scholarly journals 42 The Impact of Home Respiratory Support on Developmental Outcomes in Very Preterm Infants

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e17-e18
Author(s):  
Lindsay McRae ◽  
Emily Kieran ◽  
Thuy Mai Luu ◽  
Sandesh Shivananda ◽  
Anne Synnes
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Respiratory Support ◽  
Neurodevelopmental Outcomes ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Neurodevelopmental Impairment ◽  
Grade 3 ◽  
The Impact

Abstract Introduction/Background Bronchopulmonary dysplasia (BPD) is a common complication of extreme prematurity and may require prolonged home respiratory support. BPD is associated with worse neurodevelopmental outcomes but the impact of home respiratory support on neurodevelopmental outcomes, rehospitalization rates and association with caregiver sociodemographics is less well studied. Objectives This study examines the impact of home respiratory support on neurodevelopmental outcomes in very preterm infants at 18-24 months corrected gestational age. Design/Methods This linked Canadian Neonatal Network and Canadian Neonatal Follow-Up Network (CNFUN) multicenter cohort study of infants born April 1, 2009-December 31, 2016 at <29 weeks’ gestational age assessed at 18-24 months corrected age at a CNFUN site compared significant neurodevelopmental impairment rates, rehospitalization rates and sociodemographics in children with and without home respiratory support using Chi-square and student t-tests. Results Of the 3918 infants, 622 (15.9%) received home respiratory support. As expected, infants on home respiratory support had a lower gestational age (mean 25.5 vs 26.5 weeks, p < 0.01), lower birth weight (mean 781 vs 955 grams, p < 0.01), longer NICU stay (mean 118 vs 76 days, p < 0.01) and more comorbidities: late onset sepsis (35.1% vs 22.9%, p < 0.01), NEC ≥ stage 2 (8.9% vs 5.9%, p = 0.01), grade 3-4 IVH or PVL (12.7% vs 8.4%, p < 0.01) and ROP ≥ grade 3 (28% vs 10.8%, p < 0.01). Infants on home respiratory support had higher significant neurodevelopmental impairment rates defined as Bayley-III motor, cognitive, language scores <70, nonambulatory cerebral palsy (GMFCS ≥ 3), hearing and/or visual impairment rates (Table 1), rehospitalization rates (63.3% vs 29.2%, p < 0.01) and >3 rehospitalizations (19.8% vs 5.0%, p < 0.01). With home respiratory support, fewer families had paid employment and more were on social welfare. Conclusion Children born preterm who are discharged home on respiratory support, compared to those without home support, are more likely to experience neurodevelopmental impairment and rehospitalization, and may have an adverse impact on family income. This is important for discharge planning and follow-up care of these high risk children.

Neurodevelopmental Follow-up of Very Preterm Infants after Proactive Treatment at a Gestational Age of ≥23 Weeks

2008 ◽  
Vol 152 (6) ◽  
pp. 771-776.e2 ◽  
Author(s):  
Jochen Steinmacher ◽  
Frank Pohlandt ◽  
Harald Bode ◽  
Silvia Sander ◽  
Martina Kron ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Very Preterm Infants ◽  
Very Preterm

scholarly journals Adverse effects of small for gestational age differ by gestational week among very preterm infants

2018 ◽  
Vol 104 (2) ◽  
pp. F192-F198 ◽  
Author(s):  
Erik A Jensen ◽  
Elizabeth E Foglia ◽  
Kevin C Dysart ◽  
Rebecca A Simmons ◽  
Zubair H Aghai ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Intraventricular Haemorrhage ◽  
Neonatal Morbidity ◽  
Excess Risk ◽  
Very Preterm Infants ◽  
Adjusted Risk ◽  
Very Preterm ◽  
Grade 3

ObjectiveTo characterise the excess risk for death, grade 3–4 intraventricular haemorrhage (IVH), bronchopulmonary dysplasia (BPD) and stage 3–5 retinopathy of prematurity independently associated with birth small for gestational age (SGA) among very preterm infants, stratified by completed weeks of gestation.MethodsRetrospective cohort study using the Optum Neonatal Database. Study infants were born <32 weeks gestation without severe congenital anomalies. SGA was defined as a birth weight <10th percentile. The excess outcome risk independently associated with SGA birth among SGA babies was assessed using adjusted risk differences (aRDs).ResultsOf 6708 infants sampled from 717 US hospitals, 743 (11.1%) were SGA. SGA compared with non-SGA infants experienced higher unadjusted rates of each study outcome except grade 3–4 IVH among survivors. The excess risk independently associated with SGA birth varied by outcome and gestational age. The highest aRD for death (0.27; 95% CI 0.13 to 0.40) occurred among infants born at 24 weeks gestation and declined as gestational age increased. In contrast, the peak aRDs for BPD among survivors (0.32; 95% CI 0.20 to 0.44) and the composites of death or BPD (0.35; 95% CI 0.24 to 0.46) and death or major morbidity (0.35; 95% CI 0.24 to 0.45) occurred at 27 weeks gestation. The risk-adjusted probability of dying or developing one or more of the evaluated morbidities among SGA infants was similar to that of non-SGA infants born approximately 2–3 weeks less mature.ConclusionThe excess risk for neonatal morbidity and mortality associated with being born SGA varies by adverse outcome and gestational age.

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 Short- and Long-Term Neurodevelopmental Outcomes of Very Preterm Infants with Neonatal Sepsis: A Systematic Review and Meta-Analysis

Children ◽  
2019 ◽  
Vol 6 (12) ◽  
pp. 131 ◽  
Author(s):  
Shirley Cai ◽  
Deanne K. Thompson ◽  
Peter J. Anderson ◽  
Joseph Yuan-Mou Yang
Keyword(s):  
Systematic Review ◽  
Preterm Infants ◽  
Neonatal Sepsis ◽  
Meta Analysis ◽  
Continuous Variables ◽  
Neurodevelopmental Outcomes ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Neurodevelopmental Impairment

Sepsis is commonly experienced by infants born very preterm (<32 weeks gestational age and/or <1500 g birthweight), but the long-term functional outcomes are unclear. The objective of this systematic review was to identify observational studies comparing neurodevelopmental outcomes in very preterm infants who had blood culture-proven neonatal sepsis with those without sepsis. Twenty-four studies were identified, of which 19 used prespecified definitions of neurodevelopmental impairment and five reported neurodevelopmental outcomes as continuous variables. Meta-analysis was conducted using 14 studies with defined neurodevelopmental impairment and demonstrated that very preterm infants with neonatal sepsis were at higher risk of impairments, such as cerebral palsy and neurosensory deficits, compared with infants without sepsis (OR 3.18; 95% CI 2.29–4.41). Substantial heterogeneity existed across the studies (I2 = 83.1, 95% CI 73–89). The five studies that reported outcomes as continuous variables showed no significant difference in cognitive performance between sepsis and non-sepsis groups. Neonatal sepsis in very preterm infants is associated with increased risk of neurodevelopmental disability. Due to the paucity of longitudinal follow-up data beyond 36 months, the long-term cognitive effect of neonatal sepsis in very preterm infants could not be conclusively determined. Effects on the development of minor impairment could not be assessed, due to the small numbers of infants included in the studies.

scholarly journals 1233 The Impact of Medical Home Model on Neurodevelopmental Outcomes of Very Preterm Infants

2012 ◽  
Vol 97 (Suppl 2) ◽  
pp. A352-A352
Author(s):  
Z. Eras ◽  
G. Kanmaz ◽  
B. Ozyurt ◽  
F. Canpolat ◽  
E. Sakrucu ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Medical Home ◽  
Neurodevelopmental Outcomes ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Medical Home Model ◽  
The Impact

Behaviour at 2 years of age in very preterm infants (gestational age <32 weeks)

2003 ◽  
Vol 92 (5) ◽  
pp. 1-1 ◽  
Author(s):  
GMSJ Stoelhorst ◽  
SE Martens ◽  
M Rijken ◽  
van Zwieten PHT ◽  
AH Zwinderman ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Very Preterm Infants ◽  
Very Preterm

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

Significance of low birthweight for gestational age among very preterm infants

1997 ◽  
Vol 104 (6) ◽  
pp. 668-673 ◽  
Author(s):  
Arsenio Spinillo ◽  
Ezio Capuzzo ◽  
Gaia Piazzi ◽  
Federica Baltaro ◽  
Mauro Stronati ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Low Birthweight ◽  
Very Preterm Infants ◽  
Very Preterm

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 &lt; 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 (&lt; 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.

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