scholarly journals 24 Association of location of intubation procedure and number of tracheal intubation attempts with death or severe neurological injury among very preterm infants

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e9-e9
Author(s):  
Anthony Debay ◽  
Sharina Patel ◽  
Pia Wintermark ◽  
Martine Claveau ◽  
François Olivier ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Preterm Infants ◽  
Physiological Stress ◽  
Periventricular Leukomalacia ◽  
Adverse Outcomes ◽  
Neurological Injury ◽  
Multivariable Logistic Regression Analysis ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Increased Risk

Abstract Background The physiological stress induced by tracheal intubation (TI) is associated with increased risk of neurological injury among very preterm infants. The location of TI procedure and number of attempts required may contribute to adverse outcomes. Objectives We aimed to assess the association of location where TI is performed and the number of TI attempts with death and/or severe neurological injury (SNI) among very preterm infants born <33 weeks and intubated in the first 7 days of life. Design/Methods Retrospective cohort study of 442 infants born 23-32 weeks gestation, admitted to a Level 3 NICU 2015-2018 within the first 7 days of life. We excluded infants who were moribund and the ones with a major congenital anomaly. Data was collected from the Canadian Neonatal Network database and chart review. Exposures were location of TI (delivery room [DR] vs. NICU) and number of TI attempts (1 vs. >1) among infants intubated in the first 7 days of life. Primary outcome was death and/or SNI (intraventricular hemorrhage grade 3-4 and/or periventricular leukomalacia). Multivariable logistic regression analysis was used to assess the association between exposures and outcomes and adjust for confounders. Results Rate of intubation was 46% (202/442). Rate of death and/or SNI was 2.5% (6/240) among infants never intubated, 12% (13/105) among NICU TI, 32% (31/97) among DR TI, 20% (17/85) among infants with 1 TI attempt and 23% (27/117) among infants with >1 TI attempt. Rate of premedication use for NICU TI was 97% (102/105). Overall, median number of intubation attempts was 1 [IQR 1-2]. Compared to no TI, TI in the NICU (adjusted odds ratio [AOR] 3.39, 95% CI 1.20-10.53) and TI in the DR (AOR 9.28, 95% CI 3.33-29.43) were associated with higher odds of death and/or SNI. DR TI was associated with higher odds of death and/or SNI compared to NICU TI (AOR 2.73, 95% CI 1.23-6.35). Compared to no TI, 1 TI attempt (AOR 5.25, 95% CI 1.93-15.93) and >1 TI attempt (AOR 5.17, 95% CI 1.93-15.69) were associated with higher odds of death and/or SNI. The number of intubation attempts (1 vs. >1) was not associated with death and/or SNI (AOR 0.99, 95% CI 0.47-2.09). Conclusion Intubated infants have higher odds of death and/or SNI. Among intubated infants, DR TI is associated with higher odds of death and/or SNI vs. TI in the NICU with premedication. Optimizing non-invasive ventilation in the DR may help reduce brain injury in preterm infants.

Association of Delivery Room and Neonatal Intensive Care Unit Intubation, and Number of Tracheal Intubation Attempts with Death or Severe Neurological Injury among Preterm Infants

2020 ◽  
Author(s):  
Anthony Debay ◽  
Sharina Patel ◽  
Pia Wintermark ◽  
Martine Claveau ◽  
François Olivier ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Tracheal Intubation ◽  
Neonatal Intensive Care Unit ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Periventricular Leukomalacia ◽  
Delivery Room ◽  
Neurological Injury ◽  
Multivariable Logistic Regression Analysis

Objective The study aimed to assess the association of tracheal intubation (TI) and where it is performed, and the number of TI attempts with death and/or severe neurological injury (SNI) among preterm infants. Study Design Retrospective cohort study of infants born 23 to 32 weeks, admitted to a single level-3 neonatal intensive care unit (NICU) between 2015 and 2018. Exposures were location of TI (delivery room [DR] vs. NICU) and number of TI attempts (1 vs. >1). Primary outcome was death and/or SNI (intraventricular hemorrhage grade 3–4 and/or periventricular leukomalacia). Multivariable logistic regression analysis was used to assess association between exposures and outcomes and to adjust for confounders. Results Rate of death and/or SNI was 2.5% (6/240) among infants never intubated, 12% (13/105) among NICU TI, 32% (31/97) among DR TI, 20% (17/85) among infants with one TI attempt and 23% (27/117) among infants with >1 TI attempt. Overall, median number of TI attempts was 1 (interquartile range [IQR]: 1–2). Compared with no TI, DR TI (adjusted odds ratio [AOR]: 9.04, 95% confidence interval [CI]: 3.21–28.84) and NICU TI (AOR: 3.42, 95% CI: 1.21–10.61) were associated with higher odds of death and/or SNI. The DR TI was associated with higher odds of death and/or SNI compared with NICU TI (AOR: 2.64, 95% CI: 1.17–6.22). The number of intubation attempts (1 vs. >1) was not associated with death and/or SNI (AOR: 0.95, 95% CI: 0.47–2.03). Conclusion The DR TI is associated with higher odds of death and/or SNI compared with NICU TI, and may help identify higher risk infants. There was no association between the number of TI attempts and death and/or SNI. Key Points

scholarly journals Mortality and neurological outcomes in extremely and very preterm infants born to mothers with hypertensive disorders of pregnancy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Noriyuki Nakamura ◽  
◽  
Takafumi Ushida ◽  
Masahiro Nakatochi ◽  
Yumiko Kobayashi ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Lower Risk ◽  
Periventricular Leukomalacia ◽  
Intraventricular Haemorrhage ◽  
Hospital Death ◽  
Hypertensive Disorders Of Pregnancy ◽  
Very Preterm Infants ◽  
Neurological Outcomes ◽  
Very Preterm ◽  
Increased Risk

AbstractTo evaluate the impact of maternal hypertensive disorders of pregnancy (HDP) on mortality and neurological outcomes in extremely and very preterm infants using a nationwide neonatal database in Japan. This population-based retrospective study was based on an analysis of data collected by the Neonatal Research Network of Japan from 2003 to 2015 of neonates weighing 1,500 g or less at birth, between 22 and 31 weeks’ gestation. A total of 21,659 infants were randomly divided into two groups, HDP (n = 4,584) and non-HDP (n = 4,584), at a ratio of 1:1 after stratification by four factors including maternal age, parity, weeks of gestation, and year of delivery. Short-term (neonatal period) and medium-term (3 years of age) mortality and neurological outcomes were compared between the two groups by logistic regression analyses. In univariate analysis, HDP was associated with an increased risk for in-hospital death (crude odds ratio [OR], 1.31; 95% confidence interval, 1.04–1.63) and a decreased risk for severe intraventricular haemorrhage (0.68; 0.53–0.87) and periventricular leukomalacia (0.60; 0.48–0.77). In multivariate analysis, HDP was significantly associated with a lower risk for in-hospital death (adjusted OR, 0.61; 0.47–0.80), severe intraventricular haemorrhage (0.47; 0.35–0.63), periventricular leukomalacia (0.59; 0.45–0.78), neonatal seizures (0.40; 0.28–0.57) and cerebral palsy (0.70; 0.52–0.95) at 3 years after adjustment for covariates including birth weight. These results were consistent with those of additional analyses, which excluded cases with histological chorioamnionitis and which divided the infants into two subgroups (22–27 gestational weeks and 28–31 gestational weeks). Maternal HDP was associated with an increased risk for in-hospital death without adjusting for covariates, but it was also associated with a lower risk for mortality and adverse neurological outcomes in extremely and very preterm infants if all covariates except HDP were identical.

67 Are NICUs too busy?

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e47-e48
Author(s):  
Marc Beltempo ◽  
Robert Platt ◽  
Anne-Sophie Julien ◽  
Regis Blais ◽  
Bertelle Valerie ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Patient Outcomes ◽  
Gestational Age ◽  
Late Onset ◽  
Mode Of Delivery ◽  
Random Effect ◽  
Organizational Factors ◽  
Neurological Injury ◽  
Very Preterm Infants ◽  
Very Preterm

Abstract Primary Subject area Neonatal-Perinatal Medicine Background In a health care system with limited resources, hospital organizational factors such as unit occupancy and nurse-to-patient ratios may contribute to patient outcomes. Objectives We aimed to assess the association of NICU occupancy and nurse staffing with outcomes of very preterm infants born < 33 weeks gestational age (GA). Design/Methods This was a multicenter retrospective cohort study of infants born 23-32 weeks GA without major congenital anomaly, admitted within 2 days after birth to one of four Level 3 NICUs in Quebec, Canada (2015-2018). For each 8 h shift, data on unit occupancy were obtained from a central provincial database (SiteNeo) and linked to the hospital nursing hours database (Logibec). Unit occupancy rates and nursing provision ratios (nursing hours/recommended nursing hours based on patient dependency categories) were pooled for the first shift, 24 h, and 7 days of admission for each infant. Patient data were obtained from the Canadian Neonatal Network database. Primary outcome was mortality and/or morbidity (severe neurological injury, bronchopulmonary dysplasia, necrotizing enterocolitis, and late-onset sepsis, severe retinopathy of prematurity). Adjusted odds ratios (AOR) for association of exposure with outcomes were estimated using generalized linear mixed models with a random effect for center, while adjusting for confounders (gestational age, small for gestational age, sex, outborn, Score for Neonatal Acute Physiology version 2, mode of delivery, and the other organizational variables). Results Among 1870 infants included in analyses, 796 (43%) had mortality/morbidity. Median occupancy was 89% (IQR 82-94) and median nursing provision was 1.13 (IQR 0.97-1.37). Overall higher NICU occupancy on shift of admission, first 24 h, and 7 days were associated with higher odds of mortality/morbidity (Figure 1) but nursing provision was not (Figure 2). Subgroup analysis by GA (< 29 and 29-32 weeks) yielded similar results (not shown). Generalized linear mixed model analyses showed that a 5% reduction in occupancy in the first 24 h of admission was associated with a 6% reduction in mortality/morbidity. Conclusion NICU occupancy is associated with mortality/morbidity among very preterm infants and may reflect lack of adequate resources in periods of high activity. Interventions aimed at reducing occupancy and maintaining adequate resources need to be considered as strategies to improve patient outcomes.

scholarly journals Outcomes of intraventricular hemorrhage and posthemorrhagic hydrocephalus in a population-based cohort of very preterm infants born to residents of Nova Scotia from 1993 to 2010

2015 ◽  
Vol 15 (6) ◽  
pp. 580-588 ◽  
Author(s):  
Julia A. E. Radic ◽  
Michael Vincer ◽  
P. Daniel McNeely
Keyword(s):  
Cerebral Palsy ◽  
Nova Scotia ◽  
Preterm Infants ◽  
Selection Bias ◽  
Population Based ◽  
Posthemorrhagic Hydrocephalus ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Increased Risk ◽  
Csf Shunting

OBJECT Intraventicular hemorrhage (IVH) is a common complication of preterm birth, and the prognosis of IVH is incompletely characterized. The objective of this study was to describe the outcomes of IVH in a population-based cohort with minimal selection bias. METHODS All very preterm (≥ 30 completed weeks) patients born in the province of Nova Scotia were included in a comprehensive database. This database was screened for infants born to residents of Nova Scotia from January 1, 1993, to December 31, 2010. Among very preterm infants successfully resuscitated at birth, the numbers of infants who died, were disabled, developed cerebral palsy, developed hydrocephalus, were blind, were deaf, or had cognitive/language scores assessed were analyzed by IVH grade. The relative risk of each outcome was calculated (relative to the risk for infants without IVH). RESULTS Grades 2, 3, and 4 IVH were significantly associated with an increased overall mortality, primarily in the neonatal period, and the risk increased with increasing grade of IVH. Grade 4 IVH was significantly associated with an increased risk of disability (RR 2.00, p < 0.001), and the disability appeared to be primarily due to cerebral palsy (RR 6.07, p < 0.001) and cognitive impairment (difference in mean MDI scores between Grade 4 IVH and no IVH: −19.7, p < 0.001). No infants with Grade 1 or 2 IVH developed hydrocephalus, and hydrocephalus and CSF shunting were not associated with poorer outcomes when controlling for IVH grade. CONCLUSIONS Grades 1 and 2 IVH have much better outcomes than Grades 3 or 4, including a 0% risk of hydrocephalus in the Grade 1 and 2 IVH cohort. Given the low risk of selection bias, the results of this study may be helpful in discussing prognosis with families of very preterm infants diagnosed with IVH.

Neonatal care bundles are associated with a reduction in the incidence of intraventricular haemorrhage in preterm infants: a multicentre cohort study

2019 ◽  
Vol 105 (4) ◽  
pp. 419-424 ◽  
Author(s):  
Karen de Bijl-Marcus ◽  
Annemieke Johanna Brouwer ◽  
Linda S De Vries ◽  
Floris Groenendaal ◽  
Gerda van Wezel-Meijler
Keyword(s):  
Cohort Study ◽  
Preterm Infants ◽  
Periventricular Leukomalacia ◽  
Intraventricular Haemorrhage ◽  
Nursing Intervention ◽  
Hospital Death ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Multicentre Cohort Study ◽  
Multicentre Cohort

ObjectiveTo investigate the effect of a nursing intervention bundle, applied during the first 72 hours of life, on the incidence of germinal matrix-intraventricular haemorrhage (GMH-IVH) in very preterm infants.DesignMulticentre cohort study.SettingTwo Dutch tertiary neonatal intensive care units.PatientsThe intervention group consisted of 281 neonates, whereas 280 infants served as historical controls (gestational age for both groups <30 weeks).InterventionsAfter a training period, the nursing intervention bundle was implemented and applied during the first 72 hours after birth. The bundle consisted of maintaining the head in the midline, tilting the head of the incubator and avoidance of flushing/rapid withdrawal of blood and sudden elevation of the legs.Main outcome measuresThe incidence of GMH-IVH occurring and/or increasing after the first ultrasound (but within 72 hours), cystic periventricular leukomalacia and/or in-hospital death was the primary composite outcome measure. Logistic regression analysis was used to explore differences between groups.ResultsThe nursing intervention bundle was associated with a lower risk of developing a GMH-IVH (any degree), cystic periventricular leukomalacia and/or mortality (adjusted OR 0.42, 95% CI 0.27 to 0.65). In the group receiving the bundle, also severe GMH-IVH, cystic periventricular leukomalacia and/or death were less often observed (adjusted OR 0.54, 95% CI 0.33 to 0.91).ConclusionsThe application of a bundle of nursing interventions is associated with reduced risk of developing a new/progressive (severe) GMH-IVH, cystic periventricular leukomalacia and/or mortality in very preterm infants when applied during the first 72 hours postnatally.

scholarly journals Oxygen in the First Minutes of Life in Very Preterm Infants

Neonatology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Ola Didrik Saugstad ◽  
Vishal Kapadia ◽  
Ju Lee Oei
Keyword(s):  
Heart Rate ◽  
Relevant Literature ◽  
Newborn Infants ◽  
Adverse Outcomes ◽  
Delivery Room ◽  
Positive Pressure ◽  
Very Preterm Infants ◽  
Liaison Committee ◽  
Very Preterm ◽  
Increased Risk

Even a few minutes of exposure to oxygen in the delivery room in very preterm and immature infants may have detrimental effects. The initial oxygenation in the delivery room should therefore be optimized, but knowledge gaps, including initial fraction of oxygen (FiO<sub>2</sub>) and how FiO<sub>2</sub> should be changed to reach an optimal oxygen saturation measured by pulse oximetry (SpO<sub>2</sub>) target within the first 5–10 min of life, remain. In order to answer this question, we therefore reviewed relevant literature. For newly born infants with gestational age (GA) &#x3c;32 weeks in need of positive pressure ventilation (PPV) immediately after birth, we identified 2 fundamental issues: (1) the optimal initial FiO<sub>2</sub> and (2) the target SpO<sub>2</sub> within the first 5–10 min of life. For newly born infants between 29 and 31 weeks of GA, an initial FiO<sub>2</sub> of 0.3 hit the target defined by the International Liaison Committee on Resuscitation (ILCOR) best. Newborn infants with GA &#x3c;29 weeks in need of PPV and supplementary oxygen, we suggest starting with FiO<sub>2</sub> 0.3 and adjusting the FiO<sub>2</sub> to reach SpO<sub>2</sub> of 80% within 5 min of life for best outcomes. Prolonged bradycardia (heart rate &#x3c;100 bpm for &#x3e;2 min) is associated with increased risk of adverse outcomes, including death. The combination of strict control of development of SpO<sub>2</sub> in the first 10 min of life and a heart rate &#x3e;100 bpm represents the best tool today to achieve the most optimal outcome in the delivery room of very preterm and immature newborn infants.

Prescriptive birthweight charts can improve the prediction of adverse outcomes in very preterm infants who are small for gestational age

2018 ◽  
Vol 107 (6) ◽  
pp. 981-989 ◽  
Author(s):  
Liset Hoftiezer ◽  
Renske G. Snijders ◽  
Chantal W.P.M. Hukkelhoven ◽  
Richard A. van Lingen ◽  
Marije Hogeveen
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Adverse Outcomes ◽  
Very Preterm Infants ◽  
Very Preterm

scholarly journals Early Detection of Cognitive, Language, and Motor Delays for Low-Income Preterm Infants: A Brazilian Cohort Longitudinal Study on Infant Neurodevelopment and Maternal Practice

2021 ◽  
Vol 12 ◽  
Author(s):  
Nadia C. Valentini ◽  
Luana S. de Borba ◽  
Carolina Panceri ◽  
Beth A. Smith ◽  
Renato S. Procianoy ◽  
...  
Keyword(s):  
Protective Factors ◽  
Preterm Infants ◽  
Infant Development ◽  
Adverse Outcomes ◽  
Late Preterm ◽  
Maternal Factors ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Infant Neurodevelopment ◽  
Composite Scores

Aim: This study examined the neurodevelopment trajectories, the prevalence of delays, and the risks and protective factors (adverse outcomes, environment, and maternal factors) associated with cognitive, motor, and language development for preterm infants from 4– to 24-months.Method: We assessed 186 preterm infants (24.7% extremely preterm; 54.8% very preterm; 20.4% moderate/late preterm) from 4– to 24-months using the Bayley Scales of Infant Development – III. Maternal practices and knowledge were assessed using the Daily Activities of Infant Scale and the Knowledge of Infant Development Inventory. Birth risks and adverse outcomes were obtained from infant medical profiles.Results: A high prevalence of delays was found; red flags for delays at 24-months were detected at 4– and 8-months of age. The neurodevelopmental trajectories showed steady scores across time for cognitive composite scores for extremely- and very-preterm infants and for language composite scores for the extremely- and moderate/late-preterm; a similar trend was observed for the motor trajectories of moderate/late preterm. Changes over time were restricted to motor composite scores for extremely- and very-preterm infants and for cognitive composite scores for moderate/late preterm; declines, stabilization, and improvements were observed longitudinally. Positive, strong, and significant correlations were for the neurodevelopment scores at the first year of life and later neurodevelopment at 18 and 24 months. The cognitive, language, and motor composite scores of extremely and very preterm groups were associated with more risk factors (adverse outcomes, environment, and maternal factors). However, for moderate/late preterm infants, only APGAR and maternal practices significantly explained the variance in neurodevelopment.Discussion: Although adverse outcomes were strongly associated with infant neurodevelopment, the environment and the parents’ engagement in play and breastfeeding were protective factors for most preterm infants. Intervention strategies for preterm infants should start at 4– to 8-months of age to prevent unwanted outcomes later in life.

Sign in / Sign up

Export Citation Format

Share Document