scholarly journals Predictive Role of Urinary Metabolic Profile for Abnormal MRI Score in Preterm Neonates

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Maria Luisa Tataranno ◽  
Serafina Perrone ◽  
Mariangela Longini ◽  
Caterina Coviello ◽  
Maria Tassini ◽  
...  
Keyword(s):  
At Risk ◽  
Preterm Infants ◽  
Early Identification ◽  
Metabolic Profile ◽  
Area Under The Curve ◽  
Preterm Neonates ◽  
Resonance Spectroscopy ◽  
Equivalent Age ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Background and Objective. Early identification of neonates at risk for brain injury is important to start appropriate intervention. Urinary metabolomics is a source of potential, noninvasive biomarkers of brain disease. We studied the urinary metabolic profile at 2 and 10 days in preterm neonates with normal/mild and moderate/severe MRI abnormalities at term equivalent age.Methods. Urine samples were collected at two and 10 days after birth in 30 extremely preterm infants and analyzed using proton magnetic resonance spectroscopy. A 3 T MRI was performed at term equivalent age, and images were scored for white matter (WM), cortical grey matter (cGM), deep GM, and cerebellar abnormalities. Infants were divided in two groups: normal/mild and moderately/severely abnormal MRI scores.Results. No significant clustering was seen between normal/mild and moderate/severe MRI scores for all regions at both time points. The ROC curves distinguished neonates at 2 and 10 days who later developed a markedly less mature cGM score from the others (2 d: area under the curve (AUC) = 0.72, specificity (SP) = 65%, sensitivity (SE) = 75% and 10 d: AUC = 0.80, SP = 78%, SE = 80%) and a moderately to severely abnormal WM score (2 d: AUC = 0.71, specificity (SP) = 80%, sensitivity (SE) = 72% and 10 d: AUC = 0.69, SP = 64%, SE = 89%).Conclusions. Early urinary spectra of preterm infants were able to discriminate metabolic profiles in patients with moderately/severely abnormal cGM and WM scores at term equivalent age. Urine spectra are promising for early identification of neonates at risk of brain damage and allow understanding of the pathogenesis of altered brain development.

scholarly journals Extremely Preterm Infants Have a Higher Fat Mass Percentage in Comparison to Very Preterm Infants at Term-Equivalent Age

2020 ◽  
Vol 8 ◽  
Author(s):  
Marlies Bruckner ◽  
Zahra Khan ◽  
Christoph Binder ◽  
Nicholas Morris ◽  
Bernadette Windisch ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Fat Mass ◽  
Mass Percentage ◽  
Very Preterm Infants ◽  
Equivalent Age ◽  
Very Preterm ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

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 Effects of Postnatal Hydrocortisone Treatment on Cytokine Profile in Preterm Infants at Risk of Bronchopulmonary Dysplasia

2021 ◽  
Author(s):  
Kentaro Tamura ◽  
Mitsuhide Nagaoka ◽  
Satomi Inomata ◽  
Yukako Kawasaki ◽  
Masami Makimoto ◽  
...  
Keyword(s):  
At Risk ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Early Phase ◽  
Late Phase ◽  
High Serum ◽  
Duration Of Treatment ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Hydrocortisone Treatment

Abstract Systemic hydrocortisone administration has been widely used in preterm infants who are at a risk of bronchopulmonary dysplasia (BPD). However, the effects of hydrocortisone on cytokine profiles have not been examined. We aimed to investigate the effects of postnatal hydrocortisone treatment on serum cytokine levels in extremely preterm infants at risk for BPD. In 29 extremely preterm infants (born at less than 28 weeks of gestational age), we obtained serum from blood samples collected during an early phase (5–20 days) and a late phase (28‒60 days) after birth. We measured the levels of proinflammatory cytokines (tumor necrosis factors α and β, interleukin [IL]-1β, and IL-6), T-helper (Th) 1 cytokines (interferon-γ, IL-2, and IL-12p70), Th2 cytokines (IL-4, IL-5, and IL-10), Th17 cytokine IL-17A, and chemokine IL-8. We found that serum IL-6 and IL-8 levels were significantly higher during the early phase than during the late phase (both P = 0.03). Other cytokines concentrations did not change between the phases. Thirteen infants (45%) received systemic hydrocortisone treatment at a median age of 15 days (IQR 10.0–21.5) after birth due to respiratory deterioration, after which the serum IL-6 levels significantly decreased (P = 0.04). Median duration of treatment was 16.0 (IQR 8.0–34.5) days. Conclusion: Extremely preterm infants show high serum IL-6 and IL-8 levels in the early phase of life. Moreover, postnatal systemic hydrocortisone treatment might suppress IL-6 overproduction.

scholarly journals Shape variability of the central sulcus in the developing brain: a longitudinal descriptive and predictive study in preterm infants.

2021 ◽  
Author(s):  
Héloïse de Vareilles ◽  
Denis Rivière ◽  
Zhongyi Sun ◽  
Clara Fischer ◽  
François Leroy ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Developing Brain ◽  
Adult Brain ◽  
Fine Motor ◽  
Age Group ◽  
Shape Features ◽  
Central Sulcus ◽  
Equivalent Age ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Despite growing evidence of links between sulcation and function in the adult brain, the folding dynamics, occurring mostly before normal-term-birth, is vastly unknown. Looking into the development of cortical sulci in babies can give us keys to address fundamental questions: what is the sulcal shape variability in the developing brain? When are the shape features encoded? How are these morphological parameters related to further functional development? In this study, we aimed to investigate the shape variability of the developing central sulcus, which is the frontier between the primary somatosensory and motor cortices. We studied a cohort of 71 extremely preterm infants scanned twice using MRI - once around 30 weeks post-menstrual age (w PMA) and once at term-equivalent age, around 40w PMA -, in order to quantify the sulcus's shape variability using manifold learning, regardless of age-group or hemisphere. We then used these shape descriptors to evaluate the sulcus's variability at both ages and to assess hemispheric and age-group specificities. This led us to propose a description of ten shape features capturing the variability in the central sulcus of preterm infants. Our results suggested that most of these features (8/10) are encoded as early as 30w PMA. We unprecedentedly observed hemispheric asymmetries at both ages, and the one captured at term-equivalent age seems to correspond with the asymmetry pattern previously reported in adults. We further trained classifiers in order to explore the predictive value of these shape features on manual performance at 5 years of age (handedness and fine motor outcome). The central sulcus's shape alone showed a limited but relevant predictive capacity in both cases. The study of sulcal shape features during early neurodevelopment may participate to a better comprehension of the complex links between morphological and functional organization of the developing brain.

Mortality and significant neurosensory impairment in preterm infants: an international comparison

2021 ◽  
pp. fetalneonatal-2021-322288
Author(s):  
Marie Chevallier ◽  
Thierry Debillon ◽  
Brian A Darlow ◽  
Anne R Synnes ◽  
Véronique Pierrat ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Population Based ◽  
Preterm Neonates ◽  
Composite Outcome ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Observational Cohort ◽  
Baseline Characteristics ◽  
French Cohort

ObjectiveTo compare mortality and rates of significant neurosensory impairment (sNSI) at 18–36 months’ corrected age in infants born extremely preterm across three international cohorts.DesignRetrospective analysis of prospectively collected neonatal and follow-up data.SettingThree population-based observational cohort studies: the Australian and New Zealand Neonatal Network (ANZNN), the Canadian Neonatal and Follow-up Networks (CNN/CNFUN) and the French cohort Etude (Epidémiologique sur les Petits Ages Gestationnels: EPIPAGE-2).PatientsExtremely preterm neonates of <28 weeks’ gestation in year 2011.Main outcome measuresPrimary outcome was composite of mortality or sNSI defined by cerebral palsy with no independent walking, disabling hearing loss and bilateral blindness.ResultsOverall, 3055 infants (ANZNN n=960, CNN/CNFUN n=1019, EPIPAGE-2 n=1076) were included in the study. Primary composite outcome rates were 21.3%, 20.6% and 28.4%; mortality rates were 18.7%, 17.4% and 26.3%; and rates of sNSI among survivors were 4.3%, 5.3% and 3.3% for ANZNN, CNN/CNFUN and EPIPAGE-2, respectively. Adjusted for gestational age and multiple births, EPIPAGE-2 had higher odds of composite outcome compared with ANZNN (OR 1.71, 95% CI 1.38 to 2.13) and CNN/CNFUN (OR 1.72, 95% CI 1.39 to 2.12). EPIPAGE-2 did have a trend of lower odds of sNDI but far short of compensating for the significant increase in mortality odds. These differences may be related to variations in perinatal approach and practices (and not to differences in infants’ baseline characteristics).ConclusionsComposite outcome of mortality or sNSI for extremely preterm infants differed across high-income countries with similar baseline characteristics and access to healthcare.

A Mystery of Patent Ductus Arteriosus and Serum Osmolality in Preterm Infants

2018 ◽  
Vol 36 (06) ◽  
pp. 641-646 ◽  
Author(s):  
Ufuk Cakir ◽  
Cuneyt Tayman
Keyword(s):  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Ductus Arteriosus ◽  
Area Under The Curve ◽  
Clinical Problem ◽  
Serum Osmolality ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Important Clinical Problem ◽  
Patent Ductus

Objective Patent ductus arteriosus (PDA) is an important clinical problem associated with mortality and serious morbidities. It is thought that serum osmolality may affect ductal patency. We aimed to investigate the importance of serum osmolality related to ductal patency in preterm infants. Study Design Our study was conducted between January 2013 and December 2017. Premature infants with birth weight <1,500 g and gestational age <32 weeks were included in the study. Serum osmolality was compared between infants with hemodynamically significant PDA (hsPDA) and non-hsPDA. Results During the study period, 799 patients were evaluated. Mean serum osmolality levels were higher in the “hsPDA” group (297 ± 10.9 vs. 292 ± 8.3 mOsm/L) (p = 0.001). The area under the curve for osmolality was 0.582 (p = 0.0006, 95% confidence interval: 0.541–0.622) at the time of diagnosis for predicting hsPDA, with a cutoff value for osmolality of 300 mOsm/L. Conclusion Serum osmolality may be recognized as an important contributing factor for ductal patency especially among extremely preterm infants who are most likely to have hsPDA in the early days of life.

scholarly journals BNP, troponin I, and YKL-40 as screening markers in extremely preterm infants at risk for pulmonary hypertension associated with bronchopulmonary dysplasia

2016 ◽  
Vol 311 (6) ◽  
pp. L1076-L1081 ◽  
Author(s):  
Kai König ◽  
Katelyn J. Guy ◽  
Claudia A. Nold-Petry ◽  
Charles P. Barfield ◽  
Geraldine Walsh ◽  
...  
Keyword(s):  
At Risk ◽  
Pulmonary Hypertension ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Gestational Age ◽  
Troponin I ◽  
Systolic Pressure ◽  
Ventricular Systolic Pressure ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Bronchopulmonary dysplasia (BPD) is often complicated by pulmonary hypertension (PH). We investigated three biomarkers potentially suitable as screening markers for extremely preterm infants at risk of BPD-associated PH. In this prospective observational cohort study conducted in a tertiary neonatal intensive care unit, 83 preterm infants with BPD born <28-wk gestation and still inpatients at 36-wk corrected age received an echocardiogram and blood tests of B-type natriuretic peptide (BNP), troponin I, and YKL-40. Infants were analyzed according to echocardiographic evidence of tricuspid regurgitation (TR). Thirty infants had evidence of TR on echocardiogram at 36-wk corrected age. Infants with or without TR had similar baseline demographics: mean ± SD gestational age 261 ± 12 vs. 261 ± 11 wk and birth weight 830 ± 206 vs. 815 ± 187 g, respectively. There was no difference in duration of respiratory support. The right ventricular systolic pressure of infants with evidence of TR was 40 ± 16 mmHg. BNP was the only biomarker that proved to be significantly higher in infants with evidence of TR: median (interquartile range) serum level 54.5 (35–105) vs. 41.5 (30–59) pg/ml, P = 0.043. Subgroup analysis of infants with severe BPD requiring discharge on home oxygen or BPD-related mortality revealed similar results. There was no difference between groups for troponin I and YKL-40. In conclusion, increased serum levels of BNP were associated with evidence of TR at 36-wk corrected gestational age in extremely preterm infants, suggesting a potential role as a screening biomarker for BPD-associated PH.

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.

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