Assessing the Effectiveness of Care for Very Low Birth Weight Infants—Do We Really Need Population-Based Data?

PEDIATRICS ◽  
1989 ◽  
Vol 84 (5) ◽  
pp. 912-913
Author(s):  
KIRSTI M. HEINONEN
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
Population Based ◽  
Low Birth Weight Infants ◽  
Large Hospital ◽  
Mortality And Morbidity ◽  
Vlbw Infants ◽  
Additional Information ◽  
Randomized Controlled Clinical Trials

The active and vigorous care now provided for even the smallest infants has reduced both mortality and morbidity among very low birth weight (VLBW, birth weight <1500 g) infants. The efficacy of individual therapeutic elements has been documented as a part of this management, in some cases by randomized controlled clinical trials. Thus the present practices of providing respiratory, nutritional, and environmental support for VLBW infants seem to be well supported by experimental evidence, usually derived from large hospital-based experience. What—if any—additional information can be gained by relating the outcome of VLBW infants to geographic data covering all such births? In the present commentary, an attempt is made to answer this question by focusing first on two important aspects, namely, the availability and overall effectiveness of intensive care services for VLBW infants.

Changes in Intubation Rates and Outcome of Very Low Birth Weight Infants: A Population-based Study

PEDIATRICS ◽  
1996 ◽  
Vol 98 (1) ◽  
pp. 24-27 ◽  
Author(s):  
Christian F. Poets ◽  
Brigitte Sens
Keyword(s):  
Quality Assurance ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
Controlled Trial ◽  
Population Based ◽  
Quality Assurance Program ◽  
Low Birth Weight Infants ◽  
Vlbw Infants ◽  
Selective Approach

Objective. There have been indications of a recent decrease in intubation rates of very low birth weight (VLBW) infants in Germany. We wanted to quantify this decrease and analyze its effect on clinical outcome. Methods. Population-based data on the treatment and outcome at hospital discharge from a statewide quality assurance program were analyzed for 2001 VLBW infants (500 to 1499 g) born from 1992 to 1994 in Lower Saxony, North Germany. Results. The proportion of patients not intubated and mechanically ventilated increased from 7% to 14% in infants less than 1000 g and from 28% to 44% in those greater than or equal to 1000 g (P < .02 and < .01, respectively). This increase was not associated with any significant increase in adverse outcome such as death, intraventricular hemorrhage, periventricular leucomalacia, or bronchopulmonary dysplasia (BPD). Instead, there was an increase in the proportion of infants less than 1000 g who survived without BPD (from 38% in 1992 to 48% in 1994; P > .05) and a decrease in the proportion of infants greater than or equal to 1000 g in whom BPD developed (from 14% to 9%; P < .05). Conclusions. The data from a statewide quality assurance program show a significant reduction in the aggressiveness of the treatment of VLBW infants, which was not associated with an increased mortality or morbidity. This observational study, however, cannot define whether a more selective approach to the intubation of VLBW infants will ultimately result in a better outcome. A randomized, controlled trial would be required to answer this clinically important question.

Comparison of Mortality and Morbidity of Very Low Birth Weight Infants Between Canada and Japan

PEDIATRICS ◽  
2012 ◽  
Vol 130 (4) ◽  
pp. e957-e965 ◽  
Author(s):  
T. Isayama ◽  
S. K. Lee ◽  
R. Mori ◽  
S. Kusuda ◽  
M. Fujimura ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
Low Birth Weight Infants ◽  
Mortality And Morbidity

Very Low Birth Weight Outcomes

PEDIATRICS ◽  
1992 ◽  
Vol 89 (2) ◽  
pp. 357-357
Author(s):  
HELEN HARRISON
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Meta Analysis ◽  
Low Birth Weight Infants ◽  
Randomized Controlled Clinical Trials ◽  
Weight Outcomes ◽  
Term Evaluation

To the Editor.— The authors of the National Institute of Child Health and Human Development report on neonatal care1 found "important" variations among neonatal intensive care units in philosophies of treatment, methods of treatment, and short-term outcomes. In a recent meta-analysis of follow-up studies,2 researchers document a similarly haphazard approach to the long-term evaluation of very low birth weight survivors. Until randomized controlled clinical trials validate the safety and efficacy of neonatal therapies, and until long-term outcomes are assessed accurately, the treatment of very low birth weight infants should be declared experimental.

Early Vital Sign Differences in Very Low Birth Weight Infants with Severe Intraventricular Hemorrhage

2021 ◽  
Author(s):  
Santina A. Zanelli ◽  
Maryam Abubakar ◽  
Robert Andris ◽  
Kavita Patwardhan ◽  
Karen D. Fairchild ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Vital Sign ◽  
Intraventricular Hemorrhage ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Cranial Ultrasound ◽  
Low Birth Weight Infants ◽  
Vlbw Infants ◽  
Arterial Blood

Objective Severe intraventricular hemorrhage (sIVH, grades 3 and 4) is a serious complication for very low birth weight (VLBW) infants and is often clinically silent requiring screening cranial ultrasound (cUS) for detection. Abnormal vital sign (VS) patterns might serve as biomarkers to identify risk or occurrence of sIVH. Study Design This retrospective study was conducted in VLBW infants admitted to two level-IV neonatal intensive care units (NICUs) between January 2009 and December 2018. Inclusion criteria were: birth weight <1.5 kg and gestational age (GA) <32 weeks, at least 12 hours of systemic oxygen saturation from pulse oximetry (SpO2) data over the first 24 hours and cUS imaging. Infants were categorized as early sIVH (sIVH identified in the first 48 hours), late sIVH (sIVH identified after 48 hours and normal imaging in the first 48 hours), and no IVH. Infants with grades 1 and 2 or unknown timing IVH were excluded. Mean heart rate (HR), SpO2, mean arterial blood pressure (MABP), number of episodes of bradycardia (HR < 100 bpm), and desaturation (SpO2 < 80%) were compared. Results A total of 639 infants (mean: 27 weeks' gestation) were included (567 no IVH, 34 early sIVH, and 37 late sIVH). In the first 48 hours, those with sIVH had significantly higher HR compared with those with no IVH. Infants with sIVH also had lower mean SpO2 and MABP and more desaturations <80%. No significant differences in VS patterns were identified in early versus late sIVH. Logistic regression identified higher HR and greater number of desaturations <80% as independently associated with sIVH. Conclusion VLBW infants who develop sIVH demonstrate VS differences with significantly lower SpO2 and higher mean HR over the first 48 hours after birth compared with VLBW infants with no IVH. Abnormalities in early VS patterns may be a useful biomarker for sIVH. Whether VS abnormalities predict or simply reflect sIVH remains to be determined. Key Points

scholarly journals Beneficial Effects of Probiotic Treatment on Gut Microbiota in Very Low Birth Weight Infants

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Yue-feng Li ◽  
Chuan-rui Zhu ◽  
Xue-lei Gong ◽  
Hui-ling Li ◽  
Li-kuan Xiong ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Gut Microbiota ◽  
Very Low Birth Weight ◽  
Secondary Outcome ◽  
Rrna Gene ◽  
Low Birth Weight Infants ◽  
Microbial Composition ◽  
Vlbw Infants ◽  
Probiotic Treatment

The very low birth weight (VLBW) infant is at great risk for marked dysbiosis of the gut microbiota. In the present study, a total of 36 VLBW infants were randomly divided into two groups, who were treated with combined probiotics and placebo, and 72 fecal specimens on days 14 and 28 of life were collected from them. Finally, 32 fecal specimens extracted from 16 preterm VLBW infants were qualified and analyzed using 16S rRNA gene sequencing. The primary outcome was to evaluate the change of gut microbiota in VLBW infants after combined probiotic supplement. The secondary outcome was to analyze the correlation gut microbial composition and levels of cytokines. We found that probiotic treatment, but not placebo, decreased the α-diversity of gut microbiota in VLBW infants. At the phylum level, probiotic treatment strongly increased the abundance of Firmicutes, whereas that of Proteobacteria was significantly reduced. At the family level, Streptococcaceae and Lactobacillaceae became prevalent after probiotic treatment, while the relative abundance of Enterobacteriaceae was reduced in the meantime. Most notably, significant correlations were observed between Lactobacillaceae abundance and serum cytokine levels. Further studies are required to shed more light on the characteristics of gut microbiota of VLBW neonates. And the modulation of microbiota should be considered to improve the survival rate of VLBW infants.

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