scholarly journals Global prevalence of long-term neurodevelopmental impairment following extremely preterm birth: a systematic literature review

2021 ◽  
Vol 49 (7) ◽  
pp. 030006052110280
Author(s):  
Sujata P. Sarda ◽  
Grammati Sarri ◽  
Csaba Siffel
Keyword(s):  
Systematic Review ◽  
North America ◽  
Major Complication ◽  
Neurodevelopmental Outcomes ◽  
Extreme Prematurity ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Neurodevelopmental Impairment ◽  
Extremely Preterm Birth

Objective Neurodevelopmental impairment (NDI) is a major complication of extreme prematurity. This systematic review was conducted to summarize the worldwide long-term prevalence of NDI associated with extreme prematurity. Methods Embase and MEDLINE databases were searched for epidemiologic and observational/real-world studies, published in English between 2011 and 2016, reporting long-term prevalence of NDI (occurring from 1 year) among extremely preterm infants born at gestational age (GA) ≤28 weeks. Results Of 2406 articles identified through searches, 69 met the protocol NDI definition (24 North America, 25 Europe, 20 Rest of World). Prevalence of any severity NDI in North America was 8%–59% at 18 months to 2 years, and 11%–37% at 2–5 years; prevalence of moderate NDI in Europe was 10%–13% at 18 months to 2 years, 3% at 2–5 years, and 9%–19% at ≥5 years; prevalence of any NDI in Rest of World was 15%–61% at 18 months to 2 years, and 42% at 2–5 years (no North America/Rest of World studies reported any NDI at ≥5 years). A trend toward higher prevalence of NDI with lower GA at birth was observed. Conclusions Extreme prematurity has a significant long-term worldwide impact on neurodevelopmental outcomes.

Extremely preterm infant with persistent peeling skin: X-linked ichthyosis imitates prematurity

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Brigitte Burcescu ◽  
Heather L. Brumberg ◽  
Shetal I. Shah
Keyword(s):  
Preterm Infant ◽  
Genetic Disorder ◽  
Steroid Sulfatase ◽  
Neurodevelopmental Outcomes ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Surfactant Production ◽  
Age Of Diagnosis ◽  
Scaly Skin

Abstract Objectives X-linked ichthyosis (XLI) is a genetic disorder caused by a deficiency in steroid sulfatase, an enzyme which catalyzes a reaction in estrone synthesis. The disorder primarily manifests as dry, scaly skin which may be difficult to diagnose in extremely preterm infants, as the dermatological features may be falsely attributed to a normal variant of skin for this population. Case presentation In this case report, we describe a male with XLI, born at 24 weeks gestation, who had persistent dry, flaky and hyperpigmented skin. This case is notable for the age of diagnosis in an extremely premature infant; day of life 105. In addition, this infant experienced out of proportion bronchopulmonary symptoms that we postulate may be linked to the steroid sulfatase deficiency, as estrogen is a mediator of surfactant production. Conclusions This report underscores the need to potentially evaluate persistent dry, flaky skin in the preterm infant, as XLI may also impact long term neurodevelopmental outcomes.

scholarly journals Diffusion Tensor Imaging Changes Do Not Affect Long-Term Neurodevelopment Following Early Erythropoietin Among Extremely Preterm Infants in the Preterm Erythropoietin Neuroprotection Trial

2021 ◽  
Vol 11 (10) ◽  
pp. 1360
Author(s):  
Janessa B. Law ◽  
Bryan A. Comstock ◽  
Todd L. Richards ◽  
Christopher M. Traudt ◽  
Thomas R. Wood ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
White Matter ◽  
Linear Models ◽  
Diffusion Tensor ◽  
Mean Diffusivity ◽  
Neurodevelopmental Outcomes ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Postmenstrual Age

We aimed to evaluate diffusion tensor imaging (DTI) in infants born extremely preterm, to determine the effect of erythropoietin (Epo) on DTI, and to correlate DTI with neurodevelopmental outcomes at 2 years of age for infants in the Preterm Erythropoietin Neuroprotection (PENUT) Trial. Infants who underwent MRI with DTI at 36 weeks postmenstrual age were included. Neurodevelopmental outcomes were evaluated by Bayley Scales of Infant and Toddler Development (BSID-III). Generalized linear models were used to assess the association between DTI parameters and treatment group, and then with neurodevelopmental outcomes. A total of 101 placebo- and 93 Epo-treated infants underwent MRI. DTI white matter mean diffusivity (MD) was lower in placebo- compared to Epo-treated infants in the cingulate and occipital regions, and occipital white matter fractional isotropy (FA) was lower in infants born at 24–25 weeks vs. 26–27 weeks. These values were not associated with lower BSID-III scores. Certain decreases in clustering coefficients tended to have lower BSID-III scores. Consistent with the PENUT Trial findings, there was no effect on long-term neurodevelopment in Epo-treated infants even in the presence of microstructural changes identified by DTI.

scholarly journals Extreme Prematurity and Pulmonary Outcomes Program in Saitama (EPOPS): A Study Protocol of a Prospective Multicenter Cohort Study of Extremely Preterm Infants in Japan (Preprint)

2020 ◽  
Author(s):  
Fumihiko Namba ◽  
Kosuke Tanaka ◽  
Sayu Omori ◽  
Kazushige Ikeda ◽  
Ken Kawabata ◽  
...  
Keyword(s):  
Cohort Study ◽  
Preterm Infants ◽  
Developed Countries ◽  
Respiratory Morbidity ◽  
Extreme Prematurity ◽  
Multicenter Cohort Study ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Definition Of

UNSTRUCTURED Introduction: Because of the improvements in survival rates for preterm infants, not only the rates of bronchopulmonary dysplasia (BPD) but also that of long-term respiratory complications of premature birth are increasing, which results in financial and health burdens in developed countries. Thus far, risk factors of respiratory morbidities of extremely preterm infants remain unknown. Furthermore, the definition, as well as the predictive ability, of BPD for long-term respiratory outcomes are yet to be determined. Therefore, Extreme Prematurity and Pulmonary Outcomes Program in Saitama (EPOPS) aims to develop the diagnostic criteria for BPD and to determine the prognostic factors contributing to the long-term pulmonary outcomes manifested in extremely preterm infants. Methods and analysis: The EPOPS is an observational prospective cohort study performed by a consortium of six neonatal intensive care units (NICUs) in Saitama, Japan. The subjects included in this study were infants (from each clinical center) with gestational ages 22 to 27 weeks, having an expected target of 400 subjects. This study aims to determine the definition of BPD and other perinatal factors which accurately predict the long-term pulmonary outcomes in survivors of extreme prematurity. Moreover, association between BPD and post-prematurity respiratory disease (PRD) will also be investigated using generalized linear models. Discussion: The EPOPS incorporates the aspects of neonatal care in secondary- and tertiary-level NICUs to develop the existing research studies on the definition of BPD, objective biomarkers, and outcome measures of respiratory morbidity in extremely preterm infants beyond the NICU hospitalization, thereby leading to a novel understanding of the nature and natural history of BPD and of potential mechanistic and therapeutic targets among at-risk subjects. Ethics and Dissemination: The protocol and consent forms were evaluated and approved by institutional review boards at each EPOPS center. Registration details: Not registered because of an observational study without any interventions.

scholarly journals Does a Split-Week Gestational Age Model Provide Valuable Information on Neurodevelopmental Outcomes in Extremely Preterm Infants?

Children ◽  
2021 ◽  
Vol 8 (9) ◽  
pp. 731
Author(s):  
Elizabeth Asztalos ◽  
Alberto Nettel Aguirre ◽  
Leonora Hendson ◽  
Paige Church ◽  
Rudaina Banihani ◽  
...  
Keyword(s):  
Gestational Age ◽  
Primary Objective ◽  
Neurodevelopmental Outcomes ◽  
Additional Information ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Significant Impairment ◽  
Age Model ◽  
Gestational Week ◽  
Neurodevelopmental Impairment

Our primary objective for this follow-up study was to compare the neurodevelopmental outcomes of a surviving cohort of infants using a split-week gestational model (early versus late) gestational age (GA) and the standard completed GA categorization. Neurodevelopmental outcomes using a split-week GA model defined as early (X, 0–3) and late (X, 4–6), with X being 23–26 weeks GA, were compared to outcomes using completed weeks GA. In total, 1012 infants were included in the study. Statistically significant differences were noted in outcomes between the early and late split of the gestational week at 23 weeks (early vs. late), with 13.3% vs. 54.5% for no neurodevelopmental impairment, and 53.3% vs. 22.7% for significant impairment (p = 0.034), respectively. There were no differences seen in the split week model for 24, 25, and 26 weeks. A trend towards improved neurodevelopmental outcomes was seen with each increasing gestation week. The split-week model did not provide additional information for pregnancies and infants between 24 and 26 weeks gestation. It did, however, provide information for counsel for infants at 23 weeks gestation, showing benefits in the late versus early half of the week.

scholarly journals Short- and Long-Term Neurodevelopmental Outcomes of Very Preterm Infants with Neonatal Sepsis: A Systematic Review and Meta-Analysis

Children ◽  
2019 ◽  
Vol 6 (12) ◽  
pp. 131 ◽  
Author(s):  
Shirley Cai ◽  
Deanne K. Thompson ◽  
Peter J. Anderson ◽  
Joseph Yuan-Mou Yang
Keyword(s):  
Systematic Review ◽  
Preterm Infants ◽  
Neonatal Sepsis ◽  
Meta Analysis ◽  
Continuous Variables ◽  
Neurodevelopmental Outcomes ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Neurodevelopmental Impairment

Sepsis is commonly experienced by infants born very preterm (<32 weeks gestational age and/or <1500 g birthweight), but the long-term functional outcomes are unclear. The objective of this systematic review was to identify observational studies comparing neurodevelopmental outcomes in very preterm infants who had blood culture-proven neonatal sepsis with those without sepsis. Twenty-four studies were identified, of which 19 used prespecified definitions of neurodevelopmental impairment and five reported neurodevelopmental outcomes as continuous variables. Meta-analysis was conducted using 14 studies with defined neurodevelopmental impairment and demonstrated that very preterm infants with neonatal sepsis were at higher risk of impairments, such as cerebral palsy and neurosensory deficits, compared with infants without sepsis (OR 3.18; 95% CI 2.29–4.41). Substantial heterogeneity existed across the studies (I2 = 83.1, 95% CI 73–89). The five studies that reported outcomes as continuous variables showed no significant difference in cognitive performance between sepsis and non-sepsis groups. Neonatal sepsis in very preterm infants is associated with increased risk of neurodevelopmental disability. Due to the paucity of longitudinal follow-up data beyond 36 months, the long-term cognitive effect of neonatal sepsis in very preterm infants could not be conclusively determined. Effects on the development of minor impairment could not be assessed, due to the small numbers of infants included in the studies.

Improving Feeding Outcomes in the NICU: Moving From Volume-Driven to Infant-Driven Feeding

2010 ◽  
Vol 19 (3) ◽  
pp. 68-74 ◽  
Author(s):  
Catherine S. Shaker
Keyword(s):  
Intensive Care Unit ◽  
Dynamic Systems ◽  
Neonatal Intensive Care ◽  
Well Being ◽  
Dynamic Systems Theory ◽  
Feeding Problems ◽  
Care Giving ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Current research on feeding outcomes after discharge from the neonatal intensive care unit (NICU) suggests a need to critically look at the early underpinnings of persistent feeding problems in extremely preterm infants. Concepts of dynamic systems theory and sensitive care-giving are used to describe the specialized needs of this fragile population related to the emergence of safe and successful feeding and swallowing. Focusing on the infant as a co-regulatory partner and embracing a framework of an infant-driven, versus volume-driven, feeding approach are highlighted as best supporting the preterm infant's developmental strivings and long-term well-being.

scholarly journals Early oxygen levels contribute to brain injury in extremely preterm infants

2021 ◽  
Author(s):  
Krista Rantakari ◽  
Olli-Pekka Rinta-Koski ◽  
Marjo Metsäranta ◽  
Jaakko Hollmén ◽  
Simo Särkkä ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Brain Structures ◽  
High Oxygen ◽  
List Type ◽  
Neurodevelopmental Outcomes ◽  
Oxygen Levels ◽  
Arterial Blood ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Abstract Background Extremely low gestational age newborns (ELGANs) are at risk of neurodevelopmental impairments that may originate in early NICU care. We hypothesized that early oxygen saturations (SpO2), arterial pO2 levels, and supplemental oxygen (FiO2) would associate with later neuroanatomic changes. Methods SpO2, arterial blood gases, and FiO2 from 73 ELGANs (GA 26.4 ± 1.2; BW 867 ± 179 g) during the first 3 postnatal days were correlated with later white matter injury (WM, MRI, n = 69), secondary cortical somatosensory processing in magnetoencephalography (MEG-SII, n = 39), Hempel neurological examination (n = 66), and developmental quotients of Griffiths Mental Developmental Scales (GMDS, n = 58). Results The ELGANs with later WM abnormalities exhibited lower SpO2 and pO2 levels, and higher FiO2 need during the first 3 days than those with normal WM. They also had higher pCO2 values. The infants with abnormal MEG-SII showed opposite findings, i.e., displayed higher SpO2 and pO2 levels and lower FiO2 need, than those with better outcomes. Severe WM changes and abnormal MEG-SII were correlated with adverse neurodevelopment. Conclusions Low oxygen levels and high FiO2 need during the NICU care associate with WM abnormalities, whereas higher oxygen levels correlate with abnormal MEG-SII. The results may indicate certain brain structures being more vulnerable to hypoxia and others to hyperoxia, thus emphasizing the role of strict saturation targets. Impact This study indicates that both abnormally low and high oxygen levels during early NICU care are harmful for later neurodevelopmental outcomes in preterm neonates. Specific brain structures seem to be vulnerable to low and others to high oxygen levels. The findings may have clinical implications as oxygen is one of the most common therapies given in NICUs. The results emphasize the role of strict saturation targets during the early postnatal period in preterm infants.

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