66 Long-term survival and neurodevelopmental outcomes of very-preterm infants born in Canada between 2009 and 2016

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e46-e47
Author(s):  
M Florencia Ricci ◽  
Prakesh Shah ◽  
Diane Moddemann ◽  
Ruben Alvaro ◽  
Eugene Ng ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Hearing Impairment ◽  
Late Onset ◽  
Cognitive Outcome ◽  
Neurodevelopmental Outcomes ◽  
Perinatal Medicine ◽  
Term Survival ◽  
Extremely Preterm ◽  
Neurodevelopmental Impairment ◽  
Improvement Programs

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Quality improvement programs across Canadian Neonatal Network (CNN) sites have led to increased neonatal survival without major neonatal morbidity among infants born extremely preterm. The next step is to determine if such activities impact longer-term survival and neurodevelopmental outcomes. Objectives This cohort study aimed to compare death or significant neurodevelopmental impairment (sNDI) (Bayley-III scores < 70, severe cerebral palsy, blind, or hearing aided) at 18-24 months corrected age among infants born < 29 weeks’ gestation admitted to CNN sites, between 2 Epochs: 1 (2009-2012) and 2 (2013-2016). Secondary objectives included death or neurodevelopmental impairment (NDI) (Bayley-III < 85, any cerebral palsy, visual or hearing impairment), death, sNDI, NDI, and components of neurodevelopmental impairment. Design/Methods Only sites with ≥ 70% follow-up rates were included. Differences in maternal-infant characteristics and neonatal morbidities were assessed by Pearson Chi-square and Student t-test testing. Adjusted odds ratios with 95% CIs were calculated for outcome change between the 2 Epochs, accounting for patient characteristic differences in the model. Results Study population included 4426 children; Epoch 1: 1895 (43%) and Epoch 2: 2531 (57%). In Epoch 2, more mothers received MgSO4 (56.3% vs. 28.4%; p<0.01), antibiotics (69%vs.65.3%; p 0.01) and delayed cord clamping (37.1% vs. 31.3%; p 0.02), and fewer infants had SNAP-2 (illness severity score) >20 (30.7% vs. 35.2%; p<0.01) or late-onset sepsis (23.3% vs. 26.9%; p 0.01). See Table 1. Conclusion Significant reductions in rate of death or sNDI, and in visual and hearing impairment, were identified between Epoch 2 to Epoch 1. An increase in poor cognitive outcome rates requires further study.

Neurodevelopmental impairment in preterm infants with late-onset infection: not only in extremely preterm infants

2014 ◽  
Vol 173 (8) ◽  
pp. 1017-1023 ◽  
Author(s):  
Alexis Chenouard ◽  
Géraldine Gascoin ◽  
Christèle Gras-Le Guen ◽  
Yannis Montcho ◽  
Jean-Christophe Rozé ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Late Onset ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Neurodevelopmental Impairment ◽  
Late Onset Infection

scholarly journals Epilepsy in children with perinatal arterial ischemic stroke

2021 ◽  
Author(s):  
Fabienne Kühne ◽  
Alexander Jungbluth ◽  
Joanna Schneider ◽  
Christoph Bührer ◽  
Christine Prager ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Ischemic Stroke ◽  
Neonatal Period ◽  
Refractory Epilepsy ◽  
Late Onset ◽  
Cognitive Outcome ◽  
Response To Treatment ◽  
Arterial Ischemic Stroke ◽  
Structural Epilepsy ◽  
Drug Refractory Epilepsy

Purpose: Perinatal ischemic stroke (PIS) is a frequent cause for perinatal brain structure defects resulting in epilepsy, cerebral palsy and disability. Since the severity of symptoms is variable, the aim of this study was to evaluate the outcome of children with PIS and seizures/epilepsy to aid parental counseling and therapy decisions. Material: We studied retrospectively patients with arterial PIS and structural epilepsy or seizures in the newborn treated at a single center in 2000-2019. Specifically, signs and symptoms of cerebral palsy (CP), developmental and motor delay, epilepsy and thrombophilia were assessed. Results: From the identified 69 individuals with arterial PIS, we only included the 50 patients (64% male) who had structural epilepsy at the time of investigation or previously in their medical history.The mean age of the included patients was 7.1 years (range 0.08-22) at last consultation. Infarct localisation was predominantly unilateral (86%), left sided (58%) and affecting the middle cerebral artery (94%). Genetic thrombophilia was identified in 52% of the patients examined with genetic testing. More than half of the individuals had CP (52%), and 38.5% had a cognitive outcome below average. First seizures occurred in the neonatal period in 58% of patients and developed into drug-refractory epilepsy in 24.1%. Children with late-onset of epilepsy were twice as likely to develop drug-refractory epilepsy (52.4%). Discussion: Our study shows that patients with PIS and seizures as common sequela often also develop CP. Children with later onset of epilepsy have a worse outcome. Patients with seizure onset in the neonatal period and reccuring seizures have a good response to treatment. Therefore, early diagnosis, follow-up examination and adequate therapy are important. Most children need intensive physiotherapy and speech therapy; however, participation in life is usually age-appropriate.

scholarly journals School-age outcomes following intraventricular haemorrhage in infants born extremely preterm

2020 ◽  
Vol 106 (1) ◽  
pp. 4-8 ◽  
Author(s):  
Nicky Laura Hollebrandse ◽  
Alicia J Spittle ◽  
Alice C Burnett ◽  
Peter J Anderson ◽  
Gehan Roberts ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Executive Function ◽  
Motor Function ◽  
Intraventricular Haemorrhage ◽  
Academic Skills ◽  
Intellectual Ability ◽  
Low Grade ◽  
Cranial Ultrasound ◽  
Neurodevelopmental Outcomes ◽  
Extremely Preterm

ObjectiveTo determine the associations of different grades of intraventricular haemorrhage (IVH), particularly grades 1 and 2, with neurodevelopmental outcomes at 8 years of age in children born extremely preterm.DesignPopulation-based cohort study.SettingState of Victoria, Australia.PatientsSurvivors born at <28 weeks’ gestational age (n=546) and matched term-born controls (n=679) from three distinct eras, namely, those born in 1991–1992, 1997 and 2005.ExposureWorst grade of IVH detected on serial neonatal cranial ultrasound.Outcome measuresIntellectual ability, executive function, academic skills, cerebral palsy and motor function at 8 years.ResultsThere was a trend for increased motor dysfunction with increasing severity of all grades of IVH, from 24% with no IVH, rising to 92% with grade 4 IVH. Children with grade 1 or 2 IVH were at higher risk of developing cerebral palsy than those without IVH (OR 2.24, 95% CI 1.21 to 4.16). Increased rates of impairment in intellectual ability and academic skills were observed with higher grades of IVH, but not for grade 1 and 2 IVH. Parent-rated executive functioning was not related to IVH.ConclusionWhile low-grade IVH is generally considered benign, it was associated with higher rates of cerebral palsy in school-aged children born EP, but not with intellectual ability, executive function, academic skills or overall motor function. Higher grades of IVH were associated with higher rates and risks of impairment in motor function, intellectual ability and some academic skills, but not parental ratings of executive function.

Neurodevelopmental Outcomes in Very Low-Birth-Weight Infants in Korea

2011 ◽  
Vol 26 (11) ◽  
pp. 1405-1410 ◽  
Author(s):  
Dae-Hyun Jang ◽  
In Young Sung ◽  
Jae Yong Jeon ◽  
Hye Jin Moon ◽  
Ki-Soo Kim ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Birth Weight ◽  
Survival Rate ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
Low Birth Weight Infants ◽  
Neurodevelopmental Outcomes ◽  
Recent Group ◽  
Neurodevelopmental Impairment ◽  
Over Time

The authors reviewed the medical records of very low-birth-weight infants admitted from 1998 to 2007 and compared neurodevelopmental outcomes with their previously reported data from 1989 to 1997. The recent group included 824 infants, and the previous group included 471 infants. Neurodevelopmental outcomes were classified into cerebral palsy and non–cerebral palsy neurodevelopmental impairment. In the recent group, the survival rate was significantly higher (79.4% vs 66.2%), the rate of cerebral palsy was lower (7.9% vs 10.5%), and the rate of non–cerebral palsy neurodevelopmental impairment was higher (6.0% vs 4.5%) but not significant. The survival rate increased significantly over time, but there was no significant change in neurodevelopmental outcomes over time. Multivariate analysis indicated that abnormal neurosonographic findings, using assisted ventilation, vaginal delivery, and abnormal brainstem auditory evoked potential, were associated with increased risk for cerebral palsy.

64 Association of 24-hour In-house Neonatologist Coverage with Outcomes of Extremely Preterm Infants

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e45-e46
Author(s):  
Anthony Debay ◽  
Prakesh Shah ◽  
Abhay Lodha ◽  
Sandesh Shivananda ◽  
Stephanie Redpath ◽  
...  
Keyword(s):  
Late Onset ◽  
Neurological Injury ◽  
Multivariable Logistic Regression Analysis ◽  
Care Providers ◽  
Chest Compressions ◽  
Perinatal Medicine ◽  
Major Morbidity ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Care Practices

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Medical team composition at the delivery of high-risk neonates may contribute to better outcomes. The presence of 24-hour (h) in-house staff neonatologist (NN) may improve delivery room (DR) care practices and outcomes. Objectives To assess if 24-h in-house NN coverage is associated with better care practices and outcomes among inborn infants born &lt; 29 weeks GA. Design/Methods Cross-sectional cohort study of 2476 inborn infants born at 23-28 weeks gestation, admitted in 2014-2015 to Canadian Neonatal Network level 3 NICUs with a maternity unit that participated in a 2015 survey on NICU coverage. Exposures were classified using survey responses based on the most senior provider offering 24-h in-house coverage: NN, fellow, and no NN/fellow. Primary outcome was death and/or major morbidity (bronchopulmonary dysplasia, severe neurological injury, late-onset sepsis, necrotizing enterocolitis, retinopathy of prematurity). Multivariable logistic regression analysis was used to assess the association between exposures and outcomes and adjust for confounders with generalized estimating equations to account for clustering within each site. Results Among the 28 participating NICUs, most senior providers ensuring 24-h in-house coverage were NN (32%, 9/28), fellows (39%, 11/28), and no NN/fellow (29%, 8/28). Infants’ characteristics are shown in Table 1. No NN/fellow coverage and 24-h fellow coverage were associated with higher odds of infants receiving DR chest compressions or epinephrine compared to 24-h NN coverage (adjusted odds ratio [AOR] 4.72, 95% CI 2.12-10.6 and AOR 3.33, 95% CI 1.44-7.70, respectively) (Table 2). 24-h fellow coverage was associated with higher odds of normothermia (36.5°C-37.2°C) on admission (AOR 2.26, 95% CI 1.51-3.37) compared to 24-h NN coverage (Table 2). Rates of mortality or major morbidity did not differ significantly among the three groups: NN, 63% (249/395); fellow, 64% (1092/1700); no NN/fellow, 70% (266/381). Compared to 24-h NN coverage, 24-h fellow coverage was associated with lower odds of mortality (AOR 0.62, 95% CI, 0.43-0.88) (Table 2). Conclusion 24-h in-house NN coverage was associated with lower rates of DR chest compressions or epinephrine use; however, it was not associated with death and/or major morbidity. These results are from a survey linked cohort, and data on the actual presence of individuals in NICU/resuscitation is unknown. Future prospective research on care providers present in the NICU, and its impact on outcomes, is needed.

scholarly journals Global prevalence of long-term neurodevelopmental impairment following extremely preterm birth: a systematic literature review

2021 ◽  
Vol 49 (7) ◽  
pp. 030006052110280
Author(s):  
Sujata P. Sarda ◽  
Grammati Sarri ◽  
Csaba Siffel
Keyword(s):  
Systematic Review ◽  
North America ◽  
Major Complication ◽  
Neurodevelopmental Outcomes ◽  
Extreme Prematurity ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Neurodevelopmental Impairment ◽  
Extremely Preterm Birth

Objective Neurodevelopmental impairment (NDI) is a major complication of extreme prematurity. This systematic review was conducted to summarize the worldwide long-term prevalence of NDI associated with extreme prematurity. Methods Embase and MEDLINE databases were searched for epidemiologic and observational/real-world studies, published in English between 2011 and 2016, reporting long-term prevalence of NDI (occurring from 1 year) among extremely preterm infants born at gestational age (GA) ≤28 weeks. Results Of 2406 articles identified through searches, 69 met the protocol NDI definition (24 North America, 25 Europe, 20 Rest of World). Prevalence of any severity NDI in North America was 8%–59% at 18 months to 2 years, and 11%–37% at 2–5 years; prevalence of moderate NDI in Europe was 10%–13% at 18 months to 2 years, 3% at 2–5 years, and 9%–19% at ≥5 years; prevalence of any NDI in Rest of World was 15%–61% at 18 months to 2 years, and 42% at 2–5 years (no North America/Rest of World studies reported any NDI at ≥5 years). A trend toward higher prevalence of NDI with lower GA at birth was observed. Conclusions Extreme prematurity has a significant long-term worldwide impact on neurodevelopmental outcomes.

scholarly journals Does a Split-Week Gestational Age Model Provide Valuable Information on Neurodevelopmental Outcomes in Extremely Preterm Infants?

Children ◽  
2021 ◽  
Vol 8 (9) ◽  
pp. 731
Author(s):  
Elizabeth Asztalos ◽  
Alberto Nettel Aguirre ◽  
Leonora Hendson ◽  
Paige Church ◽  
Rudaina Banihani ◽  
...  
Keyword(s):  
Gestational Age ◽  
Primary Objective ◽  
Neurodevelopmental Outcomes ◽  
Additional Information ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Significant Impairment ◽  
Age Model ◽  
Gestational Week ◽  
Neurodevelopmental Impairment

Our primary objective for this follow-up study was to compare the neurodevelopmental outcomes of a surviving cohort of infants using a split-week gestational model (early versus late) gestational age (GA) and the standard completed GA categorization. Neurodevelopmental outcomes using a split-week GA model defined as early (X, 0–3) and late (X, 4–6), with X being 23–26 weeks GA, were compared to outcomes using completed weeks GA. In total, 1012 infants were included in the study. Statistically significant differences were noted in outcomes between the early and late split of the gestational week at 23 weeks (early vs. late), with 13.3% vs. 54.5% for no neurodevelopmental impairment, and 53.3% vs. 22.7% for significant impairment (p = 0.034), respectively. There were no differences seen in the split week model for 24, 25, and 26 weeks. A trend towards improved neurodevelopmental outcomes was seen with each increasing gestation week. The split-week model did not provide additional information for pregnancies and infants between 24 and 26 weeks gestation. It did, however, provide information for counsel for infants at 23 weeks gestation, showing benefits in the late versus early half of the week.

Late-Onset Circulatory Collapse and Risk of Cerebral Palsy in Extremely Preterm Infants

2019 ◽  
Vol 212 ◽  
pp. 117-123.e4 ◽  
Author(s):  
Kazuaki Yasuoka ◽  
Hirosuke Inoue ◽  
Naoki Egami ◽  
Masayuki Ochiai ◽  
Koichi Tanaka ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Preterm Infants ◽  
Late Onset ◽  
Circulatory Collapse ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Neurodevelopmental outcome descriptions in cohorts of extremely preterm children

2020 ◽  
Vol 105 (5) ◽  
pp. 510-519 ◽  
Author(s):  
Sharon Ding ◽  
Emma J Mew ◽  
Alyssandra Chee-A-Tow ◽  
Martin Offringa ◽  
Nancy J Butcher ◽  
...  
Keyword(s):  
Decision Making ◽  
Cerebral Palsy ◽  
Cognitive Function ◽  
Cohort Studies ◽  
Neurodevelopmental Outcomes ◽  
Outcome Reporting ◽  
Study Results ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Outcome Selection

Background and objectivesCaregivers and clinicians of extremely preterm infants (born before 26 weeks’ gestation) depend on long-term follow-up research to inform clinical decision-making. The completeness of outcome reporting in this area is unknown. The objective of this study was to evaluate the reporting of outcome definitions, selection, measurement and analysis in existing cohort studies that report on neurodevelopmental outcomes of children born extremely preterm.MethodsWe evaluated the completeness of reporting of ‘cognitive function’ and ‘cerebral palsy’ in prospective cohort studies summarised in a meta-analysis that assessed the effect of preterm birth on school-age neurodevelopment. Outcome reporting was evaluated using a checklist of 55 items addressing outcome selection, definition, measurement, analysis, presentation and interpretation. Reporting frequencies were calculated to identify strengths and deficiencies in outcome descriptions.ResultsAll 14 included studies reported ‘cognitive function’ as an outcome; nine reported both ‘cognitive function’ and ‘cerebral palsy’ as outcomes. Studies reported between 26% and 46% of the 55 outcome reporting items assessed; results were similar for ‘cognitive function’ and ‘cerebral palsy’ (on average 34% and 33% of items reported, respectively). Key methodological concepts often omitted included the reporting of masking of outcome assessors, methods used to handle missing data and stakeholder involvement in outcome selection.ConclusionsThe reporting of neurodevelopmental outcomes in cohort studies of infants born extremely preterm is variable and often incomplete. This may affect stakeholders’ interpretation of study results, impair knowledge synthesis efforts and limit evidence-based decision-making for this population.

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 &gt;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 &gt;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 &lt; 0.0003). Conclusions Infants on prolonged TPN &gt;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.

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