Resuscitation Decisions for Extremely Premature Infants: A UK NICU Experience

2021 ◽  
pp. 097321792110597
Author(s):  
Jennifer Peterson ◽  
Mia Kahvo ◽  
Ramiyya Tharumakunarajah ◽  
Nabiah Malik ◽  
Ranganath Ranganna
Keyword(s):  
Premature Infants ◽  
Gestational Age ◽  
Perinatal Care ◽  
Management Strategies ◽  
Age Groups ◽  
P Value ◽  
Chest Compressions ◽  
Infant Outcomes ◽  
Antenatal Steroids ◽  
Extremely Preterm

Background: Improvements in extreme preterm infant outcomes have led to an increasing recognition of the importance of antenatal optimization and delivery room (DR) management strategies for these infants. Methods: Retrospective cohort evaluation of every infant born at 22+0 to 25+6 weeks gestation in St Mary’s tertiary NICU between 2008 and 2018. Aiming to evaluate utilization of chest compressions and resuscitation medications during DR-resuscitation of extremely premature infants. Results: This study found that 90% of infants 22+0 to 22+6 weeks did not receive antenatal steroids. Whereas, for infants born between 23+0 and 23+6 weeks gestation, 75% did receive antenatal steroids. This difference is significant ( P value = .00006). This study shows there is a predisposition to not provide DR-chest compressions (DR-CC) and/or adrenaline (DR-CC+/−A) to extremely preterm For infants. Infants that received DR-CC, there was no statistically significant increase in death and no clear association with poorer long-term outcomes in survivors. Conclusions: Marked differences in provision of perinatal care were found dependent on gestational age. If infants are inadequately prepared for delivery and resuscitative measures are not fully utilized, it cannot be clear whether subsequently increased rates of death in the lower gestational age groups are solely due to gestational age or are influenced by the lack of preparative management.

scholarly journals Intensity of perinatal care for extremely preterm babies and outcomes at a higher gestational age: evidence from the EPIPAGE-2 cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Andrei Scott Morgan ◽  
Babak Khoshnood ◽  
Caroline Diguisto ◽  
Laurence Foix L’Helias ◽  
Laetitia Marchand-Martin ◽  
...  
Keyword(s):  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Perinatal Care ◽  
Sensitivity Analyses ◽  
Intensity Level ◽  
Free Survival ◽  
Mortality And Morbidity ◽  
Antenatal Steroids ◽  
Extremely Preterm ◽  
Preterm Babies

Abstract Background Perinatal decision-making affects outcomes for extremely preterm babies (22–26 weeks’ gestational age (GA)): more active units have improved survival without increased morbidity. We hypothesised such units may gain skills and expertise meaning babies at higher gestational ages have better outcomes than if they were born elsewhere. We examined mortality and morbidity outcomes at age two for babies born at 27–28 weeks’ GA in relation to the intensity of perinatal care provided to extremely preterm babies. Methods Fetuses from the 2011 French national prospective EPIPAGE-2 cohort, alive at maternal admission to a level 3 hospital and delivered at 27–28 weeks’ GA, were included. Morbidity-free survival (survival without sensorimotor (blindness, deafness or cerebral palsy) disability) and overall survival at age two were examined. Sensorimotor disability and Ages and Stages Questionnaire (ASQ) result below threshold among survivors were secondary outcomes. Perinatal care intensity level was based on birth hospital, grouped using the ratio of 24–25 weeks’ GA babies admitted to neonatal intensive care to fetuses of the same gestation alive at maternal admission. Sensitivity analyses used ratios based upon antenatal steroids, Caesarean section, and newborn resuscitation. Multiple imputation was used for missing data; hierarchical logistic regression accounted for births nested within centres. Results 633 of 747 fetuses (84.7%) born at 27–28 weeks’ GA survived to age two. There were no differences in survival or morbidity-free survival: respectively, fully adjusted odds ratios were 0.96 (95% CI: 0.54 to 1.71) and 1.09 (95% CI: 0.59 to 2.01) in medium and 1.12 (95% CI: 0.63 to 2.00) and 1.16 (95% CI: 0.62 to 2.16) in high compared to low-intensity hospitals. Among survivors, there were no differences in sensorimotor disability or ASQ below threshold. Sensitivity analyses were consistent with the main results. Conclusions No difference was seen in survival or morbidity-free survival at two years of age among fetuses alive at maternal hospital admission born at 27–28 weeks’ GA, or in sensorimotor disability or presence of an ASQ below threshold among survivors. There is no evidence for an impact of intensity of perinatal care for extremely preterm babies on births at a higher gestational age.

scholarly journals Prevalence of Language Delay among Healthy Preterm Children, Language Outcomes and Predictive Factors

Children ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. 282
Author(s):  
Miguel Pérez-Pereira
Keyword(s):  
Gestational Age ◽  
Language Impairment ◽  
Maternal Education ◽  
Longitudinal Design ◽  
Age Groups ◽  
Full Term ◽  
Language Delay ◽  
Preterm Children ◽  
General Terms ◽  
Extremely Preterm

Language delay (LD) and its relationship with later language impairment in preterm children is a topic of major concern. Previous studies comparing LD in preterm (PT) and full-term (FT) children were mainly carried out with samples of extremely preterm and very preterm children (sometimes with additional medical problems). Very few of them were longitudinal studies, which is essential to understand developmental relationships between LD and later language impairment. In this study, we compare the prevalence of LD in low-risk preterm children to that of FT children in a longitudinal design ranging from 10 to 60 months of age. We also analyze which variables are related to a higher risk of LD at 22, 30 and 60 months of age. Different language tests were administered to three groups of preterm children of different gestational ages and to one group of full-term children from the ages of 10 to 60 months. ANOVA comparisons between groups and logistic regression analyses to identify possible predictors of language delay at 22, 30 and 60 months of age were performed. The results found indicate that there were practically no differences between gestational age groups. Healthy PT children, therefore, do not have, in general terms, a higher risk of language delay than FT children. Previous language delay and cognitive delay are the strongest and longest-lasting predictors of later language impairment. Other factors, such as a scarce use of gestures at 10 months or male gender, affect early LD at 22 months of age, although their effect disappears as children grow older. Low maternal education appears to have a late effect. Gestational age does not have any significant effect on the appearance of LD.

scholarly journals Reference values for N-terminal Pro-brain natriuretic peptide in premature infants during their first weeks of life

2020 ◽  
Author(s):  
Agnes-Sophie Fritz ◽  
Titus Keller ◽  
Angela Kribs ◽  
Christoph Hünseler
Keyword(s):  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Preterm Infants ◽  
Premature Infants ◽  
Reference Values ◽  
Gestational Age ◽  
Temporal Distribution ◽  
Cross Sectional ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Abstract The aim of our study was to observe the temporal distribution of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) in premature infants of ≤ 31 weeks of gestational age (GA) during the first weeks of life. NT-proBNP values of 118 preterm infants born ≤ 31 weeks GA were determined during the first week of life, after 4 ± 1 weeks of life, and at a corrected GA of 36 ± 2 weeks. Infants were divided into two groups: those without relevant complications and those with complications related to prematurity. NT-proBNP values of infants without complications define our exploratory reference values. The Median NT-proBNP level of these infants was 1896 ng/l (n = 27, interquartile range (IQR): 1277–5200) during the first week of life, 463 ng/l (n = 26, IQR: 364–704) at 4 ± 1 weeks of life, and 824 ng/l (n = 33, IQR: 714–1233) at a corrected GA of 36 ± 2 weeks. Infants born < 28 + 0 weeks GA had significantly higher NT-proBNP values (n = 9, median: 5200, IQR: 1750–8972) than infants born ≥ 28 + 0–31 weeks GA (n = 18, median: 1528, IQR: 838–3052; p = 0.017). Growth restriction or PDA status could not account for the difference in NT-proBNP values between GA groups. Conclusions: The results of our observational and cross-sectional study describe exploratory reference values for NT-proBNP levels in preterm infants of ≤ 31 weeks GA according to postnatal age. NT-proBNP levels during the first week of life are high and widely distributed in preterm infants and decrease subsequently to reach a distinctly lower and stable plateau at around 1 month of life. Our results suggest an influence of GA on NT-proBNP values in the first week of life. What is Known:• Several complications related to prematurity, e.g., hemodynamically significant PDA, pulmonary hypertension, bronchopulmonary dysplasia, and retinopathy of prematurity, have been associated with a temporary rise in NT-proBNP values in preterm infants during their first weeks of life.What is New:• This observational study provides reference values for NT-proBNP levels of very and extremely preterm infants during their first weeks of life.• In premature infants without complications, NT-proBNP values during their first week of life depend on gestational age at birth.

Amplitude Integrated Electroencephalogram Integration to Monitor the Relationship Between Development and Changes of the Nervous System in Late Preform Infants

2021 ◽  
Vol 11 (6) ◽  
pp. 1704-1712
Author(s):  
Sehua Qu ◽  
Lianqiang Shan ◽  
Xin Chen ◽  
Rui Zhou ◽  
Huaixiang Yin ◽  
...  
Keyword(s):  
Nervous System ◽  
Premature Infants ◽  
Gestational Age ◽  
Exercise Intervention ◽  
Controlled Trial ◽  
Age Groups ◽  
Voltage Difference ◽  
Randomized Controlled ◽  
Neuroprotective Strategy ◽  
The Relationship

This article uses amplitude integration of electroencephalogram integration to detect the development of the nervous system of late perform infants, and to study its changes, using a stratified randomized controlled trial method. The preform infants in the neonatal department of postnatal birth had the research object. The sample size was calculated, according to the first set of tires into small gestational age groups, and gestational age large. The subjects of each group were randomly divided into small gestational age groups, small gestational age intervention groups, large gestational age groups and large gestational age intervention groups. Two preterm children increased with age growth. The performance of the broadband and narrowband sector decreased voltage need the voltage lower bound ofa growing trend to the voltage difference becomes smaller. Oral exercise intervention is safe and effective for premature infants over 30 weeks old and can be used clinically as a neuroprotective strategy.

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.

Variation in Gastrostomy Tube Placement in Premature Infants in the United States

2018 ◽  
Vol 36 (12) ◽  
pp. 1243-1249 ◽  
Author(s):  
Nathaniel H. Greene ◽  
Rachel G. Greenberg ◽  
Sean M. O'Brien ◽  
Alex R. Kemper ◽  
Marie Lynn Miranda ◽  
...  
Keyword(s):  
United States ◽  
Premature Infants ◽  
Gestational Age ◽  
The United States ◽  
Gastrostomy Tube ◽  
Tube Placement ◽  
Adjusted Risk ◽  
Risk Estimates ◽  
Antenatal Steroids ◽  
Gastrostomy Tube Placement

Objective To describe the variation in surgical gastrostomy tube (SGT) placement in premature infants among neonatal intensive care units (NICUs) in the United States. Study Design We identified 8,781 premature infants discharged from 114 NICUs in the Pediatrix Medical Group from 2010 to 2012. The outcome of interest was SGT placement prior to discharge home from an NICU. Unadjusted proportions and adjusted risk estimates were calculated to quantify variation observed among individual NICUs. Results SGT placement occurred in 360 of 8,781 (4.1%) of infants. Across NICUs, any gastrostomy tube placement ranged from none in 45 NICUs up to 19.6%. Adjusted risk estimates for factors associated with SGT placement included gestational age at birth (odds ratio [OR]: 0.7/week, 95% confidence interval[CI]: [0.65, 0.75]), small for gestational age status (OR: 2.78 [2.09, 3.71]), administration of antenatal steroids (OR: 0.69 [0.52, 0.92]), Hispanic ethnicity (OR: 0.54 [0.37, 0.78]), and higher 5-minute Apgar scores (7–10, OR: 0.54 [0.37, 0.79]). Conclusion Individual NICU center has a strong clinical effect on the probability of SGT placement relative to other medical factors. Future work is needed to understand the cause of this variation and the degree to which it represents over or under use of gastrostomy tubes.

scholarly journals L-Arginine Modulates Neonatal Leukocyte Recruitment in a Gestational Age-Dependent Manner

2020 ◽  
Vol 9 (9) ◽  
pp. 2772
Author(s):  
Raphaela Fitterer ◽  
Trim Lajqi ◽  
Simon Alexander Kranig ◽  
Maylis Braun ◽  
Nicole Theissig ◽  
...  
Keyword(s):  
Premature Infants ◽  
Gestational Age ◽  
Ex Vivo ◽  
Age Groups ◽  
Leukocyte Recruitment ◽  
Leukocyte Rolling ◽  
Dependent Manner ◽  
Immune Functions ◽  
Arginase 1

(1) Background: L-arginine is a complex modulator of immune functions, and its levels are known to decrease under septic conditions. L-arginine may suppress leukocyte recruitment in vivo; however, little is known about the gestational age-specific effects of L-arginine on leukocyte recruitment in preterm infants. We now asked whether L-arginine alters leukocyte recruitment in preterm and term neonates. (2) Methods: Leukocytes were isolated from preterm (28 + 0 to 32 + 6 weeks of gestation) and term (>37 weeks of gestation) newborns as well as from healthy adults. After incubation with 10 µg/mL L-arginine, we assessed leukocyte rolling and adhesion in dynamic microflow chamber experiments and leukocyte transmigration in fluorescence assays. In addition, we measured the expression of inducible nitric oxide synthase (iNOS) and Arginase 1 (Arg-1) in neutrophils by flow cytometry. (3) Results: Leukocyte rolling, adhesion, and transmigration increased with gestational age. Leukocyte rolling, adhesion, and transmigration were decreased by L-arginine in term-born infants and adults. Preterm leukocytes showed no change in recruitment upon L-arginine exposure. Leukocyte adhesion after L-arginine exposure reached similar levels among all groups. In line, the expression of iNOS and Arg-1 was similar in all three age groups. (4) Conclusion: L-arginine dampens the ex vivo recruitment capacity of leukocytes from term-born infants, whereas no effect was seen in premature infants. As levels of iNOS and Arg-1 in neutrophils remain ontogenetically unchanged, the anti-inflammatory effect of L-arginine on the leukocyte recruitment cascade needs further investigation. These results add to the controversial debate of L-arginine supplementation in premature infants in sepsis.

scholarly journals Prevalence of positional skull deformities in 530 premature infants with a corrected age of up to 6 months: a multicenter study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Wang Yang ◽  
Jianping Chen ◽  
Wenzhi Shen ◽  
Chengju Wang ◽  
Zhifeng Wu ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Premature Infants ◽  
Gestational Age ◽  
Healthcare Providers ◽  
Age Groups ◽  
The United States ◽  
Adverse Outcomes ◽  
Cranial Measurements ◽  
Outpatient Departments ◽  
Low Incidence

Abstract Background Positional deformities (PD) are common during early infancy. Severe cases may result in facial abnormalities and be associated with delayed neurological development in infants. The earlier the detection of PD, the better the intervention effect and the lower the cost of treatment. Currently, there are many studies on PD in Europe and the United States. However, in China, there is little data on the basic metrics and incidence of PD. Premature infants have a high risk of PD. However, there are few studies on PD in premature infants globally, and none in Asia. This study aimed to investigate PD and its characteristics inpremature infants to help its early detection and intervention and thus improve the quality of life for premature infants. Methods We analyzed 530 preterm infants who visited the outpatient departments at Xinqiao Hospital of Army Medical University and Maternal and Child Health Care Hospitals of Wanzhou and Yongchuan Districts in Chongqing from September 1, 2016, to August 31, 2017. The head shape data measured by a simple manual method were recorded. The diagonal difference (DD) between the transcranial diagonals and the cranial index (CI) was calculated. PD and its incidences indifferent gestational ages and corrected age groups were analyzed. Results According to previously defined international diagnostic criteria, the incidence of plagiocephaly, brachycephaly, and dolichocephaly were 51.1, 85.1, and 3.0% respectively, and those of right and left plagiocephalywere69.4 and 30.6%, respectively. The incidence of PD was highest among infants with a gestational age of < 32 weeks and decreased as the gestational age increased. As the corrected age (CA) increased, the incidence of plagiocephaly and dolichocephaly decreased, and the incidence of brachycephaly increased. Conclusions PD incidence is high among preterm infants. As gestational age decreased, PD incidence and severity increased. Therefore, healthcare providers should implement early PD detection and intervention to prevent the adverse outcomes. The extremely high incidence of brachycephaly and extremely low incidence of dolichocephaly in this study are likely to be due to the variance of cranial metrics caused by cultural differences. The Chinese standards for infant cranial measurements must be established.

10 High spontaneous ductal closure even at the extreme of prematurity

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e7-e7
Author(s):  
Gabriela de Carvalho Nunes ◽  
Punnanee Wutthigate ◽  
Jessica Simoneau ◽  
Marc Beltempo ◽  
Guilherme Sant'Anna ◽  
...  
Keyword(s):  
Premature Infants ◽  
Gestational Age ◽  
Ductus Arteriosus ◽  
Subject Area ◽  
Outpatient Setting ◽  
Perinatal Medicine ◽  
Extremely Preterm ◽  
Ductal Closure ◽  
Catheter Closure ◽  
Preterm Newborns

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Extremely preterm newborns are at risk of prolonged patency of the ductus arteriosus (PDA). Current literature has failed to indicate improvement in outcomes after exposure to strategies promoting ductal closure. As such, our center abandoned these practices in 2013. Objectives Describe the spontaneous PDA closure in premature infants, including those infants born at the extreme of gestational age (&lt; 26 weeks). Design/Methods Retrospective study of newborns &lt; 29 weeks, admitted within 24 hours after birth between 2015 and 2019 and without genetic or congenital anomalies. Newborns who were last known to be alive, with an available echocardiography, and who were not exposed to any intervention to accelerate PDA closure were included. Images were reviewed by experts blinded to the outcomes. Results 296 infants were analyzed. 37 (12%) did not survive their hospitalization, and 16 were exposed to interventions to accelerate ductal closure at some point during their lifetime (4 ligations, 4 catheter-closure, 5 ibuprofen and 3 acetaminophen). Out of the 243 remaining newborns, 214 had at least one echocardiography to ascertain ductal patency or closure (100% of those &lt;26 weeks). The average gestational age was 26.3±1.5 weeks, with 84 (39%) being &lt;26 weeks. PDA closed spontaneously in 194 (91%), with 60 having closure ascertainment after discharge (average age at closure ascertainment of 36.4 [IQR: 34.4 – 40.1] weeks). Of the 84 &lt;26 weeks, 76 (90%) had confirmation of ductal closure. The 20 infants with an open PDA at the last evaluation were followed in an outpatient setting and considered small/restrictive. In our cohort, 92/243 (38%) were exposed to post-natal steroids. In the &lt;26 weeks group, 74% were exposed to steroids, at a cumulative dose of 1.64 [0.89 – 2.44] mg/kg. BPD was found in 57% of the overall cohort and in 79% of &lt;26 weeks. Conclusion The majority of newborns &lt; 29 weeks, and even those at the extreme of gestational age (&lt; 26 weeks) spontaneously closed their PDA before term-corrected age. While BPD rate was similar to previous cohorts, post-natal steroids use was high.

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