Evaluation of the congenital hypothyroidism detection strategy in extremely preterm infants in western Andalusia

2021 ◽  
Author(s):  
Ricardo Rubio-Sánchez ◽  
David Núñez-Jurado ◽  
Enrique Melguizo-Madrid ◽  
Ana Isabel Álvarez-Ríos ◽  
Carmen Delgado-Pecellín
Keyword(s):  
Retrospective Study ◽  
Preterm Infants ◽  
Congenital Hypothyroidism ◽  
Premature Infants ◽  
Free T4 ◽  
Detection Strategy ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Screening Population ◽  
The Moment

Objective: To identify extremely premature infants (< 31 weeks of gestation and/or < 1,500 grams) affected by congenital hypothyroidism (CH) with delayed elevation of thyrotropin (TSH) and to evaluate the detection strategy for this pathology in our reference screening population. Study Design: A descriptive and retrospective study was carried out with samples collected from western Andalusia and the autonomous city of Ceuta. Results: This protocol allowed us to detect six neonates with delayed TSH elevation. One of them, due to serious heart problems, died without being able to confirm CH. In two neonates, however, it was possible to detect CH, another two presented a persistent TSH elevation but normal free T4, and another one presented a temporary TSH elevation. Conclusion: It is essential to repeat the CH screening in extremely premature infants; not only at the age of 15 days, but also with a third sample at the moment of hospital discharge to detect cases with delayed TSH elevation.

scholarly journals Reference values for N-terminal Pro-brain natriuretic peptide in premature infants during their first weeks of life

2020 ◽  
Author(s):  
Agnes-Sophie Fritz ◽  
Titus Keller ◽  
Angela Kribs ◽  
Christoph Hünseler
Keyword(s):  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Preterm Infants ◽  
Premature Infants ◽  
Reference Values ◽  
Gestational Age ◽  
Temporal Distribution ◽  
Cross Sectional ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Abstract The aim of our study was to observe the temporal distribution of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) in premature infants of ≤ 31 weeks of gestational age (GA) during the first weeks of life. NT-proBNP values of 118 preterm infants born ≤ 31 weeks GA were determined during the first week of life, after 4 ± 1 weeks of life, and at a corrected GA of 36 ± 2 weeks. Infants were divided into two groups: those without relevant complications and those with complications related to prematurity. NT-proBNP values of infants without complications define our exploratory reference values. The Median NT-proBNP level of these infants was 1896 ng/l (n = 27, interquartile range (IQR): 1277–5200) during the first week of life, 463 ng/l (n = 26, IQR: 364–704) at 4 ± 1 weeks of life, and 824 ng/l (n = 33, IQR: 714–1233) at a corrected GA of 36 ± 2 weeks. Infants born < 28 + 0 weeks GA had significantly higher NT-proBNP values (n = 9, median: 5200, IQR: 1750–8972) than infants born ≥ 28 + 0–31 weeks GA (n = 18, median: 1528, IQR: 838–3052; p = 0.017). Growth restriction or PDA status could not account for the difference in NT-proBNP values between GA groups. Conclusions: The results of our observational and cross-sectional study describe exploratory reference values for NT-proBNP levels in preterm infants of ≤ 31 weeks GA according to postnatal age. NT-proBNP levels during the first week of life are high and widely distributed in preterm infants and decrease subsequently to reach a distinctly lower and stable plateau at around 1 month of life. Our results suggest an influence of GA on NT-proBNP values in the first week of life. What is Known:• Several complications related to prematurity, e.g., hemodynamically significant PDA, pulmonary hypertension, bronchopulmonary dysplasia, and retinopathy of prematurity, have been associated with a temporary rise in NT-proBNP values in preterm infants during their first weeks of life.What is New:• This observational study provides reference values for NT-proBNP levels of very and extremely preterm infants during their first weeks of life.• In premature infants without complications, NT-proBNP values during their first week of life depend on gestational age at birth.

scholarly journals Psychosocial support for parents of extremely preterm infants in neonatal intensive care: a qualitative interview study

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
Anna Bry ◽  
Helena Wigert
Keyword(s):  
Intensive Care ◽  
Preterm Infants ◽  
Premature Infants ◽  
Emotional Support ◽  
Neonatal Intensive Care ◽  
Psychosocial Support ◽  
Medical Condition ◽  
Qualitative Interview Study ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Abstract Background Extremely premature infants (those born before 28 weeks’ gestational age) are highly immature, requiring months of care at a neonatal intensive care unit (NICU). For parents, their child’s grave medical condition and prolonged hospitalization are stressful and psychologically disruptive. This study aimed at exploring the needs of psychosocial support of parents of extremely premature infants, and how the NICU as an organization and its staff meets or fails to meet these needs. Method Sixteen open-ended interviews were conducted with 27 parents after their infant’s discharge from the NICU. Inductive content analysis was performed. Results Four themes were identified: Emotional support (with subthemes Empathic treatment by staff, Other parents as a unique source of support, Unclear roles of the various professions); Feeling able to trust the health care provider; Support in balancing time spent with the infant and other responsibilities; Privacy. Parents of extremely premature infants needed various forms of emotional support at the NICU, including support from staff, professional psychological help and/or companionship with other patients’ parents. Parents were highly variable in their desire to discuss their emotional state with staff. The respective roles of nursing staff, social workers and psychologists in supporting parents emotionally and identifying particularly vulnerable parents appeared unclear. Parents also needed to be able to maintain a solid sense of trust in the NICU and its staff. Poor communication with and among staff, partly due to staff discontinuity, damaged trust. Parents struggled with perceived pressure from staff to be at the hospital more than they could manage and with the limited privacy of the NICU. Conclusions The complex and individual psychosocial needs of parents of extremely preterm infants present many challenges for the NICU and its staff. Increasing staffing and improving nurses’ competence in addressing psychosocial aspects of neonatal care would help both nurses and families. Clarifying the roles of different professions in supporting parents and developing their teamwork would lessen the burden on nurses. Communicating with parents about their needs and informing them early in their NICU stay about available support would be essential in helping them cope with their infant’s hospitalization.

scholarly journals CEREBRAL OXYGENATION AND PERIPHERAL OXIMETRY IN EXTREMELY PRETERM INFANTS WITH PULMONARY AND/OR CEREBRAL INTRAVENTRICULAR HEMORRHAGE IN THE FIRST 72 HOURS OF LIFE

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e22-e23
Author(s):  
Thierry Beausoleil ◽  
Marie Janaillac ◽  
Keith Barrington ◽  
Marie-Josée Raboisson ◽  
Oliver Karam ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Preterm Infants ◽  
Premature Infants ◽  
Cross Correlation ◽  
Cerebral Oxygenation ◽  
Invasive Monitoring ◽  
Time Frequency ◽  
Non Invasive ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Abstract BACKGROUND Extremely premature infants born <28 weeks of gestation are at higher risk of pulmonary (PH) and cerebral intraventricular (IVH) hemorrhage due to immature cardiovascular and transitioning physiology. Non-invasive monitoring has the potential to detect early abnormal circulation. OBJECTIVES To explore time-frequency relationships between cerebral oxygenation and peripheral oximetry. DESIGN/METHODS Near infrared spectroscopy cerebral regional haemoglobin oxygen saturation (CrSO2), preductal peripheral perfusion index (PI), heart rate (HR), capillary oxygen saturation (SpO2), and blood pressure (BP) were monitored in the first 72h of life. Patients were grouped in infants with PH and/or IVH (n=8) and controls (n=10). Signals were decomposed in wavelets allowing the analysis of localized variations of power. This approach allowed to quantify the common power and determine the duration of significant cross-correlation, phase and coherence between each pair of signals. Groups were compared with Wilcoxon tests. RESULTS Figure 1 shows an example of CrSO2 and PI, and their cross-correlation, phase (semblance) and coherence in a control (left column) and a PH-IVH patient (right column). Durations of significant cross-correlation between CrSO2 and HR (p<0.01), and CrSO2 and SpO2 (p=0.02) were significantly lower in PH-IVH infants compared to controls. The duration of significant anti-phase between CrSO2 and SpO2 (p=0.01) and the duration of significant coherence between PI and BP (p=0.03) were also significantly lower in PH-IVH infants compared to controls. These differences may indicate a disruption in auto-regulation, which is currently incompletely understood in this population. CONCLUSION This study is the first to apply time-frequency analysis to simultaneous NIRS and preductal peripheral oximetry in extremely preterm infants early in life. Significantly lower durations of cross-correlation (CrSO2 with HR and SpO2), anti-phase (CrSO2, SpO2) and coherence (PI, BP) in PH-IVH patients may reflect early abnormal circulation. Our results show the potential of non-invasive monitoring to identify premature infants at-risk of early PH-IVH.

scholarly journals Radiation Exposure of Premature Infants Beyond the Perinatal Period

2018 ◽  
Vol 8 (11) ◽  
pp. 672-678
Author(s):  
Alexander H. Hogan ◽  
Eran Bellin ◽  
Lindsey Douglas ◽  
Terry L. Levin ◽  
Nora Esteban-Cruciani
Keyword(s):  
Radiation Exposure ◽  
Preterm Infants ◽  
Premature Infants ◽  
Low Socioeconomic Status ◽  
Urban Hospital ◽  
Term Infants ◽  
Hospital System ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Birth Hospitalization

OBJECTIVES: To determine the odds of premature compared with term infants exceeding the recommended radiation exposure threshold in the first year after discharge from birth hospitalization. METHODS: In this observational retrospective cohort study, we compared the radiation exposure of premature and term infants between 2008 and 2015 in an urban hospital system. The primary outcome was crossing the radiation exposure threshold of 1 millisievert. We assessed prematurity’s effect on this outcome with multivariable logistic regression. RESULTS: In our study, 20 049 term and 2047 preterm infants met inclusion criteria. The population was approximately one-half female, predominantly multiracial or people of color (40% African American and 44% multiracial), and of low socioeconomic status. Premature infants had 2.25 times greater odds of crossing the threshold compared with term infants after adjustment for demographics (95% confidence interval [CI]: 1.66–3.05). Adjustment for complex chronic conditions, which are validated metrics of pediatric chronic illness, attenuated this association; however, premature infants still had 1.58 times greater odds of crossing the threshold (95% CI: 1.16–2.15). When the final model was analyzed by degree of prematurity, very preterm and extremely preterm infants were significantly more likely to cross the threshold (1.85 [95% CI: 1.03–3.32] and 2.53 [95% CI: 1.53–4.21], respectively), whereas late preterm infants were not (1.14 [95% CI: 0.73–1.78]). CONCLUSIONS: Premature infants crossed the recommended radiation threshold more often than term infants in the year after discharge from birth hospitalization.

scholarly journals Absence of relationship between serum cortisol and critical illness in premature infants

2021 ◽  
pp. fetalneonatal-2020-319970
Author(s):  
Irina Prelipcean ◽  
James Lawrence Wynn ◽  
Lindsay Thompson ◽  
David James Burchfield ◽  
Laurence James-Woodley ◽  
...  
Keyword(s):  
Critical Illness ◽  
Preterm Infants ◽  
Premature Infants ◽  
Gestational Age ◽  
Serum Cortisol ◽  
Illness Severity ◽  
Cortisol Concentration ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
The Relationship

BackgroundInadequate cortisol production in response to critical illness in extremely preterm infants may exacerbate poor outcomes. Despite commonly measuring cortisol concentration and administering hydrocortisone for presumed adrenal insufficiency, the relationship between serum cortisol concentration and illness severity remains unclear in this unique population.ObjectiveTo determine the relationship between cortisol concentrations and illness severity as measured by the Score for Neonatal Acute Physiology II, neonatal Sequential Organ Failure Assessment and Vasoactive-Inotropic Score in premature infants.Design/MethodsThis retrospective, single-center cohort study included preterm infants born <30 weeks gestational age admitted to a level IV neonatal intensive care unit (NICU) between June 2011 and July 2018, who had a serum cortisol obtained for clinical indications before 36 weeks PMA. Demographic data were collected on infants and mothers. Nine clinical variables were identified a priori that could potentially modify cortisol concentration including critical illness. Univariate and multivariable analyses determined the relationship between cortisol concentration and each of these variables.ResultsA total of 224 preterm infants with pretreatment serum cortisol concentration met criteria for inclusion. The median (IQR) gestational age at birth was 25 weeks (24, 26) and at cortisol measurement was 26 weeks (25, 28). The median cortisol was 13.3 ug/dL. Non-survivors had the highest values. Cortisol concentration did not correlate with any of the selected illness severity scores.Conclusion(s)Cortisol concentrations in extremely preterm infants did not correlate with illness severity regardless of gestational age. Further studies are needed to identify clinically useful mediators of adrenal dysfunction and to guide clinical management.

scholarly journals Early spectral EEG in preterm infants correlates with neurocognitive outcomes in late childhood

2022 ◽  
Author(s):  
Tone Nordvik ◽  
Eva M. Schumacher ◽  
Pål G. Larsson ◽  
Are H. Pripp ◽  
Gro C. Løhaugen ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Premature Infants ◽  
Adaptive Behavior ◽  
Composite Score ◽  
Late Childhood ◽  
List Type ◽  
Neurodevelopmental Outcomes ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Neurocognitive Outcomes

Abstract Background Evidence regarding the predictive value of early amplitude-integrated electroencephalography (aEEG)/EEG on neurodevelopmental outcomes at school age and beyond is lacking. We  aimed to investigate whether there is an association between early postnatal EEG and neurocognitive outcomes in late childhood. Methods This study is an observational prospective cohort study of premature infants with a gestational age <28 weeks. The total absolute band powers (tABP) of the delta, theta, alpha, and beta bands were analyzed from EEG recordings during the first three days of life. At 10–12 years of age, neurocognitive outcomes were assessed using the Wechsler Intelligence Scale for Children 4th edition (WISC-IV), Vineland adaptive behavior scales 2nd edition, and Behavior Rating Inventory of Executive Function (BRIEF). The mean differences in tABP were assessed for individuals with normal versus unfavorable neurocognitive scores. Results Twenty-two infants were included. tABP values in all four frequency bands were significantly lower in infants with unfavorable results in the main composite scores (full intelligence quotient, adaptive behavior composite score, and global executive composite score) on all three tests (p < 0.05). Conclusions Early postnatal EEG has the potential to assist in predicting cognitive outcomes at 10–12 years of age in extremely premature infants <28 weeks’ gestation. Impact Evidence regarding the value of early postnatal EEG in long-term prognostication in preterm infants is limited. Our study suggests that early EEG spectral analysis correlates with neurocognitive outcomes in late childhood in extremely preterm infants. Early identification of infants at-risk of later impairment is important to initiate early and targeted follow-up and intervention.

Delayed cord clamping in infants born less than 35 weeks: A retrospective study

2020 ◽  
pp. 1-5
Author(s):  
N. Singh ◽  
D. Brammer
Keyword(s):  
Retrospective Study ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Primary Outcome ◽  
Practice Variation ◽  
Delayed Cord Clamping ◽  
Cord Clamping ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
The Difference

BACKGROUND: Evidence supports delayed cord clamping (DCC) in preterm infants. However, practice variation exists, and many preterm infants do not receive DCC despite multiple benefits and lack of harm. We aim to 1) study the rate of DCC in preterm infants, 2) compare the difference between infants who received DCC and those who did not receive DCC and 3) investigate the reasons for not performing DCC. METHODS: We conducted this retrospective study to evaluate DCC practice at our institution since its implementation in September 2015. We collected and analyzed the data on DCC of 30–45 sec duration in inborn infants <  35 weeks gestation admitted to the neonatal intensive care unit from June 2016- June 2019. The primary outcome was the rate of delayed cord clamping. RESULTS: Of the 447 infants, 275 (62%) received DCC. The rate of DCC was 36% , 54% , and 66% in infants <  27 weeks, 27–29 weeks and >  30 weeks gestation, respectively (p = 0.001). Infants not receiving DCC were smaller, of lower gestational age, and more likely to be delivered via cesarean section than those who received DCC (p <  0.0001). Infants not receiving DCC had a higher rate of receiving PPV or intubation and a 1minute Apgar score of <  5 compared to those receiving DCC. We could not establish the reason for not performing DCC because of inadequate documentation in the medical records. CONCLUSIONS: The rate of DCC is low in clinical practice, in particular among extremely preterm infants.

Life expectancy of extremely preterm infants

2007 ◽  
Vol 148 (48) ◽  
pp. 2279-2284 ◽  
Author(s):  
Gabriella Vida ◽  
Ilona Sárkány ◽  
Simone Funke ◽  
Judit Gyarmati ◽  
Judit Storcz ◽  
...  
Keyword(s):  
Life Expectancy ◽  
Preterm Infants ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Optimális esetben a 24–28. gesztációs hét közötti, igen éretlen újszülöttek olyan szülészeti intézményben születnek, ahol neonatalis intenzív centrum működik, így mind az akut, mind a hosszú távú ellátásukat magas színvonalon biztosítják. A PTE OEKK ÁOK Szülészeti és Nőgyógyászati Klinikán 2000. január 1. és 2004. december 31. között 7499 újszülött született. A koraszülési frekvencia 20% (1499/7499), ezen belül az extrém alacsony gesztációs korúak aránya (≦28. gesztációs hét) 18% (272/1499), míg a 25. gesztációs hét alattiaké 3,2% (48/1499) volt. A túlélés a gesztációs hetek emelkedésével fokozatosan javul. Az életben maradt koraszülöttek későbbi életkilátásai és társadalmi beilleszkedése függ az olyan maradandó károsodásoktól, mint a látáscsökkenés, halláskárosodás, somatomentalis fejlődés zavarai, krónikus tüdőbetegség. A klinikán vizsgált alacsony gesztációs korú csoportban az összes fogyatékkal élő betegek aránya 15,3%. Döntő többségük a 25. gesztációs hétnél korábban született koraszülöttek közül kerül ki. A 26. gesztációs héttől a koraszülöttek több mint fele tartós károsodás nélkül éli túl az extrém éretlenség társuló problémáit. Megállapították, hogy a korai koponya-ultrahangvizsgálattal, szemészeti szűréssel, otoacusticus emissio mérésével jól prognosztizálhatók a maradandó károsodások, így lehetővé válik a korai kezelés.

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