and/or SNI (AOR 0.99, 95% CI 0.47-2.09). Conclusion Intubated infants have higher odds of death and/or SNI. Among intubated infants, DR TI is associated with higher odds of death and/or SNI vs. TI in the NICU with premedication. Optimizing non-invasive ventilation in the DR may help reduce brain injury in preterm infants.

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Adverse effects of small for gestational age differ by gestational week among very preterm infants

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2017-314171 ◽

2018 ◽

Vol 104 (2) ◽

pp. F192-F198 ◽

Cited By ~ 6

Author(s):

Erik A Jensen ◽

Elizabeth E Foglia ◽

Kevin C Dysart ◽

Rebecca A Simmons ◽

Zubair H Aghai ◽

...

Keyword(s):

Preterm Infants ◽

Gestational Age ◽

Small For Gestational Age ◽

Intraventricular Haemorrhage ◽

Neonatal Morbidity ◽

Excess Risk ◽

Very Preterm Infants ◽

Adjusted Risk ◽

Very Preterm ◽

Grade 3

ObjectiveTo characterise the excess risk for death, grade 3–4 intraventricular haemorrhage (IVH), bronchopulmonary dysplasia (BPD) and stage 3–5 retinopathy of prematurity independently associated with birth small for gestational age (SGA) among very preterm infants, stratified by completed weeks of gestation.MethodsRetrospective cohort study using the Optum Neonatal Database. Study infants were born <32 weeks gestation without severe congenital anomalies. SGA was defined as a birth weight <10th percentile. The excess outcome risk independently associated with SGA birth among SGA babies was assessed using adjusted risk differences (aRDs).ResultsOf 6708 infants sampled from 717 US hospitals, 743 (11.1%) were SGA. SGA compared with non-SGA infants experienced higher unadjusted rates of each study outcome except grade 3–4 IVH among survivors. The excess risk independently associated with SGA birth varied by outcome and gestational age. The highest aRD for death (0.27; 95% CI 0.13 to 0.40) occurred among infants born at 24 weeks gestation and declined as gestational age increased. In contrast, the peak aRDs for BPD among survivors (0.32; 95% CI 0.20 to 0.44) and the composites of death or BPD (0.35; 95% CI 0.24 to 0.46) and death or major morbidity (0.35; 95% CI 0.24 to 0.45) occurred at 27 weeks gestation. The risk-adjusted probability of dying or developing one or more of the evaluated morbidities among SGA infants was similar to that of non-SGA infants born approximately 2–3 weeks less mature.ConclusionThe excess risk for neonatal morbidity and mortality associated with being born SGA varies by adverse outcome and gestational age.

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Outcomes of intraventricular hemorrhage and posthemorrhagic hydrocephalus in a population-based cohort of very preterm infants born to residents of Nova Scotia from 1993 to 2010

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.11.peds14364 ◽

2015 ◽

Vol 15 (6) ◽

pp. 580-588 ◽

Cited By ~ 46

Author(s):

Julia A. E. Radic ◽

Michael Vincer ◽

P. Daniel McNeely

Keyword(s):

Cerebral Palsy ◽

Nova Scotia ◽

Preterm Infants ◽

Selection Bias ◽

Population Based ◽

Posthemorrhagic Hydrocephalus ◽

Very Preterm Infants ◽

Very Preterm ◽

Increased Risk ◽

Csf Shunting

OBJECT Intraventicular hemorrhage (IVH) is a common complication of preterm birth, and the prognosis of IVH is incompletely characterized. The objective of this study was to describe the outcomes of IVH in a population-based cohort with minimal selection bias. METHODS All very preterm (≥ 30 completed weeks) patients born in the province of Nova Scotia were included in a comprehensive database. This database was screened for infants born to residents of Nova Scotia from January 1, 1993, to December 31, 2010. Among very preterm infants successfully resuscitated at birth, the numbers of infants who died, were disabled, developed cerebral palsy, developed hydrocephalus, were blind, were deaf, or had cognitive/language scores assessed were analyzed by IVH grade. The relative risk of each outcome was calculated (relative to the risk for infants without IVH). RESULTS Grades 2, 3, and 4 IVH were significantly associated with an increased overall mortality, primarily in the neonatal period, and the risk increased with increasing grade of IVH. Grade 4 IVH was significantly associated with an increased risk of disability (RR 2.00, p < 0.001), and the disability appeared to be primarily due to cerebral palsy (RR 6.07, p < 0.001) and cognitive impairment (difference in mean MDI scores between Grade 4 IVH and no IVH: −19.7, p < 0.001). No infants with Grade 1 or 2 IVH developed hydrocephalus, and hydrocephalus and CSF shunting were not associated with poorer outcomes when controlling for IVH grade. CONCLUSIONS Grades 1 and 2 IVH have much better outcomes than Grades 3 or 4, including a 0% risk of hydrocephalus in the Grade 1 and 2 IVH cohort. Given the low risk of selection bias, the results of this study may be helpful in discussing prognosis with families of very preterm infants diagnosed with IVH.

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O-009. Intrauterine exposure to hypertensive disorders of pregnancy and postnatal growth in extremely and very preterm infants

Pregnancy Hypertension ◽

10.1016/j.preghy.2021.07.033 ◽

2021 ◽

Vol 25 ◽

pp. e28

Author(s):

Takafumi Ushida ◽

Satoru Katsuki ◽

Sho Tano ◽

Noriyuki Nakamura ◽

Tomomi Kotani ◽

...

Keyword(s):

Preterm Infants ◽

Postnatal Growth ◽

Hypertensive Disorders Of Pregnancy ◽

Very Preterm Infants ◽

Very Preterm ◽

Intrauterine Exposure ◽

Hypertensive Disorders

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Neurodevelopmental sequelae of intraventricular haemorrhage at 8 years of age in a regional cohort of ELBW/very preterm infants

Early Human Development ◽

10.1016/j.earlhumdev.2005.07.007 ◽

2005 ◽

Vol 81 (11) ◽

pp. 909-916 ◽

Cited By ~ 101

Author(s):

R.L. Sherlock ◽

P.J. Anderson ◽

L.W. Doyle

Keyword(s):

Preterm Infants ◽

Intraventricular Haemorrhage ◽

Very Preterm Infants ◽

Very Preterm

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Early Prediction of Periventricular Leukomalacia Using Quantitative Texture Analysis of Serial Cranial Ultrasound Scans in Very Preterm Infants

Ultrasound in Medicine & Biology ◽

10.1016/j.ultrasmedbio.2019.06.413 ◽

2019 ◽

Vol 45 (10) ◽

pp. 2658-2665

Author(s):

Hye Na Jung ◽

Sang-il Suh ◽

Arim Park ◽

Gun-ha Kim ◽

Inseon Ryoo

Keyword(s):

Texture Analysis ◽

Preterm Infants ◽

Periventricular Leukomalacia ◽

Early Prediction ◽

Cranial Ultrasound ◽

Very Preterm Infants ◽

Very Preterm

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Wide variation in severe neonatal morbidity among very preterm infants in European regions

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2017-313697 ◽

2018 ◽

Vol 104 (1) ◽

pp. F36-F45 ◽

Cited By ~ 17

Author(s):

Anna Karin Edstedt Bonamy ◽

Jennifer Zeitlin ◽

Aurélie Piedvache ◽

Rolf F Maier ◽

Arno van Heijst ◽

...

Keyword(s):

Medical Records ◽

Periventricular Leukomalacia ◽

Intraventricular Haemorrhage ◽

Neonatal Morbidity ◽

Mortality Rates ◽

Secondary Outcome ◽

Inhospital Mortality ◽

European Regions ◽

Very Preterm Infants ◽

Very Preterm

ObjectiveTo investigate the variation in severe neonatal morbidity among very preterm (VPT) infants across European regions and whether morbidity rates are higher in regions with low compared with high mortality rates.DesignArea-based cohort study of all births before 32 weeks of gestational age.Setting16 regions in 11 European countries in 2011/2012.PatientsSurvivors to discharge from neonatal care (n=6422).Main outcome measuresSevere neonatal morbidity was defined as intraventricular haemorrhage grades III and IV, cystic periventricular leukomalacia, surgical necrotizing enterocolitis and retinopathy of prematurity grades ≥3. A secondary outcome included severe bronchopulmonary dysplasia (BPD), data available in 14 regions. Common definitions for neonatal morbidities were established before data abstraction from medical records. Regional severe neonatal morbidity rates were correlated with regional in-hospital mortality rates for live births after adjustment on maternal and neonatal characteristics.Results10.6% of survivors had a severe neonatal morbidity without severe BPD (regional range 6.4%–23.5%) and 13.8% including severe BPD (regional range 10.0%–23.5%). Adjusted inhospital mortality was 13.7% (regional range 8.4%–18.8%). Differences between regions remained significant after consideration of maternal and neonatal characteristics (P<0.001) and severe neonatal morbidity rates were not correlated with mortality rates (P=0.50).ConclusionSevere neonatal morbidity rates for VPT survivors varied widely across European regions and were independent of mortality rates.

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