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.

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 Incidence, Risk Factors, and Outcomes of Preterm and Early Term Births: A Population-Based Register Study

2021 ◽  
Vol 18 (11) ◽  
pp. 5865
Author(s):  
Salma Younes ◽  
Muthanna Samara ◽  
Rana Al-Jurf ◽  
Gheyath Nasrallah ◽  
Sawsan Al-Obaidly ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Population Based ◽  
Incidence Rates ◽  
Large For Gestational Age ◽  
Mortality And Morbidity ◽  
Early Term ◽  
Incidence Risk

Preterm birth (PTB) and early term birth (ETB) are associated with high risks of perinatal mortality and morbidity. While extreme to very PTBs have been extensively studied, studies on infants born at later stages of pregnancy, particularly late PTBs and ETBs, are lacking. In this study, we aimed to assess the incidence, risk factors, and feto-maternal outcomes of PTB and ETB births in Qatar. We examined 15,865 singleton live births using 12-month retrospective registry data from the PEARL-Peristat Study. PTB and ETB incidence rates were 8.8% and 33.7%, respectively. PTB and ETB in-hospital mortality rates were 16.9% and 0.2%, respectively. Advanced maternal age, pre-gestational diabetes mellitus (PGDM), assisted pregnancies, and preterm history independently predicted both PTB and ETB, whereas chromosomal and congenital abnormalities were found to be independent predictors of PTB but not ETB. All groups of PTB and ETB were significantly associated with low birth weight (LBW), large for gestational age (LGA) births, caesarean delivery, and neonatal intensive care unit (NICU)/or death of neonate in labor room (LR)/operation theatre (OT). On the other hand, all or some groups of PTB were significantly associated with small for gestational age (SGA) births, Apgar <7 at 1 and 5 minutes and in-hospital mortality. The findings of this study may serve as a basis for taking better clinical decisions with accurate assessment of risk factors, complications, and predictions of PTB and ETB.

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.

Neonatal Care in a Japanese NICU: Notes Based on a Site Visit

2012 ◽  
Vol 31 (2) ◽  
pp. 89-96 ◽  
Author(s):  
Nevart Chirinian ◽  
Atsuko Uji ◽  
Tetsuya Isayama ◽  
Vibhuti Shah
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Site Visit ◽  
Mortality And Morbidity ◽  
Academic Center ◽  
Specific Category ◽  
English Speaking ◽  
A Site

This article presents an overview of a neonatal intensive care unit along with resuscitative care and management of the 22 to 23 weeks gestational age infant is as it was noted during a visit to the NICU of a large academic center in Japan.Non-English speaking neonatology communities may be at a disadvantage of having their research and practices well known in the English speaking ones. Thus, visits such as this are beneficial in exchanging ideas and practices that may ultimately be mutually beneficial in reducing mortality and morbidity in a specific category of neonates.

scholarly journals A STUDY ON VERY LOW BIRTH WEIGHT BABIES ADMITTED IN NICU

2020 ◽  
pp. 1-3
Author(s):  
Janki Prajapati ◽  
Sucheta Munshi ◽  
Ankit Chauhan
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Gestational Age ◽  
Very Low Birth Weight ◽  
Perinatal Care ◽  
Morbidity And Mortality ◽  
Mortality Pattern ◽  
Cross Sectional ◽  
Mortality And Morbidity ◽  
Major Factors

Background: Very low birth weight (VLBW) neonates are at high risk for morbidity and mortality. Preterm birth is one of the major clinical problems in Obstetrics and Neonatology. Aim & Objective: To study morbidity and mortality pattern of VLBW neonates admitted to NICU at Department of Pediatrics, Civil hospital, Ahmedabad. Methodology: This cross-sectional prospective observational study was performed on all hospitalized VLBW neonates. Their course during hospitalization and relevant was documented in pre designed performa. Results: In the present study, out of 1748 neonates, 374 (21.39%) were VLBW with 69% males. Mean gestational age was 31.3±1.8 weeks; mean birth weight 1279±193 grams. Common morbidities in VLBW neonates are Neonatal jaundice, Probable sepsis, Apnea of prematurity and RDS. Mortality rate is improved with increasing gestational age and weight. Conclusion: Birth weight and mechanical ventilation are the 2 major factors responsible for mortality. A decline in the mortality and morbidity of these newborns (especially the ELBW neonates) can only be made possible through optimizing perinatal care including regionalization, CPR at birth, early NCPAP and quality improved collaborative (QIC) in our NICU.

Prevalence and Longevity of PTSD Symptoms Among Parents of NICU Infants Analyzed Across Gestational Age Categories

2019 ◽  
Vol 59 (2) ◽  
pp. 163-169 ◽  
Author(s):  
Rachel Schecter ◽  
Tammy Pham ◽  
Alexandra Hua ◽  
Regina Spinazzola ◽  
Jill Sonnenklar ◽  
...  
Keyword(s):  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Counseling Services ◽  
Ptsd Symptoms ◽  
Exact Test ◽  
Very Preterm ◽  
High Severity ◽  
Extremely Preterm ◽  
P 16

Objective. This study aims to investigate whether posttraumatic stress disorder (PTSD) symptoms exist >1 year after neonatal intensive care unit (NICU) experience and whether PTSD symptomatology differs across parents of infants of different gestational age categories. Methods. A survey was given to parents at routine NICU follow-up visits. Parents completed the PTSD CheckList–Civilian (PCL-C), a standardized scale comprising 17 key symptoms of PTSD. Parents also rated how traumatic their birth experience, first day in the NICU, and first week in the NICU were from “Not Traumatic at All” to “Most Traumatic.” Fisher’s exact test was used to compare PCL-C responses across gestational age categories (Extremely Preterm, Very Preterm, Moderate to Late preterm, and Full Term). Results. Eighty parents participated. In total, 15% of parents had “Moderate to High Severity” PTSD symptoms. There were no statistical differences in PTSD prevalence between parents of children <1 year old and parents of children >1 year old ( P = .51). There was also no statistical difference in prevalence of “Moderate to High Severity” level of PTSD symptoms across gestational age ( P = .16). Overall, 38% of parents rated at least one experience as “Most traumatic.” Conclusion. A high percentage of parents who had a recent NICU experience and parents who had a NICU experience more than a year ago demonstrated PTSD symptoms. In light of these results, many parents of NICU graduates—both mothers and fathers—would benefit from access to long-term counseling services.

scholarly journals Growth and neurodevelopmental outcome of high risk premature neonates at 1 year in a tertiary level NICU of central India

2017 ◽  
Vol 4 (5) ◽  
pp. 1787
Author(s):  
Sudhir U. ◽  
Pawan Ghanghoriya ◽  
Mangilal Barman ◽  
Trusha Joshi
Keyword(s):  
Gestational Age ◽  
Perinatal Care ◽  
Neurodevelopmental Outcome ◽  
Late Preterm ◽  
Tertiary Level ◽  
Developmental Assessment ◽  
Early Assessment ◽  
Neurodevelopmental Outcomes ◽  
Very Preterm ◽  
Preterm Babies

Background: To study the outcome of growth and development till one year of age of very preterm neonates and moderate to late preterm admitted and discharged from a tertiary level NICU in central India.Methods: 120 preterm babies admitted and discharged from NICU were enrolled consecutively. Out of them 82 were followed up for a period of 1 year. Physical parameter like weight, length and head circumference were recorded on admission and at 1, 3, 6 and 12 months of corrected gestational age. Developmental assessment was done at 12 months of corrected gestational age by DASII (developmental assessment scale for Indian infants).Results: Among the 82 enrolled subjects 28 were very preterm (28-<32 weeks) and 54 were moderate to late preterm (32-<37 weeks). Overall growth (all the anthropometric parameters) was higher in the moderate to late preterm group. In very preterm babies weight gain was better from 6-12 months of postnatal age and was statistically significant (p<0.005). Length gain was higher in very premature babies group but not statistically significant and head growth was significantly higher in very preterm babies from 1 month to 1 year compared to moderate to late preterm babies (p<0.05). Neurodevelopmental delay was seen in 28% (n=23) of the study group at 1 year, 65.2% (n=15) were very preterm babies. Associated risk factors were RDS, hypoglycemia, NEC and sepsis. Developmental quotient was lower in very preterm (66.45) compared to moderate preterm babies (79.86).Conclusions: Prematurity and its associated complications are linked to adverse physical and neurodevelopmental outcomes. Improved perinatal care, early assessment of development by appropriate tools and early intervention is a must to improve the outcome of these babies. 

scholarly journals Gestational age-related neonatal survival at a tertiary health institution in Nigeria: The age of fetal viability dilemma

2020 ◽  
Vol 47 (2) ◽  
pp. 61-67
Author(s):  
L.I. Audu ◽  
AT Otuneye ◽  
A.B. Mairami ◽  
M. Mukhtar-Yola ◽  
L.J. Mshelia ◽  
...  
Keyword(s):  
Survival Rate ◽  
Mortality Rate ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
National Hospital ◽  
Age Related ◽  
Specific Mortality ◽  
Preterm Babies ◽  
Gestational Age Estimation ◽  
Registry Database

Background: Although the official age of fetal viability in Nigeria is 28 weeks, there are pockets of reports some anecdotal, of survival of babies  delivered at younger gestational age (GA) from different parts of the country. The routine resuscitation and management of premature infants born before the official age of fetal viability (28 weeks) is likely to generate important ethical and medical concerns that are bound to influence our  approach to the management of such infants. Aim: To determine the GAspecific neonatal mortality and survival among preterm deliveries at the National Hospital Abuja. Subjects and Methods: A retrospective review of relevant data from the National Hospital Neonatal Registry Database based on the Research Electronic Data Capture software (REDCap) was undertaken to determine the mortality rate of preterm babies managed in the neonatal intensive care unit (NICU) from January 2017 to February 2018. Disaggregated GA specific mortality rates were also computed to determine the fetal age at which extra uterine neonatal survival rate was at least 50%. Gestational age estimation was based on mothers’ last menstrual period (LMP) in over  96% of cases.Results: Sixty-three (63) of 305 preterm babies admitted died during hospitalization giving a mortality rate of 20.7%. This was significantly higher than the mortality rate among term babies (7.5%, P=0.01) hospitalized over the same period. Antenatal corticosteroid use was low (11.2%), 188  (25.8%) received CPAP for Respiratory Distress Syndrome (RDS), and none of the babies received surfactant or mechanical ventilation. There were no survivors among babies delivered at GA of 22-25 weeks (11, 3.6%). However, the survival rate at 26 weeks gestation was 53.8%, and this  subsequently increased, reaching a peak of 96.5% survival at 35 weeks. RDS accounted for 53.9% of all deaths. Conclusion: It is concluded that the survival rate (53.8%) of babies at GA of 26 weeks despite minimal antenatal interventions and limited postnatal  respiratory support was reasonably high, and this could serve the basis for discussions for a downward review of the age of fetal viability in Nigeria. Key words: Gestational age. Fetal viability

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.

“You Can Only Give Warmth to Your Baby When It’s Too Late”: Parents’ Bonding With Their Extremely Preterm and Dying Child

2017 ◽  
Vol 27 (14) ◽  
pp. 2100-2115 ◽  
Author(s):  
Andrea Abraham ◽  
Manya J. Hendriks
Keyword(s):  
End Of Life ◽  
Neonatal Intensive Care ◽  
Primary Caregivers ◽  
Physical Distance ◽  
End Of Life Decisions ◽  
Extremely Preterm ◽  
Study Experience ◽  
Preterm Babies ◽  
Child's Death ◽  
Bereavement Care

This study on end-of-life decisions in extremely preterm babies shows that the parents under study experience a multitude of stressors due to the immediate separation after birth, the alienating setting of the neonatal intensive care unit (NICU), the physical distance to the child, medical uncertainties, and upcoming decisions. Even though they are considered to be parents (assigned parenthood), they cannot act as primary caregivers. Instead, they depend on professional instructions for access and care. Embodied parenthood can be experienced only at the end-of-life, that is, during the dying trajectory and after the child’s death. Professionally supporting parents during this compressed process (from assigned and distant to embodied parenthood) contributes fundamentally to their perception of being a family and supports their mourning. This calls for the further establishment of palliative and bereavement care concepts in neonatology.

Sign in / Sign up

Export Citation Format

Share Document