Association of Early Postnatal Transfer and Birth Outside a Tertiary Hospital With Mortality and Severe Brain Injury in Extremely Preterm Infants

2020 ◽  
Vol 75 (3) ◽  
pp. 145-147
Author(s):  
Kjell Helenius ◽  
Nicholas Longford ◽  
Liisa Lehtonen ◽  
Neena Modi ◽  
Chris Gale
Keyword(s):  
Brain Injury ◽  
Preterm Infants ◽  
Tertiary Hospital ◽  
Severe Brain Injury ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

scholarly journals Association of early postnatal transfer and birth outside a tertiary hospital with mortality and severe brain injury in extremely preterm infants: observational cohort study with propensity score matching

BMJ ◽  
2019 ◽  
pp. l5678 ◽  
Author(s):  
Kjell Helenius ◽  
Nicholas Longford ◽  
Liisa Lehtonen ◽  
Neena Modi ◽  
Chris Gale
Keyword(s):  
Brain Injury ◽  
Preterm Infants ◽  
Tertiary Care ◽  
Tertiary Hospital ◽  
Severe Brain Injury ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Significant Difference ◽  
Transfer Group ◽  
Upward Transfer

Abstract Objective To determine if postnatal transfer or birth in a non-tertiary hospital is associated with adverse outcomes. Design Observational cohort study with propensity score matching. Setting National health service neonatal care in England; population data held in the National Neonatal Research Database. Participants Extremely preterm infants born at less than 28 gestational weeks between 2008 and 2015 (n=17 577) grouped based on birth hospital and transfer within 48 hours of birth: upward transfer (non-tertiary to tertiary hospital, n=2158), non-tertiary care (born in non-tertiary hospital; not transferred, n=2668), and controls (born in tertiary hospital; not transferred, n=10 866). Infants were matched on propensity scores and predefined background variables to form subgroups with near identical distributions of confounders. Infants transferred between tertiary hospitals (horizontal transfer) were separately matched to controls in a 1:5 ratio. Main outcome measures Death, severe brain injury, and survival without severe brain injury. Results 2181 infants, 727 from each group (upward transfer, non-tertiary care, and control) were well matched. Compared with controls, infants in the upward transfer group had no significant difference in the odds of death before discharge (odds ratio 1.22, 95% confidence interval 0.92 to 1.61) but significantly higher odds of severe brain injury (2.32, 1.78 to 3.06; number needed to treat (NNT) 8) and significantly lower odds of survival without severe brain injury (0.60, 0.47 to 0.76; NNT 9). Compared with controls, infants in the non-tertiary care group had significantly higher odds of death (1.34, 1.02 to 1.77; NNT 20) but no significant difference in the odds of severe brain injury (0.95, 0.70 to 1.30) or survival without severe brain injury (0.82, 0.64 to 1.05). Compared with infants in the upward transfer group, infants in the non-tertiary care group had no significant difference in death before discharge (1.10, 0.84 to 1.44) but significantly lower odds of severe brain injury (0.41, 0.31 to 0.53; NNT 8) and significantly higher odds of survival without severe brain injury (1.37, 1.09 to 1.73; NNT 14). No significant differences were found in outcomes between the horizontal transfer group (n=305) and controls (n=1525). Conclusions In extremely preterm infants, birth in a non-tertiary hospital and transfer within 48 hours are associated with poor outcomes when compared with birth in a tertiary setting. We recommend perinatal services promote pathways that facilitate delivery of extremely preterm infants in tertiary hospitals in preference to postnatal transfer.

Admission Systolic Blood Pressure and Outcomes in Preterm Infants of ≤ 26 Weeks' Gestation

2017 ◽  
Vol 34 (13) ◽  
pp. 1271-1278 ◽  
Author(s):  
Yanyu Lyu ◽  
Xiang Ye ◽  
Tetsuya Isayama ◽  
Ruben Alvaro ◽  
Chuks Nwaesei ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Brain Injury ◽  
Preterm Infants ◽  
Gestational Age ◽  
Early Mortality ◽  
Composite Outcome ◽  
Severe Brain Injury ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
The Relationship

Objective To examine the relationship between admission systolic blood pressure (SBP) and adverse neonatal outcomes. Specifically, we aimed to identify the optimal SBP that is associated with the lowest rates of adverse outcomes in extremely preterm infants of ≤ 26 weeks' gestation. Methods In this retrospective study, inborn neonates born at ≤ 26 weeks' gestational age and admitted to tertiary neonatal units participating in the Canadian Neonatal Network between 2003 and 2009 were included. The primary outcome was early mortality (≤ 7 days). Secondary outcomes included severe brain injury, late mortality, and a composite outcome defined as early mortality or severe brain injury. Nonlinear multivariable logistic regression models examined the relationship between admission SBP and outcomes. Results Admission SBP demonstrated a U-shaped relationship with early mortality, severe brain injury, and composite outcome after adjustment for confounders (p < 0.01). The lowest risks of early mortality, severe brain injury, and composite outcome occurred at admission SBPs of 51, 55, and 54 mm Hg, respectively. Conclusion In extremely preterm infants of ≤ 26 weeks' gestational age, the relationship between admission SBP, and early mortality and severe brain injury was “U-shaped.” The optimal admission SBP associated with lowest rates of adverse outcome was between 51 and 55 mm Hg.

scholarly journals Cerebral near-infrared spectroscopy monitoring versus treatment as usual for extremely preterm infants. A protocol for the SafeBoosC randomised clinical phase III trial

2019 ◽  
Author(s):  
Mathias Hansen ◽  
Adelina Pellicer ◽  
Christian Gluud ◽  
Eugene Dempsey ◽  
Jonathan Mintzer ◽  
...  
Keyword(s):  
Infrared Spectroscopy ◽  
Preterm Infants ◽  
Near Infrared ◽  
Control Group ◽  
Severe Brain Injury ◽  
Treatment As Usual ◽  
Opt Out ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Postmenstrual Age

Abstract Background: Cerebral oxygenation monitoring may reduce the risk of death and neurologic complications in extremely preterm infants, but no such effects have yet been demonstrated in preterm infants in sufficiently powered randomised clinical trials. The objective of the SafeBoosC-III trial is to investigate the benefits and harms of treatment based on near-infrared spectroscopy (NIRS) monitoring compared with treatment as usual for extremely preterm infants. Methods/Design: SafeBoosC III is an investigator-initiated multinational randomised, pragmatic phase III clinical trial. Inclusion criteria will be infants born below 28 weeks postmenstrual age and parental informed consent (unless the site is using ‘opt-out’ or deferred consent). Exclusion criteria will be no parental informed consent (or if ‘opt-out’ is used, lack of record that clinical staff have explained the trial and the ‘opt-out’ consent process to parents and/or a record of parents’ decision to opt-out in the infants clinical file); decision not to provide full life support; and no possibility to initiate cerebral NIRS oximetry within 6 hours after birth. Participants will be randomised 1:1 into either the experimental or control group. Participants in the experimental group will be monitored during the first 72 hours of life with a cerebral NIRS oximeter. Cerebral hypoxia will be treated according to an evidence-based treatment guideline. Participants in the control group will not undergo cerebral oxygenation monitoring and will receive treatment as usual. Each participant will be followed up at 36 weeks postmenstrual age. The primary outcome will be a composite of either death or severe brain injury detected on any of the serial cranial ultrasound scans that are routinely performed in these infants up to 36 weeks postmenstrual age. Severe brain injury will be assessed by a person blinded to group allocation. To detect a 22% relative risk difference between the experimental and control group, we intend to randomise a cohort of 1600 infants. Discussion: Treatment guided by cerebral NIRS oximetry has the potential to decrease the risk of death or survival with severe brain injury in preterm infants. There is an urgent need to assess the clinical effects of NIRS monitoring among preterm neonates. Trial registration: ClinicalTrial.gov NCT03770741 (registered 10/12-2018), https://clinicaltrials.gov/ct2/show/NCT03770741?recrs=b&cond=cerebral+near+infrared+spectroscopy&rank=3

scholarly journals The Apolipoprotein Gene and Recovery from Brain Injury among Extremely Preterm Infants

Neonatology ◽  
2014 ◽  
Vol 105 (3) ◽  
pp. 227-229 ◽  
Author(s):  
James A. Blackman ◽  
Heather Gordish-Dressman ◽  
Yondge Bao ◽  
Julie A. Matsumoto ◽  
Robert A. Sinkin
Keyword(s):  
Brain Injury ◽  
Preterm Infants ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

scholarly journals Preventing Brain Injury in the Preterm Infant—Current Controversies and Potential Therapies

2021 ◽  
Vol 22 (4) ◽  
pp. 1671
Author(s):  
Nathanael Yates ◽  
Alistair J. Gunn ◽  
Laura Bennet ◽  
Simerdeep K. Dhillon ◽  
Joanne O. Davidson
Keyword(s):  
Cerebral Palsy ◽  
Brain Injury ◽  
Preterm Infant ◽  
Brain Damage ◽  
Preterm Infants ◽  
Preclinical Studies ◽  
Recombinant Erythropoietin ◽  
Neurological Outcomes ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Preterm birth is associated with a high risk of morbidity and mortality including brain damage and cerebral palsy. The development of brain injury in the preterm infant may be influenced by many factors including perinatal asphyxia, infection/inflammation, chronic hypoxia and exposure to treatments such as mechanical ventilation and corticosteroids. There are currently very limited treatment options available. In clinical trials, magnesium sulfate has been associated with a small, significant reduction in the risk of cerebral palsy and gross motor dysfunction in early childhood but no effect on the combined outcome of death or disability, and longer-term follow up to date has not shown improved neurological outcomes in school-age children. Recombinant erythropoietin has shown neuroprotective potential in preclinical studies but two large randomized trials, in extremely preterm infants, of treatment started within 24 or 48 h of birth showed no effect on the risk of severe neurodevelopmental impairment or death at 2 years of age. Preclinical studies have highlighted a number of promising neuroprotective treatments, such as therapeutic hypothermia, melatonin, human amnion epithelial cells, umbilical cord blood and vitamin D supplementation, which may be useful at reducing brain damage in preterm infants. Moreover, refinements of clinical care of preterm infants have the potential to influence later neurological outcomes, including the administration of antenatal and postnatal corticosteroids and more accurate identification and targeted treatment of seizures.

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