scholarly journals Necrotizing Enterocolitis in Moderate Preterm Infants

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Jayasree Nair ◽  
Rachel Longendyke ◽  
Satyan Lakshminrusimha
Keyword(s):  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Gestational Age ◽  
Age At Onset ◽  
Late Preterm ◽  
Preterm Neonates ◽  
Term Infants ◽  
Hypertensive Disorders ◽  
Extremely Preterm ◽  
Perinatal Center

Necrotizing enterocolitis (NEC) is a devastating morbidity usually seen in preterm infants, with extremely preterm neonates (EPT ≤28 weeks) considered at highest risk. Moderately preterm infants (MPT 28–34 weeks) constitute a large percentage of NICU admissions. In our retrospective data analysis of NEC in a single regional perinatal center, NEC was observed in 10% of extremely EPT and 7% of MPT, but only 0.7% of late-preterm/term admissions. There was an inverse relationship between postnatal age at onset of NEC and gestational age at birth. Among MPT infants with NEC, maternal hypertensive disorders (29%) and small for gestational age (SGA-15%) were more common than in EPT infants (11.6 and 4.6%, resp.). Congenital gastrointestinal anomalies were common among late preterm/term infants with NEC. SGA MPT infants born to mothers with hypertensive disorders are particularly at risk and should be closely monitored for signs of NEC. Identifying risk factors specific to each gestational age may help clinicians to tailor interventions to prevent NEC.

scholarly journals Receipt of Breast Milk by Gestational Age – United States, 2017 (P11-060-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Katelyn Chiang ◽  
Andrea Sharma ◽  
Jennifer Nelson ◽  
Christine Olson ◽  
Cria Perrine
Keyword(s):  
United States ◽  
Breast Milk ◽  
Gestational Age ◽  
Infant Nutrition ◽  
Birth Certificate ◽  
The United States ◽  
Late Preterm ◽  
Term Infants ◽  
Oak Ridge ◽  
Extremely Preterm

Abstract Objectives Breast milk is the optimal source of infant nutrition. For the nearly 1 in 10 infants born prematurely in the United States annually, breast milk is especially beneficial, helping prevent sepsis and necrotizing enterocolitis (NEC) and promoting neurological development. Though the importance of breast milk for preterm infants has been established, national estimates of feeding practices by gestational age are unavailable. Our objective was to describe receipt of breast milk among preterm and term infants delivered in the United States in 2017. Methods Birth certificate data from 48 states and the District of Columbia (n = 3,194,873; 82.7% of all births) were analyzed to describe receipt of breast milk before birth certificate completion among extremely preterm (20-27 weeks), early preterm (28-33 weeks), late preterm (34-36 weeks) and term infants (≥ 37 weeks) with further stratification by maternal and infant characteristics. Results The prevalence of infants receiving breast milk was 83.9% overall and varied by gestational age: 71.3% (extremely preterm), 76.0% (early preterm), 77.3% (late preterm), and 84.6% (term). Disparities in receipt of breast milk by maternal race/ethnicity were noted across gestational ages. Infants delivered to black or American Indian/Alaska Native mothers were the least likely to have received breast milk while those delivered to white, Hispanic, and Asian mothers were more likely to have received breast milk. Differences in receipt of breast milk by other maternal sociodemographic factors also persisted similarly across gestational ages. Among late preterm and term infants, receipt of breast milk was lower for those admitted to the neonatal intensive care unit (NICU) than those not admitted to the NICU. Conclusions Fewer preterm than term infants received breast milk in the first few days of life. Optimal hospital policies and practices that support breast milk feeding and ensure availability of donor milk for high-risk infants may help improve infant nutrition and reduce infant morbidity and mortality. Mothers of infants admitted to the NICU may need additional support given the challenges associated with having a medically fragile infant such as mother-infant separation and extended infant hospitalization. Funding Sources Centers for Disease Control and Prevention, Oak Ridge Institute for Science and Education.

Antenatal Exposure to Magnesium Sulfate and Spontaneous Intestinal Perforation and Necrotizing Enterocolitis in Extremely Preterm Neonates

2017 ◽  
Vol 34 (12) ◽  
pp. 1227-1233 ◽  
Author(s):  
Mohamed Shalabi ◽  
Adel Mohamed ◽  
Brigitte Lemyre ◽  
Khalid Aziz ◽  
Daniel Faucher ◽  
...  
Keyword(s):  
Magnesium Sulfate ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Intestinal Perforation ◽  
Preterm Neonates ◽  
Network Database ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Using Data ◽  
Spontaneous Intestinal Perforation

Background There have been recent concerns regarding the higher rates of spontaneous intestinal perforation (SIP) in preterm infants that have been exposed to intrapartum magnesium sulfate (MgSO4). Objective To assess the association between intrapartum MgSO4 exposure and necrotizing enterocolitis (NEC) and/or SIP in extremely preterm neonates. Design A retrospective cohort study was conducted using data from the Canadian Neonatal Network database. Infants born at < 28 weeks' gestation admitted to neonatal units in Canada between 2011 and 2014 were divided into two groups: those exposed antenatally to MgSO4 and those unexposed. Stratified analyses for infants born between 22 and 25 weeks' gestation and those born between 26 and 27 weeks' gestation were conducted. The primary outcome was intestinal injury, identified as either NEC or SIP. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated using multivariable logistic regression. Results We compared 2,300 unexposed infants with 2,055 exposed infants. There was no difference in the odds of NEC (9.88% exposed vs. 9.59% unexposed; aOR: 0.92; 95% CI: 0.75–1.14) or SIP (3.4% exposed vs. 3.39% unexposed; aOR: 1.05; 95% CI: 0.75–1.48) between the two groups. Conclusion Antenatal exposure to MgSO4 was not associated with NEC or SIP in extremely preterm infants.

scholarly journals CHARACTERIZATION OF THE LIPID SPECTRUM IN LATE PRETERM AND TERM INFANTS BORN LARGE TO GESTATIONAL AGE FROM OBESE MOTHERS

2020 ◽  
Vol 20 (2) ◽  
pp. 90-95
Author(s):  
A.V. Sliusarieva
Keyword(s):  
Gestational Age ◽  
Maternal Obesity ◽  
High Density ◽  
Late Preterm ◽  
High Density Lipoproteins ◽  
Term Infants ◽  
Normal Birth ◽  
Perinatal Center ◽  
The Mean ◽  
Lipid Spectrum

Introduction. Today, up to 35% of pregnant women are overweight or obese. Maternal obesity or excessive weight gain during pregnancy increases the risk of developing metabolic syndrome and cardiovascular disease in the offspring. The development of early and long-term adverse effects may occur through the mechanisms of intrauterine lipotoxicity, including inflammatory changes and oxidative stress and / or glucometabolic changes. The aim. Determine the lipid spectrum in late preterm and term infants born large to gestational age from obese mothers. Materials and methods. A single-center study included 54 newborns born at the Poltava Perinatal Center during 2019 from singleton pregnancies in women with a body mass index ≥ 35 kg / m2 without type 2 diabetes or type 1 diabetes. 1 group consisted of children (n=23), large to gestational age (> 90 percentiles), and 2 - children (n=27) in the range of 10-90 percentiles. Total cholesterol, high-density lipoproteins, low-density lipoproteins, triglycerides, and atherogenic factor were determined. Research results. The mean high-density lipoproteins in late preterm infants was significantly lower than in term born infants (0.71 ± 0.17 mmol / L vs. 1.05 ± 0.34 mmol / L), and the mean was significantly higher in infants with normal birth weight (3.49 ± 0.44 vs. 2.56 ± 0.67). After correction for a number of factors (gestational age and the presence of gestational diabetes in the mother) overweight in the newborn was significantly associated with high-density lipoproteins (OR 0.008, p = 0.002) and atherogenic factor (OR 2.96, p = 0.021). Conclusion. Overweight in infants born from obese mothers is accompanied by a significant increase atherogenic factor and the development of dyslipoproteinemia due to a decrease in the high-density lipoproteins fraction. It is necessary to improve the supervision of children who were born large to gestation age, from the first months of life.

scholarly journals Morbidity profile and immediate outcome of late preterm neonates compared to term neonates in a rural tertiary care hospital of Gujarat

2017 ◽  
Vol 4 (4) ◽  
pp. 1329 ◽  
Author(s):  
Manish Rasania ◽  
Prasad Muley
Keyword(s):  
Preterm Infants ◽  
Tertiary Care ◽  
Preterm Births ◽  
Full Term ◽  
Late Preterm ◽  
Preterm Neonates ◽  
Care Hospital ◽  
Term Infants ◽  
Term Neonates ◽  
Late Preterm Infants

Background: Late premature infants are born near term, but are immature. As a consequence, late preterm infants are at higher risk than term infants to develop morbidities. Although late preterm infants are the largest subgroup of preterm infants, there is a very limited data available on problems regarding late preterm infants in rural India.Methods: This is a retrospective cohort study using previously collected data from neonates born at Dhiraj Hospital and neonates who were born outside but admitted at SNCU of Dhiraj Hospital, Piparia, Vadodara district, Gujarat, India between January 2015 to December 2015.Results: 168 late preterm infants and 1025 term infants were included in this study. The need for SNCU admission is significantly higher in late preterm compared to full term (41.07% vs 2.04%). Morbidities were higher in late preterm neonates compared to full term neonates. Sepsis (4.76% vs 1.07%), TTN (10.11% vs 2.04%), hyperbilirubinemia (19.04% vs 9.36%), RDS (1.78% vs 0.09%), hypoglycemia (1.78% vs 0.29%), PDA (1.78% vs 0.58%), risk of major congenital malformation (2.38% vs 0.58%). Need for respiratory support was 5.95% in late preterm vs 2.04% in full term neonates. Immediate neonatal outcome in terms of death and DAMA (non-salvageable) cases was poor in late preterm neonates compared to full term neonates (1.19% vs 0.78%).Conclusions: Late preterm neonates are at higher risk of morbidities and mortalities. They require special care. Judicious obstetric decisions are required to prevent late preterm births. 

Increased incidence of necrotizing enterocolitis associated with routine administration of Infloran™ in extremely preterm infants

2018 ◽  
Vol 9 (5) ◽  
pp. 683-690 ◽  
Author(s):  
E. Escribano ◽  
C. Zozaya ◽  
R. Madero ◽  
L. Sánchez ◽  
J. van Goudoever ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Gestational Age ◽  
Late Onset ◽  
Blood Cultures ◽  
Antenatal Steroids ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Routine Administration ◽  
Probiotic Product

We aimed to evaluate the isolation of strains contained in the Infloran™ probiotic preparation in blood cultures and its efficacy in reducing necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) in extremely preterm infants. Routine use of probiotics was implemented in 2008. Infants born at <28 weeks gestational age were prospectively followed and compared with historical controls (HC) born between 2005 and 2008. Data on sepsis due to any of the two probiotic strains contained in Infloran and rates of LOS and NEC were analysed. A total of 516 infants were included. During the probiotic period (PC), none of the strains included in the administered probiotic product were isolated from blood cultures. Probiotic administration was associated with an increase in NEC stage II or higher (HC 10/170 [5.9%]; PC 46/346 [13.3%]; P=0.010). Surgical NEC was 12.1% in PC (42/346) versus 5.9% (10/170) in HC (P=0.029). Adjusting for confounders (sex, gestational age, antenatal steroids and human milk) did not change those trends (P=0.019). Overall, clinical LOS and the incidence of staphylococcal sepsis were lower in PC (172/342, 50.3, and 37%, respectively) compared with HC (102/169, 60.3 and 50.9%, respectively) (P=0.038 and P=0.003, respectively). No episodes of sepsis attributable to the probiotic product were recorded. The period of probiotic administration was associated with an increased incidence of NEC after adjusting for neonatal factors, but also with a reduction in the LOS rate.

scholarly journals Short-term Outcome of Low Birth Weight Preterm Infants with Necrotizing Enterocolitis: A Prospective Cohort Study

2018 ◽  
Vol 7 (4) ◽  
pp. 42
Author(s):  
Pradyumna Pan
Keyword(s):  
Survival Rate ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Gestational Age ◽  
Tertiary Care ◽  
Preterm Neonates ◽  
High Morbidity ◽  
Short Term ◽  
Term Outcome ◽  
Stage 1

Aim: The purpose of this study was to analyze the nature of the disease, the surgical procedures, complications, and survival of preterm infants with necrotizing enterocolitis (NEC) from two tertiary care referral neonatal intensive units in central India.Materials and Methods: A prospective study of a cohort of 110 preterm neonates with gestational age less than 36 weeks and weight less than 1600 g infants diagnosed to have NEC were followed for 90 days. All the neonates were born between January 2015 and December 2017 and treated at two neonatal intensive care units. Infants with sepsis, congenital gastrointestinal anomalies, major cardiac problems, and intraventricular hemorrhage were excluded.Results: Mean gestational age in this cohort was 32.40 ± 3.87 weeks, and the mean age of NEC onset was 13.04 ± 3.54 postnatal days. There were 39 neonates with Stage 1, 45 with Stage 2, and 26 with stage 3 NEC. Pneumoperitoneum, positive paracentesis and progressive clinical deterioration were the indications for laparotomy. The most common complications were sepsis 97/110 (88.18%). Post-operative complications occurred in 22 (84.61%) infants, wound infection in 19 (73.07%), intestinal stricture in 9 (34.61%), wound dehiscence in 7 (26.92%), stoma stenosis in 3 (11.53%), ileostomy prolapse in 2 (7.69%), and burst abdomen in 1 (3.84 %). The overall 90-day survival rate was 87.27% (96/110), and the post-operative survival rate was 46.15% (12/26). The age of gestation, weight, and extent of the disease were the main risk factor for mortality.Conclusion: The short-term outcomes for Stage 3 NEC were associated with high morbidity and mortality. The outlook for infants with Stage 1 and 2 NEC was favorable.

Privacy, Early Colostrum, and Gestational Age are Associated with Exclusive Breastfeeding in Preterm and Sick Term Infants

2021 ◽  
Vol 225 (04) ◽  
pp. 346-352
Author(s):  
Eva Heine ◽  
Katrin Mehler ◽  
Michiko Schöpping ◽  
Lisa Ganesh ◽  
Ruth Klein ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Preterm Infants ◽  
Gestational Age ◽  
Exclusive Breastfeeding ◽  
Phase 1 ◽  
Emergency Evacuation ◽  
Late Preterm ◽  
Term Infants ◽  
Late Preterm Infants

AbstractOur study was designed to assess the rates of exclusive breastfeeding (defined as direct breastfeeding) and the use of mother’s own milk (MOM) in preterm infants and sick term infants at discharge and to identify potential influencing factors such as gestational age, early colostrum, and privacy. The study was conducted at a German level III neonatal department. All preterm and sick term infants admitted to the neonatal intensive care unit, the pediatric intensive care unit, the intermediate care unit, and the low care ward were included in the study. Infants were recruited between March and October 2015 (phase 1) and April to July 2016 (phase 2). Due to an emergency evacuation, privacy was limited during the first phase. Breastfeeding and the use of MOM were assessed daily using a self-designed score. In total, 482 infants of 452 mothers were included. More than 90% initiated breastfeeding and one-third were exclusively breastfed at discharge. Extremely immature infants and late preterm infants were less likely to be exclusively breastfed at discharge. Privacy (p<0.001) and early colostrum (p=0.002) significantly increased exclusive breastfeeding. Conclusion Extremely immature and late preterm infants were least likely to be exclusively breastfed at discharge and need special support. Interventions such as privacy and early colostrum should be promoted to increase breastfeeding.

Respiratory Syncytial Virus Associated Hospitalizations in Infants of 33 to 42 Weeksʼ Gestation: Does Gestational Age Matter?

2019 ◽  
Vol 231 (04) ◽  
pp. 206-211 ◽  
Author(s):  
Bernhard Resch ◽  
Charlotte Wörner ◽  
Selma Özdemir ◽  
Magdalena Hubner ◽  
Claudia Puchas ◽  
...  
Keyword(s):  
Risk Factor ◽  
Preterm Infants ◽  
Gestational Age ◽  
Respiratory Illness ◽  
Late Preterm ◽  
Term Infants ◽  
History Of ◽  
Near Term ◽  
Syncytial Virus ◽  
Older Siblings

Abstract Background To evaluate rates and characteristics of respiratory syncytial virus hospitalizations (RSV-H) in infants of 33 to 42 weeks of gestational age (GA). Patients All infants with a history of neonatal hospitalization and a GA of 33 to 42 weeks born between 2005 and 2015 and follow-up at least over one RSV season (first year of life). Infants with congenital heart disease and other congenital anomalies were excluded. Methods Retrospective single-center cohort STROBE compliant study. Data were collected regarding demographic data and re-hospitalization characteristics due to respiratory illness and due to RSV infection; and data were compared between moderate-late preterm, near term, term, and post term infants, respectively. Results A total of 81.656 live born infants were registered in our catchment area with gestational age from 33 to 42 weeks during the study period; and 2188 of 2356 preterm infants and 1004 of 1168 term infants with history of neonatal hospitalization were included for analysis. Rehospitalizations due to respiratory illness occurred in 301 preterm (13.8%) and 136 term (13.5%) infants for 381 and 183 times, respectively. In total 84 of 3192 infants (2.6%) were tested RSV positive, 61 of 2188 preterm (2.8%) and 23 of 1004 term (2.3%). Preterm infants without history of neonatal hospitalization had a RSV hospitalization (RSV-H) rate of 1.7% (61/3488) and term infants of 1.3% (967/74.644) that were significantly lower compared to study infants (p=0.004 and 0.002, respectively). Moderate and late preterm (2.8%), near term (3.1%) and post term (3.5%) infants had significantly higher RSV-H rates compared to term infants (1.2%). Risk factors for RSV-H in preterm infants included discharge during RSV season (4.2 vs. 2.0%, p=0.017) and presence of older siblings (4.2 vs. 2.1%, p=0.023), in term infants presence of older siblings (p=0.019). The course of RSV disease did not differ between groups. Discussion Interestingly, we did not observe decreasing RSV-H rates with increasing GA. Term infants represented the group with lowest RSV-H rates. Neonatal hospitalization was a risk factor for RSV-H for both preterm and term infants. Near term infants do more resemble the late preterm than term infants regarding RSV-H rates. Conclusion We found comparable higher RSV-H rates in all groups compared to term infants without differences in the course of disease and identified neonatal hospitalization as an independent risk factor.

scholarly journals Preterm Morbidity and Mortality by Gestational Age. A Birth Population-Based Study

2020 ◽  
Author(s):  
Bo Sun ◽  
Xiaojing Guo ◽  
Xiaoqiong Li ◽  
Tingting Qi ◽  
Zhaojun Pan ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Death Rate ◽  
Preterm Births ◽  
Population Based ◽  
Morbidity And Mortality ◽  
Preterm Neonates ◽  
Hospital Death ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Abstract Background: Despite 15-17 million of annual births in China, there is a paucity of information on preterm morbidity and mortality. We characterized the outcome of preterm births and hospitalized preterm infants by gestational age (GA) in Huai’an in 2015, an emerging prefectural region of China.Methods: Of 59,245 regional total births, clinical data on 2,651 preterm births and 1,941 hospitalized preterm neonates were extracted from Huai’an Women and Children’s Hospital (HWCH) and non-HWCH hospitals in 2018-2020. Preterm morbidity and mortality rates were characterized and compared by hospital categories and GA spectra. Death risks of preterm births and hospitalized preterm infants in the whole region were analyzed with multivariable logistic regression.Results: The incidences of extreme, very, moderate, late and total preterm of the regional total births were 1.4, 5.3, 7.2, 30.8 and 44.7‰, with all-death rates being 1.0, 1.6, 0.6, 1.1 and 4.3‰, respectively, of the regional total births. There were 1,025 (52.8% of whole region) preterm admissions in HWCH, with significantly lower in-hospital death rate of inborn (33/802) than out-born (23/223) infants. Compared to non-HWCH, four-fold more neonates in HWCH were under critical care with higher death rate, including most extremely preterm infants. Significant all-death risks were found for the total preterm births in BW < 1,000g, II-III degree of amniotic fluid contamination, Apgar-5 min < 7, and birth defects (BD). For the hospitalized preterm infants, significant in-hospital death risks were found in out-born of HWCH, GA < 32 weeks, Apgar-5 min < 7, BD, necrotizing enterocolitis and ventilation, whereas born in HWCH, antenatal glucocorticoids, cesarean delivery and surfactant use were protective factors against death.Conclusions: The integrated data revealed GA-specific morbidity and mortality on the basis of total preterm births and their hospitalization, demonstrating the efficacy of leading referral center and whole regional perinatal-neonatal network in China. The concept and protocol of our current study should be extended to gain comprehensive understanding in the world-wide campaign for prevention of preterm birth.

Abstract 12713: Epidemiology and Mortality of Very and Extremely Preterm Infants With Congenital Heart Defects

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Patricia Y Chu ◽  
Jennifer S Li ◽  
Andrzej S Kosinski ◽  
Christoph P Hornik ◽  
Kevin D Hill
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Congenital Heart ◽  
Heart Defects ◽  
Multivariate Logistic Regression Analysis ◽  
Administrative Database ◽  
Term Infants ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Nationally Representative

Introduction: Congenital heart disease (CHD) is estimated to occur in 6-10 per 1000 births. Although epidemiology and outcomes for term and near term infants with CHD are well described, data are limited for very and extremely preterm (VEP) infants. We used the Healthcare Cost and Utilization Project Kids’ Inpatient Database (KID), a nationally representative administrative database, to evaluate epidemiology and outcomes for VEP infants (25 to 32 weeks gestational age, GA) with CHD. Methods: Two separate cohorts were defined from the KID: an epidemiologic cohort including birth hospitalizations in ‘03, ’06, ’09 and ‘12; and an outcomes cohort including hospitalizations at a children’s hospital or pediatric unit for infants < 1 month of age in ‘06 and ‘09. CHD was defined by ICD-9-CM codes with severe CHD defined as those defects expected to be universally diagnosed during a preterm birth hospitalization. Weighted multivariate logistic regression analysis was used to calculate odds ratios (OR) for mortality, adjusted for race, sex, GA, year, small for gestational age and hospital teaching status. Results: Our epidemiologic and outcomes cohorts included 249,011 and 49,893 VEP infants, respectively. Incidence of CHD (116/1000 VEP births) and severe CHD (7/1000 VEP births) were both higher than previously reported in term infants. Relative risk of severe CHD in VEP vs term infants was 4.80 (95% CI 4.76, 4.84) and decreased with increasing GA (5.7 at 25 weeks GA to 4.3 at 31 weeks, p=0.005). Hospital mortality (Figure) was substantially higher for VEP infants with vs without severe CHD (26% vs 5%; adjusted OR 7.5 [95% CI: 5.9, 9.6]). Overall 16% of VEP infants with severe CHD underwent cardiac surgery during the neonatal hospitalization with mortality after surgery of 16%. Conclusions: CHD incidence is increased in very and extremely preterm infants and outcomes are poor. These data underscore the need for interventions to decrease preterm delivery when severe CHD is diagnosed in utero.

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