Brain growth in extremely preterm infants before and after implementing NAVA ventilation

2021 ◽  
Author(s):  
H Soukka ◽  
R Parkkola ◽  
L Lehtonen
Keyword(s):  
Preterm Infants ◽  
Brain Growth ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Before And After

Effect of an Educational Presentation about Extremely Preterm Infants on Knowledge and Attitudes of Health Care Providers

2017 ◽  
Vol 34 (10) ◽  
pp. 0982-0989 ◽  
Author(s):  
Stefani Doucette ◽  
Brigitte Lemyre ◽  
Thierry Daboval ◽  
Sandra Dunn ◽  
Salwa Akiki ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Health Care Providers ◽  
Ethical Issues ◽  
Survival Rates ◽  
Care Providers ◽  
Perinatal Medicine ◽  
Knowledge And Attitudes ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Before And After

Objective To determine healthcare providers' knowledge (HCP) about survival rates of extremely preterm infants (EPI) and attitudes toward resuscitation before and after an educational presentation and, to examine the relationship between knowledge and attitudes toward resuscitation. Study Design Participants completed a survey before and after attending a presentation detailing evidence-based estimates of survival rates and surrounding ethical issues. Respondents included neonatologists, obstetricians, pediatricians, maternal-fetal medicine specialists, trainees in pediatrics, obstetrics, neonatal-perinatal medicine and neonatal and obstetrical nurses. Results In total, 166 participants attended an educational presentation and 130 participants completed both pre- and postsurveys (response rate 78%). Prepresentation, for all gestations, ≤ 50% of respondents correctly identified survival/intact survival rates. Postpresentation, correct responses regarding survival/intact survival rates ranged from 49 to 86% (p < 0.001) and attitudes shifted toward being more likely to resuscitate at all gestations regardless of parental wishes. There was a weak-to-modest relationship (Spearman's coefficient 0.24–0.40, p < 0.001–0.004) between knowledge responses and attitudes. Conclusion Attendance at an educational presentation did improve HCP knowledge about survival and long term outcomes for EPI, but HCP still underestimated survival and were not always willing to resuscitate in accordance with parental wishes. These findings may represent barriers to some experts' recommendation to use shared decision-making with parents when considering the resuscitation options for their EPI.

scholarly journals Brain Growth Gains and Losses in Extremely Preterm Infants at Term

2014 ◽  
Vol 25 (7) ◽  
pp. 1897-1905 ◽  
Author(s):  
Nelly Padilla ◽  
Georgios Alexandrou ◽  
Mats Blennow ◽  
Hugo Lagercrantz ◽  
Ulrika Ådén
Keyword(s):  
Preterm Infants ◽  
Brain Growth ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Gains And Losses

scholarly journals Association between Fat-Free Mass and Brain Size in Extremely Preterm Infants

Nutrients ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 4205
Author(s):  
Christoph Binder ◽  
Julia Buchmayer ◽  
Alexandra Thajer ◽  
Vito Giordano ◽  
Victor Schmidbauer ◽  
...  
Keyword(s):  
Body Composition ◽  
Preterm Infants ◽  
Brain Size ◽  
Fat Free Mass ◽  
Brain Growth ◽  
Z Score ◽  
Equivalent Age ◽  
Biparietal Diameter ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Postnatal growth restriction and deficits in fat-free mass are associated with impaired neurodevelopment. The optimal body composition to support normal brain growth and development remains unclear. This study investigated the association between body composition and brain size in preterm infants. We included 118 infants born <28 weeks of gestation between 2017–2021, who underwent body composition (fat-free mass (FFM) and fat mass (FM)) and cerebral magnetic resonance imaging to quantify brain size (cerebral biparietal diameter (cBPD), bone biparietal diameter (bBPD), interhemispheric distance (IHD), transverse cerebellar diameter (tCD)) at term-equivalent age. FFM Z-Score significantly correlated with higher cBPD Z-Score (rs = 0.69; p < 0.001), bBPD Z-Score (rs = 0.48; p < 0.001) and tCD Z-Score (rs = 0.30; p = 0.002); FM Z-Score significantly correlated with lower brain size (cBPD Z-Score (rs = −0.32; p < 0.001) and bBPD Z-Score (rs = −0.42; p < 0.001). In contrast weight (rs = 0.08), length (rs = −0.01) and head circumference Z-Score (rs = 0.14) did not. Linear regression model adjusted for important neonatal variables revealed that FFM Z-Score was independently and significantly associated with higher cBPD Z-Score (median 0.50, 95% CI: 0.59, 0.43; p < 0.001) and bBPD Z-Score (median 0.31, 95% CI: 0.42, 0.19; p < 0.001); FM Z-Score was independently and significantly associated with lower cBPD Z-Score (median −0.27, 95% CI: −0.42, −0.11; p < 0.001) and bBPD Z-Score (median −0.32, 95% CI: −0.45, −0.18; p < 0.001). Higher FFM Z-Score and lower FM Z-scores were significantly associated with larger brain size at term-equivalent age. These results indicate that early body composition might be a useful tool to evaluate and eventually optimize brain growth and neurodevelopment.

scholarly journals Reduced antibiotic use in extremely preterm infants with an antimicrobial stewardship intervention

2020 ◽  
Vol 4 (1) ◽  
pp. e000872
Author(s):  
Lars Gustavsson ◽  
Simon Lindquist ◽  
Anders Elfvin ◽  
Elisabet Hentz ◽  
Marie Studahl
Keyword(s):  
Preterm Infants ◽  
Antibiotic Treatment ◽  
Antimicrobial Stewardship ◽  
Gestational Age ◽  
Antibiotic Use ◽  
Baseline Period ◽  
Intervention Period ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Before And After

IntroductionExcessive administration of antibiotics to preterm infants is associated with increased rates of complications. The purpose of the study was to evaluate the effect of an antimicrobial stewardship intervention on antibiotic use in extremely preterm infants.Design, setting, patients and interventionA before and after study of infants born at ≤28 weeks’ gestational age was performed in the neonatal intensive care unit of Queen Silvia’s Children’s Hospital, Gothenburg, Sweden. Retrospective analysis of the baseline period (January–December 2014) guided the development of a limited antimicrobial stewardship intervention. The intervention consisted of updated local guidelines with a focus on shortened and standardised treatment duration plus increased access to infectious disease consultant advice. It was fully implemented during the intervention period (October 2017–September 2018).ObjectivePrimary aim was to compare antibiotic use, defined as antibiotic treatment days per 1000 patient-days, between the two periods, and the secondary aim was to evaluate the number of days with meropenem-based regimens before and after the intervention.ResultsWe included 145 infants with a median birth weight of 870 g and median gestational age of 26 weeks. The baseline period comprised 82 infants and 3478 patient-days, the intervention period comprised 63 infants and 2753 patient-days. Overall antibiotic use (treatment and prophylaxis) was 534 versus 466 days per 1000 patient-days during the baseline and intervention periods, respectively. Antibiotic treatment days decreased from 287 to 197 days per 1000 patient-days. The proportion of meropenem-based regimens was 69% versus 44%, respectively. No increases in mortality or reinitiation of antibiotics were seen.ConclusionsImplementation of a limited antimicrobial stewardship intervention anchored in analysis of previous prescription patterns can contribute to safe decreases in antibiotic use in extremely preterm infants.

scholarly journals Fresh-Frozen Plasma as a Source of Exogenous Insulin-Like Growth Factor-I in the Extremely Preterm Infant

2009 ◽  
Vol 94 (2) ◽  
pp. 477-482 ◽  
Author(s):  
Ingrid Hansen-Pupp ◽  
Eva Engström ◽  
Aimon Niklasson ◽  
Ann-Cathrine Berg ◽  
Vineta Fellman ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Fresh Frozen Plasma ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Igf I ◽  
Before And After ◽  
Fresh Frozen ◽  
Igf Binding ◽  
Frozen Plasma ◽  
Igfbp 3

Abstract Context: Preterm birth is followed by a decrease in circulatory levels of IGF-I and IGF binding protein (IGFBP)-3, proteins with important neurogenic and angiogenic properties. Objective: Our objective was to evaluate the effects of iv administration of fresh-frozen plasma (FFP) from adult donors on circulatory levels of IGF-I and IGFBP-3 in extremely preterm infants. Design, Setting, and Patients: A prospective cohort study was performed in 20 extremely preterm infants [mean (sd) gestational age 25.3 (1.3) wk] with clinical requirement of FFP during the first postnatal week. Sampling was performed before initiation of transfusion, directly after, and at 6, 12, 24, and 48 h after completed FFP transfusion. Main Outcome Measures: Concentrations of IGF-I and IGFBP-3 before and after transfusion of FFP were determined. Results: FFP with a mean (sd) volume of 11 ml/kg (3.1) was administered at a median postnatal age of 2 d (range 1–7). Mean (sd) IGF-I and IGFBP-3 concentrations in administered FFP were 130 (39) and 2840 μg/liter (615), respectively. Immediately after FFP transfusion, mean (sd) concentrations of IGF-I increased by 133% from 11 (6.4) to 25 μg/liter (9.3) (P &lt; 0.001) and IGFBP-3 by 61% from 815 (451) to 1311 μg/liter (508) (P &lt; 0.001). Concentrations of IGF-I and IGFBP-3 remained higher at 6 (P &lt; 0.001, P = 0.009) and 12 h (P = 0.017, P = 0.018), respectively, as compared with concentrations before FFP transfusion. Typical half-life of administrated IGF-I was 3.4 h for a 1-kg infant. Conclusion: Transfusion of FFP to extremely preterm infants during the first postnatal week elevates levels of IGF-I and IGFBP-3.

scholarly journals Cardiorespiratory Events Following the Second Routine Immunization in Preterm Infants: Risk Assessment and Monitoring Recommendations

Vaccines ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 909
Author(s):  
Bettina Bohnhorst ◽  
Cornelia Weidlich ◽  
Corinna Peter ◽  
Carolin Böhne ◽  
Evelyn Kattner ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Tactile Stimulation ◽  
Prospective Observational Study ◽  
Routine Immunization ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Before And After ◽  
Assessment And Monitoring ◽  
To Receive ◽  
Current Guidelines

Due to frequent cardiorespiratory events (CREs) in response to the first routine immunization (rIM), current guidelines recommend readmitting and monitoring extremely preterm infants after the second rIM, though evidence on CREs in response to the second rIM is weak. In a prospective observational study, preterm infants with an increase in CREs after the first rIM were monitored for CREs before and after the second rIM. Seventy-one infants with a median gestational age of 26.4 weeks and a median weight of 820 g at birth were investigated at a median postnatal age of 94 days. All but seven infants showed an increase in CREs after the second rIM. The frequency of hypoxemias (p < 0.0001), apneas (p = 0.0003) and cardiorespiratory events requiring tactile stimulation (CRE-ts) (p = 0.0034) increased significantly. The 25 infants (35%) presenting with CRE-ts were significantly more likely to have been continuously hospitalized since birth (p = 0.001) and to receive analeptic therapy at the first rIM (p = 0.002) or some kind of respiratory support at the first (p = 0.005) and second rIM (p < 0.0001). At a postmenstruational age of 43.5 weeks, CRE-ts ceased. Our data support the recommendation to monitor infants who fulfil the above-mentioned criteria during the second rIM up to a postmenstruational age of 44 weeks.

Life expectancy of extremely preterm infants

2007 ◽  
Vol 148 (48) ◽  
pp. 2279-2284 ◽  
Author(s):  
Gabriella Vida ◽  
Ilona Sárkány ◽  
Simone Funke ◽  
Judit Gyarmati ◽  
Judit Storcz ◽  
...  
Keyword(s):  
Life Expectancy ◽  
Preterm Infants ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Optimális esetben a 24–28. gesztációs hét közötti, igen éretlen újszülöttek olyan szülészeti intézményben születnek, ahol neonatalis intenzív centrum működik, így mind az akut, mind a hosszú távú ellátásukat magas színvonalon biztosítják. A PTE OEKK ÁOK Szülészeti és Nőgyógyászati Klinikán 2000. január 1. és 2004. december 31. között 7499 újszülött született. A koraszülési frekvencia 20% (1499/7499), ezen belül az extrém alacsony gesztációs korúak aránya (≦28. gesztációs hét) 18% (272/1499), míg a 25. gesztációs hét alattiaké 3,2% (48/1499) volt. A túlélés a gesztációs hetek emelkedésével fokozatosan javul. Az életben maradt koraszülöttek későbbi életkilátásai és társadalmi beilleszkedése függ az olyan maradandó károsodásoktól, mint a látáscsökkenés, halláskárosodás, somatomentalis fejlődés zavarai, krónikus tüdőbetegség. A klinikán vizsgált alacsony gesztációs korú csoportban az összes fogyatékkal élő betegek aránya 15,3%. Döntő többségük a 25. gesztációs hétnél korábban született koraszülöttek közül kerül ki. A 26. gesztációs héttől a koraszülöttek több mint fele tartós károsodás nélkül éli túl az extrém éretlenség társuló problémáit. Megállapították, hogy a korai koponya-ultrahangvizsgálattal, szemészeti szűréssel, otoacusticus emissio mérésével jól prognosztizálhatók a maradandó károsodások, így lehetővé válik a korai kezelés.

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