2638. Respiratory Syncitial Virus Hospitalizations (RSVH) and All-Cause Bronchiolitis Hospitalizations (BH) Among 29–34 Weeks Gestational Age (wGA) Preterm Infants Before and After the 2014 American Academy of Pediatrics (AAP) Immunoprophylaxis Policy Change Using the Children’s Hospital Association’s Pediatric Health Information System (PHIS)

Abstract Background In 2014, the AAP stopped recommending RSV immunoprophylaxis for otherwise healthy 29–34 wGA preterm infants. This study examined the risk of RSVH and BH among 29–34 wGA infants before the AAP policy change (November 1, 2010–March 31, 2014) and after (November 1, 2014–March 31, 2017) using PHIS hospital-level encounter data from 51 US children’s hospitals. Methods The study population included the first November to March RSVH (ICD9 = 79.6, 480.1, 466.11, ICD10 = B97.4, J12.1, J21.0) or BH (RSVH or unspecified bronchiolitis [ICD9 = 466.19, ICD10 = J21.1, J21.8, J21.9]) among infants 6 months of age or younger admitted to a PHIS hospital between November 1, 2010 and March 31, 2017. The proportion of RSVH and BH by wGA categories (22–28 wGA, 29–34 wGA, 35–36 wGA, and term infants [37+ wGA]) were compared in the time period before and after 2014. Frequencies and proportions were calculated overall for all infants and by demographic and clinical factors for 29–34 wGA infants for RSVH and BH, separately. Statistically significant differences before and after the AAP policy were compared using χ 2 test or Wilcoxon rank-sum test, as appropriate. Results 96,281 infants with BH, including 67,570 with RSVH, were studied. Among infants with known gestational age, the proportions of hospitalizations for RSVH and BH increased after the AAP policy change for all wGA categories, except for term infants (table). Infants 29–34 wGA represented 8.7% of all RSVH before the policy change and 14.2% of all RSVH after the policy change (P < 0.0001). No significant differences were found by gender or co-morbidity for infants 29–34 wGA. Among infants 29–34 wGA, the intensive care unit admission rate increased significantly for RSVH (from 54.5% to 64.2%, P < 0.0001) and BH (from 46.7% to 54.5%, P < 0.0001) after the policy change. The median RSVH length of stay (from 6 to 7 days, P = 0.047) and median adjusted estimated cost (from $14,077 to $16,058, P = 0.038) increased significantly after the policy change. Conclusion RSV and all-cause bronchiolitis hospitalizations and their severity increased among preterm infants 29–34 wGA in the 3-year period following the 2014 AAP policy change on RSV immunoprophylaxis. Disclosures All authors: No reported disclosures.

Download Full-text

Prevalence of small for gestational age infants in 21 cities in China, 2014–2019

Scientific Reports ◽

10.1038/s41598-021-87127-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Hui He ◽

Huazhang Miao ◽

Zhijiang Liang ◽

Ye Zhang ◽

Wei Jiang ◽

...

Keyword(s):

Gestational Age ◽

Small For Gestational Age ◽

Health Information System ◽

Guangdong Province ◽

Significant Negative Correlation ◽

Term Infants ◽

Per Capita Gdp ◽

Increased Risk ◽

Per Capita ◽

Epidemiological Characteristics

AbstractInfants who are small for gestational age (SGA) are at increased risk of neonatal and infant death, non-communicable diseases and growth retardation. However, the epidemiological characteristics of SGA remain unclear. We aim to explore the prevalence of SGA and to examine its socioeconomic associations by using data from 21 cities. 10,515,494 single live birth records between 2014 and 2019 from the Guangdong Women and Children Health Information System were included in the study. Descriptive statistical methods were used to analyze the prevalence trend of SGA and its distribution. We also analyze the associations between the prevalence of SGA and per-capita GDP. The prevalence of SGA in Guangdong Province from the years 2014–2019 was 13.17%, 12.96%, 11.96%, 12.72%, 11.45%, 11.30% respectively, and the overall prevalence was 12.28%. The prevalence of term SGA infants in Guangdong Province was 12.50%, which was much higher than that of preterm SGA (7.71%). There was a significant negative correlation between the SGA prevalence and per-capita GDP in 21 cities of Guangdong Province. The level of economic development may affect the prevalence of SGA. The prevalence of SGA in full term infants is significantly higher than in premature infants, suggesting that most SGA infants may be born at a later gestational age.

Download Full-text

Preterm infants comfort before and after capillary blood sampling procedure

European Journal of Public Health ◽

10.1093/eurpub/ckab120.086 ◽

2021 ◽

Vol 31 (Supplement_2) ◽

Author(s):

Karolina Balciunaite ◽

Alina Vaskelyte

Keyword(s):

Preterm Infants ◽

Gestational Age ◽

Inverse Relationship ◽

Sampling Procedure ◽

Capillary Blood ◽

Blood Sampling ◽

University Hospital ◽

Negative Consequences ◽

Before And After ◽

Capillary Blood Sampling

Abstract Background Because of the immaturity and severe condition preterm infants undergoes a lot of painful and stressful procedures during their care that can cause short-term and long-term negative consequences. Maintenance of optimal comfort is essential for good clinical practice. To assess the comfort of preterm infants before and after the capillary blood sampling procedure. Methods The quantitative observational study was conducted in May 2019—February 2020 in the University hospital NICU. The research instrument was a neonatal comfort scale COMFORTneo, which total scores ranged 6–30. Higher scores indicated higher discomfort. Preterm infant comfort was assessed before the capillary blood sampling procedure and 30 min. after applying non-pharmacological pain relief and comfort assurance methods and implementing the procedure. The research was conducted in accordance with ethical principles. Results Comfort was assessed in 157 preterm newborns with a gestational age of 30 ± 3.3 weeks and a postnatal age of 6.0 ± 5.7 days. The mean value of neonatal comfort before the capillary blood sampling procedure was 10.0 ± 3.2 points, after the procedure 9.1 ± 2.4 points. A statistically significant inverse relationship was found between pre-procedure and post-procedure comfort (Z = -5.374; P < 0.001). A statistically significant weak inverse relationship was found between gestational age and comfort scores before the procedure (r = -0.204; P = 0.01) and after the procedure (r = -0.321; P = 0.008). Conclusions In most cases, preterm infants were feeling moderate discomfort before and after the capillary blood sampling procedure. Newborns had more discomfort before the procedure than 30 min. after the completion of the procedure. Lower gestational age newborns were feeling greater discomfort.

Download Full-text

New charts for the assessment of body composition, according to air-displacement plethysmography, at birth and across the first 6 mo of life

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqy377 ◽

2019 ◽

Vol 109 (5) ◽

pp. 1353-1360 ◽

Cited By ~ 13

Author(s):

Tom Norris ◽

Sara E Ramel ◽

Patrick Catalano ◽

Carol ni Caoimh ◽

Paola Roggero ◽

...

Keyword(s):

United States ◽

Body Composition ◽

Preterm Infants ◽

Fat Mass ◽

Gestational Age ◽

The United States ◽

Fat Free Mass ◽

Term Infants ◽

Air Displacement Plethysmography ◽

Young Infants

ABSTRACT Background Air-displacement plethysmography (ADP) is a good candidate for monitoring body composition in newborns and young infants, but reference centile curves are lacking that allow for assessment at birth and across the first 6 mo of life. Objective Using pooled data from 4 studies, we aimed to produce new charts for assessment according to gestational age at birth (30 + 1 to 41 + 6 wk) and postnatal age at measurement (1–27 wk). Methods The sample comprised 222 preterm infants born in the United States who were measured at birth; 1029 term infants born in Ireland who were measured at birth; and 149 term infants born in the United States and 57 term infants born in Italy who were measured at birth, 1 and 2 wk, and 1, 2, 3, 4, 5, and 6 mo of age. Infants whose birth weights were <3rd or >97th centile of the INTERGROWTH-21st standard were excluded, thereby ensuring that the charts depict body composition of infants whose birth weights did not indicate suboptimal fetal growth. Sex-specific centiles for fat mass (kg), fat-free mass (kg), and percentage body fat were estimated using the lambda-mu-sigma (LMS) method. Results For each sex and measure (e.g., fat mass), the new charts comprised 2 panels. The first showed centiles according to gestational age, allowing term infants to be assessed at birth and preterm infants to be monitored until they reached term. The second showed centiles according to postnatal age, allowing all infants to be monitored to age 27 wk. The LMS values underlying the charts were presented, enabling researchers and clinicians to convert measurements to centiles and z scores. Conclusions The new charts provide a single tool for the assessment of body composition, according to ADP, in infants across the first 6 mo of life and will help enhance early-life nutritional management.

Download Full-text

Circulating Peptide YY Concentrations Are Higher in Preterm than Full-Term Infants and Correlate Negatively with Body Weight and Positively with Serum Ghrelin Concentrations

Clinical Chemistry ◽

10.1373/clinchem.2005.054908 ◽

2005 ◽

Vol 51 (11) ◽

pp. 2131-2137 ◽

Cited By ~ 19

Author(s):

Tania Siahanidou ◽

Helen Mandyla ◽

Maria Vounatsou ◽

Dimitris Anagnostakis ◽

Ioannis Papassotiriou ◽

...

Keyword(s):

Body Mass Index ◽

Body Weight ◽

Energy Balance ◽

Food Intake ◽

Preterm Infants ◽

Gestational Age ◽

Peptide Yy ◽

Full Term ◽

Term Infants ◽

Serum Ghrelin

Abstract Background: Peptide YY (PYY) and ghrelin are gastrointestinal tract–derived hormones that play roles in the regulation of food intake and energy balance. Negative energy balance often occurs in hospitalized preterm infants. Methods: To measure serum concentrations of PYY in preterm and full-term infants and to investigate their correlations with anthropometric characteristics, food intake, and serum ghrelin concentrations, we measured serum PYY and ghrelin concentrations by RIA in 62 healthy preterm infants [mean (SD) gestational age, 32.0 (2.1) weeks; postnatal age, 40.9 (14.8) days] and 15 healthy full-term infants of comparable postnatal age. All of the infants were formula-fed every 3 h. Results: PYY concentrations were significantly higher in preterm [1126.2 (215.4) ng/L] than in full-term infants [825.3 (234.4) ng/L; P <0.001]. In the entire study population, serum PYY concentrations correlated negatively with gestational age and anthropometric measurements (birth weight, body weight, body length, body mass index, and head circumference) and positively with serum ghrelin concentrations, whereas there was no significant correlation between PYY concentration and caloric intake or weight gain. Multiple regression analysis, after correction for prematurity, revealed that serum PYY concentrations correlated independently with serum ghrelin concentrations and infant body weight or body mass index. Conclusions: Circulating concentrations of PYY may increase in preterm infants to compensate for the negative body-weight balance. The physiologic mechanisms behind the correlation between PYY and ghrelin remain to be elucidated.

Download Full-text

Respiratory Syncytial Virus Hospitalizations among U.S. Preterm Infants Compared with Term Infants Before and After the 2014 American Academy of Pediatrics Guidance on Immunoprophylaxis: 2012–2016

American Journal of Perinatology ◽

10.1055/s-0038-1660466 ◽

2018 ◽

Vol 35 (14) ◽

pp. 1433-1442 ◽

Cited By ~ 5

Author(s):

Mitchell Goldstein ◽

Leonard Krilov ◽

Jaime Fergie ◽

Kimmie McLaurin ◽

Sally Wade ◽

...

Keyword(s):

Respiratory Syncytial Virus ◽

American Academy ◽

Preterm Infants ◽

Term Infants ◽

American Academy Of Pediatrics ◽

Before And After ◽

Syncytial Virus ◽

Using Data ◽

Rate Ratios ◽

Calculated Difference

Objective The objective of this study was to compare risk for respiratory syncytial virus (RSV) hospitalizations (RSVH) for preterm infants 29 to 34 weeks gestational age (wGA) versus term infants before and after 2014 guidance changes for immunoprophylaxis (IP), using data from the 2012 to 2016 RSV seasons. Study Design Using commercial and Medicaid claims databases, infants born between July 1, 2011 and June 30, 2016 were categorized as preterm or term. RSVH during the RSV season (November–March) were identified for infants aged <6 months and rate ratios (RRs) for hospitalization comparing preterm and term infants were calculated. Difference-in-difference models were fit to evaluate the changes in hospitalization risks in preterm versus term infants from 2012 to 2014 seasons to 2014 to 2016 seasons. Results In all seasons, preterm infants had higher RSVH rates than term infants. Seasonal RRs prior to the guidance change for preterm wGA categories versus term infants ranged from 1.6 to 3.4. After the guidance change, the seasonal RRs ranged from 2.6 to 5.6. In 2014 to 2016, the risk associated with prematurity of 29 to 34 wGA versus term was significantly higher than in 2012 to 2014 (P<0.0001 for commercial and Medicaid samples). Conclusion In infants aged <6 months, the risk for RSVH for infants 29 to 34 wGA compared with term infants increased significantly after the RSV IP recommendations became more restrictive.

Download Full-text

Postnatal Paraclinical Parameters Associated to Occurrence of Intracerebral Hemorrhage in Preterm Infants

Neuropediatrics ◽

10.1055/s-0038-1677515 ◽

2019 ◽

Vol 50 (02) ◽

pp. 103-110 ◽

Cited By ~ 1

Author(s):

Varvara Turova ◽

Nikolai Botkin ◽

Laura Eckardt ◽

Ursula Felderhoff-Müser ◽

Esther Rieger-Fackeldey ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Preterm Infants ◽

Gestational Age ◽

Clinical Observation ◽

Statistical Evaluation ◽

C Reactive Protein ◽

Mean Values ◽

Reactive Protein ◽

Before And After ◽

Clinical Records

AbstractIntracerebral hemorrhage (ICH) is the most frequent complication in postnatal development of preterm infants. The purpose of the present work is the statistical evaluation of seven standard paraclinical parameters and their association to the development of ICH. Clinical records of 265 preterm infants with gestational age (GA) 23 to 30 weeks were analyzed. According to ICH status, patients were divided into control (without ICH) and affected (with ICH) groups. Mean values of paraclinical parameters at each week of gestation were compared. Different ICH grades, periods before and after ICH were considered separately. Lower hematocrit, SaO2, and pH were statistically significant for preterm infants with 23 to 30 weeks GA and diagnosis of ICH relative to infants without ICH. Additionally, for preterm infants with 27 to 30 weeks GA, higher C-reactive protein, as well as lower values of thrombocytes were associated with the occurrence of ICH. Preterm infants with 23 to 26 weeks GA showed C-reactive protein values similar to those in the group without ICH and lower levels of thrombocytes after bleeding. Significant differences in paraclinical parameters between preterm infants with and without ICH may constitute useful indicators for closer clinical observation of preterm infants at risk of ICH.

Download Full-text

CHARACTERISTICS OF THE METABOLIC STATUS OF CHILDREN OF THE FIRST YEAR OF LIFE WITH PROTEIN-ENERGY DEFICIENCY DEPENDING ON THE GESTATIONAL AGE AT BIRTH

Russian Clinical Laboratory Diagnostics ◽

10.18821/0869-2084-2020-65-7-405-410 ◽

2020 ◽

Vol 65 (7) ◽

pp. 405-410

Author(s):

I. V. Gorbacheva ◽

O. U. Kuznetsova ◽

F. N. Gilmiyarova ◽

D. V. Pechkurov ◽

L. N. Vinogradova

Keyword(s):

Preterm Infants ◽

Gestational Age ◽

Protein Energy Malnutrition ◽

Transferrin Saturation ◽

Deficiency Anemia ◽

First Year ◽

Content Increase ◽

Term Infants ◽

Protein Energy ◽

First Year Of Life

Comparative analysis of energy-plastic exchange indicators in mature and premature children of the first year of life in the development of protein-energy malnutrition (PEM) was carried out. Unidirectional changes are revealed, including an increase in creatinine, lactate and creatine phosphokinase activity levels, suggesting a n increasing muscle mass deficit against the background of glucose anaerobic oxidation activation. In preterm infants, glucose and triacylglicerine levels decrease, which reflects uncompensated insufficiency of energy substrates and, accordingly, ATP level. Multidirectional deviations in metabolism are pyruvate and ATP content: increase in full-term infants and decrease in preterm infants, that should be taken into account when monitoring condition of children with PEM. A significant decrease of pyruvic acid in preterm infants against the background of the levels of total protein, albumin, hemoglobin, and transferrin, not exceeding reference values, can obviously testify to the active use of this integral metabolite to maintain the fund of substituted amino acids. Development of this pathology in both mature and premature infants creates a pre-morbid background for iron deficiency anemia-diagnostic panel, which should be supplemented by calculation of transferrin saturation coefficient. Regardless of gestational age in childbirth during the formation of PEM, the lipid spectrum is rearranged according to atherogenic type: at normal values of total cholesterol, there is a significant increase in low and very low density lipoproteins with an increase in the atherogenicity coefficient. This singles out children with the pathology in question as a risk group for the development of the atherosclerotic process later, which justifies the recommendation to control the lipid profile in children of the first year of life.

Download Full-text

Hexavalent vaccines in preterm infants: an update by Italian Society of Pediatric Allergy and Immunology jointly with the Italian Society of Neonatology

Italian Journal of Pediatrics ◽

10.1186/s13052-019-0742-7 ◽

2019 ◽

Vol 45 (1) ◽

Cited By ~ 4

Author(s):

E. Chiappini ◽

C. Petrolini ◽

C. Caffarelli ◽

M. Calvani ◽

F. Cardinale ◽

...

Keyword(s):

Adverse Events ◽

Preterm Infants ◽

Gestational Age ◽

Standard Of Care ◽

Vaccination Schedule ◽

Italian Society ◽

System Response ◽

Term Infants ◽

Hexavalent Vaccine ◽

Increased Risk

AbstractHexavalent vaccines, protecting against six diseases (diphtheria, tetanus, pertussis [DTaP], poliovirus, hepatitis B virus [HBV], and Haemophilus influenzae type b [Hib], are routinely the standard of care in Europe. The use of combined vaccines allows the reduction of number of injections and side effects, the reduction of costs, and the increase in adherence of the family to the vaccination schedule both in terms of the number of doses and timing. The safety profile, efficacy and effectiveness of hexavalent vaccines have been extensively documented in infants and children born at term, and data are accumulating in preterm infants. Hexavalent vaccines are particularly important for preterm infants, who are at increased risk for severe forms of vaccine preventable diseases. However, immunization delay has been commonly reported in this age group. All the three hexavalent vaccines currently marketed in Italy can be used in preterm infants, and recent data confirm that hexavalent vaccines have a similar or lower incidence of adverse events in preterm compared to full-term infants; this is likely due to a weaker immune system response and reduced ability to induce an inflammatory response in preterm infants. Apnoea episodes are the adverse events that can occur in the most severe preterm infants and / or with history of respiratory distress. The risk of apnoea after vaccination seems to be related to a lower gestational age and a lower birth weight, supporting the hypothesis that it represents an unspecific response of the preterm infant to different procedures. High seroprotection rates have been reported in preterm infants vaccinated with hexavalent vaccine. However, a lower gestational age seems to be associated with lower antibody titres against some vaccine antigens (e.g. HBV, Hib, poliovirus serotype 1, and pertussis), regardless of the type of hexavalent vaccine used. Waiting for large effectiveness studies, hexavalent vaccines should be administered in preterm infants according to the same schedule recommended for infants born at term, considering their chronological age and providing an adequate monitoring for cardio-respiratory events in the 48–72 h after vaccination, especially for infants at risk of recurrence of apnoea.

Download Full-text

Impact of Extending the Timing of Maternal Pertussis Vaccination on Hospitalized Infant Pertussis in England, 2014–2018

Clinical Infectious Diseases ◽

10.1093/cid/ciaa836 ◽

2020 ◽

Cited By ~ 1

Author(s):

Elise Tessier ◽

Helen Campbell ◽

Sonia Ribeiro ◽

Norman K Fry ◽

Colin Brown ◽

...

Keyword(s):

Preterm Infants ◽

Policy Change ◽

Vaccine Coverage ◽

Length Of Hospital Stay ◽

Term Infants ◽

Hospital Stays ◽

Clinical Records ◽

The Impact ◽

Median Hospital ◽

Optimal Window

Abstract Background In October 2012, a maternal pertussis vaccination program was introduced in England for women between 28 and 32 weeks of pregnancy. In April 2016, the recommended optimal window was extended to 20–32 weeks to improve vaccine coverage and protect preterm infants. This study assesses the impact of offering maternal pertussis vaccination earlier in pregnancy on hospitalized infant pertussis cases. Methods Hospitalized pertussis cases ≤60 days old in England were extracted from Hospital Episode Statistics pre- and post-policy change. Data were linked to laboratory-confirmed cases, and clinical records were reviewed where cases were not matched. Maternal vaccine status of identified cases was established. Median hospital duration was calculated, and a competing risk survival analysis was undertaken to assess multiple factors. Results A total of 201 cases were included in the analysis. Of the 151 cases with reported gestational age, the number of hospitalizations among full-term infants was 60 cases pre-policy and 62 cases post-policy, respectively, while preterm cases declined from 20 to 9 (P = .06). Length of hospital stay did not differ significantly after the policy change. Significantly longer hospital stays were seen in cases aged 0–4 weeks (median of 3 more days than infants aged 5–8 weeks), premature infants (median of 4 more days than term infants), and cases with coinfections (median of 1 more day than those without coinfection). Conclusions The number of preterm infants hospitalized with pertussis in England was halved after the policy change and preterm infants were no longer overrepresented among hospitalized cases.

Download Full-text

Clinical Pharmacology of Ibuprofen and Indomethacin in Preterm Infants with Patent Ductus Arteriosus

Current Pediatric Reviews ◽

10.2174/1573396310666140228235815 ◽

2014 ◽

Vol 10 (3) ◽

pp. 216-237 ◽

Cited By ~ 8

Author(s):

Gian Maria Pacifici

Keyword(s):

Patent Ductus Arteriosus ◽

Serum Creatinine ◽

Prostaglandin E2 ◽

Preterm Infants ◽

Gestational Age ◽

Urine Output ◽

Ductus Arteriosus ◽

Closure Rate ◽

Term Infants ◽

Patent Ductus

Background: Ibuprofen and indomethacin are potent non-selective cyclo-oxygenase inhibitors and inhibit prostaglandin E2 synthesis. The patent ductus arteriosus (PDA) occurs in more than 70% of preterm infants weighing <1500 g. Prostaglandin E2 relaxes smooth muscle, tends to inhibit the closure of PDA, yields vasodilatation of the afferent renal arterioles and maintains glomerular filtration rate (GFR). Ibuprofen and indomethacin inhibiting prostaglandin E2 synthesis close PDA and reduce GFR with consequent decrease of urine output and increase of serum creatinine concentrations. Aims: The aims of this study are to give the definitive estimates of PDA closure rate following ibuprofen or indomethacin treatment and to evaluate the extent of renal side effects following the administration of these drugs to preterm infants. Other aims are to review the metabolism and the pharmacokinetics of ibuprofen and indomethacin in preterm infants with PDA. Methods: The bibliographic search was performed using PubMed and EMBASE databases as search engines, January 2013 was the cutoff point. Results: The %PDA closed by ibuprofen (n=24) and indomethacin (n=24) is 77.7±14.1 and 77.3±11.0, respectively. For ibuprofen, the gestational age of the infants included in the study ranged from 25.0 to 39.0 weeks (mean±SD=29.3±3.1 weeks). The %PDA did not correlate with the gestational age (p=0.2516). For indomethacin, the gestational age of infants included in the study ranged from 25.0 and 39.0 weeks (mean±SD=29.4±2.9 weeks). The %PDA did not correlate with the gestational age (p=0.3742). The treatment with ibuprofen reduces the urine output and increases the serum creatinine concentrations less extensively than indomethacin. The half-life (t1/2) of ibuprofen and indomethacin is lengthened and the clearance is reduced in preterm infants as compared with fullterm infants. Conclusions. Ibuprofen and indomethacin are equally effective in closing PDA. Treatment with ibuprofen decreases the risk of renal failure. Ibuprofen has the most favourable risk/benefit ratio. The rate of metabolism is reduced and t1/2 is lengthened in prematures as compared with term infants.

Download Full-text