scholarly journals Circulating glucocorticoid bioactivity and serum cortisol concentrations in premature infants: the influence of exogenous glucocorticoids and clinical factors

2007 ◽  
Vol 156 (5) ◽  
pp. 577-583 ◽  
Author(s):  
Päivi Nykänen ◽  
Taneli Raivio ◽  
Kirsti Heinonen ◽  
Olli A Jänne ◽  
Raimo Voutilainen
Keyword(s):  
Preterm Infants ◽  
Premature Infants ◽  
Treatment Strategies ◽  
Serum Cortisol ◽  
Treatment Modalities ◽  
Clinical Factors ◽  
Glucocorticoid Treatment ◽  
Improve Treatment ◽  
Antenatal Steroids ◽  
Postmenstrual Age

Objective: Glucocorticoids are widely used before preterm delivery and in preterm infants may bear serious adverse effects. Better knowledge about the circulating glucocorticoid milieu after glucocorticoid treatment could improve treatment modalities. Therefore, we investigated the influence of exogenous glucocorticoids and clinical factors on serum cortisol (F) levels and circulating glucocorticoid bioactivity (GBA) in preterm infants. Design: Eighty-nine infants (gestational age (GA) 23.6–33.1 weeks at birth) were enrolled in a prospective cohort study in two tertiary neonatal centres. Methods: Cord, day of birth (D0), fourth day (D4) and 36 weeks postmenstrual age serum F and GBA levels were measured. Results: The cord GBA was 5.8-fold and D0 GBA 2.3-fold higher in the infants exposed to antenatal steroids within 12 h before birth when compared with those unexposed or exposed >7 days before birth (95% CI 3.8–8.6; P<0.0001, and 1.8–3.0; P<0.0001 respectively). In the infants treated with early postnatal dexamethasone, D4 GBA was 1.7-fold (1.3–2.2; P<0.0005) higher when compared with levels in the infants without this treatment. Clinical factors indicating perinatal distress, such as Apgar scores <7 and low GA, were associated with higher cord, D0 and D4 serum F levels. Conclusions: Both ante- and postnatally administered glucocorticoids increase circulating GBA not attributable to endogenous F. Perinatal distress and preceding glucocorticoid treatment need to be taken into account when circulating glucocorticoid milieu is evaluated in preterm infants. The GBA assay may prove to be a useful instrument in the development of new glucocorticoid treatment strategies.

scholarly journals A Web-Based Calculator for the Prediction of Severe Neurodevelopmental Impairment in Preterm Infants Using Clinical and Imaging Characteristics

Children ◽  
2018 ◽  
Vol 5 (11) ◽  
pp. 151
Author(s):  
Zachary Vesoulis ◽  
Nathalie El Ters ◽  
Maja Herco ◽  
Halana Whitehead ◽  
Amit Mathur
Keyword(s):  
Preterm Infants ◽  
Predictive Value ◽  
White Matter Injury ◽  
Delivery Mode ◽  
Clinical Factors ◽  
Binary Logistic Regression Model ◽  
Neurodevelopmental Outcomes ◽  
Web Based ◽  
Antenatal Steroids ◽  
Imaging Characteristics

Although the most common forms of brain injury in preterm infants have been associated with adverse neurodevelopmental outcomes, existing MRI scoring systems lack specificity, do not incorporate clinical factors, and are technically challenging to perform. The objective of this study was to develop a web-based, clinically-focused prediction system which differentiates severe neurodevelopmental outcomes from normal-moderate outcomes at two years. Infants were retrospectively identified as those who were born ≤30 weeks gestation and who had MRI imaging at term-equivalent age and neurodevelopmental testing at 18–24 months. Each MRI was scored on injury in three domains (intraventricular hemorrhage, white matter injury, and cerebellar hemorrhage) and clinical factors that were strongly predictive of an outcome were investigated. A binary logistic regression model was then generated from the composite of clinical and imaging components. A total of 154 infants were included (mean gestational age = 26.1 ± 1.8 weeks, birth weight = 889.1 ± 226.2 g). The final model (imaging score + ventilator days + delivery mode + antenatal steroids + retinopathy of prematurity requiring surgery) had strong discriminatory power for severe disability (AUC = 0.850), with a PPV (positive predictive value) of 76% and an NPV (negative predictive value) of 90%. Available as a web-based tool, it can be useful for prognostication and targeting early intervention services to infants who may benefit the most from such services.

scholarly journals Pulse Oximetry Values in Very Preterm infants Asymtomatic at 34-36 weeks post menstrual age.

2020 ◽  
Author(s):  
Ignacio Oyarzún ◽  
Marcela Diaz ◽  
Paulina Toso ◽  
Alejandra Zamorano ◽  
Soledad Montes ◽  
...  
Keyword(s):  
Pulse Oximetry ◽  
Preterm Infants ◽  
Premature Infants ◽  
Gestational Age ◽  
Oxygen Therapy ◽  
Healthy Children ◽  
Multicentric Study ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Postmenstrual Age

Background: Oxygen supplementation is an important component for preterm infants neonatal care. Pulse oximetry (SpO2) is essential to guide oxygen therapy. Evidence on SpO2 values in premature infants previous to discharge is limited. Objectives: To establish SpO2 values in asymptomatic premature infants at 34, 35, and 36 weeks postmenstrual age (PMA). Methods: Longitudinal, multicentric study. From May 2018 to May 2019 premature infants born ≤32 weeks gestational age, from three level III NICUs in Santiago, Chile (altitude 579mt), were enrolled. Healthy children without current apnea of prematurity were included. Continuous SpO2 was obtained with Masimo-Radical 7/8 (USA), averaging time 2-4 seconds. Results: 101 SpO2 recordings (n = 44, 33 and 24 at 34, 35 and 36 weeks PMA respectively) from 62 infants. Twenty eight (45%) male, median (range) gestational age at birth 30 (26-32) weeks, median (range) birth weight 1480 (785-2700) g. Oximetry variables for total recordings: mean SpO2, median (range) 96.9 (93.3-99.3); minimum SpO2, median (range) 74 (51-89); time of SpO2 <90%, median (range) 2% (0-10.6%); time of SpO2 <80%, median (range) 0.1% (0-1.3%); desaturation event by ≥4% (DI4) ≥ 0 and ≥ 10 seconds per sample hour, median (range) 45.2 (5.2-115) and median (range) 15 (3.5-62.5) respectively; desaturation event <80% (DI80), median (range) 0.58 (0-10.8). We found no differences between SpO2 values at different weeks PMA. Conclusions: We described SpO2 values in very preterm infants, asymptomatic at 34, 35 and 36 weeks PMA. These values could be used as a reference to guide oxygen therapy previous to discharge.

scholarly journals Increased incidence of chronic lung disease and respiratory sequelae in growth restricted versus appropriately grown preterms

2021 ◽  
Vol 8 (8) ◽  
pp. 280-283
Author(s):  
Kartik Sehgal ◽  
Kunal Sehgal ◽  
Kenneth Tan
Keyword(s):  
Mechanical Ventilation ◽  
Lung Disease ◽  
Preterm Infants ◽  
Premature Infants ◽  
Chronic Lung Disease ◽  
Odds Ratio ◽  
Respiratory Morbidity ◽  
Perinatal Morbidity ◽  
Antenatal Steroids ◽  
Respiratory Outcomes

Background: Fetal growth restriction (FGR) affects 5–10% term gestational age pregnancies. When accompanied by prematurity, FGR infants have significantly greater risk of perinatal morbidity and/or mortality compared to non-growth restricted preterm infants. Aim: Current study aimed to ascertain the incidence FGR among premature infants and its association with respiratory morbidity. Methods: Institution database for preterm infants of 23–31+6 weeks of gestation was accessed. FGR infants were compared with gestation/sex matched appropriately grown infants. Results: During the period 2016–2018, 973 infants between 23 and 31+6 weeks gestation were admitted amongst whom, 206 (27%) were FGR. Between 28 and 31+6 weeks gestation, approximately 1/3rd were FGR. Gestation and birth weight of the FGR and appropriately grown cohorts were 30.2±0.2 versus 30.1±0.2 weeks (p=0.8) and 1132±43 versus 1499±54 g (p<0.0001), respectively. While antenatal steroids, surfactant, mechanical ventilation, sepsis, and ductal therapy were comparable, respiratory outcomes were significantly worse in the FGR cohort (duration of respiratory support: 37±10 vs. 23±5 days [p=0.016], home oxygen: 24 [11.6%] vs. 8 [3.8%]; [p=0.005] and chronic lung disease [CLD]: 53 [25.7%] vs. 28 [13.6%], [p=0.002], respectively). The odds ratio (95% confidence intervals) for developing CLD and for home oxygen when born FGR were 2.2 (1.3–3.6) and 3.2 (1.4–7.4), respectively. Conclusions: In spite of comparable postnatal variables, FGR infants had significantly greater respiratory morbidity.

The Alteration and Significance of Erythropoietin Serum Levels in Preterm Infants with Retinopathy of Prematurity

2017 ◽  
Vol 34 (10) ◽  
pp. 1020-1025 ◽  
Author(s):  
Xiaofeng Yang ◽  
Bi Ze ◽  
Yi Dai ◽  
Li Zhu ◽  
Chao Chen
Keyword(s):  
Multivariate Analysis ◽  
Serum Level ◽  
Preterm Infants ◽  
Premature Infants ◽  
Gestational Age ◽  
Retinopathy Of Prematurity ◽  
Surrogate Marker ◽  
Serum Levels ◽  
Clinical Factors ◽  
Serum Erythropoietin

Objective This study aims to investigate the changes of serum erythropoietin (EPO) in premature infants with retinopathy of prematurity (ROP) after birth. Method The premature infants were divided into two groups, the first were infants with ROP, and the rest were infants without ROP. The peripheral blood of these infants after birth was collected, aiming to identify the correlation of serum EPO with ROP in the first 8 weeks after birth and before 38 weeks' postconceptual age. Results A total of 299 infants without ROP and 107 infants with ROP were recruited into our study. It was suggested that serum the EPO level in ROP group was significantly lower than it is in the group without ROP on the 28th day after birth. The median value of serum EPO in the group with and without ROP at day 28 of life were 0.44 mIU/mL and 0.62 mIU/mL, respectively (p = 0.017). These data indicated that there was no significant association between serum EPO and the clinical factors. Multivariate analysis identified only EPO serum level on the 28th day after birth and gestational age as independent predictors of ROP (p was 0.025 and 0.021, respectively). Conclusion EPO serum level may serve as a surrogate marker for the development of ROP.

scholarly journals Absence of relationship between serum cortisol and critical illness in premature infants

2021 ◽  
pp. fetalneonatal-2020-319970
Author(s):  
Irina Prelipcean ◽  
James Lawrence Wynn ◽  
Lindsay Thompson ◽  
David James Burchfield ◽  
Laurence James-Woodley ◽  
...  
Keyword(s):  
Critical Illness ◽  
Preterm Infants ◽  
Premature Infants ◽  
Gestational Age ◽  
Serum Cortisol ◽  
Illness Severity ◽  
Cortisol Concentration ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
The Relationship

BackgroundInadequate cortisol production in response to critical illness in extremely preterm infants may exacerbate poor outcomes. Despite commonly measuring cortisol concentration and administering hydrocortisone for presumed adrenal insufficiency, the relationship between serum cortisol concentration and illness severity remains unclear in this unique population.ObjectiveTo determine the relationship between cortisol concentrations and illness severity as measured by the Score for Neonatal Acute Physiology II, neonatal Sequential Organ Failure Assessment and Vasoactive-Inotropic Score in premature infants.Design/MethodsThis retrospective, single-center cohort study included preterm infants born <30 weeks gestational age admitted to a level IV neonatal intensive care unit (NICU) between June 2011 and July 2018, who had a serum cortisol obtained for clinical indications before 36 weeks PMA. Demographic data were collected on infants and mothers. Nine clinical variables were identified a priori that could potentially modify cortisol concentration including critical illness. Univariate and multivariable analyses determined the relationship between cortisol concentration and each of these variables.ResultsA total of 224 preterm infants with pretreatment serum cortisol concentration met criteria for inclusion. The median (IQR) gestational age at birth was 25 weeks (24, 26) and at cortisol measurement was 26 weeks (25, 28). The median cortisol was 13.3 ug/dL. Non-survivors had the highest values. Cortisol concentration did not correlate with any of the selected illness severity scores.Conclusion(s)Cortisol concentrations in extremely preterm infants did not correlate with illness severity regardless of gestational age. Further studies are needed to identify clinically useful mediators of adrenal dysfunction and to guide clinical management.

scholarly journals The Effect of Severe Intraventricular Hemorrhage on the Biorhythms of Feeding in Premature Infants

2021 ◽  
Vol 9 ◽  
Author(s):  
Ira H. Gewolb ◽  
Babatunde T. Sobowale ◽  
Frank L. Vice ◽  
Abhijit Patwardhan ◽  
Nino Solomonia ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Premature Infants ◽  
Intraventricular Hemorrhage ◽  
Neurological Injury ◽  
Independent Effect ◽  
Neurologic Injury ◽  
Developmentally Regulated ◽  
Postmenstrual Age ◽  
Feeding Rhythms ◽  
Grade 3

Background: Suck-swallow rhythmicity and the integration of breathing into infant feeding are developmentally regulated. Neurological injury and breathing abnormalities can both impact feeding in preterm infants.Objective: To determine the effects of neurologic injury independent of effects of disordered breathing on feeding biorhythms in premature infants.Methods: Low-risk preterm infants (LRP), infants with Grade 3–4 Intraventricular Hemorrhage (IVH), those with bronchopulmonary dysplasia (BPD), and those with both BPD and IVH (BPD+IVH) were identified. Forty-seven infants, 32–42 weeks Postmenstrual Age (PMA) were evaluated on one or more occasions (131 studies). Of these, 39 infants (81 studies) were performed at &gt;35 weeks PMA. Coefficient of variation (COV) (=standard deviation of the inter-event (e.g., suck-suck, swallow-breath, etc.) interval divided by the mean of the interval) was used to quantify rhythmic stability.Results: To adjust for PMA, only those infants &gt;35–42 weeks were compared. Suck-suck COV was significantly lower (more rhythmically stable) in the LRP group [COV = 0.274 ± 0.051 (S.D.)] compared to all other groups (BPD = 0.325 ± 0.066; IVH = 0.342 ± 0.072; BPD + IVH = 0.314 ± 0.069; all p &lt; 0.05). Similarly, suck-swallow COV was significantly lower in LRP babies (0.360 ± 0.066) compared to the BPD group (0.475 ± 0.113) and the IVH cohort (0.428 ± 0.075) (p &lt; 0.05). The BPD+IVH group (0.424 ± 0.109), while higher, was not quite statistically significant.Conclusions: Severe IVH negatively impacts suck-suck and suck-swallow rhythms. The independent effect of neurological injury in the form of IVH on feeding rhythms suggests that quantitative analysis of feeding may reflect and predict neurological sequelae.

scholarly journals A Web-Based Calculator for Prediction of Severe Neurodevelopmental Impairment in Preterm Infants Using Clinical and Imaging Characteristics

2018 ◽  
Author(s):  
Zachary A. Vesoulis ◽  
Nathalie M. El Ters ◽  
Maja Herco ◽  
Halana V. Whitehead ◽  
Amit M. Mathur
Keyword(s):  
Preterm Infants ◽  
Scoring Systems ◽  
White Matter Injury ◽  
Delivery Mode ◽  
Clinical Factors ◽  
Binary Logistic Regression Model ◽  
Neurodevelopmental Outcomes ◽  
Web Based ◽  
Antenatal Steroids ◽  
Imaging Characteristics

Although the most common forms of brain injury in preterm infants have been associated with adverse neurodevelopmental outcomes, existing MRI scoring systems lack specificity, do not incorporate clinical factors, and are technically challenging to perform. The objective of this study was to develop a web-based, clinically-focused prediction system which differentiates severe from normal-moderate neurodevelopmental outcomes at two years.&nbsp; Infants were retrospectively identified as those who were born &le;30 weeks gestation, had MR imaging at term-equivalent age, and neurodevelopmental testing at 18-24 months.&nbsp; Each MRI was scored on injury in three domains (intraventricular hemorrhage, white matter injury, and cerebellar hemorrhage) and clinical factors strongly predictive of outcome were investigated. &nbsp;A binary logistic regression model was then generated from the composite of clinical and imaging components.&nbsp; A total of 154 infants were included (mean GA = 26.1&plusmn;1.8 weeks, BW = 889.1&plusmn;226.2 grams).&nbsp; The final model (imaging score + ventilator days + delivery mode + antenatal steroids + ROP requiring surgery) had strong discriminatory power for severe disability (AUC=0.850), with a PPV of 76% and NPV of 90%. &nbsp;Available as a web-based tool, it can be useful for prognostication and targeting early intervention services to infants who may benefit most from such services.

Sociodemographic disparities in treatment receipt for prostate cancer: A population-based study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e16514-e16514
Author(s):  
Marianna De Camargo Cancela ◽  
Linda Sharp ◽  
Maria Kelly ◽  
Harry Comber
Keyword(s):  
Prostate Cancer ◽  
Multinomial Logistic Regression ◽  
Smoking Status ◽  
Treatment Strategies ◽  
Population Based ◽  
Treatment Modalities ◽  
Cancer Registration ◽  
Clinical Factors ◽  
Younger Men ◽  
Socio Demographic Factors

e16514 Background: Prostate cancer (PC) treatment remains controversial. Little is known about how this controversy plays out in routine clinical practice. Most studies of treatment patterns are from the US, specialist centres, and/or involve selected patients. In a national, population-based analysis, using linked cancer registration and hospital in-patient data, we investigated associations between socio-demographic and clinical factors and PC treatment in Ireland. Methods: PC cases (ICD10 C61) diagnosed 2002-2008, and with a hospital in-patient episode within one year of diagnosis (n=9658) were included. Comorbidity (assessed by Charlson and Elixhauser indices) was determined from diagnoses on hospital episodes. Multinomial logistic regression was used to investigate associations between age, marital status, smoking status, area of residence, deprivation category, comorbidity, diagnosis period, stage and Gleason score, and receipt of different treatment modalities. Results: Age was a significant determinant of treatment receipt, after adjusting for socio-demographic and clinical factors. Compared to younger men, men aged ≥70 were significantly less likely to undergo radical prostatectomy (RP), and significantly more likely to be treated by TURPS, androgen deprivation therapy (ADT) or radiotherapy with ADT. Within the 40-69 age-group, likelihood of RP decreased with increasing age. After adjusting for age and other factors, presence of comorbidities, overall, had a moderate impact on treatment receipt. Some conditions had a stronger effect (e.g. congestive heart failure). There were strong variations in treatment by area of residence, which persisted after adjustment for age, comorbidity and other factors. Conclusions: These results suggest socio-demographic factors, including patient age and area of residence, strongly influence PC treatment. Strategies to reduce these disparities have potential to improve PC survival and mortality in the population.

New Trends and Developments in Patients with Severe Aortic Stenosis – Towards Optimal Treatment?

2009 ◽  
Vol 5 (2) ◽  
pp. 81 ◽  
Author(s):  
Martijn WA van Geldorp ◽  
Johanna JM Takkenberg ◽  
Ad JJC Bogers ◽  
A Pieter Kappetein ◽  
◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Surgical Techniques ◽  
Treatment Strategies ◽  
Tissue Doppler ◽  
Doppler Imaging ◽  
Treatment Modalities ◽  
Diagnostic Tools ◽  
Number Of Patients ◽  
Transcatheter Valve

Over the next few decades the number of patients diagnosed with aortic stenosis is expected to rise as the population ages and the use of several diagnostic tools expands. This will result in a growing need for both medical and surgical treatment and stimulate the development of new diagnostic and surgical techniques. This article briefly describes the prevalence, pathogenesis and clinical presentation of patients with aortic stenosis and focuses on developments in diagnostic tools, treatment strategies and treatment modalities: the use of echocardiography, tissue Doppler imaging, stress testing and biomarkers is discussed, as well as timing of surgery and the role microsimulation can play in prosthesis selection. Furthermore, newly developed transcatheter valve implantation techniques and their possible role in treating ‘inoperable’ or ‘elderly’ patients are discussed.

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