Duration of mechanical ventilation and neurodevelopment in preterm infants

ObjectiveTo investigate the association between invasive mechanical ventilation (IMV) duration and long-term neurodevelopmental outcomes in preterm infants in an era of restricted IMV.DesignRetrospective cohort study.SettingSingle neonatal intensive care unit in Amsterdam.PatientsAll ventilated patients with a gestational age between 24 and 30 weeks born between 2010 and 2015.Main outcome measuresNeurodevelopmental impairment (NDI) at 24 months corrected age (CA). Data on patient characteristics, respiratory management, neonatal morbidities, mortality and bronchopulmonary dysplasia were collected. The relationship between IMV duration and NDI was determined by multivariate logistic regression analysis.ResultsDuring the study period, 368 admitted infants received IMV for a median duration of 2 days. Moderate and severe bronchopulmonary dysplasia was diagnosed in 33% of the infant. Multivariate regression analysis with adjustment for gestational age, small for gestational age and socioeconomic status showed a significant association between every day of IMV and NDI at 24 months CA (adjusted OR [aOR] 1.08, 95% CI 1.004 to 1.16, p=0.04). This association only reached borderline significance when also adjusting for severe neonatal morbidity (aOR 1.08, 95% CI 1.00 to 1.17, p=0.05).ConclusionEven in an era of restricted IMV, every additional day of IMV in preterm infants is strongly associated with an increased risk of NDI at 24 months CA. Limiting IMV should be an important focus in the treatment of preterm infants.

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The association between clinical and biochemical characteristics of late-onset sepsis and bronchopulmonary dysplasia in preterm infants

European Journal of Pediatrics ◽

10.1007/s00431-021-03981-9 ◽

2021 ◽

Author(s):

Melania E. Ebrahimi ◽

Michelle Romijn ◽

Roos J. S. Vliegenthart ◽

Douwe H. Visser ◽

Anton H. van Kaam ◽

...

Keyword(s):

Mechanical Ventilation ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Gestational Age ◽

Late Onset ◽

Multivariate Logistic Regression Analysis ◽

Biochemical Characteristics ◽

Late Onset Sepsis ◽

Early Onset Sepsis ◽

Increased Risk

AbstractStudies in preterm infants have shown an association between late-onset sepsis (LOS) and the development of bronchopulmonary dysplasia (BPD). It is unknown whether clinical or biochemical characteristics during sepsis modulate the risk for BPD. This single-center retrospective cohort study included all patients with a gestational age < 30 weeks, born between 2009 and 2015, in whom empiric antimicrobial treatment was initiated > 72 h after birth and continued for at least 5 days, independent on microbiological results. The association between clinical and biochemical characteristics of LOS and the development of BPD in survivors were assessed with multivariate logistic regression analysis adjusted for early-onset sepsis, small for gestational age, and gestational age. Of the 756 admitted infants, 256 infants (mean GA: 27.0 weeks; birthweight: 924 grams) had at least one LOS episode, of whom 79 (30.9%) developed BPD. Analyses showed that only the need for and duration of mechanical ventilation during LOS were independently associated with an increased risk for BPD (adjusted OR 2.62, 95% CI 1.38, 4.96, p value 0.003, and OR 1.004, 95% CI 1.00, 1.007, p value 0.045, respectively).Conclusion: During a LOS, the need for and duration of mechanical ventilation are independently associated with the risk of developing BPD in preterm infants. What is Known:• Premature infants diagnosed with a late-onset sepsis are at higher risk of developing bronchopulmonary dysplasia• This association is mainly shown in infants with a positive blood culture What is New:• This study investigates the clinical and biochemical characteristics of late-onset sepsis and the development of bronchopulmonary dysplasia• The need for mechanical ventilation and duration of mechanical ventilation during late-onset sepsis are associated with an increased risk of developing bronchopulmonary dysplasia.

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Abstract 17292: Does Morbid Obesity Worsens Outcomes in COVID-19?

Circulation ◽

10.1161/circ.142.suppl_3.17292 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Sohaib Roomi ◽

Waqas Ullah ◽

Nayab Nadeem ◽

Rehan Saeed ◽

Donald Haas ◽

...

Keyword(s):

Morbid Obesity ◽

Mechanical Ventilation ◽

Hospital Mortality ◽

Invasive Mechanical Ventilation ◽

Multivariate Logistic Regression Analysis ◽

Odds Ratios ◽

Increased Risk ◽

Significant Difference ◽

The Mean ◽

Mean Differences

Introduction: Given the high prevalence of obesity around the globe, patients with coronavirus disease 2019 (COVID-19) are at an increased risk of devastating complications. Hypothesis: We hypothesize that morbid obesity is independently associated with increased risk of in-hospital mortality, upgrade to intensive care unit, invasive mechanical ventilation(IVM), and acute renal failure necessitating dialysis. Methods: A retrospective cohort study was performed to determine the association of basal metabolic index (BMI) with the above-mentioned outcomes. Independent t-test and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios (aOR) with its 95% confidence interval (CI), respectively. Results: A total of 176 patients with confirmed COVID-19 diagnosis were included. The mean age was 62.2 years, with 51% of male patients. The mean BMI for non-surviving patients was significantly higher compared to patients surviving on the 7th day of hospitalization (35 vs. 30 kg/m2, p=0.022) and patients with a higher BMI had higher in-hospital mortality (21% vs. 9%, OR 3.2, 95% CI 1.3-8.2, p=0.01) compared to patients with a normal BMI. Similarly, patients requiring IMV had a higher BMI (33 vs. 29, p=0.002) compared to non-intubated patients. aOR of patients needing IMV (56% vs. 28%, OR 3.3, 95% CI 1.6-7.0, p=0.002) and upgrade to ICU (46% vs. 28%, OR 2.2, 1.07-4.6, p=0.04) were significantly higher compared to patients with a lower BMI. There was no significant difference between the two groups in terms of the need for dialysis (5% vs. 13%, OR 3.8, 13% vs. 4%, 1.1-14.1, p=0.07). Adjusted odds ratios controlled for baseline comorbidities and medications mirrored the overall results, except for the need to upgrade to ICU. Conclusions: In patients with confirmed COVID-19, morbid obesity serves as an independent risk factor of high in-hospital mortality and the need for invasive mechanical ventilation.

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Invasive mechanical ventilation and biomarkers as predictors of bronchopulmonary dysplasia in preterm infants

Jornal de Pediatria ◽

10.1016/j.jped.2020.03.006 ◽

2020 ◽

Author(s):

Camila Piqui Nascimento ◽

Larissa Prado Maia ◽

Patrícia Terra Alves ◽

Aline Teodoro de Paula ◽

Jair Pereira Cunha Junior ◽

...

Keyword(s):

Mechanical Ventilation ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Invasive Mechanical Ventilation

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Indications for and Risks of Noninvasive Respiratory Support

Neonatology ◽

10.1159/000515818 ◽

2021 ◽

pp. 1-9

Author(s):

Kirsten Glaser ◽

Clyde J. Wright

Keyword(s):

Mechanical Ventilation ◽

Lung Injury ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Invasive Mechanical Ventilation ◽

Respiratory Support ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Neonatal Lung ◽

The Individual

Within the last decades, therapeutic advances have significantly improved the survival of extremely preterm infants. In contrast, the incidence of major neonatal morbidities, including bronchopulmonary dysplasia, has not declined. Given the well-established relationship between exposure to invasive mechanical ventilation and neonatal lung injury, neonatologists have sought for effective strategies of noninvasive respiratory support in high-risk infants. Continuous positive airway pressure has replaced invasive mechanical ventilation for the initial stabilization and the treatment of respiratory distress syndrome. Today, noninvasive respiratory support has been adopted even in the tiniest babies with the highest risk of lung injury. Moreover, different modes of noninvasive respiratory support supplemented by a number of adjunctive measures and rescue strategies have entered clinical practice with the goal of preventing intubation or reintubation. However, does this unquestionably important paradigm shift to strategies focused on noninvasive support lull us into a false sense of security? Can we do better in (i) identifying those very immature preterm infants best equipped for noninvasive stabilization, can we improve (ii) determinants of failure of noninvasive respiratory support in the individual infant and underlying etiology, and can we enhance (iii) success of noninvasive respiratory support and (iv) better prevent ultimate harm to the developing lung? With increased survival of infants at the highest risk of developing lung injury and an unchanging burden of bronchopulmonary dysplasia, we should question indiscriminate use of noninvasive respiratory support and address the above issues.

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Brain Natriuretic Propeptide as an Early Marker of Bronchopulmonary Dysplasia or Death in the Preterm Newborn

Klinische Pädiatrie ◽

10.1055/s-0043-111597 ◽

2017 ◽

Vol 229 (04) ◽

pp. 223-228 ◽

Cited By ~ 4

Author(s):

Alicia Montaner ◽

Raquel Pinillos ◽

Zenaida Galve ◽

Hector Boix ◽

Carmen de la cuesta ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Retrospective Study ◽

Birth Weight ◽

Bronchopulmonary Dysplasia ◽

Gestational Age ◽

Multivariate Logistic Regression Analysis ◽

Preterm Newborn ◽

Multivariate Logistic Regression ◽

Free Survival

Abstract Aim To investigate whether increased brain natriuretic propeptide (NT-proBNP) levels at 48 to 72 h of life are associated with the development of bronchopulmonary dysplasia (BPD) or death in premature neonates. Methods A retrospective study was performed in neonates born before 32 weeks’ gestation or with birth weight below 1500 grams, in whom NT-proBNP determination and echocardiography were performed at 48 to 72 h of life. Associations between NT-proBNP levels and the combined outcome BPD or death were analyzed using multivariate logistic regression analysis. Results 117 neonates with mean gestational age 27.8±2.1 weeks and birth weight 949.7±267.5 grams were included. Forty (34.2%) had an outcome of BPD or death. The risk of this combined outcome was found to be 3.95-fold higher (OR 3.95; 95% CI 1.1–14.6) in neonates with NT-proBNP levels above 17800 pg/mL. Conclusion Increased NT-proBNP levels may be associated with a significant decrease in BPD-free survival in very immature newborns.

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Invasive mechanical ventilation at 36 weeks post-menstrual age, adverse outcomes with a comparison of recent definitions of bronchopulmonary dysplasia

Journal of Perinatology ◽

10.1038/s41372-021-01102-w ◽

2021 ◽

Author(s):

Milenka Cuevas Guaman ◽

Nikou Pishevar ◽

Steven H. Abman ◽

Martin Keszler ◽

William E. Truog ◽

...

Keyword(s):

Mechanical Ventilation ◽

Bronchopulmonary Dysplasia ◽

Invasive Mechanical Ventilation ◽

Adverse Outcomes ◽

Inhospital Mortality ◽

Increased Risk ◽

Grade 3 ◽

Using Data

Abstract Objectives To determine whether the need for invasive mechanical ventilation (iMV) at 36 weeks PMA in patients with severe bronchopulmonary dysplasia (sBPD) identifies those patients at highest risk for tracheostomy or gastrostomy, and to compare sBPD with recent definitions of BPD. Study design Observational study from Jan 2015 to Sept 2019 using data from the BPD Collaborative Registry. Results Five hundred and sixty-four patients with sBPD of whom 24% were on iMV at 36 weeks PMA. Those on iMV had significantly (p < 0.0001) increased risk for tracheostomy or gastrostomy. The overall mortality rate was 3% and the risk for mortality was substantially greater in those on iMV than in those on noninvasive support at 36 weeks PMA (RR 13.8, 95% CI 4.3–44.5, p < 0.0001). When applying the NICHD definition (2016) 44% had Grade III BPD. When applying the NRN definition, 6% had Grade 1 BPD, 70% had Grade 2 BPD, and 24% had Grade 3 BPD. Conclusions Patients with sBPD who were on iMV at 36 weeks had a significantly greater risk of inhospital mortality and survivors had a significantly greater risk of undergoing tracheostomy and/or gastrostomy. The use of type 2 sBPD or Grade 3 BPD would enhance the ability to target future studies to those infants with sBPD at the highest risk of adverse long-term outcomes.

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SENTINEL1: Two-Season Study of Respiratory Syncytial Virus Hospitalizations among U.S. Infants Born at 29 to 35 Weeks' Gestational Age Not Receiving Immunoprophylaxis

American Journal of Perinatology ◽

10.1055/s-0039-1681014 ◽

2019 ◽

Vol 37 (04) ◽

pp. 421-429 ◽

Cited By ~ 7

Author(s):

Evan J. Anderson ◽

John P. DeVincenzo ◽

Eric A. F. Simões ◽

Leonard R. Krilov ◽

Michael L. Forbes ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Respiratory Syncytial Virus ◽

Observational Study ◽

Preterm Infants ◽

Gestational Age ◽

Invasive Mechanical Ventilation ◽

Syncytial Virus ◽

Birth Hospitalization

Objective The SENTINEL1 observational study characterized confirmed respiratory syncytial virus hospitalizations (RSVH) among U.S. preterm infants born at 29 to 35 weeks' gestational age (wGA) not receiving respiratory syncytial virus (RSV) immunoprophylaxis (IP) during the 2014 to 2015 and 2015 to 2016 RSV seasons. Study Design All laboratory-confirmed RSVH at participating sites during the 2014 to 2015 and 2015 to 2016 RSV seasons (October 1–April 30) lasting ≥24 hours among preterm infants 29 to 35 wGA and aged <12 months who did not receive RSV IP within 35 days before onset of symptoms were identified and characterized. Results Results were similar across the two seasons. Among infants with community-acquired RSVH (N = 1,378), 45% were admitted to the intensive care unit (ICU) and 19% required invasive mechanical ventilation (IMV). There were two deaths. Infants aged <6 months accounted for 78% of RSVH observed, 84% of ICU admissions, and 91% requiring IMV. Among infants who were discharged from their birth hospitalization during the RSV season, 82% of RSVH occurred within 60 days of birth hospitalization discharge. Conclusion Among U.S. preterm infants 29 to 35 wGA not receiving RSV IP, RSVH are often severe with almost one-half requiring ICU admission and about one in five needing IMV.

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Surgical site infections following caesarean sections at Emirati teaching hospital: Incidence and implicated factors

Scientific Reports ◽

10.1038/s41598-020-75582-9 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Munther S. Alnajjar ◽

Dalia A. Alashker

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

United Arab Emirates ◽

Logistic Regression Analysis ◽

Gestational Age ◽

Multivariate Logistic Regression Analysis ◽

Surgical Site Infections ◽

Multivariate Logistic Regression ◽

Post Discharge ◽

Increased Risk

Abstract The rate of delivery by caesarean sections is increasing globally and, therefore, the incidence of post-caesarean surgical site infections (SSIs) is probably also going to rise. The aim of the present study was to determine the incidence of SSIs after caesarean operations and to explore the factors associated with an increased risk of post-caesarean SSIs. A retrospective study was performed to assess all women who underwent caesarean sections from January 2016 to December 2017 at Al Ain Hospital in the United Arab Emirates (UAE). Backward multivariate logistic regression analysis was utilized to specify the variables that were significantly and independently connected with the development of post-caesarean SSIs. In total, 807 women underwent caesarean deliveries at the study site hospital during the two-year study period (January 2016–December 2017). Post-operative SSI was detected in 11 (1.4%) of the women who underwent caesarean operations. Of these, 11 (100%) women were diagnosed post-discharge, within 30 days after the date of the surgery. Multivariate logistic regression analysis showed that increased gestational age (P = 0.045) was significantly and independently associated with the development of post-caesarean SSI. Increased gestational age was found to be an independent predictor of post-caesarean SSIs. This identified risk factor should inform targeted health care policies to reduce the rate of SSIs.

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Fenton vs. Intergrowth-21st: Postnatal Growth Assessment and Prediction of Neurodevelopment in Preterm Infants

Nutrients ◽

10.3390/nu13082841 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2841

Author(s):

Miheret Yitayew ◽

Nayef Chahin ◽

Salem Rustom ◽

Leroy R. Thacker ◽

Karen Hendricks-Muñoz

Keyword(s):

Preterm Infants ◽

Gestational Age ◽

Growth Failure ◽

Postnatal Growth ◽

Assessment Tools ◽

Growth Monitoring ◽

Neurodevelopmental Outcomes ◽

Increased Risk ◽

Growth Assessment

Although the survival rate of preterm infants has improved over the years, growth failure and associated impaired neurodevelopmental outcome remains a significant morbidity. Optimal nutrition plays an important role in achieving adequate postnatal growth. Accurate growth monitoring of preterm infants is critical in guiding nutritional protocols. Currently, there is no consensus regarding which growth assessment tool is suitable for monitoring postnatal growth of preterm infants to foster optimal neurodevelopmental outcomes while avoiding future consequences of aggressive nutritional approaches including increased risk for cardiovascular disease and metabolic syndrome. A retrospective single center cohort study was conducted to compare the performance of two growth-assessment tools, Fenton and Intergrowth-21st (IG-21st) in the classification of size at birth, identification of impaired growth and predicting neurodevelopment. A total of 340 infants with mean gestational age of 30 weeks were included. Proportion of agreement between the two tools for identification of small for gestational age (SGA) was high 0.94 (0.87, 0.1) however, agreement for classification of postnatal growth failure at discharge was moderate 0.6 (0.52, 0.69). Growth failure at discharge was less prevalent using IG-21st. There was significant association between weight-based growth failure and poor neurodevelopmental outcomes at 12 and 24 months of age.

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Respiratory Severity Score and Its Association with Adverse Outcomes in Extremely Low Birth Weight Infants Undergoing Invasive Mechanical Ventilation

Iranian Journal of Pediatrics ◽

10.5812/ijp.117193 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Mesut Dursun ◽

Umut Zubarioglu

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Logistic Regression ◽

Regression Analysis ◽

Severity Score ◽

Invasive Mechanical Ventilation ◽

Multivariate Logistic Regression Analysis ◽

Roc Curves ◽

Extremely Low Birth Weight ◽

Multivariate Logistic Regression

Background: Respiratory severity score (RSS) is a simple, non-invasive respiratory failure assessment tool that its appropriateness for lung disease severity is well-established. Objectives: This study aimed to investigate the potential value of early-life RSS values in predicting mortality or severe bronchopulmonary dysplasia (BPD) in infants with extremely low birth weight (ELBW) undergoing invasive mechanical ventilation. Methods: Following a retrospective approach, the current multi-center study intended to estimate the RSS and RSS/kg values in the first three days of life and time-weighted means of these values in ELBW babies who received invasive mechanical ventilation. Participants were categorized into two groups of survival without severe BPD and those with severe BPD or death. All RSS values and other risk factors were compared between groups. A multivariate logistic regression analysis was used to identify factors affecting severe BPD or death. The sensitivity and specificity of RSS values in predicting severe BPD or death were estimated using receiver operating characteristic (ROC) curves. Results: A total of 101 infants met the inclusion criteria. All RSS and RSS/kg values in the first three days of life were found to be significantly higher in the severe BPD or death group. The maximum area under the curve (AUC) in the ROC curves created for the respiratory severity score values was determined as RSS/kg mean with a cut-off value of 3.62 (85.3%), (P = 0.001). According to the multivariate logistic regression analysis, which included risk factors that may affect the development of severe BPD or mortality, both the mean RSS/kg score and the duration of invasive mechanical ventilation maintained statistically significant. [RSS/kg mean; OR = 2.28 (1.37 – 3.78), P = 0.001], [invasive MV duration; OR = 1.08 (95% CI, 1.03 – 1.14), P = 0.003]. Conclusions: This study demonstrated that high RSS/kg mean values in the early periods of life are valuable in predicting severe BPD or death in ELBW babies undergoing invasive mechanical ventilation. Furthermore, mean RSS had more predictive power than single RSS determinations, and incorporating body weight was associated with improved sensitivity of the score.

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