scholarly journals Retrospective Assessment of Selenium Status in High Risk Infants

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1078-1078
Author(s):  
Laura Sherlock ◽  
Kimberly Vollrath ◽  
Emma Ross ◽  
Susan Marshall ◽  
Nicole Larez ◽  
...  
Keyword(s):  
Birth Weight ◽  
High Risk ◽  
Gestational Age ◽  
Late Onset ◽  
Neurodevelopmental Outcomes ◽  
Perinatal Medicine ◽  
Average Birth Weight ◽  
Se Deficiency ◽  
High Risk Infants ◽  
Se Status

Abstract Objectives Selenium (Se) is an essential trace mineral important in neonatal development that contributes to oxidative stress and the inflammatory response. Se deficiency in preterm infants is associated with late onset sepsis, bronchopulmonary dysplasia, poor neurodevelopmental outcomes, and retinopathy of prematurity. Current Se dosing in many US Neonatal Intensive Care Units is based on the amount of Se in term breastmilk. However, it is unclear if this is sufficient and higher levels may be needed to prevent or treat Se deficiency. Our goal was to evaluate if the current practice supplementing total parenteral nutrition (TPN) with sodium selenite 2 mcg/kg/d is sufficient at preventing Se deficiency in high risk infants. Methods This is a retrospective chart review of Se status at a level IV Children's Hospital NICU from January 1, 2017 to August 30, 2019. Infants were included if born from 22–42 weeks gestation and received TPN for >4 weeks. They were excluded if there was concern for active sepsis or bacterial illness at time of Se draw. Normal Se status was defined as 45–90 ng/mL for infants 0–2 months. Birth weight, IUGR status, gestational age, and % enteral feeds were evaluated. Se deficient infants received higher Se dosing at 5–7 mcg/kg/d. Repeat levels were evaluated after 4 weeks. Results are reported as mean ± SD. Results Se status was assessed for 39 infants. Average gestational age was 29.8 ± 5.36 weeks. Average birth weight was 1499 ± 837 g. At the time of first Se assessment, 78% of infants were Se deficient, with a mean Se level of 40.95 ± 12 ng/mL. Repeat Se levels on higher dosing was assessed in 23 infants. After >4 weeks of higher Se dosing, 35% of infants remained Se deficient, with a mean Se level of 54.04 ± 14 ng/mL. By t-test, statistically fewer infants were Se deficient on higher Se dosing (P < 0.0003). Conclusions Infants on prolonged TPN >4 weeks are at high risk for Se deficiency. Se dosing at 2 mcg/kg/day is insufficient in preventing deficiency for a majority of these babies. Higher Se dosing improved the percentage of Se sufficient infants, but a third remained deficient. Future studies are needed to prospectively determine if higher Se in TPN prevents Se deficiency. Funding Sources University of Colorado, Section of Neonatal-Perinatal Medicine.

scholarly journals Is there any difference between high-risk infants with different birth weight and gestational age in neurodevelopmental characters?

2015 ◽  
Vol 50 (3) ◽  
pp. 151-157 ◽  
Author(s):  
Özgün Kaya Kara ◽  
Mintaze Kerem Günel ◽  
Cengizhan Acikel ◽  
Sule Yigit ◽  
Mutluay Arslan
Keyword(s):  
Birth Weight ◽  
High Risk ◽  
Gestational Age ◽  
High Risk Infants

scholarly journals Impact of size at birth and postnatal growth on metabolic and neurocognitive outcomes in prematurely born school-age children

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yoo Jinie Kim ◽  
Seung Han Shin ◽  
Eun Sun Lee ◽  
Young Hwa Jung ◽  
Young Ah Lee ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Infants ◽  
Gestational Age ◽  
Growth Velocity ◽  
Postnatal Growth ◽  
School Age ◽  
Z Score ◽  
Neurodevelopmental Outcomes ◽  
Neurocognitive Outcomes ◽  
Size At Birth

AbstractPrematurity, size at birth, and postnatal growth are important factors that determine cardiometabolic and neurodevelopmental outcomes later in life. In the present study, we aimed to investigate the associations between the size at birth and growth velocity after birth with cardiometabolic and neurodevelopmental outcomes in preterm infants. Fifty-six preterm infants born at < 32 weeks of gestation or having a birth weight of < 1500 g were enrolled and categorized into small for gestational age (SGA) and appropriate for gestational age (AGA) groups. Anthropometric and cardiometabolic parameters were assessed at school-age, and the Korean Wechsler Intelligence Scale for Children, fourth edition (K-WISC-IV) was used for assessing the intellectual abilities. The growth velocity was calculated by changes in the weight z-score at each time period. Multivariate analysis was conducted to investigate the associations of growth velocity at different periods with cardiometabolic and neurodevelopmental outcomes. Forty-two (75%) were classified as AGA and 25% as SGA. At school-age, despite the SGA children showing significantly lower body weight, lean mass index, and body mass index, there were no differences in the cardiometabolic parameters between SGA and AGA groups. After adjusting for gestational age, birth weight z-score, weight z-score change from birth to discharge and sex, change in weight z-score beyond 12 months were associated with a higher systolic blood pressure, waist circumference, and insulin resistance. Full-scale intelligent quotient (β = 0.314, p = 0.036) and perceptional reasoning index (β = 0.456, p = 0.003) of K-WISC-IV were positively correlated with postnatal weight gain in the neonatal intensive care unit. Although cardiometabolic outcomes were comparable in preterm SGA and AGA infants, the growth velocity at different time periods resulted in different cardiometabolic and neurocognitive outcomes. Thus, ensuring an optimal growth velocity at early neonatal period could promote good neurocognitive outcomes, while adequate growth after 1 year could prevent adverse cardiometabolic outcomes in preterm infants.

119 Communicating Sensitive Information - An Exploration of Parental Perspectives on Prognostication of High Risk Infants

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e85-e85
Author(s):  
Emily Fong ◽  
Ronit Mesterman
Keyword(s):  
High Risk ◽  
Preterm Infants ◽  
Average Length ◽  
Sensitive Information ◽  
Neurocognitive Deficits ◽  
Biological Father ◽  
Perinatal Medicine ◽  
Term Infants ◽  
Neurologic Recovery ◽  
High Risk Infants

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Preterm infants are at high risk of experiencing a range of impairments that may contribute to long-term challenges such as neurocognitive deficits. Physicians are often expected to give an outlook on future developmental outcomes of high-risk infants, often before sufficient time has elapsed to observe whether that particular child will demonstrate neurologic recovery from the initial injury. Clinicians often struggle with communicating this information, especially a poor prognosis, because of the worry about how these conversations affect families and their future expectations of the child. Objectives Our aim was to capture parents' retrospective perceptions of how their infant’s prognosis was communicated to them during their NICU stay. Design/Methods Semi-structured interviews were conducted over the phone with parents of former preterm infants with a birthweight below 1500 grams or parents of term infants who have sustained HIE requiring cooling. Parents were invited to participate when their child was between 12-36 months old at the time of the interview, so that parents would be able to have a sense of their child’s development and possible impairments. The data was analyzed thematically, with particular focus around the discourse of communication and prognostication. Results Twenty-three interviews were conducted: 20 with the biological mother, two with both biological parents, and one with the biological father. The average length of the interviews was 30 minutes. The main themes that recurred in the interviews included parental loss of control, needing to prepare for the unexpected, the value of shared decision making between the health care practitioners and parents, recognition and conveyance of uncertainty by the physician, and the importance of celebrating the present. Above all, a recurring theme mentioned by the majority of interviewees was the power of hope. While wanting to receive transparent and honest updates, parents felt strongly that giving them realistic hope was of utmost importance. Conclusion Although clinicians often feel pressured to deliver answers, parents found it helpful when clinicians acknowledged and explained the uncertainty that surrounds prognostication. While healthcare providers may feel the need to prepare parents for the worst, the importance of balancing this information with hope and positivity is what families remember and value years after the prognosis was given.

scholarly journals Association of WIC Participation and Growth and Developmental Outcomes in High-Risk Infants

2019 ◽  
Vol 59 (1) ◽  
pp. 53-61
Author(s):  
Ashwini Lakshmanan ◽  
Ashley Y. Song ◽  
Nicole Flores-Fenlon ◽  
Urvashi Parti ◽  
Douglas L. Vanderbilt ◽  
...  
Keyword(s):  
High Risk ◽  
Neurodevelopmental Outcomes ◽  
Supplemental Nutrition ◽  
Assistance Program ◽  
Wic Participation ◽  
Z Scores ◽  
Supplemental Nutrition Program ◽  
Nutrition Assistance ◽  
High Risk Infants ◽  
Bayley Scales

The objective of this study was to describe the association of enrollment in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), the Supplemental Nutrition Assistance Program (SNAP), and infant growth and neurodevelopmental outcomes. Z scores and Bayley Scales of Infant and Toddler Development–Third Edition (Bayley-III) and Vineland Adaptive/Behavior Scale–II (VABS-II) scores represented primary outcomes. We conducted bivariate analyses and linear regression. Children who were enrolled in WIC or WIC/SNAP had weight z scores U (95% confidence interval [CI]) that were 1.32 (0.42-2.21) or 1.19 (0.16-2.23) units higher. Enrollment in WIC or WIC/SNAP was associated with a higher score (95% CI) of 11.7 U (1.2-22.2 U) or 11.5 (0.1-22.9) for Bayley-III cognitive score and 10.1 U (1.9-19.1 U) or 10.3 (0.9-19.7) for the VABS-II composite score. These findings support increased advocacy for participation in WIC or WIC/SNAP for families with high-risk infants.

scholarly journals Pathological staging of chorioamnionitis contributes to complications in preterm infants

2020 ◽  
Vol 46 (1) ◽  
Author(s):  
Jiayu Miao ◽  
Zhuxiao Ren ◽  
Yunbei Rao ◽  
Xin Xia ◽  
Jianlan Wang ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Infants ◽  
Gestational Age ◽  
Intraventricular Hemorrhage ◽  
Independent Risk Factor ◽  
Late Onset ◽  
Obstetrics And Gynecology ◽  
Single Center ◽  
Pathological Staging ◽  
The Difference

Abstract Objective To investigate the effect of pathological staging of chorioamnionitis (CA) on complications in preterm infants; Methods A single-center, retrospective study was conducted to choose singleton preterm infants (gestational age < 37 weeks) from the Department of Obstetrics and Gynecology in our hospital from December 2016 to December 2017. The basic data and placental pathological results were retrospectively collected. According to the placental pathological results of whether inflammation infiltrating amnion, CA 0/I phase was classified into non-amnionitis group, CA II/III phase was classified into amnionitis group, the incidence of common complications in preterm infants was compared. Further, logistic regression was used to analyze the effects of amnionitis on complications after being adjusted to gestational age, birth weight and thrombocytopenia. Results A total of 221 preterm infants were enrolled, including 186 cases in non-amnionitis group and 35 cases in amnionitis group. The gestational age of amnionitis group (32.00 ± 2.71 weeks) was significantly lower than non-amnionitis group (34.14 ± 2.06 weeks), birth weight (1.93 ± 0.64 kg) was significantly lower than that of non-amnionitis group (2.26 ± 0.58 kg), and the hospital stay in amnionitis group was significantly longer (25.71 ± 19.23 days), all of the difference above was statistically significant(P < 0.05). The incidence of intraventricular hemorrhage (IVH) in amnionitis group (37.14%) was significantly higher than that in non-amnionitis group (13.98%) (P = 0.002), and the risk of IVH was significantly increased by amnionitis (OR = 3.636, 95%CI: 1.632–8.102); after correction of gestational age, birth weight and thrombocytopenia, the risk of IVH was still significantly increased (OR = 2.471, P = 0.046, 95% CI: 1.015–6.015). And the late-onset IVH was more common (P = 0.009). Conclusion Amnionitis leads to a significant reduction in gestational age and birth weight in preterm infants, and it is an independent risk factor for IVH.

scholarly journals The value of the middle cerebral to umbilical artery doppler ratio in the prediction of neonatal outcome in patients with high risk pregnancy

2017 ◽  
Vol 6 (9) ◽  
pp. 3965
Author(s):  
Ramkanwar Deora ◽  
Nikhila Gara
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
High Risk ◽  
Cesarean Delivery ◽  
Gestational Age ◽  
Foetal Distress ◽  
Duration Of Treatment ◽  
Risk Pregnancy ◽  
Gestational Age At Delivery

Background: To investigate the diagnostic value of MCA/UA pulsatility index ratio for the prediction of adverse perinatal outcome in patients with high risk pregnancy.Methods: We included in the study 170 patients recovered in our hospital with the diagnosis of preeclampsia and gestational hypertension, twins, postdated, IUGR, BOH from June 2016 to May 2017. All the patients underwent accurate color Doppler velocimetry examination available in our hospital. Outcome variables were intrauterine and early neonatal death, admission to neonatal intensive care unit and the duration of treatment, APGAR score below 7 at 5 minutes, cesarean delivery for foetal distress, gestational age at delivery, neonatal birth weight, IUGR.Results: In 102 patients, we found abnormal values of CPI ratio. Neonates of mothers with abnormal CPI ratio had significantly lower gestational age at delivery, lower birth weight, significantly greater risk for perinatal death, significantly greater risk of admission to intensive care unit, longer duration of treatment in NICU, greater rate of cesarean delivery for foetal distress, increased number of fetuses IUGR.Conclusions: CPI ratio is a very good predictor of adverse outcome in the fetuses of women with pre-eclampsia and other high-risk pregnancy.

scholarly journals Synbiotics use for preventing sepsis and necrotizing enterocolitis in very low birth weight neonates: a randomized controlled trial

2020 ◽  
Vol 63 (6) ◽  
pp. 226-231 ◽  
Author(s):  
Ozge Serce Pehlevan ◽  
Derya Benzer ◽  
Tugba Gursoy ◽  
Guner Karatekin ◽  
Fahri Ovali
Keyword(s):  
Randomized Controlled Trial ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Necrotizing Enterocolitis ◽  
Gestational Age ◽  
Very Low Birth Weight ◽  
Late Onset ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
Significant Difference

Background: Probiotics and prebiotics have strain-specific effects on the host. Synbiotics, a mixture of probiotics and prebiotics, are proposed to have more beneficial effects on the host than either agent has alone.Purpose: We performed a randomized controlled trial to investigate the effect of Lactobacillus and Bifidobacterium together with oligosaccharides and lactoferrin on the development of necrotizing enterocolitis (NEC) or sepsis in very low birth weight neonates.Methods: Neonates with a gestational age ≤32 weeks and birth weight ≤1,500 g were enrolled. The study group received a combination of synbiotics and lactoferrin, whereas the control group received 1 mL of distilled water as placebo starting with the first feed until discharge. The outcome measures were the incidence of NEC stage ≥2 or late-onset cultureproven sepsis and NEC stage ≥2 or death.Results: Mean birth weight and gestational age of the study (n=104) and the control (n=104) groups were 1,197±235 g vs. 1,151±269 g and 29±1.9 vs. 28±2.2 weeks, respectively (P>0.05). Neither the incidence of NEC stage ≥2 or death, nor the incidence of NEC stage ≥2 or late-onset culture-proven sepsis differed between the study and control groups (5.8% vs. 5.9%, P=1; 26% vs. 21.2%, P=0.51). The only significant difference was the incidence of all stages of NEC (1.9% vs. 10.6%, P=0.019).Conclusion: The combination of synbiotics and lactoferrin did not reduce NEC severity, sepsis, or mortality.

scholarly journals Audiological screening of high risk infants and prevalence of risk factors

2017 ◽  
Vol 4 (2) ◽  
pp. 507
Author(s):  
Regina M. ◽  
Sanu P. Moideen ◽  
Mohan M. ◽  
Mohammed M.T.P. ◽  
Khizer Hussain Afroze M.
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
High Risk ◽  
Low Birth Weight ◽  
Hearing Impairment ◽  
Significant Risk ◽  
Research Centre ◽  
Auditory Brain Stem Response ◽  
Factors Associated ◽  
High Risk Infants

Background: Hearing loss in early life can have deleterious effects on child’s psychosocial, scholastic and social-emotional development. Early identification and timely intervention can provide the child with better speech and language development. This study has been done to estimate the prevalence of hearing impairment among high risk infants as per Joint Committee on Infant Hearing (JCIH) criteria and to study the risk factors associated with neonatal hearing impairment.Methods: This multicentric observational study was conducted among 613 high risk infants admitted and discharged from neonatal intensive care units (NICU) of Academy of Medical Sciences, Kannur, Kerala and Sri Siddhartha Medical College and Research Centre, Tumakuru, Karnataka, India (level III neonatology units with an NICU admissions of average around 1200 per year), during the period August 2015 - August 2016 (12 months). The babies were selected based on the JCIH 2007 criteria. All babies were subjected to behavioral audiometry (BA) and Oto Acoustic Emissions (OAE), preferably within 3 weeks. Those failing OAE were reevaluated at 6th week and with Auditory brain stem response (ABR) within 3 months time. Results: A total of 613 high risk babies were screened. 42 (6.76%) among them were having hearing impairment. The most common risk factors associated with hearing impairment was NICU stay for more than 24 hours, prematurity, low birth weight and meningitis/sepsis etc.Conclusions: Hearing impairment among high risk babies is not a rare condition. In our study, the prevalence was 6.76%. Low birth weight, admission to NICU for more than 24 hours, low APGAR, meningitis/sepsis, maternal and neonatal complications are significant risk factors for hearing impairment among neonates. This highlights the need for neonatal screening. Though we recommend a universal screening program, at least a targeted approach should be practiced in neonatal care. Those babies who are found to have hearing impairment should be closely followed up with early intervention and rehabilitation.  

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