Neonatal care bundles are associated with a reduction in the incidence of intraventricular haemorrhage in preterm infants: a multicentre cohort study

ObjectiveTo investigate the effect of a nursing intervention bundle, applied during the first 72 hours of life, on the incidence of germinal matrix-intraventricular haemorrhage (GMH-IVH) in very preterm infants.DesignMulticentre cohort study.SettingTwo Dutch tertiary neonatal intensive care units.PatientsThe intervention group consisted of 281 neonates, whereas 280 infants served as historical controls (gestational age for both groups <30 weeks).InterventionsAfter a training period, the nursing intervention bundle was implemented and applied during the first 72 hours after birth. The bundle consisted of maintaining the head in the midline, tilting the head of the incubator and avoidance of flushing/rapid withdrawal of blood and sudden elevation of the legs.Main outcome measuresThe incidence of GMH-IVH occurring and/or increasing after the first ultrasound (but within 72 hours), cystic periventricular leukomalacia and/or in-hospital death was the primary composite outcome measure. Logistic regression analysis was used to explore differences between groups.ResultsThe nursing intervention bundle was associated with a lower risk of developing a GMH-IVH (any degree), cystic periventricular leukomalacia and/or mortality (adjusted OR 0.42, 95% CI 0.27 to 0.65). In the group receiving the bundle, also severe GMH-IVH, cystic periventricular leukomalacia and/or death were less often observed (adjusted OR 0.54, 95% CI 0.33 to 0.91).ConclusionsThe application of a bundle of nursing interventions is associated with reduced risk of developing a new/progressive (severe) GMH-IVH, cystic periventricular leukomalacia and/or mortality in very preterm infants when applied during the first 72 hours postnatally.

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Mortality and neurological outcomes in extremely and very preterm infants born to mothers with hypertensive disorders of pregnancy

Scientific Reports ◽

10.1038/s41598-021-81292-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Noriyuki Nakamura ◽

◽

Takafumi Ushida ◽

Masahiro Nakatochi ◽

Yumiko Kobayashi ◽

...

Keyword(s):

Preterm Infants ◽

Lower Risk ◽

Periventricular Leukomalacia ◽

Intraventricular Haemorrhage ◽

Hospital Death ◽

Hypertensive Disorders Of Pregnancy ◽

Very Preterm Infants ◽

Neurological Outcomes ◽

Very Preterm ◽

Increased Risk

AbstractTo evaluate the impact of maternal hypertensive disorders of pregnancy (HDP) on mortality and neurological outcomes in extremely and very preterm infants using a nationwide neonatal database in Japan. This population-based retrospective study was based on an analysis of data collected by the Neonatal Research Network of Japan from 2003 to 2015 of neonates weighing 1,500 g or less at birth, between 22 and 31 weeks’ gestation. A total of 21,659 infants were randomly divided into two groups, HDP (n = 4,584) and non-HDP (n = 4,584), at a ratio of 1:1 after stratification by four factors including maternal age, parity, weeks of gestation, and year of delivery. Short-term (neonatal period) and medium-term (3 years of age) mortality and neurological outcomes were compared between the two groups by logistic regression analyses. In univariate analysis, HDP was associated with an increased risk for in-hospital death (crude odds ratio [OR], 1.31; 95% confidence interval, 1.04–1.63) and a decreased risk for severe intraventricular haemorrhage (0.68; 0.53–0.87) and periventricular leukomalacia (0.60; 0.48–0.77). In multivariate analysis, HDP was significantly associated with a lower risk for in-hospital death (adjusted OR, 0.61; 0.47–0.80), severe intraventricular haemorrhage (0.47; 0.35–0.63), periventricular leukomalacia (0.59; 0.45–0.78), neonatal seizures (0.40; 0.28–0.57) and cerebral palsy (0.70; 0.52–0.95) at 3 years after adjustment for covariates including birth weight. These results were consistent with those of additional analyses, which excluded cases with histological chorioamnionitis and which divided the infants into two subgroups (22–27 gestational weeks and 28–31 gestational weeks). Maternal HDP was associated with an increased risk for in-hospital death without adjusting for covariates, but it was also associated with a lower risk for mortality and adverse neurological outcomes in extremely and very preterm infants if all covariates except HDP were identical.

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Cause of preterm birth and late-onset sepsis in very preterm infants: the EPIPAGE-2 cohort study

Pediatric Research ◽

10.1038/s41390-021-01411-y ◽

2021 ◽

Author(s):

Mathilde Letouzey ◽

◽

Laurence Foix-L’Hélias ◽

Héloïse Torchin ◽

Ayoub Mitha ◽

...

Keyword(s):

Cohort Study ◽

Preterm Birth ◽

Preterm Infants ◽

Late Onset ◽

Very Preterm Infants ◽

Very Preterm ◽

Late Onset Sepsis

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Neonatal Outcomes in Very Preterm Infants With Severe Congenital Heart Defects: An International Cohort Study

Journal of the American Heart Association ◽

10.1161/jaha.119.015369 ◽

2020 ◽

Vol 9 (5) ◽

Cited By ~ 3

Author(s):

Mikael Norman ◽

Stellan Håkansson ◽

Satoshi Kusuda ◽

Maximo Vento ◽

Liisa Lehtonen ◽

...

Keyword(s):

Cohort Study ◽

Preterm Infants ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Heart Defects ◽

Neonatal Outcomes ◽

Very Preterm Infants ◽

Very Preterm

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Foetal haemoglobin, blood transfusion, and retinopathy of prematurity in very preterm infants: a pilot prospective cohort study

Eye ◽

10.1038/eye.2017.76 ◽

2017 ◽

Vol 31 (10) ◽

pp. 1451-1455 ◽

Cited By ~ 18

Author(s):

C J Stutchfield ◽

A Jain ◽

D Odd ◽

C Williams ◽

R Markham

Keyword(s):

Cohort Study ◽

Blood Transfusion ◽

Preterm Infants ◽

Prospective Cohort Study ◽

Retinopathy Of Prematurity ◽

Prospective Cohort ◽

Foetal Haemoglobin ◽

Very Preterm Infants ◽

Very Preterm

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Survival of very preterm infants: Epipage, a population based cohort study

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/adc.2002.020396 ◽

2004 ◽

Vol 89 (2) ◽

pp. 139F-144 ◽

Cited By ~ 195

Author(s):

B Larroque

Keyword(s):

Cohort Study ◽

Preterm Infants ◽

Population Based ◽

Very Preterm Infants ◽

Very Preterm

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Ibuprofen treatment for patent ductus arteriosus in preterm infants: a retrospective cohort study in a leading Chinese center

Frigid Zone Medicine ◽

10.2478/fzm-2021-0013 ◽

2021 ◽

Vol 1 (2) ◽

pp. 103-110

Author(s):

Jia Chen ◽

Jinghua Luo ◽

Hao Liu ◽

Xue Du ◽

Shan Zhang ◽

...

Keyword(s):

Cohort Study ◽

Treatment Group ◽

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Intraventricular Hemorrhage ◽

Retrospective Cohort ◽

Ductus Arteriosus ◽

Very Preterm Infants ◽

Very Preterm ◽

Patent Ductus

Abstract Objective There is a dilemma of ibuprofen treatment with patent ductus arteriosus (PDA) as to how and when to treat. We aimed to clarify this issue in very preterm infants (VPIs; < 32 weeks). Methods This retrospective study included 1 659 VPIs who were diagnosed with PDA according to echocardiographic examinations and cardiovascular dysfunction scoring system (the CVD scoring). The VPIs were classified into six groups (A1, A2, A3, B1, B2, and B3) based on CVD scores (A, < 3, and B, ≥ 3), and treatment with ibuprofen for PDA (1, conservational management; 2, early ibuprofen treatment; and 3, late ibuprofen treatment). Treatment was stopped when PDA was closed, CVD score was zero or PDA needed ligation. Results VPIs with CVD scores < 3 had most PDA closure without surgery, and early ibuprofen treatment did not significantly affect PDA closure. VPIs with CVD scores ≥ 3 had some PDA closure after 2 courses of treatment, but closure rates decreased linearly with ibuprofen course (1st 75.2%, 2nd 62.3%, 3rd 50.0%, P < 0.0001), and early ibuprofen treatment (group B2) did not increase PDA closure compared to late ibuprofen treatment (group B3). In these same infants, the longer they were in CVD scores ≥ 3, the more the complications of preterm were increased (retinopathy of prematurity ROP 1st 16.5%, 2nd 23.8%, 3rd 29.6%, P = 0.016; bronchopulmonary dysplasia BPD 1st 15.5%, 2nd 26.7%, 3rd 33.8%, P < 0.0001; intraventricular hemorrhage IVH 1st 20.4%, 2nd 32.4%, 3rd 23.8%, P = 0.015). Conclusion Ibuprofen is suggested for PDA closure when the PDA reopens or has developed into the stage when the CVD score ≥ 3.

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Adverse effects of small for gestational age differ by gestational week among very preterm infants

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2017-314171 ◽

2018 ◽

Vol 104 (2) ◽

pp. F192-F198 ◽

Cited By ~ 6

Author(s):

Erik A Jensen ◽

Elizabeth E Foglia ◽

Kevin C Dysart ◽

Rebecca A Simmons ◽

Zubair H Aghai ◽

...

Keyword(s):

Preterm Infants ◽

Gestational Age ◽

Small For Gestational Age ◽

Intraventricular Haemorrhage ◽

Neonatal Morbidity ◽

Excess Risk ◽

Very Preterm Infants ◽

Adjusted Risk ◽

Very Preterm ◽

Grade 3

ObjectiveTo characterise the excess risk for death, grade 3–4 intraventricular haemorrhage (IVH), bronchopulmonary dysplasia (BPD) and stage 3–5 retinopathy of prematurity independently associated with birth small for gestational age (SGA) among very preterm infants, stratified by completed weeks of gestation.MethodsRetrospective cohort study using the Optum Neonatal Database. Study infants were born <32 weeks gestation without severe congenital anomalies. SGA was defined as a birth weight <10th percentile. The excess outcome risk independently associated with SGA birth among SGA babies was assessed using adjusted risk differences (aRDs).ResultsOf 6708 infants sampled from 717 US hospitals, 743 (11.1%) were SGA. SGA compared with non-SGA infants experienced higher unadjusted rates of each study outcome except grade 3–4 IVH among survivors. The excess risk independently associated with SGA birth varied by outcome and gestational age. The highest aRD for death (0.27; 95% CI 0.13 to 0.40) occurred among infants born at 24 weeks gestation and declined as gestational age increased. In contrast, the peak aRDs for BPD among survivors (0.32; 95% CI 0.20 to 0.44) and the composites of death or BPD (0.35; 95% CI 0.24 to 0.46) and death or major morbidity (0.35; 95% CI 0.24 to 0.45) occurred at 27 weeks gestation. The risk-adjusted probability of dying or developing one or more of the evaluated morbidities among SGA infants was similar to that of non-SGA infants born approximately 2–3 weeks less mature.ConclusionThe excess risk for neonatal morbidity and mortality associated with being born SGA varies by adverse outcome and gestational age.

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