The Role of the Hospital of Birth on Survival of Extremely Low-birthweight, Extremely Preterm Infants

NeoReviews ◽  
2003 ◽  
Vol 4 (6) ◽  
pp. 147e-152 ◽  
Author(s):  
L. R. Blackmon
Keyword(s):  
Preterm Infants ◽  
Low Birthweight ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Extremely Low Birthweight

Initiation of respiratory support for extremely preterm infants at birth

2020 ◽  
pp. fetalneonatal-2020-319798
Author(s):  
Madeleine C Murphy ◽  
Lisa K McCarthy ◽  
Colm P F O’Donnell
Keyword(s):  
Preterm Infants ◽  
Low Birthweight ◽  
Positive Pressure Ventilation ◽  
Positive Airway Pressure ◽  
Neonatal Resuscitation ◽  
Respiratory Support ◽  
Positive Pressure ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Extremely Low Birthweight

Neonatal resuscitation algorithms recommend assessing breathing and heart rate (HR) of newborns and giving respiratory support when one or both are unsatisfactory. Recommendations also state that preterm infants may be supported with continuous positive airway pressure rather than routinely intubated for positive pressure ventilation (PPV). We wished to describe the prevalence and time of initiation of respiratory support of extremely preterm and extremely low birthweight (ELBW) infants at our hospital. We reviewed videos of 55 infants. Although most were breathing, practically all newly born extremely preterm ELBW infants were given respiratory support soon after arrival to the resuscitation cot. For the majority, this was done without knowing the HR. The majority received PPV; again, this was often done without knowing the HR. A quarter of infants were managed without any PPV.

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.

scholarly journals Role of beta-2-microglobulin as a biomarker in very preterm and extremely preterm infants with CNS inflammation

PLoS ONE ◽  
2019 ◽  
Vol 14 (5) ◽  
pp. e0216498
Author(s):  
Albert Batista Muñoz ◽  
Stephanie Hadley ◽  
Marti Iriondo Sanz ◽  
Thais Agut Quijano ◽  
Marta Camprubí Camprubí
Keyword(s):  
Preterm Infants ◽  
Cns Inflammation ◽  
Very Preterm ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Beta 2 ◽  
Beta 2 Microglobulin

Role of Early Pulmonary Hypertension as a Risk Factor for Late Pulmonary Hypertension in Extremely Preterm Infants

2017 ◽  
Vol 35 (02) ◽  
pp. 120-126 ◽  
Author(s):  
Dinushan Kaluarachchi ◽  
Kaitlin Woo ◽  
Tarah Colaizy
Keyword(s):  
Pulmonary Hypertension ◽  
Risk Factor ◽  
Preterm Infants ◽  
Clinical Suspicion ◽  
Pulmonary Vascular Disease ◽  
University Of Iowa ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
The University

Objective The evidence on the role of early pulmonary vascular disease (PVD) in the development of late pulmonary hypertension (PH) in the extremely preterm infants is limited. Objectives were to determine the incidence of early and late PH in extreme preterm infants and to evaluate the role of early PH as a risk factor for development of clinically detected late PH. Methods It was a retrospective analysis of early echocardiograms (day of life 5–14) in preterm infants, 22 to 27 weeks' gestation, admitted to the University of Iowa NICU between July 01, 2012 to June 30, 2015. Late echocardiograms performed for clinical suspicion of PH were also analyzed. Results A total of 154 infants were included in the study. Early PH was diagnosed in 31 (20%) infants. Twenty-four (16%) infants were evaluated for clinically suspected PH. Eight (5%) infants were diagnosed with late PH. Infants with early PH had echocardiograms performed earlier than infants without the evidence of early PH. Early PH was not associated with the development of late PH (p = 0.99). Conclusion Early PH is common among extremely preterm infants (20%). Five percent of infants had clinically detected late PH. Infants with early PH had echocardiograms performed earlier than infants without the evidence of early PH. Early PH was not associated with the development of clinically detected late PH.

scholarly journals Case Report: Treatment of Extremely Preterm Infants With Birthweight Below 300 g: Case Series

2021 ◽  
Vol 9 ◽  
Author(s):  
Yoshihiko Shitara ◽  
Satsuki Kakiuchi ◽  
Takeo Mukai ◽  
Kohei Kashima ◽  
Motohiro Kato ◽  
...  
Keyword(s):  
Best Practices ◽  
Low Birthweight ◽  
Clinical Course ◽  
Case Series ◽  
Hepatic Rupture ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Neurodevelopmental Impairment ◽  
Parental Counseling ◽  
Extremely Low Birthweight

Reports on the birth of infants weighing <300 g are quite rare and little is known about the best practices in treating such micropreemies. Therefore, we report here on three cases of low birthweight infants weighing <300 g, of whom two infants survived. The birthweights and gestational ages were ranging 279–293 g and 22 + 6/7 – 23 + 6/7 weeks, respectively. All the infants had severe fetal growth restriction and prematurity. The infant in case 1 died of hepatic rupture, perhaps due to birth trauma, which emphasized the need for less invasive obstetric procedures including en caul delivery. The infant in case 2 managed to survive through severe prematurity secondary to hydrops fetalis. However, complications followed soon as tracheal granulation tissue was formed with neurodevelopmental impairment. The infant in case 3 was born recently and her clinical course was less remarkable without severe complications, despite having the least gestational age and birthweight among the three patients. The improved care protocols for extremely low birthweight infants over these years through experiential learning including that with cases 1 and 2 may have ensured the better outcome of case 3. Accumulating evidence and recording the experience of such cases with continuous constructive discussion can contribute to better outcomes and appropriate parental counseling for extremely small babies in the future.

scholarly journals Patho-mechanisms of the origins of bronchopulmonary dysplasia

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Mitali Sahni ◽  
Vineet Bhandari
Keyword(s):  
Oxidative Stress ◽  
Extracellular Matrix ◽  
Growth Factor ◽  
Lung Injury ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Growth Factor Signaling ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

AbstractBronchopulmonary dysplasia (BPD) continues to be one of the most common complications of prematurity, despite significant advancement in neonatology over the last couple of decades. The new BPD is characterized histopathologically by impaired lung alveolarization and dysregulated vascularization. With the increased survival of extremely preterm infants, the risk for the development of BPD remains high, emphasizing the continued need to understand the patho-mechanisms that play a role in the development of this disease. This brief review summarizes recent advances in our understanding of the maldevelopment of the premature lung, highlighting recent research in pathways of oxidative stress-related lung injury, the role of placental insufficiency, growth factor signaling, the extracellular matrix, and microRNAs.

Life expectancy of extremely preterm infants

2007 ◽  
Vol 148 (48) ◽  
pp. 2279-2284 ◽  
Author(s):  
Gabriella Vida ◽  
Ilona Sárkány ◽  
Simone Funke ◽  
Judit Gyarmati ◽  
Judit Storcz ◽  
...  
Keyword(s):  
Life Expectancy ◽  
Preterm Infants ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Optimális esetben a 24–28. gesztációs hét közötti, igen éretlen újszülöttek olyan szülészeti intézményben születnek, ahol neonatalis intenzív centrum működik, így mind az akut, mind a hosszú távú ellátásukat magas színvonalon biztosítják. A PTE OEKK ÁOK Szülészeti és Nőgyógyászati Klinikán 2000. január 1. és 2004. december 31. között 7499 újszülött született. A koraszülési frekvencia 20% (1499/7499), ezen belül az extrém alacsony gesztációs korúak aránya (≦28. gesztációs hét) 18% (272/1499), míg a 25. gesztációs hét alattiaké 3,2% (48/1499) volt. A túlélés a gesztációs hetek emelkedésével fokozatosan javul. Az életben maradt koraszülöttek későbbi életkilátásai és társadalmi beilleszkedése függ az olyan maradandó károsodásoktól, mint a látáscsökkenés, halláskárosodás, somatomentalis fejlődés zavarai, krónikus tüdőbetegség. A klinikán vizsgált alacsony gesztációs korú csoportban az összes fogyatékkal élő betegek aránya 15,3%. Döntő többségük a 25. gesztációs hétnél korábban született koraszülöttek közül kerül ki. A 26. gesztációs héttől a koraszülöttek több mint fele tartós károsodás nélkül éli túl az extrém éretlenség társuló problémáit. Megállapították, hogy a korai koponya-ultrahangvizsgálattal, szemészeti szűréssel, otoacusticus emissio mérésével jól prognosztizálhatók a maradandó károsodások, így lehetővé válik a korai kezelés.

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