scholarly journals Premature infants display discriminable behavioural, physiological and brain responses to noxious and non-noxious stimuli

2021 ◽  
Author(s):  
Marianne van der Vaart ◽  
Caroline Hartley ◽  
Luke Baxter ◽  
Gabriela Schmidt Mellado ◽  
Foteini Andritsou ◽  
...  
Keyword(s):  
Heart Rate ◽  
Preterm Infants ◽  
Pain Assessment ◽  
Developmental Stages ◽  
Brain Activity ◽  
Event Related Potential ◽  
Evoked Responses ◽  
Term Infants ◽  
Postmenstrual Age ◽  
Noxious Stimuli

AbstractPain assessment in preterm infants is challenging, as behavioural, autonomic and neurophysiological measures of pain are reported to be less sensitive and specific than in term infants. Understanding the pattern of preterm infants’ noxious-evoked responses is vital to improve pain assessment in this group. This study investigated the discriminability and development of multi-modal noxious-evoked responses in infants aged 28-40 weeks postmenstrual age. A classifier was trained to discriminate responses to a noxious heel lance from a non-noxious control in 47 infants, using measures of facial expression, brain activity, heart rate and limb withdrawal, and tested in two independent cohorts with a total of 98 infants. The model discriminates responses to the noxious from the non-noxious procedure from 28 weeks onwards with an overall accuracy of 0.77-0.83 and an accuracy of 0.78-0.79 in the 28-31 week group. Noxious-evoked responses have distinct developmental patterns. Heart rate responses increase in magnitude with age, while noxious-evoked brain activity undergoes three distinct developmental stages, including a previously unreported transitory stage consisting of a negative event-related potential between 30-33 weeks postmenstrual age. These findings demonstrate that while noxious-evoked responses change across early development, infant responses to noxious and non-noxious stimuli are discriminable from 28 weeks onwards.

Breath-to-breath variability of exhaled CO2 as a marker of lung dysmaturity in infancy

2017 ◽  
Vol 123 (6) ◽  
pp. 1563-1570 ◽  
Author(s):  
Sotirios Fouzas ◽  
Ilias Theodorakopoulos ◽  
Edgar Delgado-Eckert ◽  
Philipp Latzin ◽  
Urs Frey
Keyword(s):  
Lung Disease ◽  
Preterm Infants ◽  
Chronic Lung Disease ◽  
Tidal Breathing ◽  
Term Infants ◽  
Young Infants ◽  
Postmenstrual Age ◽  
Preterm Group ◽  
Preterm Born ◽  
The Relationship

The concept of diffusional screening implies that breath-to-breath variations in CO2 clearance, when related to the variability of breathing, may contain information on the quality and utilization of the available alveolar surface. We explored the validity of the above hypothesis in a cohort of young infants of comparable postmenstrual age but born at different stages of lung maturity, namely, in term-born infants ( n = 128), preterm-born infants without chronic lung disease of infancy (CLDI; n = 53), and preterm infants with moderate/severe CLDI ( n = 87). Exhaled CO2 volume (VE,CO2) and concentration (FE,CO2) were determined by volumetric capnography, whereas their variance was assessed by linear and nonlinear variability metrics. The relationship between relative breath-to-breath change of VE,CO2 (ΔVE,CO2) and the corresponding change of tidal volume (ΔVT) was also analyzed. Nonlinear FE,CO2 variability was lower in CLDI compared with term and non-CLDI preterm group ( P < 0.001 for both comparisons). In CLDI infants, most of the VE,CO2 variability was attributed to the variability of VT ( r2 = 0.749), whereas in term and healthy preterm infants this relationship was weaker ( r2 = 0.507 and 0.630, respectively). The ΔVE,CO2 − ΔVT slope was less steep in the CLDI group (1.06 ± 0.07) compared with non-CLDI preterm (1.16 ± 0.07; P < 0.001) and term infants (1.20 ± 0.10; P < 0.001), suggesting that the more dysmature the infant lung, the less efficiently it eliminates CO2 under tidal breathing conditions. We conclude that the temporal variation of CO2 clearance may be related to the degree of lung dysmaturity in early infancy. NEW & NOTEWORTHY Young infants exhibit appreciable breath-to-breath CO2 variability that can be quantified by nonlinear variability metrics and may reflect the degree of lung dysmaturity. In infants with moderate/severe chronic lung disease of infancy (CLDI), the variability of the exhaled CO2 is mainly driven by the variability of breathing, whereas in term-born and healthy preterm infants this relationship is less strong. The slope of the relative CO2-to-volume change is less steep in CLDI infants, suggesting that dysmature lungs are less efficient in eliminating CO2 under tidal breathing conditions.

scholarly journals Fat and Fat-Free Mass of Preterm and Term Infants from Birth to Six Months: A Review of Current Evidence

Nutrients ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 288 ◽  
Author(s):  
Constanze Hamatschek ◽  
Efrah I. Yousuf ◽  
Lea Sophie Möllers ◽  
Hon Yiu So ◽  
Katherine M. Morrison ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Fat Mass ◽  
Infant Nutrition ◽  
Dual Energy ◽  
Fat Free Mass ◽  
Current Evidence ◽  
Term Infants ◽  
Air Displacement Plethysmography ◽  
X Ray ◽  
Postmenstrual Age

To optimize infant nutrition, the nature of weight gain must be analyzed. This study aims to review publications and develop growth charts for fat and fat-free mass for preterm and term infants. Body composition data measured by air displacement plethysmography (ADP) and dual energy X-ray absorptiometry (DXA) in preterm and term infants until six months corrected age were abstracted from publications (31 December 1990 to 30 April 2019). Age-specific percentiles were calculated. ADP measurements were used in 110 studies (2855 preterm and 22,410 term infants), and DXA was used in 28 studies (1147 preterm and 3542 term infants). At term age, preterm infants had higher percent-fat than term-born infants (16% vs. 11%, p < 0.001). At 52 weeks postmenstrual age (PMA), both reached similar percent-fat (24% vs. 25%). In contrast, at term age, preterm infants had less fat-free mass (2500 g vs. 2900 g) by 400 g. This difference decreased to 250 g by 52 weeks, and to 100 g at 60 weeks PMA (5000 g vs. 5100 g). DXA fat-free mass data were comparable with ADP. However, median percent-fat was up to 5% higher with DXA measurements compared with ADP with PMA > 50 weeks. There are methodological differences between ADP and DXA measures for infants with higher fat mass. The cause of higher fat mass in preterm infants at term age needs further investigation.

scholarly journals A Longitudinal Description of Heart Rate Variability in 28—34-Week-Old Preterm Infants

2009 ◽  
Vol 11 (3) ◽  
pp. 261-268 ◽  
Author(s):  
Charlene Krueger ◽  
JoHannes H. van Oostrom ◽  
Jonathan Shuster
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Preterm Infants ◽  
High Frequency ◽  
Test Session ◽  
Significant Interaction Effect ◽  
Convenience Sample ◽  
General Linear Model Analysis ◽  
Postmenstrual Age ◽  
The Impact

The purpose of this study was to longitudinally describe changes in heart rate variability (HRV) from 28 to 34 weeks postmenstrual age (PMA). A convenience sample of 31 low-risk preterm infants participated. HRV was quantified using a spectral analysis of heart periods and recorded during seven weekly test sessions from an electrocardiogram (ECG) signal. The total range of frequency components (0.04—2.0 Hz), high-frequency (HF) components (0.30—1.3 Hz), and ratio of low-to-high frequency (LF/HF) components (0.04—0.20/ 0.30—1.3 Hz) were measured. A mixed general linear model analysis revealed no significant change over weekly test sessions for the total, the high, and the ratio of LF/HF components. A significant interaction effect was, however, noted in the HF components for test session × gender (df = 1; F = 4.85; p = .030). With increasing age, the HF components for females increased or displayed a pattern of HRV indicative of a more mature autonomic nervous system (ANS). Study findings warrant further investigation of the impact of gender on normative descriptions of HRV.

Early Detection of Delayed Myelination in Preterm Infants

PEDIATRICS ◽  
1989 ◽  
Vol 84 (3) ◽  
pp. 407-411
Author(s):  
Margot van de Bor ◽  
Gerard L. Guit ◽  
Anneke M. Schreuder ◽  
John Wondergem ◽  
G. Jan Vielvoye
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Preterm Infants ◽  
Intraventricular Hemorrhage ◽  
Periventricular Leukomalacia ◽  
Resonance Imaging ◽  
Term Infants ◽  
Postmenstrual Age ◽  
The Central Nervous System ◽  
Delayed Myelination

Myelination of the central nervous system can be demonstrated with magnetic resonance imaging. The influence of periventricular-intraventricular hemorrhage and periventricular leukomalacia on cerebral myelination was studied using magnetic resonance imaging. The subjects were 33 preterm infants of less than 30 weeks' gestation studied at 44 weeks' postmenstrual age: 11 infants with periventricular-intraventricular hemorrhage, 7 with periventricular leukomalacia, and 15 without periventricular-intraventricular hemorrhage or periventricular leukomalacia. There were no differences in mean gestational age and birth weight between the three groups. However, infants without periventricular-intraventricular hemorrhage or periventricular leukomalacia had significantly less respiratory distress syndrome. At 44 weeks postmenstrual age, infants with periventricular leukomalacia had a significantly delayed myelination pattern (stage M2) in comparison with infants without periventricular-intraventricular hemorrhage or periventricular leukomalacia and infants with periventricular-intraventricular hemorrhage (stages M3 and M4). The latter two groups had myelination stages that were similar to those of healthy term infants at 44 weeks' postmenstrual age. The results demonstrate that periventricular leukomalacia causes delayed myelination of the cerebrum, whereas periventricular-intraventricular hemorrhage does not.

scholarly journals Can Event-Related Potentials Evoked by Heel Lance Assess Pain Processing in Neonates? A Systematic Review

Children ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 58
Author(s):  
Yui Shiroshita ◽  
Hikari Kirimoto ◽  
Mio Ozawa ◽  
Tatsunori Watanabe ◽  
Hiroko Uematsu ◽  
...  
Keyword(s):  
Pain Assessment ◽  
Sample Size Calculation ◽  
Event Related Potentials ◽  
Event Related Potential ◽  
Noxious Stimulation ◽  
Heel Lance ◽  
C Fibers ◽  
Related Potentials ◽  
Noxious Stimuli ◽  
Aβ Fibers

To clarify the possibility of event-related potential (ERP) evoked by heel lance in neonates as an index of pain assessment, knowledge acquired by and problems of the methods used in studies on ERP evoked by heel lance in neonates were systematically reviewed, including knowledge about Aδ and C fibers responding to noxious stimuli and Aβ fibers responding to non-noxious stimuli. Of the 863 reports searched, 19 were selected for the final analysis. The following points were identified as problems for ERP evoked by heel lance in neonates to serve as a pain assessment index: (1) It is possible that the ERP evoked by heel lance reflected the activation of Aβ fibers responding to non-noxious stimuli and not the activation of Aδ or C fibers responding to noxious stimulation; (2) Sample size calculation was presented in few studies, and the number of stimulation trials to obtain an averaged ERP was small. Accordingly, to establish ERP evoked by heel lance as a pain assessment in neonates, it is necessary to perform a study to clarify ERP evoked by Aδ- and C-fiber stimulations accompanied by heel lance in neonates.

Hypoxemic and hyperoxemic likelihood in pulse oximetry ranges: NICU observational study

2018 ◽  
Vol 104 (3) ◽  
pp. F274-F279 ◽  
Author(s):  
Thomas E Bachman ◽  
Christopher J L Newth ◽  
Narayan P Iyer ◽  
Patrick A Ross ◽  
Robinder G Khemani
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Observational Study ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Term Infants ◽  
Postmenstrual Age ◽  
Preterm Group

ObjectiveDescribe the likelihood of hypoxemia and hyperoxemia across ranges of oxygen saturation (SpO2), during mechanical ventilation with supplemental oxygenation.DesignRetrospective observational study.SettingUniversity affiliated tertiary care neonatal intensive care unit.PatientsTwo groups of neonates based on postmenstrual age (PMA): <32 weeks (n=104) and >36 weeks (n=709).Main measuresHypoxemia was defined as a PaO2 <40 mm Hg, hyperoxemia as a PaO2 of >99 mm Hg and normoxemia as a PaO2 of 50–80 mm Hg. Twenty-five per cent was defined as marked likelihood of hypoxemia or hyperoxemia.ResultsFrom these infants, 18 034 SpO2–PaO2 pairs were evaluated of which 10% were preterm. The PMA (median and IQR) of the two groups were: 28 weeks (27–30) and 40 weeks (38–41). With SpO2 levels between 90% and 95%, the likelihoods of hypoxemia and hyperoxemia were low and balanced. With increasing levels of SpO2, the likelihood of hyperoxemia increased. It became marked in the preterm group when SpO2 was 99%–100% (95% CI 29% to 41%) and in the term group with SpO2 levels of 96%–98% (95% CI 29% to 32%). The likelihood of hypoxemia increased as SpO2 decreased. It became marked in both with SpO2 levels of 80%–85% (95% CI 20% to 31%, 24% to 28%, respectively).ConclusionsThe likelihood of a PaO2 <40 mm Hg is marked with SpO2 below 86%. The likelihood of a PaO2 >99 mm Hg is marked in term infants with SpO2 above 95% and above 98% in preterm infants. SpO2 levels between 90% and 95% are appropriate targets for term and preterm infants.

scholarly journals Human Milk Oligosaccharides in the Milk of Mothers Delivering Term versus Preterm Infants

Nutrients ◽  
2019 ◽  
Vol 11 (6) ◽  
pp. 1282 ◽  
Author(s):  
Sean Austin ◽  
Carlos A. De Castro ◽  
Norbert Sprenger ◽  
Aristea Binia ◽  
Michael Affolter ◽  
...  
Keyword(s):  
Human Milk ◽  
Preterm Infants ◽  
Human Milk Oligosaccharides ◽  
Milk Oligosaccharides ◽  
Term Infants ◽  
Very Preterm Infants ◽  
Stage Of Lactation ◽  
Improved Outcomes ◽  
Postmenstrual Age ◽  
Potential Clinical Impact

Human milk oligosaccharides (HMOs) are a major component of human milk, and play an important role in protecting the infant from infections. Preterm infants are particularly vulnerable, but have improved outcomes if fed with human milk. This study aimed to determine if the HMO composition of preterm milk differed from that of term milk at equivalent stage of lactation and equivalent postmenstrual age. In all, 22 HMOs were analyzed in 500 samples of milk from 25 mothers breastfeeding very preterm infants (< 32 weeks of gestational age, < 1500 g of birthweight) and 28 mothers breastfeeding term infants. The concentrations of most HMOs were comparable at equivalent postpartum age. However, HMOs containing α-1,2-linked fucose were reduced in concentration in preterm milk during the first month of lactation. The concentrations of a number of sialylated oligosaccharides were also different in preterm milk, in particular 3′-sialyllactose concentrations were elevated. At equivalent postmenstrual age, the concentrations of a number of HMOs were significantly different in preterm compared to term milk. The largest differences manifest around 40 weeks of postmenstrual age, when the milk of term infants contains the highest concentrations of HMOs. The observed differences warrant further investigation in view of their potential clinical impact.

Impact of gestational and postmenstrual age on excretion of fetal zone steroids in preterm infants determined by GC-MS

2021 ◽  
Author(s):  
Johanna Ruhnau ◽  
Stephanie Hübner ◽  
Sunny Donna ◽  
Ittermann Till ◽  
F Hartmann Michaela ◽  
...  
Keyword(s):  
Amniotic Fluid ◽  
Preterm Infants ◽  
Gestational Age ◽  
Age Groups ◽  
Gas Chromatography Mass Spectrometry ◽  
Protective Effects ◽  
Term Infants ◽  
Postmenstrual Age ◽  
High Concentrations ◽  
Excretion Rates

Abstract Context Fetal zone steroids (FZS) are excreted in high concentrations in preterm infants. Experimental data suggest protective effects of FZS in models of neonatal disease. Objective We aimed to characterize the postnatal FZS metabolome of well preterm and term infants. Methods 24-hour urinary FZS excretion rates were determined in early preterm (&lt; 30 weeks gestational age), preterm (30-36 weeks) and term (&gt;37 weeks) infants. Pregnenolone and 17-OH-pregnenolone metabolites (n=5), and DHEA and metabolites (n=12) were measured by gas chromatography-mass spectrometry (GC–MS). Postnatal concentrations of FZS were compared with already published prenatal concentrations in amniotic fluid. Results Excretion rates of total FZS and most of the single metabolites were highest in early preterm infants. In this group, excretion rates approach those of term infants at term equivalent postmenstrual age. Preterm infants of 30-36 weeks had more than half lower median excretion rates of FZS compared to early preterm infants at the same time of postmenstrual age. Postnatal concentrations of FZS were partly more than hundredfold higher in all gestational age groups compared to prenatal concentrations in amniotic fluid at mid gestation. Conclusions The excretion rates of FZS as a proxy of the involution of the fetal zone of the most immature preterm infants approached those of term infants at term equivalent. In contrast, the fetal zone in more mature preterm infants undergoes more rapid involution. These data in exclusively well neonates can serve as a basis to investigate the effects of illness on the FZS metabolome in future studies.

scholarly journals Comparison of Postnatal Growth Charts of Singleton Preterm and Term Infants Using World Health Organization Standards at 40–160 Weeks Postmenstrual Age: A Chinese Single-Center Retrospective Cohort Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Li Zhang ◽  
Jian-Gong Lin ◽  
Shuang Liang ◽  
Jin Sun ◽  
Nan-Nan Gao ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Retrospective Cohort ◽  
Postnatal Growth ◽  
World Health ◽  
Growth Charts ◽  
Term Infants ◽  
Who Standards ◽  
Postmenstrual Age ◽  
Z Scores ◽  
Health Organization

There remains controversy regarding whether the growth charts constructed from data of term infants, such as those produced by the World Health Organization (WHO) standards, can appropriately evaluate the postnatal growth of preterm infants. This retrospective cohort study, conducted in the First Affiliated Hospital of Shandong First Medical University in Jinan China, aimed to compare the postnatal growth charts of singleton preterm and term infants using WHO standards at 40–160 weeks postmenstrual age (PMA). A total of 5,459 and 15,185 sets of longitudinal measurements [length/height, weight, head circumference (HC), and body mass index (BMI)] from birth to 160 weeks PMA were used to construct growth charts for 559 singleton preterm (mean PMA at birth, 33.84 weeks) and 1,596 singleton term infants (born at 40 weeks PMA), respectively, using the Generalized Additive Models for Location, Scale, and Shape (GAMLSS) method. Z-scores (prematurity corrected) were calculated using WHO Anthro software. Compared to WHO standards, all parameters of preterm infants were increased, especially in terms of length/height and weight; the gap between the two almost spanned two adjacent centile curves. Compared to term controls, the length/height, weight, and BMI of preterm infants were higher at 40 weeks PMA, surpassed by term infants at 52–64 weeks PMA, and quite consistent thereafter. The HC of preterm infants at 40–160 weeks PMA was quite consistent with both term controls and the WHO standards. The Z-scores for length/height, weight, and BMI of preterm infants relative to the WHO standards gradually decreased from 1.20, 1.13, and 0.74 at 40–44 weeks PMA to 0.67, 0.42, and 0.03 at 132–160 weeks PMA, respectively; Z-scores for HC of preterm infants rapidly decreased from 0.73 to 0.29 at 40–50 weeks PMA, and then fluctuated in the range of 0.08–0.23 at 50–160 weeks PMA. Preterm infants had higher growth trajectories than the WHO standards and similar but not identical trajectories to term infants during the first 2 years of life. These findings reemphasize the necessity of constructing local growth charts for Chinese singleton preterm infants.

Pulmonary Gas Exchange Improves over the First Year in Preterm Infants with and without Bronchopulmonary Dysplasia

Neonatology ◽  
2021 ◽  
Vol 118 (1) ◽  
pp. 98-105
Author(s):  
Y. Jane Choi ◽  
Benjamin Stoecklin ◽  
Naomi R. Hemy ◽  
Graham L. Hall ◽  
Dorota A. Doherty ◽  
...  
Keyword(s):  
Gas Exchange ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Pulmonary Gas Exchange ◽  
First Year ◽  
Term Infants ◽  
Extremely Preterm ◽  
Postmenstrual Age ◽  
First Year Of Life ◽  
The Impact

Background: Right shift of the peripheral oxyhaemoglobin saturation (SpO2) versus inspired oxygen pressure (PIO2) curve is a sensitive marker of pulmonary gas exchange. Objectives: The aim of this study was to assess the impact of prematurity and bronchopulmonary dysplasia (BPD) on gas exchange and right-to-left shunt in the neonatal period, and its evolution over the first year of life. Method: We assessed shift and shunt in extremely preterm (EP) and very preterm (VP) infants at 36 and 44 weeks’ postmenstrual age (PMA), and at 1-year corrected postnatal age (cPNA). PIO2 was decreased stepwise to achieve SpO2 between 85 and 98%. Shift and shunt were calculated from paired SpO2/PIO2 measurements using customized software. Results were examined cross-sectionally at each time point, and longitudinally using generalized linear regression. Term infants were assessed at 44 wk PMA as a comparative reference. Results: Longitudinal modelling showed continuous decline in shift in EP and VP infants during the first year of life. There was no difference in shift compared to term infants at 44 wk PMA (p = 0.094). EP infants with BPD had higher shift than infants without BPD at 36 wk PMA (p < 0.001) and 44 wk PMA (p = 0.005) but not at 1-year cPNA. Conclusions: In the absence of lung disease, prematurity per se did not result in reduced gas exchange at 1-year cPNA. We report ongoing, significant improvements in pulmonary gas exchange in all preterm infants during the first year of life, despite evidence of early deficits in gas exchange in EP infants with BPD.

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