scholarly journals Neonatal Preterm Respiratory Care in Ukraine: An Observational Study of Outcomes in Relation to Timing and Methods of Surfactant Treatment

2020 ◽  
Author(s):  
Dmytro O. Dobryanskyy ◽  
Anna O. Menshykova ◽  
Zoriana V. Salabay ◽  
Olga Y. Detsyk
Keyword(s):  
Clinical Outcomes ◽  
Preterm Infants ◽  
Morbidity And Mortality ◽  
Control Group ◽  
Very Preterm Infants ◽  
Less Invasive ◽  
Very Preterm ◽  
Surfactant Administration ◽  
The Impact ◽  
Cpap Failure

Objective Timely and effective noninvasive respiratory support and surfactant administration are the key determinants of clinical outcomes in very preterm infants. The objective of this study was to evaluate the impact of the changes in clinical practice of surfactant administration on clinical outcomes and the incidence of continuous positive airway pressure (CPAP) failure defined as the need for mechanical ventilation (MV) during the first 5 days of life in preterm infants <32 weeks. Study Design One hundred sixty-five outborn very preterm infants with respiratory distress syndrome (RDS), initially managed on CPAP, were enrolled in a retrospective cohort study. Fifty-two infants treated with surfactant using less invasive or INSURE technique were included in the surfactant group. One hundred thirteen control infants received surfactant only in case of CPAP failure. Results The study groups were similar in gestational age, rates of main obstetric complications, and antenatal steroid prophylaxis. The rate of cesarean delivery was significantly higher but birth weight and need for resuscitation were lower in infants from the surfactant group. Fifty-five infants with CPAP failure (49%) received surfactant after initiation of MV in the control group in comparison with 52 (100%) in the surfactant group (p < 0.001). The incidence of CPAP failure was significantly higher in the control group (49 vs. 27%; p < 0.01) and it occurred earlier (median [interquartile range age: 4 [2–5] vs. 47 [36–99] hours, respectively; p < 0.001). Early surfactant administration significantly and independently affected the probability of CPAP failure (adjusted odds ratio: 0.29, 95% confidence interval: 0.13–0.67; p < 0.01). There were no differences in morbidities between the groups, but CPAP failure was significantly associated with higher morbidity and mortality. Conclusion Adherence to the European RDS guidelines with early rescue, less invasive surfactant administration in very preterm infants decreased the probability of CPAP failure which was significantly associated with higher morbidity and mortality. Key Points

scholarly journals The Impact of Neonatal Morbidities on Smooth Pursuit Eye Movements in Very Preterm Infants

2011 ◽  
Vol 70 ◽  
pp. 352-352 ◽  
Author(s):  
K Strand Brodd ◽  
K Rosander ◽  
H Grönqvist ◽  
G Holmström ◽  
B Strömberg ◽  
...  
Keyword(s):  
Eye Movements ◽  
Preterm Infants ◽  
Smooth Pursuit ◽  
Smooth Pursuit Eye Movements ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Pursuit Eye Movements ◽  
The Impact

scholarly journals Serial Assessment of Body Fat and Fat-Free Mass Accretion in Very Preterm Infants: A Randomized Trial

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1067-1067
Author(s):  
Ariel Salas ◽  
Maggie Jerome ◽  
Paula Chandler-Laney ◽  
Namasivayam Ambalavanan
Keyword(s):  
Body Composition ◽  
Preterm Infants ◽  
Body Fat ◽  
Intervention Group ◽  
Feeding Practices ◽  
Control Group ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Study Participants ◽  
Serial Assessments

Abstract Objectives To incorporate assessment of body composition in the routine care of preterm infants to guide feeding practices before and after hospital discharge. Methods Very preterm infants with gestational ages between 29 and 32 weeks of gestation were included. Infants with gastrointestinal or neurologic malformations and terminal illness needing to limit or withhold support were excluded. All study participants were eligible for serial assessments of body composition between birth and 32 weeks PMA, at 36 weeks PMA or hospital discharge, and at 3 months of corrected age. Infants randomly assigned to the intervention group had the information about infant body composition available to the clinicians caring for them (including reference data). Infants randomly assigned to the control group also underwent serial assessments, but this information on infant body composition was not shown to the clinicians caring for them. The primary outcome was % body fat (%BF) estimated by air displacement plethysmography. Results Fifty very preterm infants were randomized. Mean birthweight of study participants was 1387 g +/– SD 283 and median gestational age at birth was 30 weeks (IQR: 30 – 31). Sociodemographic characteristics did not differ between groups. Mean %BF between birth and 32 weeks PMA (n = 45) was 6 +/– 4, mean %BF at 36 weeks PMA (n = 35) was 14 +/– 4, and mean %BF at 3 months of corrected age (n = 25) was 20 +/– 4. Mean differences in %BF between the intervention group and the control group were not statistically significant at 36 weeks PMA (−0.8) or 3 months corrected age (−1.2). Similarly, feeding practices during hospitalization did not differ between groups. Growth outcomes did not differ between groups. Conclusions Serial assessments of body composition at birth, 36 weeks PMA, and 3 months corrected age in very preterm infants show increased %BF in both intervention and control groups without an apparent influence of the intervention on feeding practices. While 36 weeks PMA has been a common assessment point for research purposes, body composition assessments may need to be done at earlier intervals in order to make meaningful clinical changes to the infant diet in order to affect body composition later in infancy. Funding Sources UAB OHDRC.

scholarly journals Impact of macro-socioeconomic determinants on perinatal healthcare quality for very preterm infants

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
J Doetsch ◽  
S C S Marques ◽  
T Krafft ◽  
H Barros
Keyword(s):  
Private Sector ◽  
Preterm Infants ◽  
Economic Crisis ◽  
Healthcare Quality ◽  
Wage Distribution ◽  
Very Preterm Infants ◽  
Socioeconomic Determinants ◽  
Very Preterm ◽  
Secondary Stage ◽  
The Impact

Abstract The WHO identified the importance of macro-socioeconomic determinants and the political context as interlinked key factors affecting health equity. The 2008 economic crisis was associated with a significant low-birth-weight increase in Portugal, 2007-2014. The Economic Adjustment Programme (EAP), implemented to economize non-essential health care costs (2011-2014), substantially affected healthcare delivery and occupational environment of Healthcare Professionals (HCPs). This study aims to analyse the impact observed by HCPs of the economic crisis and EAP on equitable quality of perinatal healthcare for very preterm infants in Portugal. A Qualitative study design with 21 HCPs in clinical settings equally distributed among Portuguese mainland were selected according to their response. Semi-structured interviews were conducted between October 2018-April 2019 until saturation point was achieved. A content analysis was performed using Nvivo2011 software. Preliminary results on macro-socioeconomic determinants, classified and conceptualized into a three-stage-effect framework, disclosed an interrelation between factors impacting perinatal healthcare quality, according to HCPs. Primary-stage: increase in working hours and patient-ratio per HCPs, cuts in salaries and investment, increasing waiting time and HCPs demotivation. Secondary-stage: burnout, work-absence, time constraints, decreasing quality and consultation availability. Tertiary-stage: HCPs Brain-drain to private sector, double-shifts in public-private sector, increasing inadequacy of transmissivity within sector communication. The economic crisis and EAP were perceived to have modified equitable perinatal healthcare quality for very preterm infants in Portugal. Increased private-public sector transparency to maximise quality assurance, equal HCP wage distribution to sustain capability, strengthening of social maternity protection strategies to enhance socioeconomic equity in perinatal healthcare, is recommended. Key messages The added value is the disclosure of an in-depth understanding on the interrelation of macro-socioeconomic determinants and healthcare permitting a distinct representation from quantitative methods. The non-linearity between policy response and expected outcomes chiefly complements its comprehension and demonstrates its relevance for further research on assessing effects of austerity measures.

Misdiagnosing Midgut Volvulus in Very Preterm Infants: What is the Impact of Delay Before Surgery?

2020 ◽  
Vol 88 (1) ◽  
pp. 89-90
Author(s):  
Louise Montalva ◽  
Liza Ali ◽  
Alice Heneau ◽  
Florence Julien-Marsollier ◽  
Valérie Biran ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Midgut Volvulus ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
The Impact

scholarly journals The impact of prenatal and neonatal infection on neurodevelopmental outcomes in very preterm infants

2014 ◽  
Vol 34 (10) ◽  
pp. 741-747 ◽  
Author(s):  
I Lee ◽  
J J Neil ◽  
P C Huettner ◽  
C D Smyser ◽  
C E Rogers ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Neonatal Infection ◽  
Neurodevelopmental Outcomes ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
The Impact

scholarly journals Cardio-Respiratory Events and Food Autonomy Responses to Early Uni-Modal Orofacial Stimulation in Very Premature Babies: A Randomized, Controlled Study

Children ◽  
2021 ◽  
Vol 8 (12) ◽  
pp. 1188
Author(s):  
Sahra Méziane ◽  
Véronique Brévaut-Malaty ◽  
Aurélie Garbi ◽  
Muriel Busuttil ◽  
Gaelle Sorin ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Controlled Study ◽  
Control Group ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Randomized Controlled ◽  
Respiratory Events ◽  
Experimental Group

Uni-modal orofacial stimulation (OFS) for preventing very preterm infants’ oral disorders is highly controversial. Our study sought to demonstrate that OFS reduced cardio-respiratory events and improved food autonomy in a population of very preterm infants. Our study was randomized, controlled, prospective, and unicentric. The preterm included were born between 26–29 weeks gestational age (GA) with a corrected postnatal age <33 weeks GA. They were randomized into two groups: the experimental group underwent OFS, according to a protocol established, over 10 consecutive days, and the control group underwent no OFS. The primary outcome was the number of cardiorespiratory events: apnea–bradycardia (with or without desaturations) or number of isolated desaturations, which were evaluated at four separate times. Measurements occurred during the first, fourth and eighth independent feedings. Seventeen patients were included in the experimental group and 18 in the control group. The number of cardiorespiratory events for all independent feeding times was significantly reduced in the OFS group (p = 0.003) with univariate analysis, but not with multivariable analysis. The quantity of milk ingested during the first autonomous feeding was higher in the experimental group. The acquisition of food autonomy and the duration of hospitalization were similar in the two groups. While our study does not affirm that an early unimodal OFS improves premature infants’ cardiorespiratory evolution and/or the acquisition of food autonomy, it does indicate an improved food efficiency during their first autonomous feedings.

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