Cardiac Troponin T in very low birthweight preterm infants with patent ductus arteriosus

Abstract Aim to assess the role of cardiac troponin C (cTnT) as a marker of cardiac injury in VLBW infants with clinically significant PDA and its relation to echocardiographic findings. Methods Seventy-seven VLBW preterm infants, were included, divided according to their diameter of PDA and its hemodynamic significance into patients and control groups. For all neonates, CBC, CRP, cTnT and echocardiography, were done at 48 hours of life and as follow up 5-7 days later. Results 41 preterm infants with a mean gestational age of 31.7±1.57 weeks and birth weight of (1.38±0.2kg) were included as patients group, 36 preterm infants were included as control group with a mean gestational age of 32.2±0.9 weeks and birth weight of (1.33±0.2kg). At 48 hours, cTnT concentrations in patients group was significantly increased than in control group (0.31±0.06 ng/dl, 0.16±0.03 ng/dl, respectively, P < 0.001) and was positively corelated to PDA diameter in patients group (r:0.313, P:0.046). Mean left ventricular end systolic diameter was significantly decreased in patients than in control groups (9.00±1.94, 14.72±1.56, P:0.023). On 5th day, cTnT concentrations (0.15 ±0.03 ng/dl) significantly decreased with closure of the duct (p: 0.004) together with increase in ejection fraction and fraction shortening (P < 0.001, P:0.008 respectively) Conclusion cTnT may provide the basis for early diagnosis and detection of hemodynamically significant PDA in VLBW neonates for trials of medical treatment.

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Disseminated Candidal Infections and Intravenous Hydrocortisone in Preterm Infants

PEDIATRICS ◽

10.1542/peds.95.6.883 ◽

1995 ◽

Vol 95 (6) ◽

pp. 883-887

Author(s):

Carlos M. Botas ◽

Isabel Kurlat ◽

Shirley M. Young ◽

Augusto Sola

Keyword(s):

Risk Factors ◽

Intensive Care ◽

Birth Weight ◽

San Francisco ◽

Preterm Infants ◽

Gestational Age ◽

Selection Process ◽

Control Group ◽

Major Teaching Hospital ◽

Intensive Care Nursery

Background. Intravenous (IV) hydrocortisone (HC) has been used recently in selected preterm infants for hypotension soon after birth. During the same time period that HC was used, there was a marked increase in the incidence of disseminated candidal infections (DCIs). Objective. To determine whether there is an association between DCI in the first 35 days of life and IV HC in preterm infants. Research design. A hospital case-control study comparing the exposure of HC between preterm infants with DCI and matched infants without DCI. Setting. A tertiary level intensive care nursery in a major teaching hospital in San Francisco, CA. Patients. Seventeen preterm infants with DCI and 25 infants without DCI, with gestational age younger than 28 weeks and birth weight less than 1000 g, inborn and outborn admitted to the intensive care nursery between January 1992 and September 1993. Methods. All preterm infants diagnosed with DCI at younger than 35 days of age were identified using a perinatal and neonatal database. DCI was defined as a blood, cerebrospinal fluid, or two urine cultures positive for Candida requiring antifungal therapy. A control group of uninfected infants matched for the major risk factors for DCI (gestational age, birth weight, duration of intubation, broad-spectrum antibiotics, and IV alimentation, including lipids and central venous catheters) admitted during the same period was identified using the same database. Postmatching comparison was performed for several other factors to detect any other differences between the groups. Results. The infants with DCI (n = 17) and control infants (n = 25) had no statistical difference in exposure to the major risk factors for DCI or in postmatching comparison. Ten (59%) of the infants with DCI were receiving HC at the time of infection, whereas four (16%) of the control infants received HC during the first 35 days of life. Infants with DCI were 7.5 times as likely as control infants (95% confidence interval, 5 to 11) to have received IV HC before the onset of fungal infection. Conclusion. We conclude that the administration of IV HC significantly increases the risk of DCI in susceptible preterm infants younger than 35 days of age. The potentially serious risks of DCI should be considered particularly in the patient selection process for administration of IV HC.

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The Post-Discharge Growth of Very Low Birth Weight Preterm Infants

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2020.1023 ◽

2020 ◽

pp. 1

Author(s):

Tuba Ozdemir ◽

Abdullah Baris Akcan ◽

Munevver Kaynak Turkmen

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Preterm Infants ◽

Gestational Age ◽

Very Low Birth Weight ◽

Ductus Arteriosus ◽

Somatic Growth ◽

Growth Time ◽

Appropriate For Gestational Age ◽

Catch Up

OBJECTIVE: In the present study, we investigate the growth characteristics of very low birth weight premature infants of up to two years corrected age, considering the factors affecting growth and catch-up growth time.STUDY DESIGN: The demographic data, clinical features, and comorbidities of 77 preterm infants with birth weights of less than or equal to 1.500 g were examined, the infants’ growth statuses in the 40th gestational week (gw) and at 6, 12, 18 and 24 months the corrected age, including their weight, height and head circumference, were evaluated.RESULTS: The findings revealed that very low birth weight infants should be closely monitored either during their stay in the Neonatal Intensive Care Unit, or for up to 6 months corrected age, paying particular attention to growth data, and the appropriate supportive treatment should be administered. The applied support process is influential on the future somatic growth of preterm infants. It was noted in the study that bronchopulmonary dysplasia, proven sepsis, respiratory distress syndrome, steroid treatment for more than three days, patent ductus arteriosus, and ibuprofen treatment seemed to affect somatic growth negatively.CONCLUSION: Small for gestational age newborns were found to catch up with appropriate for gestational age newborns at 2 years corrected age in terms of growth, although the percentage of catch-up growth during follow-up at the 40thgw, and at the 6th, 12th and 18th months was lower than that of appropriate for gestational age newborns.

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Recém-Nascido de Muito Baixo Peso numa Unidade de Cuidados Intensivos Portuguesa Comparativamente ao Vermont Oxford Network: 15 Anos de Registo

Acta Médica Portuguesa ◽

10.20344/amp.9130 ◽

2019 ◽

Vol 32 (11) ◽

pp. 686

Author(s):

Joana Saldanha ◽

Carlos Moniz ◽

Maria do Céu Machado

Keyword(s):

Birth Weight ◽

Length Of Stay ◽

Low Birth Weight ◽

Gestational Age ◽

Low Birthweight ◽

Very Low Birth Weight ◽

Post Partum ◽

Ductus Arteriosus ◽

Corticosteroid Treatment ◽

The Past

Introduction: Our neonatal service is part of a differentiated perinatal hospital and has contributed to the Vermont Oxford Network for more than 15 years. This data base includes data on the morbidity and mortality of newborns born in the member hospitals with birth weight between 401 and 1500 g and/ or from 22 to 29 weeks and six days of gestation, or those admitted to these hospitals with up to 28 days of age. It thus allows the analysis of clinical practice and its comparison with similar units. The goal of the present paper is to disclose some of our data from the past 15 years and to compare it with the Vermont Oxford Network data trying to identify areas of possible improvement and permitting other neonatal units to compare their data with our in a benchmarking process.Material and Methods: Observational, retrospective study. It included newborns with birth weight ≤ 1500 g (very low birth weight newborns) born and treated at our hospital from 2001 to 2015. Descriptive data analysis, chi-square test and ANOVA, significance when p < 0.05.Results: A total of 869 very low birth weight newborns were studied, median weight 1100 g and gestational age 29 weeks. Twinning was found in 37.6%. In the delivery room, 23% did not require any resuscitation, 52.2% of the newborns required invasive intubation, 78.3% had surfactant, and, since 2011, 29.7% have started noninvasive ventilation. Of the total very low birth weight newborns, 12.9% had oxygen therapy at 36 weeks of corrected age, 23% patent ductus arteriosus and late sepsis in 17.1%. There was higher neurological morbidity compared to the Vermont Oxford Network except in the case of retinopathy of prematurity. Overall mortality was 14% (122 newborns). The time of hospitalization was on average 52.7 ± 34.4 days. The 629 newborns that were discharged home had equivalent length of stay and head circumference measure but a lower weight than those in the Vermont Oxford Network, and 14.3% went home with exclusive breastfeeding.Discussion: This work allowed us to study our very low birth weight newborns data and compare it with one of the largest neonatal world networks. Our population is similar from the point of view of gestational age, somatometric data, pregnancy surveillance rates and cesarean section with the most noticeable difference being the percentage of low birthweight for gestational age babies, twin pregnancies and antenatal corticosteroid treatment, superior in our center. Cardio-pulmonary and gastrointestinal disorders were overlapping. It is urgent to improve our rate of sepsis, neurologic sequelae, post-partum hypothermia control and neuroprotection with magnesium sulphate. The mortality rate and the length of stay at discharge was similar.Conclusion: This study allowed us to compare our population of very low birth weight newborns with those registered in the network. We have verified that we have been accompanying the evolution of Neonatology over the past years and we have identified areas for improvement.

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Influence of a Patent Ductus Arteriosus on Cardiac Troponin T Levels in Preterm Infants

The Journal of Pediatrics ◽

10.1016/j.jpeds.2008.04.014 ◽

2008 ◽

Vol 153 (3) ◽

pp. 350-353.e2 ◽

Cited By ~ 32

Author(s):

Afif F. El-Khuffash ◽

Eleanor J. Molloy

Keyword(s):

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Cardiac Troponin ◽

Troponin T ◽

Ductus Arteriosus ◽

Cardiac Troponin T ◽

Patent Ductus

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The Correlation Between Bronchopulmonary Dysplasia and Platelet Metabolism in Preterm Infants

Frontiers in Pediatrics ◽

10.3389/fped.2021.670469 ◽

2021 ◽

Vol 9 ◽

Author(s):

Longli Yan ◽

Zhuxiao Ren ◽

Jianlan Wang ◽

Xin Xia ◽

Liling Yang ◽

...

Keyword(s):

Platelet Count ◽

Birth Weight ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Premature Infants ◽

Gestational Age ◽

Admission Diagnosis ◽

Control Group ◽

The Relationship

Background: Platelets play an important role in the formation of pulmonary blood vessels, and thrombocytopenia is common in patients with pulmonary diseases. However, a few studies have reported on the role of platelets in bronchopulmonary dysplasia.Objective: The objective of the study was to explore the relationship between platelet metabolism and bronchopulmonary dysplasia in premature infants.Methods: A prospective case-control study was performed in a cohort of premature infants (born with a gestational age <32 weeks and a birth weight <1,500 g) from June 1, 2017 to June 1, 2018. Subjects were stratified into two groups according to the diagnostic of bronchopulmonary dysplasia: with bronchopulmonary dysplasia (BPD group) and without bronchopulmonary dysplasia (control group). Platelet count, circulating megakaryocyte count (MK), platelet-activating markers (CD62P and CD63), and thrombopoietin (TPO) were recorded and compared in two groups 28 days after birth; then serial thrombopoietin levels and concomitant platelet counts were measured in infants with BPD.Results: A total of 252 premature infants were included in this study. Forty-eight premature infants developed BPD, 48 premature infants without BPD in the control group who were matched against the study infants for gestational age, birth weight, and admission diagnosis at the age of postnatal day 28. Compared with the controls, infants with BPD had significantly lower peripheral platelet count [BPD vs. controls: 180.3 (24.2) × 109/L vs. 345.6 (28.5) × 109/L, p = 0.001]. Circulating MK count in the BPD group was significantly more abundant than that in the control group [BPD vs. controls: 30.7 (4.5)/ml vs. 13.3 (2.6)/ml, p = 0.025]. The level of CD62p, CD63, and TPO in BPD group was significantly higher than the control group [29.7 (3.1%) vs. 14.5 (2.5%), 15.4 (2.0%) vs. 5.8 (1.7%), 301.4 (25.9) pg/ml vs. 120.4 (14.2) pg/ml, all p < 0.05]. Furthermore, the concentration of TPO was negatively correlated with platelet count in BPD group with thrombocytopenia.Conclusions: Our findings suggest that platelet metabolism is involved in the development of BPD in preterm infants. The possible mechanism might be through increased platelet activation and promoted TPO production by feedback.

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The study of clinical profile and assess the outcome of preterm infants diagnosed to have clinically significant PDA

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20183029 ◽

2018 ◽

Vol 7 (8) ◽

pp. 1593

Author(s):

Bhabagrahi Mallick ◽

Sarthak R. Nayak ◽

Subrat Ku. Tripathy

Keyword(s):

Birth Weight ◽

Preterm Infants ◽

Gestational Age ◽

Ductus Arteriosus ◽

Clinical Profile ◽

Fluid Restriction ◽

Surgical Ligation ◽

Fetal Survival ◽

Ductal Closure ◽

Clinically Significant

Background: Patency of ductus arteriosus is vital for fetal survival. Ductus often fails to close in premature infants called patent ductus arteriosus (PDA). Our objective is to find the clinical profile and assess the outcome of preterm infants diagnosed to have clinically significant PDA.Methods: 20 infants diagnosed as PDA clinically and confirmed by echocardiography. Symptomatic infants initially treated with fluid restriction and frusemide. Non responders treated with per rectal ibuprofen with dose of 10 mg/kg stat followed by 5 mg/kg x 2 doses at 24 hour intervals. Failure to ductal closure followed by similar second course of ibuprofen. Echocardiography repeated after 72 hours of each therapy. Surgical ligation of ductus was carried after failure to drug therapies. Secondary outcomes during hospitalization were documented.Results: PDA was diagnosed in seventeen infants during first week and three after seven postnatal day. Mean gestational age and birth weight were 31±2 weeks and 1466±378grams respectively. Three babies responded well to fluid therapy. Thirteen infants out of seventeen had ductal closure after first course and two to second course of ibuprofen. Two had undergone surgical treatment. Six infants detected with sepsis, five with intraventricular hemorrhage and retinopathy of prematurity. Two developed bronchopulmonary dysplasia. Pulmonary hemorrhage and NEC were found in one each. Two babies died.Conclusions: PDA is inversely related to gestational age and birth weight. Prostaglandin synthase inhibitors are essential in ductal closure. Surgical ligation is reserved for medical therapy failure. Co-morbidities in PDA are less in well treated babies.

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Prevalence of patent ductus arteriosus in premature infants at the Neonatal Ward, Cipto Mangunkusumo Hospital, Jakarta

Paediatrica Indonesiana ◽

10.14238/pi44.6.2004.223-7 ◽

2016 ◽

Vol 44 (6) ◽

pp. 223 ◽

Cited By ~ 2

Author(s):

Benita Deselina ◽

Sukman Tulus Putra ◽

Rulina Suradi

Keyword(s):

Birth Weight ◽

Incidence Rate ◽

Preterm Infants ◽

Premature Infants ◽

Gestational Age ◽

Heart Diseases ◽

Ductus Arteriosus ◽

Chronological Age ◽

Neonatal Ward ◽

Patent Ductus

Background Patent ductus arterious (PDA) is one of the mostcommon congenital heart diseases encountered in preterm infants.The lower the birth weight and gestational age are, the higher theincidence of PDA is.Objectives To investigate the incidence of PDA in premature infantshospitalized in the neonatal wards of Cipto Mangunkusumo Hospitalusing echocardiography.Methods Preterm infants born between August and October 2003were included in this study. Clinical features were retrieved from medicalcharts. The first echocardiography was conducted on all of the preterminfants at the chronological age of 3 days. If PDA was detected,echocardiography was repeated at the chronological age of 6 days.Results During the 3-month period, sixty-five preterm infantsparticipated in this study and underwent echocardiography. In thefirst echocardiogram, the incidence rate of PDA was 32%. Atgestational age of less than 28 weeks, 1 of 2 infants had PDA. Of 3infants with birth weight of more than 1000 grams, 2 had PDA. Onthe second echocardiography, the incidence rate of PDA was 14%and mostly found in infants at gestational age of less than 28 weeks(8/9) and in those with birth weight of less than 1000 grams (7/9).All infants with RDS whose PDA was identified in the firstechocardiography proved to maintain their PDA in the secondechocardiography.Conclusion The incidence rate of PDA in preterm infants was14%. The lower the birth weight, the higher the incidence rate ofPDA. The presence of RDS is related to the delay in the closing ofthe arterial duct

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Effect of early prophylactic low-dose recombinant human erythropoietin on retinopathy of prematurity in very preterm infants

Journal of Translational Medicine ◽

10.1186/s12967-020-02562-y ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Huiqing Sun ◽

Juan Song ◽

Wenqing Kang ◽

Yong Wang ◽

Xiantao Sun ◽

...

Keyword(s):

Birth Weight ◽

Preterm Infants ◽

Gestational Age ◽

Recombinant Human Erythropoietin ◽

Low Dose ◽

Control Group ◽

Very Preterm Infants ◽

Very Preterm ◽

Human Erythropoietin

Abstract Background Very preterm infants are at risk of developing retinopathy of prematurity (ROP). Recombinant human erythropoietin (rhEPO) is routinely used to prevent anemia in preterm infants; however, the effect of rhEPO on ROP development is still controversial. The purpose of this study was to evaluate the effect of early prophylactic low-dose rhEPO administration on ROP development in very preterm infants. Methods A total of 1898 preterm infants born before 32 weeks of gestation were included. Preterm infants received rhEPO (n = 950; 500 U/kg, rhEPO group) or saline (n = 948, control group) intravenously within 72 h of birth and then once every other day for 2 weeks. Results The total incidence of ROP was not significantly different between the two groups (10.2% vs. 13.2%, p = 0.055). Further analysis showed that rhEPO group had lower rates of type 2 ROP than the control group (2.2% vs. 4.1%, RR 0.98; 95% CI 0.96–1.00; p = 0.021). Subgroup analysis found that rhEPO treatment significantly decreased the incidence of type 2 ROP in infant boys (1.8% vs. 4.3%, p = 0.021) and in those with a gestational age of 28–296/7 weeks (1.1% vs. 4.9%, p = 0.002) and birth weight of 1000–1499 g (1.2% vs. 4.2%, p = 0.002). There was a small increasing tendency for the incidence of ROP in infants with a gestational age of < 28 weeks after rhEPO treatment. Conclusions Repeated low-dose rhEPO administration has no significant influence on the development of ROP; however, it may be effective for type 2 ROP in infant boys or in infants with gestational age > 28 weeks and birth weight > 1500 g. Trial registration The data of this study were retrieved from two clinical studies registered ClinicalTrials.gov (NCT 02036073) on January 14, 2014, https://clinicaltrials.gov/ct2/show/NCT02036073; and (NCT03919500) on April 18, 2019. https://clinicaltrials.gov/ct2/show/NCT03919500.

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Packed Cell Transfusion and Feeding Tolerance in Healthy Preterm Infants: A Randomized Clinical Tria

Iranian Journal of Pediatrics ◽

10.5812/ijp.110275 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Minoo Fallahi ◽

Mohammad Kazemian ◽

Saeed Hojat Kashani ◽

Saleheh Tajalli ◽

Naeeme Taslimi

Keyword(s):

Birth Weight ◽

Preterm Infants ◽

Gestational Age ◽

Neonatal Intensive Care ◽

Intervention Group ◽

Preterm Neonates ◽

Control Group ◽

Significant Difference ◽

Packed Cell Transfusion ◽

Feeding Tolerance

Background: Recently, the correlation between necrotizing enterocolitis (NEC) and packed cell transfusion (PCT) has been identified. Evidence shows that 25 - 35% of NEC cases are associated with PCT. Objectives: this study aimed to determine the association between PCT and feeding tolerance in healthy preterm newborns. Methods: Materials and Methods: This clinical trial was performed on preterm infants, admitted to the neonatal intensive care unit (NICU) of Mofid Children's Hospital, Tehran, Iran, from April 2017 to May 2018. A total of 70 healthy premature infants (birth weight < 1500 g and gestational age < 32 weeks) with enteral feeding, who required PCT, were included in this study. The eligible infants were divided into two groups by simple randomization. In the intervention group (n = 35), breastfeeding was withheld only during PCT and then continued as usual. On the other hand, in the control group (n = 35), feeding was performed as usual, regardless of PCT. Feeding tolerance within the first 72 hours post-transfusion was compared between the two groups. Sick newborns were excluded from the study. Data analysis was performed in SPSS version 20. Results: The mean gestational age, birth weight, and postnatal age of the neonates were 30.13 weeks, 1245.71 g, and 17 days in the intervention group and 29.97 weeks, 1169.43 g, and 15.46 days in the control group, respectively; there was no significant difference between the two groups. Except for pre-transfusion hemoglobin and hematocrit levels, other characteristics of the two groups were similar. Feeding tolerance was reported in 32 (91.2%), 33 (94.73%), and 34 (97.1%) newborns at 24, 48, and 72 hours post-transfusion in both groups, without any significant difference. There was no significant difference between neonates with and without feeding tolerance in either of the groups. Conclusions: According to the present results, withholding feeding during PCT is not necessary in healthy preterm neonates with a good general condition, and continued breastfeeding seems to be a safe option.

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Preterm birth and low birth weight in neonates with postnatal respiratory failure at a tertiary hospital in Viet Nam

Biomedical Research and Therapy ◽

10.15419/bmrat.v7i9.633 ◽

2020 ◽

Vol 7 (9) ◽

pp. 4010-4015

Author(s):

Nguyen Thanh Nam ◽

Pham Van Dem ◽

Ngo Thi Tam ◽

Nguyen Tien Dung

Keyword(s):

Mechanical Ventilation ◽

Birth Weight ◽

Preterm Birth ◽

Respiratory Failure ◽

Low Birth Weight ◽

Gestational Age ◽

Treatment Plan ◽

Ductus Arteriosus ◽

Tertiary Hospital ◽

Control Group

Introduction: This study aimed to evaluate the rate of preterm birth and low birth weight in neonates having postnatal respiratory failure. Methods: A cross-sectional design was used in the study. There were 139 neonates with postnatal respiratory failure and 278 neonates without respiratory failure included in the study. Data on comorbidities, gestational age, and mechanical ventilation status were collected. Results: Among neonates with respiratory failure, the rate of preterm birth (< 37 weeks) was 70.5%. The average gestational age and weight of the respiratory failure group were significantly lower compared to the control group (p < 0.001). Asphyxia, patent ductus arteriosus, and hyaline membrane were the most common causes of respiratory failure. The rate of neonates having less than 37 gestational weeks and requiring mechanical ventilation as treatment for respiratory failure was 73.5%, in which the proportion of neonates born before 32 gestational weeks was 47.1% (p < 0.001). Conclusion: The rates of preterm birth and low birth weight among infants with respiratory failure in a tertiary hospital in Vietnam were significantly high. Causes of preterm birth and low birth weight were preventable and treatable if having appropriate care and treatment plan.

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