Outcomes of outborn very-low-birth-weight infants in Japan

BackgroundOutcomes of prenatal covariate-adjusted outborn very-low-birth-weight infants (VLBWIs) (≤1500 g) remain uncertain.ObjectiveTo compare morbidity and mortality between outborn and inborn VLBWIs.DesignObservational cohort study using inverse-probability-of-treatment weighting.SettingNeonatal Research Network of Japan.PatientsSingleton VLBWIs with no major anomalies admitted to a neonatal intensive care unit from 2012 to 2016.MethodsInverse-probability-of-treatment weighting with propensity scores was used to reduce imbalances in prenatal covariates (gestational age (GA), birth weight, small for GA, sex, maternal age, premature rupture of membranes, chorioamnionitis, preeclampsia, maternal diabetes mellitus, antenatal steroids and caesarean section). The primary outcome was severe intraventricular haemorrhage (IVH). The secondary outcomes were outcomes at resuscitation, other neonatal morbidities and mortality.ResultsThe full cohort comprised 15 842 VLBWIs (668 outborns). The median (IQR) GA and birth weight were 28.9 (26.4–31.0) weeks and 1128 (862–1351) g for outborns and 28.7 (26.3–30.9) weeks and 1042 (758–1295) g for inborns. Outborn VLBWIs had a higher incidence of severe IVH (8.2% vs 4.1%; OR, 3.45; 95% CI 1.16 to 10.3) and pulmonary haemorrhage (3.7% vs 2.8%; OR, 5.21; 95% CI 1.41 to 19.2). There were no significant differences in Apgar scores, oxygen rates at delivery, intubation ratio at delivery, persistent pulmonary hypertension of the newborn, IVH of any grade, periventricular leukomalacia, chronic lung disease, oxygen at discharge, patent ductus arteriosus, retinopathy of prematurity, necrotising enterocolitis, sepsis or mortality.ConclusionOutborn delivery of VLBWIs was associated with an increased risk of severe IVH.

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Association of perinatal factors of epilepsy in very low birth weight infants, using a nationwide database in Japan

Journal of Perinatology ◽

10.1038/s41372-019-0494-7 ◽

2019 ◽

Vol 39 (11) ◽

pp. 1472-1479 ◽

Cited By ~ 1

Author(s):

Yuki Matsushita ◽

◽

Yasunari Sakai ◽

Michiko Torio ◽

Hirosuke Inoue ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

Periventricular Leukomalacia ◽

Research Network ◽

Low Birth Weight Infants ◽

Multicenter Cohort Study ◽

Neurological Sequelae ◽

Psychomotor Delay ◽

History Of

Abstract Objective To determine clinical features of very low birth weight infants (VLBWIs) who had developed epilepsy by age 3 years. Study design Multicenter cohort study using the Neonatal Research Network of Japan database. We analyzed clinical variables of 8431 VLBWIs who had recorded data of neurological sequelae at age 3 years. Logistic regression identified the association between variables and development of epilepsy. Result One hundred and forty-three (1.7%) infants developed epilepsy, 683 (8.1%) showed cerebral palsy (CP), and 1114 (13.2%) had psychomotor delay. Epilepsy was associated with history of sepsis [adjusted odds ratio (AOR) 3.23], severe intraventricular hemorrhage (IVH; AOR 5.13), and cystic periventricular leukomalacia (PVL; AOR 12.7). Severe IVH and cystic PVL were also frequently associated with CP and psychomotor delay. Conclusion Severe IVH and cystic PVL are strongly associated with development of epilepsy, as well as other neurological sequelae, and are potential critical therapeutic targets.

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Hypotension within 1 week of life associated with poor short- and long-term outcomes in very low birth weight infants

Cardiology in the Young ◽

10.1017/s1047951118000732 ◽

2018 ◽

Vol 28 (8) ◽

pp. 1037-1041

Author(s):

Tae-Hoon Kim ◽

Cheong-Jun Moon ◽

In K. Sung ◽

Young A. Youn

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

Periventricular Leukomalacia ◽

Screening Tests ◽

Multivariable Logistic Regression Analysis ◽

Low Birth Weight Infants ◽

Neurodevelopmental Outcomes ◽

Increased Risk ◽

Overall Mortality

AbstractWe examined whether hypotension in very low birth weight infants aged⩽1 week was associated with hospital morbidities and overall mortality. Further, we studied whether hypotension was associated with poor neurodevelopmental outcomes in these patients at the corrected age of 18 months. A total of 166 very low birth weight infants were studied during this period. Hospital outcomes and neurodevelopmental outcomes at the corrected age of 18 months were evaluated. Among the 166 very low birth weight infants, 95 patients (57.2%) experienced hypotension at⩽1 week and were associated with an increased incidence of morbidities and mortality. At the corrected age of 18 months, hypotension of the⩽1 week group had significantly lower scores in all three – cognitive, language, and motor – composites of the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) screening tests. In addition, a multivariable logistic regression analysis showed that longer mechanical ventilation and periventricular leukomalacia were additionally associated with worse cognitive and language neurodevelopmental outcomes. Hypotension in very low birth weight infants within 1 week of life was associated with increased morbidities and overall mortality. It was also associated with an increased risk of cognitive and language outcomes.

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The Comparison of Efficiency of Oral Ibuprofen and Intravenous Indomethacin for Patent Ductus Arteriosus in Very Low Birth Weight Infants

Perinatology ◽

10.14734/pn.2018.29.1.33 ◽

2018 ◽

Vol 29 (1) ◽

pp. 33

Author(s):

Jong Woan Yun ◽

Hyun A Park ◽

Jong Hee Hwang

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Patent Ductus Arteriosus ◽

Very Low Birth Weight ◽

Ductus Arteriosus ◽

Low Birth Weight Infants ◽

Oral Ibuprofen ◽

Patent Ductus

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Neonatal Morbidity and Growth in Very Low Birth-Weight Infants after Multiple Courses of Antenatal Steroids

Journal of Perinatology ◽

10.1038/sj.jp.7211393 ◽

2005 ◽

Vol 25 (11) ◽

pp. 698-702 ◽

Cited By ~ 8

Author(s):

Praveen Kumar ◽

Roopa Seshadri

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

Neonatal Morbidity ◽

Low Birth Weight Infants ◽

Antenatal Steroids

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Treatment of Patent Ductus Arteriosus with Cyclo-oxygenase Inhibitors beyond 2 Weeks of Age in Very Low Birth Weight Infants

American Journal of Perinatology ◽

10.1055/s-0035-1570340 ◽

2016 ◽

Vol 33 (06) ◽

pp. 584-589 ◽

Cited By ~ 3

Author(s):

Naveed Hussain ◽

Shabnam Lainwala

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Patent Ductus Arteriosus ◽

Very Low Birth Weight ◽

Ductus Arteriosus ◽

Low Birth Weight Infants ◽

Patent Ductus

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Implementation of Potentially Better Practices for the Prevention of Brain Hemorrhage and Ischemic Brain Injury in Very Low Birth Weight Infants

PEDIATRICS ◽

10.1542/peds.111.se1.e497 ◽

2003 ◽

Vol 111 (Supplement_E1) ◽

pp. e497-e503

Author(s):

Debra McLendon ◽

Jennifer Check ◽

Patricia Carteaux ◽

Laura Michael ◽

Jim Moehring ◽

...

Keyword(s):

Birth Weight ◽

Brain Injury ◽

Low Birth Weight ◽

Intraventricular Hemorrhage ◽

Very Low Birth Weight ◽

Periventricular Leukomalacia ◽

Communication Education ◽

Low Birth Weight Infants ◽

Head Positioning ◽

Ventilator Management

Objective. Using an evidence-based approach, a Vermont Oxford Network focus group whose goal was to reduce brain injury developed and implemented a number of potentially better practices. Each center approached implementation of the practices differently. Reducing the incidence of intraventricular hemorrhage and periventricular leukomalacia are important for improving long-term outcomes for low birth weight infants. Methods. Implementation approaches for some but not all of the practices at the various centers are discussed. The practices reviewed include optimal peripartum management, such as resuscitation, avoidance of hypothermia, optimal surfactant delivery, early neonatal management by the most experienced providers, and measures to minimize pain and stress. Additional practices include maintenance of neutral head positioning, fluid volume therapy for hypotension, indomethacin prophylaxis, ventilator management, avoidance of routine suctioning, and limiting the use of sodium bicarbonate and postnatal dexamethasone. Results. Approaches to implementation were center specific, and results vary. Although some practices were easier to implement than others, communication, education, and leadership were critical to the process. Conclusions. The quality improvement multidisciplinary approach is a useful tool for finding ways to reduce the incidence of intraventricular hemorrhage and periventricular leukomalacia.

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