Extremely preterm infants had a higher fat mass at discharge compared to very preterm infants

Abstract Study Objectives Preterm infants undergoing intensive care are often placed prone to improve respiratory function. Current clinical guidelines recommend preterm infants are slept supine from 32 weeks’ postmenstrual age, regardless of gestational age at birth. However, respiratory function is also related to gestational and chronological ages and is affected by sleep state. We aimed to identify the optimal timing for adopting the supine sleeping position in preterm infants, using a longitudinal design assessing the effects of sleep position and state on cardiorespiratory stability. Methods Twenty-three extremely (24–28 weeks’ gestation) and 33 very preterm (29–34 weeks’ gestation) infants were studied weekly from birth until discharge, in both prone and supine positions, in quiet and active sleep determined by behavioral scoring. Bradycardia (heart rate ≤100 bpm), desaturation (oxygen saturation ≤80%), and apnea (pause in respiratory rate ≥10 s) episodes were analyzed. Results Prone positioning in extremely preterm infants reduced the frequency of bradycardias and desaturations and duration of desaturations. In very preterm infants, prone positioning only reduced the frequency of desaturations. The position-related effects were not related to postmenstrual age. Quiet sleep in both preterm groups was associated with fewer bradycardias and desaturations, and also reduced durations of bradycardia and desaturations in the very preterm group. Conclusions Cardiorespiratory stability is improved by the prone sleep position, predominantly in extremely preterm infants, and the improvements are not dependent on postmenstrual age. In very preterm infants, quiet sleep has a more marked effect than the prone position. This evidence should be considered in individualizing management of preterm infant positioning.

Download Full-text

Customized Human Milk Fortification Based on Measured Human Milk Composition to Improve the Quality of Growth in Very Preterm Infants: A Mixed-Cohort Study Protocol

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020823 ◽

2021 ◽

Vol 18 (2) ◽

pp. 823

Author(s):

Manuela Cardoso ◽

Daniel Virella ◽

Israel Macedo ◽

Diana Silva ◽

Luís Pereira-da-Silva

Keyword(s):

Human Milk ◽

Preterm Infants ◽

Fat Mass ◽

Study Protocol ◽

Milk Composition ◽

Fixed Dose ◽

Very Preterm Infants ◽

Very Preterm ◽

Pea Pod

Adequate nutrition of very preterm infants comprises fortification of human milk (HM), which helps to improve their nutrition and health. Standard HM fortification involves a fixed dose of a multi-nutrient HM fortifier, regardless of the composition of HM. This fortification method requires regular measurements of HM composition and has been suggested to be a more accurate fortification method. This observational study protocol is designed to assess whether the target HM fortification method (contemporary cohort) improves the energy and macronutrient intakes and the quality of growth of very preterm infants, compared with the previously used standard HM fortification (historical cohorts). In the contemporary cohort, a HM multi-nutrient fortifier and modular supplements of protein and fat are used for HM fortification, and the enteral nutrition recommendations of the European Society for Paediatric Gastroenterology Hepatology and Nutrition for preterm infants will be considered. For both cohorts, the composition of HM is assessed using the Miris Human Milk analyzer (Uppsala, Sweden). The quality of growth will be assessed by in-hospital weight, length, and head circumference growth velocities and a single measurement of adiposity (fat mass percentage and fat mass index) performed just after discharge, using the air displacement plethysmography method (Pea Pod, Cosmed, Italy). ClinicalTrials.gov registration number: NCT04400396.

Download Full-text

Role of beta-2-microglobulin as a biomarker in very preterm and extremely preterm infants with CNS inflammation

PLoS ONE ◽

10.1371/journal.pone.0216498 ◽

2019 ◽

Vol 14 (5) ◽

pp. e0216498

Author(s):

Albert Batista Muñoz ◽

Stephanie Hadley ◽

Marti Iriondo Sanz ◽

Thais Agut Quijano ◽

Marta Camprubí Camprubí

Keyword(s):

Preterm Infants ◽

Cns Inflammation ◽

Very Preterm ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Beta 2 ◽

Beta 2 Microglobulin

Download Full-text

Changes in perinatal care and survival in very preterm and extremely preterm infants in The Netherlands between 1983 and 1995

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/s0301-2115(03)00328-2 ◽

2004 ◽

Vol 112 (2) ◽

pp. 170-177 ◽

Cited By ~ 19

Author(s):

Sabine Anthony ◽

Lya den Ouden ◽

Ronald Brand ◽

Pauline Verloove-Vanhorick ◽

Jack Bennebroek Gravenhorst

Keyword(s):

The Netherlands ◽

Preterm Infants ◽

Perinatal Care ◽

Very Preterm ◽

Extremely Preterm ◽

Extremely Preterm Infants

Download Full-text

Temporal Trends of Acute Kidney Injury and Associated Risk Exposures in Extremely Preterm Infants

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.19301220 ◽

2021 ◽

pp. CJN.19301220

Author(s):

Chih-Chia Chen ◽

Yung-Chieh Lin ◽

Shan-Tair Wang ◽

Chao-Ching Huang ◽

Keyword(s):

Serum Creatinine ◽

Preterm Infants ◽

Gestational Age ◽

Temporal Trends ◽

Content Type ◽

Very Preterm ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Preterm Group ◽

Care Practices

Background and objectivesNeonatal AKI in the preterm population is an under-recognized morbidity. Detecting AKI in preterm infants is important for their long-term kidney health. We aimed to examine the yearly trends of incidence and the related morbidities and care practices affecting the occurrence of neonatal AKI in extremely preterm (gestational age <29 weeks) and very preterm (gestational age 29–32 weeks) infants.Design, setting, participants, & measurementsThe trends and the related risk factors and care practices of AKI were examined in the extremely preterm (n=434) and very preterm (n=257) infants who were admitted within 14 days after birth from 2005 to 2018 to the University Hospital and had at least two serum creatinine measurements during hospitalization. We defined AKI as a serum creatinine rise of 0.3 mg/dl or more within 48 hours or a 1.5-fold increase within 7 days.ResultsThe extremely preterm group had a three-fold higher incidence of AKI (30% versus 10%) than the very preterm group. Among preterm infants with AKI, 92% had one episode of AKI, and 45% experienced stage 2 or 3 AKI; the mean duration of AKI was 12±9 days. Across the 14-year period, the crude incidence of AKI declined markedly from 56% to 17% in the extremely preterm group and from 23% to 6% in the very preterm group. After adjustment, a significant decline of AKI incidence was still observed in the extremely preterm group. The declining AKI in the extremely preterm infants was related to the trends of decreasing incidences of neonatal transfer, prolonged aminoglycoside exposure, prophylactic use of nonsteroidal anti-inflammatory drugs, and sepsis.ConclusionsWe observed a declining trend in the incidence of neonatal AKI among extremely preterm infants from 2005 to 2018, which may be related to improvement of care practices.

Download Full-text

Behavioural and cognitive outcomes following an early stress-reduction intervention for very preterm and extremely preterm infants

Pediatric Research ◽

10.1038/s41390-019-0385-9 ◽

2019 ◽

Vol 86 (1) ◽

pp. 92-99

Author(s):

Jeannette Milgrom ◽

Paul R. Martin ◽

Carol Newnham ◽

Christopher J. Holt ◽

Peter J. Anderson ◽

...

Keyword(s):

Preterm Infants ◽

Stress Reduction ◽

Cognitive Outcomes ◽

Very Preterm ◽

Early Stress ◽

Extremely Preterm ◽

Extremely Preterm Infants

Download Full-text

Drug utilisation in neonatal units in England and Wales: a national cohort study

European Journal of Clinical Pharmacology ◽

10.1007/s00228-021-03267-x ◽

2022 ◽

Author(s):

Asma Al-Turkait ◽

Lisa Szatkowski ◽

Imti Choonara ◽

Shalini Ojha

Keyword(s):

Cohort Study ◽

Preterm Infants ◽

Drug Utilisation ◽

Late Preterm ◽

Research Database ◽

Term Infants ◽

England And Wales ◽

Very Preterm ◽

Extremely Preterm ◽

Extremely Preterm Infants

Abstract Purpose To describe drug utilisation patterns in neonatal units. Methods Retrospective observational cohort study using data held in the National Neonatal Research Database (NNRD) for neonatal units in England and Wales including infants born at 23 to 44 weeks’ gestational age (GA) from 01 January 2010 to 31 December 2017. Results The cohort included 17,501 (3%) extremely preterm infants; 40,607 (7%) very preterm infants; 193,536 (31%) moderate-to-late preterm infants; and 371,606 (59%) term infants. The number of unique drugs received by an infant (median (IQR)) increased with decreasing GA: 17 (11–24) in extremely preterm, 7 (5–11) in very preterm, 3 (0–4) in moderate-to-late preterm, and 3 (0–3) in term infants. The two most frequently prescribed drugs were benzylpenicillin and gentamicin in all GA groups, and caffeine in extremely preterm. Other frequently used drugs among preterm infants were electrolytes, diuretics and anti-reflux medications. Among infants <32 weeks’ GA, the largest increase in use was for surfactant (given on the neonatal unit), caffeine and probiotics, while domperidone and ranitidine had the largest decline. Conclusion Antibiotics, for all GAs and caffeine, among preterm infants, are the most frequently used drugs in neonatal medicine. Preterm infants are exposed to a high burden of drugs, particularly antibiotics. Changing patterns in use reflect the emergence of evidence in some areas but several non-evidence-based drugs continue to be used widely. Improvements are needed to ensure rational drug use on neonatal units. Registration ClinicalTrials.gov (NCT03773289). Date of registration 21 Dec 2018.

Download Full-text