SNAP-II for prediction of mortality and morbidity in extremely preterm infants

Abstract Rationale Bronchopulmonary dysplasia (BPD) is the most common complication of prematurity and significantly contributes to mortality and morbidity with few predictive biomarkers. Given that nitrites have been implicated in pathways associated with lung disease, we hypothesized that nitrite levels would be altered in the airways of premature infants diagnosed with BPD. Methods This was a prospective cohort study of extremely low birth infants (< 28 weeks’ gestation) at the University of Alabama at Birmingham. Nitrite levels from tracheal aspirates (TAs) were compared between intubated and ventilated infants with BPD and gestation matched full term (FT) controls. TA derived nitrite levels from day one after birth were also compared between preterm infants who did and did not develop BPD. Results Infants with BPD were found to have significantly elevated nitrite levels in their tracheal aspirates compared to gestation matched FT controls (p < 0.05). There was a trend for increased nitrite levels on postnatal day one in infants that developed BPD compared to infants that did not develop BPD (p = 0.05). Conclusions In conclusion, nitrite levels are significantly increased in airways of infants with BPD. Data from a larger cohort are needed to further support the utility of nitrite for BPD prediction. Trial registration Not applicable.

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Less Invasive Surfactant Administration in Extremely Preterm Infants: Impact on Mortality and Morbidity

Neonatology ◽

10.1159/000346521 ◽

2013 ◽

Vol 103 (4) ◽

pp. 252-258 ◽

Cited By ~ 63

Author(s):

Katrin Klebermass-Schrehof ◽

Martin Wald ◽

Jens Schwindt ◽

Agnes Grill ◽

Andrea-Romana Prusa ◽

...

Keyword(s):

Preterm Infants ◽

Mortality And Morbidity ◽

Less Invasive ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Surfactant Administration

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“Getting to Zero”: Preventing invasive Candida infections and eliminating infection-related mortality and morbidity in extremely preterm infants

Early Human Development ◽

10.1016/s0378-3782(12)70014-2 ◽

2012 ◽

Vol 88 ◽

pp. S45-S49 ◽

Cited By ~ 16

Author(s):

D.A. Kaufman

Keyword(s):

Preterm Infants ◽

Mortality And Morbidity ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Candida Infections ◽

Related Mortality

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Greater Mortality and Morbidity in Extremely Preterm Infants Fed a Diet Containing Cow Milk Protein Products

Breastfeeding Medicine ◽

10.1089/bfm.2014.0024 ◽

2014 ◽

Vol 9 (6) ◽

pp. 281-285 ◽

Cited By ~ 82

Author(s):

Steven A. Abrams ◽

Richard J. Schanler ◽

Martin L. Lee ◽

David J. Rechtman ◽

Keyword(s):

Preterm Infants ◽

Milk Protein ◽

Cow Milk ◽

Mortality And Morbidity ◽

Extremely Preterm ◽

Extremely Preterm Infants

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Changes of Infant- and Family-Centered Care Practices Administered to Extremely Preterm Infants During Implementation of the NIDCAP Program

Frontiers in Pediatrics ◽

10.3389/fped.2021.718813 ◽

2021 ◽

Vol 9 ◽

Author(s):

Valérie Klein ◽

Claire Zores-Koenig ◽

Laurence Dillenseger ◽

Claire Langlet ◽

Benoît Escande ◽

...

Keyword(s):

Preterm Infants ◽

Short Term ◽

Mortality And Morbidity ◽

Developmental Care ◽

Skin Contact ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Time Periods ◽

The Impact ◽

Family Centered

Introduction: Many studies have evaluated the Neonatal Individualized Developmental Care and Assessment Program (NIDCAP), but few studies have assessed changes in infant- and family-centered developmental care (IFCDC) practices during its implementation.Objectives: The primary objective of this single center study was to investigate the impact of the implementation of the NIDCAP program on IFCDC practices used for management of extremely preterm infants (EPIs). The secondary objective was to determine during implementation the impact of this program on the short-term medical outcomes of all EPIs hospitalized at our center.Methods: All EPIs (<28 weeks gestational age) who were hospitalized at Strasbourg University Hospital from 2007 to 2014 were initially included. Outborn infants were excluded. The data of EPIs were compared for three time periods: 2007 to 2008 (pre-NIDCAP), 2010 to 2011, and 2013 to 2014 (during-NIDCAP implementation) using appropriate statistical tests. The clinical and caring procedures used during the first 14 days of life were analyzed, with a focus on components of individualized developmental care (NIDCAP observations), infant pain management (number of painful procedures, clinical pain assessment), skin-to-skin contact (SSC; frequency, day of initiation, and duration), and family access and involvement in the care of their children (duration of parental presence, parental participation in care). The short-term mortality and morbidity at discharge were evaluated.Results: We examined 228 EPIs who received care during the three time periods. Over time, painful procedures decreased, but pain evaluations, parental involvement in care, individualized observations, and SSC increased (all p < 0.01). In addition, the first SSC was performed earlier (p = 0.03) and lasted longer (p < 0.01). There were no differences in mortality and morbidity, but there were reductions in the duration of mechanical ventilation (p = 0.02) and the time from birth to first extubation (p = 0.02), and an increase of weight gain at discharge (p = 0.02).Conclusion: NIDCAP implementation was accompanied by progressive, measurable, and significant changes in IFCDC strategies. There were, concomitantly, moderate but statistically significant improvements in multiple important outcome measures of all hospitalized EPI.

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Association of Gastric Residual Volumes With Necrotising Enterocolitis in Extremely Preterm Infants

10.21203/rs.3.rs-368218/v1 ◽

2021 ◽

Author(s):

gajanan purohit ◽

Mehkarkar Puja ◽

Athalye-Jape Gayatri ◽

Nathan Elizabeth ◽

Patole Sanjay

Keyword(s):

Birth Weight ◽

Preterm Infants ◽

Necrotising Enterocolitis ◽

Stage Ii ◽

Mortality And Morbidity ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Significant Difference ◽

Median Maximum ◽

Control Study

Abstract Necrotising enterocolitis (NEC) is a potentially serious illness with significant mortality and morbidity in preterm infants. Previous studies have reported association of volume and colour (bile and blood stained) of gastric residuals (GR) with NEC. We aimed to study this association in our cohort of extremely preterm (EP) infants. In a case-control study using retrospective data (January 2006-December 2011), EP (Gestation <28 weeks) infants with confirmed NEC ≥ Stage II (Cases) were compared with infants without NEC (Controls) matched for birth weight (BW) and gestational age (GA). Forty cases of NEC ≥ Stage II diagnosed at a median (IQR) age of 16.5 (10.3-23) days were compared with 40 controls matched for gestation (±3 days), and birth weight (±680 g). Median maximum GR volume (GRV) from birth to the day of occurrence of NEC was significantly higher in cases vs. controls (5.9 vs.3.7 ml; p<0.001). Increased maximum GRV was associated with NEC ≥ Stage II in adjusted analysis (aOR 1.36, 95%CI 1.06-1.75, p=0.017). There was no significant difference in GRV between cases and controls throughout the clinical course, including 72, 48 and 24 hours before the onset of NEC. However, green (65.0% vs. 27.5%, p=0.001) and haemorrhagic GRs (45.0% vs. 27.5%, p=0.092) were higher 24 hours before the diagnosis of NEC.Conclusion: GRV was not associated with NEC ≥ Stage II. However, green and haemorrhagic GRs were significantly higher 24 hours before the diagnosis of the illness. Adequately powered prospective studies are needed to confirm the significance of our findings.

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Preterm Brain Injury, Antenatal Triggers, and Therapeutics: Timing Is Key

Cells ◽

10.3390/cells9081871 ◽

2020 ◽

Vol 9 (8) ◽

pp. 1871 ◽

Cited By ~ 1

Author(s):

Daan R.M.G. Ophelders ◽

Ruth Gussenhoven ◽

Luise Klein ◽

Reint K. Jellema ◽

Rob J.J. Westerlaken ◽

...

Keyword(s):

Preterm Birth ◽

Brain Injury ◽

Preterm Infants ◽

Critical Role ◽

Perinatal Brain Injury ◽

Preclinical Research ◽

Mortality And Morbidity ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Hypoxia Ischemia

With a worldwide incidence of 15 million cases, preterm birth is a major contributor to neonatal mortality and morbidity, and concomitant social and economic burden Preterm infants are predisposed to life-long neurological disorders due to the immaturity of the brain. The risks are inversely proportional to maturity at birth. In the majority of extremely preterm infants (<28 weeks’ gestation), perinatal brain injury is associated with exposure to multiple inflammatory perinatal triggers that include antenatal infection (i.e., chorioamnionitis), hypoxia-ischemia, and various postnatal injurious triggers (i.e., oxidative stress, sepsis, mechanical ventilation, hemodynamic instability). These perinatal insults cause a self-perpetuating cascade of peripheral and cerebral inflammation that plays a critical role in the etiology of diffuse white and grey matter injuries that underlies a spectrum of connectivity deficits in survivors from extremely preterm birth. This review focuses on chorioamnionitis and hypoxia-ischemia, which are two important antenatal risk factors for preterm brain injury, and highlights the latest insights on its pathophysiology, potential treatment, and future perspectives to narrow the translational gap between preclinical research and clinical applications.

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