scholarly journals The Risk of Necrotizing Enterocolitis following the Administration of Hyperosmolar Enteral Medications to Extremely Preterm Infants

Neonatology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Faiza Latheef ◽  
Hanna Wahlgren ◽  
Helene Engstrand Lilja ◽  
Barbro Diderholm ◽  
Mattias Paulsson
Keyword(s):  
Clinical Practice ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Neonatal Intensive Care ◽  
Significant Risk ◽  
Quality Register ◽  
Increased Risk ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Hyperosmolar Solutions

<b><i>Introduction:</i></b> Necrotizing enterocolitis (NEC) is a disease predominantly affecting preterm infants. The administration of hyperosmolar solutions could lead to the development of NEC. The objective of this study was to measure the osmolality of enteral medications used in clinical practice and to assess the risk of NEC following exposure to hyperosmolar medications. <b><i>Methods:</i></b> A retrospective cohort study in extremely preterm infants (gestational age &#x3c;28 weeks) born between 2010 and 2016 at a tertiary neonatal intensive care unit in Sweden. 465 infants were identified via the Swedish Neonatal Quality register. Data relating to enteral administrations received during a two-week period were collected from the medical records. The osmolalities of medications were measured using an osmometer. Logistic regression was used to calculate the odds ratio of developing NEC. <b><i>Results:</i></b> A total of 253 patients met the inclusion criteria. The osmolalities of 5 commonly used medications significantly exceeded the recommended limit of 450 mOsm/kg set by the American Academy of Paediatrics (AAP). Most patients (94%) received at least one hyperosmolar medication. No significant risk of developing NEC could be found. <b><i>Conclusion:</i></b> The medications used in clinical practice can significantly exceed the limit set by the AAP. This study does not indicate an increased risk of developing NEC in extremely preterm infants following exposure to hyperosmolar medications. Further studies in larger cohorts are needed to determine the specific cut-off level of osmolality in relation to the pathogenesis of NEC.

scholarly journals Risk Factors Associated with Retinopathy of Prematurity in Very and Extremely Preterm Infants

Medicina ◽  
2021 ◽  
Vol 57 (5) ◽  
pp. 420
Author(s):  
Claudia Ioana Borțea ◽  
Florina Stoica ◽  
Marioara Boia ◽  
Emil Radu Iacob ◽  
Mihai Dinu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Preterm Infants ◽  
Gestational Age ◽  
Retinopathy Of Prematurity ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Surfactant Administration ◽  
Stage 1

Background and Objectives: Retinopathy of prematurity (ROP) is the leading cause of blindness in preterm infants. We studied the relationship between different perinatal characteristics, i.e., sex; gestational age (GA); birth weight (BW); C-reactive protein (CRP) and lactate dehydrogenase (LDH) concentrations; ventilation, continuous positive airway pressure (CPAP), and surfactant administration; and the incidence of Stage 1–3 ROP. Materials and Methods: This study included 247 preterm infants with gestational age (GA) < 32 weeks that were successfully screened for ROP. Univariate and multivariate binary analyses were performed to find the most significant risk factors for ROP (Stage 1–3), while multivariate multinomial analysis was used to find the most significant risk factors for specific ROP stages, i.e., Stage 1, 2, and 3. Results: The incidence of ROP (Stage 1–3) was 66.40% (164 infants), while that of Stage 1, 2, and 3 ROP was 15.38% (38 infants), 27.53% (68 infants), and 23.48% (58 infants), respectively. Following univariate analysis, multiple perinatal characteristics, i.e., GA; BW; and ventilation, CPAP, and surfactant administration, were found to be statistically significant risk factors for ROP (p < 0.001). However, in a multivariate model using the same characteristics, only BW and ventilation were significant ROP predictors (p < 0.001 and p < 0.05, respectively). Multivariate multinomial analysis revealed that BW was only significantly correlated with Stage 2 and 3 ROP (p < 0.05 and p < 0.001, respectively), while ventilation was only significantly correlated with Stage 2 ROP (p < 0.05). Conclusions: The results indicate that GA; BW; and the use of ventilation, CPAP, and surfactant were all significant risk factors for ROP (Stage 1–3), but only BW and ventilation were significantly correlated with ROP and specific stages of the disease, namely Stage 2 and 3 ROP and Stage 2 ROP, respectively, in multivariate models.

scholarly journals Regional variation in cost of neonatal intensive care for extremely preterm infants

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Asaph Rolnitsky ◽  
David Urbach ◽  
Sharon Unger ◽  
Chaim M. Bell
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Preterm Infants ◽  
Gestational Age ◽  
Regional Variation ◽  
Neonatal Intensive Care ◽  
Cost Optimization ◽  
Program Cost ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Abstract Background Regional variation in cost of neonatal intensive care for extremely preterm infant is not documented. We sought to evaluate regional variation that may lead to benchmarking and cost saving. Methods An analysis of a Canadian national costing data from the payor perspective. We included all liveborn 23–28-week preterm infants in 2011–2015. We calculated variation in costs between provinces using non-parametric tests and a generalized linear model to evaluate cost variation after adjustment for gestational age, survival, and length of stay. Results We analysed 6932 infant records. The median total cost for all infants was $66,668 (Inter-Quartile Range (IQR): $4920–$125,551). Medians for the regions varied more than two-fold and ranged from $48,144 in Ontario to $122,526 in Saskatchewan. Median cost for infants who survived the first 3 days of life was $91,000 (IQR: $56,500–$188,757). Median daily cost for all infants was $1940 (IQR: $1518–$2619). Regional variation was significant after adjusting for survival more than 3 days, length of stay, gestational age, and year (pseudo-R2 = 0.9, p < 0.01). Applying the model on the second lowest-cost region to the rest of the regions resulted in a total savings of $71,768,361(95%CI: $65,527,634–$81,129,451) over the 5-year period ($14,353,672 annually), or over 11% savings for the total program cost of $643,837,303 over the study period. Conclusion Costs of neonatal intensive care are high. There is large regional variation that persists after adjustment for length of stay and survival. Our results can be used for benchmarking and as a target for focused cost optimization, savings, and investment in healthcare.

scholarly journals Near-Infrared Spectroscopy in Extremely Preterm Infants

2021 ◽  
Vol 8 ◽  
Author(s):  
Leeann R. Pavlek ◽  
Clifford Mueller ◽  
Maria R. Jebbia ◽  
Matthew J. Kielt ◽  
Omid Fathi
Keyword(s):  
Infrared Spectroscopy ◽  
Preterm Infants ◽  
Near Infrared Spectroscopy ◽  
Neonatal Intensive Care ◽  
Near Infrared ◽  
Tissue Oxygen Saturation ◽  
Tissue Oxygen ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Potential Applications

With advances in neonatal care, survival of premature infants at the limits of viability has improved significantly. Despite these improvement in mortality, infants born at 22–24 weeks gestation are at a very high risk for short- and long-term morbidities associated with prematurity. Many of these diseases have been attributed to abnormalities of tissue oxygenation and perfusion. Near-infrared spectroscopy utilizes the unique absorption properties of oxyhemoglobin and deoxyhemoglobin to provide an assessment of regional tissue oxygen saturation, which can be used to calculate the fractional tissue oxygen extraction. This allows for a non-invasive way to monitor tissue oxygen consumption and enables targeted hemodynamic management. This mini-review provides a brief and complete overview of the background and physiology of near-infrared spectroscopy, practical use in extremely preterm infants, and potential applications in the neonatal intensive care unit. In this mini-review, we aim to summarize the three primary application sites for near-infrared spectroscopy, disease-specific indications, and available literature regarding use in extremely preterm infants.

Factors affecting parents' presence with their extremely preterm infants in a neonatal intensive care room

2013 ◽  
Vol 102 (7) ◽  
pp. 695-702 ◽  
Author(s):  
Ann-Britt Heinemann ◽  
Lena Hellström-Westas ◽  
Kerstin Hedberg Nyqvist
Keyword(s):  
Intensive Care ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Factors Affecting ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

scholarly journals Conservative Non-intervention Approach for Hemodynamically Significant Patent Ductus Arteriosus in Extremely Preterm Infants

2020 ◽  
Vol 8 ◽  
Author(s):  
Se In Sung ◽  
Yun Sil Chang ◽  
So Yoon Ahn ◽  
Heui Seung Jo ◽  
Misun Yang ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Ductus Arteriosus ◽  
Intervention Approach ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Surgical Treatments ◽  
Minimal Evidence ◽  
Patent Ductus

While persistent patent ductus arteriosus (PDA) in preterm infants has been known to be associated with increased mortality and morbidities including bronchopulmonary dysplasia, and necrotizing enterocolitis, there is minimal evidence supporting their causal relationships, and most traditional medical and/or surgical treatments have failed to show improvements in these outcomes. As such, the pendulum has swung toward the conservative non-intervention approach for the management of persistent PDA during the last decade; however, the benefits and risks of this approach are unclear. In this mini review, we focused on whom, when, and how to apply the conservative non-intervention approach for persistent PDA, especially in extremely preterm infants.

Association between Umbilical Catheters and Neonatal Outcomes in Extremely Preterm Infants

2017 ◽  
Vol 35 (03) ◽  
pp. 233-241
Author(s):  
Mohamed Elboraee ◽  
Jennifer Toye ◽  
Xiang Ye ◽  
Prakesh Shah ◽  
Khalid Aziz ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Neonatal Morbidity ◽  
Neonatal Intensive Care Units ◽  
Design Data ◽  
Major Morbidity ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Umbilical Catheters ◽  
Multivariable Analyses

Objective The objective of this study was to examine the association between umbilical catheters and a composite outcome of mortality or major neonatal morbidity in extremely preterm infants. Study Design Data were abstracted from the Canadian Neonatal Network database for infants born at <29 weeks' gestational age and admitted to 29 neonatal intensive care units between January 2010 and December 2012. Four groups were identified: those with no umbilical catheters, umbilical venous catheters (UVCs), umbilical artery catheters (UACs), and those with both UVCs and UACs. The outcomes were compared among the groups using univariate and multivariable analyses. Results Of 4,623 eligible infants, 820 (17.7%) had no catheters, 1,032 (22.3%) a UVC only, 120 (2.6%) a UAC only, and 2,651 (57.3%) had both catheters. After adjustment for acuity and other potential confounders, umbilical catheters were associated with higher odds of mortality or any major morbidity (UVC vs. no catheter: adjusted odds ratio [aOR]: 1.47; 95% CI: 1.18–1.85; UAC vs. no catheter: aOR: 1.67; 95% CI: 1.05–2.63; and both UVC + UAC vs. no catheter: aOR: 2.17; 95% CI: 1.79–2.70). Conclusion Most of the infants born at <29 weeks' gestation had UVC and/or UAC placement. The presence of either catheter was associated with mortality or major morbidity, and the association was stronger when both catheters were present.

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.

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