Disseminated Candidal Infections and Intravenous Hydrocortisone in Preterm Infants

PEDIATRICS ◽  
1995 ◽  
Vol 95 (6) ◽  
pp. 883-887
Author(s):  
Carlos M. Botas ◽  
Isabel Kurlat ◽  
Shirley M. Young ◽  
Augusto Sola
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Birth Weight ◽  
San Francisco ◽  
Preterm Infants ◽  
Gestational Age ◽  
Selection Process ◽  
Control Group ◽  
Major Teaching Hospital ◽  
Intensive Care Nursery

Background. Intravenous (IV) hydrocortisone (HC) has been used recently in selected preterm infants for hypotension soon after birth. During the same time period that HC was used, there was a marked increase in the incidence of disseminated candidal infections (DCIs). Objective. To determine whether there is an association between DCI in the first 35 days of life and IV HC in preterm infants. Research design. A hospital case-control study comparing the exposure of HC between preterm infants with DCI and matched infants without DCI. Setting. A tertiary level intensive care nursery in a major teaching hospital in San Francisco, CA. Patients. Seventeen preterm infants with DCI and 25 infants without DCI, with gestational age younger than 28 weeks and birth weight less than 1000 g, inborn and outborn admitted to the intensive care nursery between January 1992 and September 1993. Methods. All preterm infants diagnosed with DCI at younger than 35 days of age were identified using a perinatal and neonatal database. DCI was defined as a blood, cerebrospinal fluid, or two urine cultures positive for Candida requiring antifungal therapy. A control group of uninfected infants matched for the major risk factors for DCI (gestational age, birth weight, duration of intubation, broad-spectrum antibiotics, and IV alimentation, including lipids and central venous catheters) admitted during the same period was identified using the same database. Postmatching comparison was performed for several other factors to detect any other differences between the groups. Results. The infants with DCI (n = 17) and control infants (n = 25) had no statistical difference in exposure to the major risk factors for DCI or in postmatching comparison. Ten (59%) of the infants with DCI were receiving HC at the time of infection, whereas four (16%) of the control infants received HC during the first 35 days of life. Infants with DCI were 7.5 times as likely as control infants (95% confidence interval, 5 to 11) to have received IV HC before the onset of fungal infection. Conclusion. We conclude that the administration of IV HC significantly increases the risk of DCI in susceptible preterm infants younger than 35 days of age. The potentially serious risks of DCI should be considered particularly in the patient selection process for administration of IV HC.

scholarly journals The Cytokines, Exhaled Nitric Oxide are Risk Factors in Preterm Infants for Bronchopulmonary Dysplasia

2020 ◽  
Author(s):  
Zhenjie Zhang ◽  
Wuchen Wu ◽  
Lian Hou ◽  
Jingjing Jiang ◽  
Yunwei Li ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Risk Factors ◽  
Mechanical Ventilation ◽  
Birth Weight ◽  
High Risk ◽  
Preterm Infants ◽  
Gestational Age ◽  
Control Group ◽  
High Risk Factors ◽  
Tnf Α

Abstract Background Bronchopulmonary dysplasia (BPD) remains the most frequently complication of extreme preterm infants. Multiple clinical factors and inflammatory markers have all been associated with BPD. Therefore, this study targeted to detect cytokines and fractional exhaled nitric oxide(FeNO) to evaluate their mechanism and possible predicted significance for BPD. Methods Preterm infants born at gestational age ≤ 32 weeks were recruited between January 2018 and October 2019. The clinical data of infant characteristics and maternal characteristics were collected. Our study detected a total of ten cytokines include IFN-γ, IL-10, IL-12p70, IL-13, IL-1β, IL-2, IL-4, IL-6, IL-8 and TNF-α on day 1–3, day 7–14, and day 21–28 after birth via Meso Scale Discovery (MSD) technology. FeNO levels were measured when the infants met discharge criteria. Results A total of 46 preterm infants were enrolled in this study, including 14 infants in BPD group and 32 infants in control group. The gestational age 【(27.5 ± 1.3) vs. (29.9 ± 1.3) weeks】and birth weight【(1021 ± 261)g vs. (1489 ± 357)g】of BPD group were lower than those of control group. Multivariate logistic regression analysis showed that gestational age < 30 weeks, birth weight < 1000 g, PDA, longer mechanical ventilation and invasive ventilation duration were high risk factors for BPD. The cytokines of IL-6, IL-8 on day 7–14 and IL-4, IL-6, IL-8, TNF-α on day 21–28 were also the high risk factors for BPD. Other risk factors for BPD included elevated Eosnophils on day 21–28 and FeNO. Conclusion The preterm infants with PDA, prolonged mechanical ventilation tended to develop BPD. The FeNO, Eosnophils, cytokines such as IL-4, IL-6, IL-8, TNF-α were high risk factors for BPD. Our study speculate that NO was related to BPD though Th2-cell-mediatedinflammatory responses such as IL-4. The cytokines may provide a certain predictive value for the occurrence of BPD.

scholarly journals Retinopathy of Prematurity in A Tertiary Care Hospital in Eastern Nepal

2008 ◽  
Vol 47 (169) ◽  
Author(s):  
Srijana Adhikari ◽  
B P Badhu ◽  
N K Bhatta ◽  
R S Rajbhandari ◽  
B K Kalakheti
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Birth Weight ◽  
Gestational Age ◽  
Retinopathy Of Prematurity ◽  
Neonatal Intensive Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Screening Criteria

World Health Organization’s Vision 2020 program has recognized Retinopathy of Prematurity(ROP) as an important cause of childhood blindness in industrialized and developing countries. Inthe last few years, it has been identifi ed in many under developed countries as well, as a result ofimproved neonatal intensive care. In Nepal, ROP screening is carried out in a few tertiary hospitalsbut there is no published data on this disease. The purpose of this study was to fi nd out the incidence,severity and risk factors of ROP among infants screened in a tertiary care hospital in the EasternRegion of Nepal.A prospective cohort study was carried out in neonates with gestational age of 34 weeks or less and,or birth weight of 1700 gm or less born over the period of one year. Dilated fundus examination ofall babies was done by indirect ophthalmoscopy between 2-4 weeks after birth and followed up tillthe retinal vascularization was complete. Classifi cation of ROP was done according to internationalclassifi cation (ICROP). Maternal and neonatal risk factors were also noted.A total of 55 babies fulfi lled the screening criteria. ROP was present in 25.45% (n=14) of the babies.Threshold disease was noted in 5.45% (n=3) of the babies screened. Low birth weight (p<0.01)and low gestational age (p<0.01) was signifi cantly associated with the incidence of ROP. Oxygensupplementation (p=<0.01) was an independent risk factor.ROP screening should be performed in all preterm low birth weight infants where there is availabilityof good neonatal intensive care units. The examination should be intensifi ed in those having riskfactors like oxygen. Further studies in the other tertiary care hospitals in Nepal would help toestablish the screening criteria for Nepalese infants.Key words: Retinopathy of prematurity, Eastern Nepal, screening

scholarly journals Cardiac Troponin T in very low birthweight preterm infants with patent ductus arteriosus

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M H Mohamed ◽  
H M Aboraya ◽  
M A Makawy ◽  
H H Elgebaly
Keyword(s):  
Birth Weight ◽  
Preterm Infants ◽  
Gestational Age ◽  
Cardiac Troponin ◽  
Low Birthweight ◽  
Troponin T ◽  
Ductus Arteriosus ◽  
Left Ventricular ◽  
Control Group ◽  
Control Groups

Abstract Aim to assess the role of cardiac troponin C (cTnT) as a marker of cardiac injury in VLBW infants with clinically significant PDA and its relation to echocardiographic findings. Methods Seventy-seven VLBW preterm infants, were included, divided according to their diameter of PDA and its hemodynamic significance into patients and control groups. For all neonates, CBC, CRP, cTnT and echocardiography, were done at 48 hours of life and as follow up 5-7 days later. Results 41 preterm infants with a mean gestational age of 31.7±1.57 weeks and birth weight of (1.38±0.2kg) were included as patients group, 36 preterm infants were included as control group with a mean gestational age of 32.2±0.9 weeks and birth weight of (1.33±0.2kg). At 48 hours, cTnT concentrations in patients group was significantly increased than in control group (0.31±0.06 ng/dl, 0.16±0.03 ng/dl, respectively, P &lt; 0.001) and was positively corelated to PDA diameter in patients group (r:0.313, P:0.046). Mean left ventricular end systolic diameter was significantly decreased in patients than in control groups (9.00±1.94, 14.72±1.56, P:0.023). On 5th day, cTnT concentrations (0.15 ±0.03 ng/dl) significantly decreased with closure of the duct (p: 0.004) together with increase in ejection fraction and fraction shortening (P &lt; 0.001, P:0.008 respectively) Conclusion cTnT may provide the basis for early diagnosis and detection of hemodynamically significant PDA in VLBW neonates for trials of medical treatment.

scholarly journals Late hyponatremia: its risk factors in preterm infants and short-term outcome

2021 ◽  
Vol 43 (5) ◽  
pp. 434-443
Author(s):  
Manizheh Gharehbaghi ◽  
Sadollah Yegane Dust ◽  
Elmira Naseri
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Gestational Age ◽  
Short Term ◽  
Term Outcome ◽  
Short Term Outcome ◽  
Osteopenia Of Prematurity

Background. Prematurity is one of the major health problems and common causes of neonatal mortality. One of the complications of premature infants is hyponatremia. The effect of hyponatremia on the prognosis of preterm infants has not been well studied. This study aimed to evaluate infants with late hyponatremia, its risk factors, and prognosis. Methods. This descriptive analytical study reviewed preterm infants (<34 weeks) admitted to Al-Zahra or Children’s Hospital in Tabriz for one year (2019). Neonates diagnosed with hyponatremia after the second week were identified and evaluated for risk factors and short-term outcome. Results. A total of 186 neonates were studied. The mean gestational age of the neonates was 30 weeks (first and third quarters = 29-32 weeks). 101 (54.3%) infants were male. The route of delivery was the cesarean section in 60.7% of cases. Late hyponatremia was present in 50 (26.8 %) infants. Gestational age and birth weight were significantly lower in infants with hyponatremia than in the control group. Multivariate analysis showed that low birth weight, the use of prenatal steroids, and inappropriate weight for gestational age status independently predict the incidence of late hyponatremia. There was a significant relationship between the presence of prolonged late hyponatremia (over 7 days) and bronchopulmonary dysplasia and osteopenia of prematurity. However, no significant association was found between the presence of prolonged late hyponatremia in preterm infants with the length of hospital stay and in-hospital mortality. Conclusion. Based on the findings of this study, low birth weight, prenatal steroid use, and lack of appropriate weight for gestational age were risk factors for late hyponatremia in preterm infants. Prolonged hyponatremia is associated with bronchopulmonary dysplasia and osteopenia of prematurity

scholarly journals Validation of The DIGIROP-Birth Model in A Chinese Cohort

2021 ◽  
Author(s):  
Sizhe Chen ◽  
Rong Wu ◽  
He Chen ◽  
Wenbei Ma ◽  
Shaolin Du ◽  
...  
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Receiver Operating Characteristic ◽  
Preterm Infants ◽  
Gestational Age ◽  
Retinopathy Of Prematurity ◽  
Roc Curve ◽  
Operating Characteristic ◽  
Predictive Performance ◽  
Postnatal Risk Factors

Abstract Background We aimed to validate the predictive performance of the DIGIROP-Birth model for identifying treatment-requiring retinopathy of prematurity (TR-ROP) in Chinese preterm infants to evaluate its generalizability across countries and races. Methods We retrospectively reviewed the medical records of preterm infants who were screened for retinopathy of prematurity (ROP) in a single Chinese hospital between June 2015 and August 2020. The predictive performance of the model for TR-ROP was assessed through the construction of a receiver-operating characteristic (ROC) curve and calculating the areas under the ROC curve (AUC), sensitivity, specificity, and positive and negative predictive values. Results Four hundred and forty-two infants (mean (SD) gestational age = 28.8 (1.3) weeks; mean (SD) birth weight = 1237.0 (236.9) g; 64.7% males) were included in the study. Analyses showed that the DIGIROP-Birth model demonstrated less satisfactory performance than previously reported in identifying infants with TR-ROP, with an area under the receiver-operating characteristic curve of 0.634 (95% confidence interval = 0.564–0.705). With a cutoff value of 0.0084, the DIGIROP-Birth model showed a sensitivity of 48/93 (51.6%), which increased to 89/93 (95.7%) after modification with the addition of postnatal risk factors. In infants with a gestational age < 28 weeks or birth weight < 1000 g, the DIGIROP-Birth model exhibited sensitivities of 36/39 (92.3%) and 20/23 (87.0%), respectively. Conclusions Although the predictive performance was less satisfactory in China than in developed countries, modification of the DIGIROP-Birth model with postnatal risk factors shows promise in improving its efficacy for TR-ROP. The model may also be effective in infants with a younger gestational age or with an extremely low birth weight.

scholarly journals The Correlation Between Bronchopulmonary Dysplasia and Platelet Metabolism in Preterm Infants

2021 ◽  
Vol 9 ◽  
Author(s):  
Longli Yan ◽  
Zhuxiao Ren ◽  
Jianlan Wang ◽  
Xin Xia ◽  
Liling Yang ◽  
...  
Keyword(s):  
Platelet Count ◽  
Birth Weight ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Premature Infants ◽  
Gestational Age ◽  
Admission Diagnosis ◽  
Control Group ◽  
The Relationship

Background: Platelets play an important role in the formation of pulmonary blood vessels, and thrombocytopenia is common in patients with pulmonary diseases. However, a few studies have reported on the role of platelets in bronchopulmonary dysplasia.Objective: The objective of the study was to explore the relationship between platelet metabolism and bronchopulmonary dysplasia in premature infants.Methods: A prospective case-control study was performed in a cohort of premature infants (born with a gestational age &lt;32 weeks and a birth weight &lt;1,500 g) from June 1, 2017 to June 1, 2018. Subjects were stratified into two groups according to the diagnostic of bronchopulmonary dysplasia: with bronchopulmonary dysplasia (BPD group) and without bronchopulmonary dysplasia (control group). Platelet count, circulating megakaryocyte count (MK), platelet-activating markers (CD62P and CD63), and thrombopoietin (TPO) were recorded and compared in two groups 28 days after birth; then serial thrombopoietin levels and concomitant platelet counts were measured in infants with BPD.Results: A total of 252 premature infants were included in this study. Forty-eight premature infants developed BPD, 48 premature infants without BPD in the control group who were matched against the study infants for gestational age, birth weight, and admission diagnosis at the age of postnatal day 28. Compared with the controls, infants with BPD had significantly lower peripheral platelet count [BPD vs. controls: 180.3 (24.2) × 109/L vs. 345.6 (28.5) × 109/L, p = 0.001]. Circulating MK count in the BPD group was significantly more abundant than that in the control group [BPD vs. controls: 30.7 (4.5)/ml vs. 13.3 (2.6)/ml, p = 0.025]. The level of CD62p, CD63, and TPO in BPD group was significantly higher than the control group [29.7 (3.1%) vs. 14.5 (2.5%), 15.4 (2.0%) vs. 5.8 (1.7%), 301.4 (25.9) pg/ml vs. 120.4 (14.2) pg/ml, all p &lt; 0.05]. Furthermore, the concentration of TPO was negatively correlated with platelet count in BPD group with thrombocytopenia.Conclusions: Our findings suggest that platelet metabolism is involved in the development of BPD in preterm infants. The possible mechanism might be through increased platelet activation and promoted TPO production by feedback.

scholarly journals EARLY VS LATE CAFFEINE THERAPY IN PRETERM INFANTS: ANALYSIS OF CLINICAL OUTCOME

2021 ◽  
Vol 71 (2) ◽  
pp. 503-06
Author(s):  
Hafsa Niaz ◽  
Jawad Jalil ◽  
Muhammad Adil ◽  
Faisal Basheer ◽  
Shahzad Akhtar ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Clinical Outcome ◽  
Neonatal Intensive Care Unit ◽  
Intensive Care Unit Stay ◽  
Preterm Infants ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Female Ratio

Objective: To study clinical outcome of early versus late caffeine therapy in preterm infants. Study Design: Prospective comparative study. Place and Duration of Study: Neonatal Intensive Care Unit, Pak Emirates Military Hospital, Rawalpindi, from Jan to Jul 2018. Methodology: A total of 40 preterm infants with gestational age <32 weeks and birth weight <1500 grams were randomly divided into two groups on the basis of initiation of caffeine therapy i.e. group A (early caffeine group) and group B (late caffeine group). Infant’s demographic data and clinical outcomes were compared between both groups using SPSS IBM software. Results: Mean gestational age was 29.9 ± 1.19 weeks with male to female ratio of 1.5:1 Mean birth weight was 1165.3 ± 316 grams. Half (50%) of the infants were delivered by cesarean section while surfactant was given in 29 (72.5%) infants. While comparing both groups we observed that early caffeine shortens duration of Neonatal Intensive Care Unit stay (p<0.05) whereas caffeine therapy initiation timings didn’t influence the risk of development of Respiratory Distress Syndrome or need of mechanical ventilation. Conclusion: Early caffeine therapy in preterm infants is associated with decrease duration of Neonatal Intensive Care Unit stay. However further work is needed in this regards to establish its efficacy and safety.

scholarly journals Risk factors associated with retinopathy of prematurity among neonates in a tertiary care hospital in Nepal

2017 ◽  
Vol 5 (1) ◽  
pp. 28-33
Author(s):  
Jyoti Baba Shrestha ◽  
Reena Yadav ◽  
Jeevan Kumar Shrestha ◽  
Laxman Shrestha ◽  
Raman Prasad Sah
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Neonatal Intensive Care Unit ◽  
Gestational Age ◽  
Retinopathy Of Prematurity ◽  
Neonatal Intensive Care ◽  
Multiple Gestation ◽  
Factors Associated

Background: Retinopathy of prematurity is a vascular retinal disease that can cause blindness in premature new born babies. Several risk factors are associated with the incidence of ROP. Information and data on risk factors associated with ROP in context to Nepalese population is scarcely documented in literature.Objectives: The purpose of this study was to evaluate the risk factors of retinopathy of prematurity in premature infants admitted in the neonatal intensive care unit of Tribhuvan University Teaching Hospital.Methods: Neonates with gestational age of 36 weeks or less and birth weight of 2000 gram or less admitted to neonatal intensive care unit (NICU), during 2013 to 2015 were screened for retinopathy of prematurity. Risk factors and severity of retinopathy of prematurity were evaluated. The initial examination was carried out at 4-6 weeks after birth by indirect ophthalmoscope and retinopathy of prematurity positive and negative infants were compared subsequently. The Chisquare and independent t-tests were used for statistical analysis. A p value less than 0.05 was considered statistically signifi cant.Results: The incidence of retinopathy of prematurity was 22.6% and severe retinopathy of prematurity requiring treatment was observed in 3.2% of 93 neonates who had eye examinations. There was a signifi cant relationship between the occurrence of ROP and birth weight (p=0.000), gestational age (p=0.000), duration of oxygen therapy (p=0.009) and sepsis (p=0.002). However, insignifi cant relationship was observed between the occurrence of retinopathy of prematurity and gender, type of delivery, multiple gestation, premature rupture of foetal membrane, respiratory distress syndrome and hyperbilirubinaemia.Conclusion: The risk factors contributing to development of retinopathy of prematurity showed signifi cant relationship with immaturity, duration of oxygen supplementation and septicaemia.Journal of Kathmandu Medical CollegeVol. 5, No. 1, Issue 15, Jan.-Mar., 2016,page: 28-33

scholarly journals SAT-103 Extrauterine Growth Restriction (EUGR) in Preterm Infants: Incidence, Risk Factors, Nutrition, Auxological and Neurological Outcome.A Retrospective Study from 2010 to 2016

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Marta Del Pistoia ◽  
Maria Giulia Tozzi ◽  
Alessandra Carmignani ◽  
Massimiliano Ciantelli ◽  
Rosa Teresa Scaramuzzo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Preterm Infants ◽  
Enteral Feeding ◽  
Gestational Age ◽  
Minimum Weight ◽  
Gradual Improvement ◽  
Increased Risk

Abstract EUGR is still a serious problem in very low birth weight preterm infants. The gradual improvement in neonatal intensive care has allowed the survival of newborns with increasing low weight and gestational age, with a higher incidence of major nutritional problems and diseases (Goldenberg 2008). EUGR was defined as growth parameters ≤ 10° centile at discharge, compared to the expected intrauterine growth for post-menstrual age. Recently EUGR was defined, in a dynamic way, as the reduction in anthropometric parameters z-score between birth and discharge &gt;1SD (Griffin 2016). Aims of our study were to evaluate: the incidence of EUGR, the nutritional intake, the main risk factors, the auxological and neurological outcome. We enrolled 346 newborns admitted to our NICU from 2010 to 2016 with gestational age (GA) at birth &lt; 30 weeks and/or birth weight &lt;1500 gr. Infants with malformations or syndromes were excluded. The incidence of EUGR was 73.1% for weight, 66.3% for length and 39.3% for head circumference. We observed a decrease in SD mainly during the first 14 days of life. From two weeks to discharge, no significant catch-up growth was observed. Risk factors for EUGR were: male gender, reduced GA (p=0.000), low birth weight (p=0.000), lower minimum weight achieved (p=0.000), more time to recover birth weight (p=0.000), lower growth rate per day (p=0.001), longer period of total parenteral nutrition (p=0.008), later onset of minimal enteral feeding (p=0.006), later achievement of the full enteral feeding (p=0.000), cesarean section (p=0.006), incomplete corticosteroid prophylaxis (p=0.025), postnatal steroids use (p=0.000), mechanical ventilation (p=0.000), pulmonary bronchodysplasia (p= 0.000), leukomalacia (p=0.06), patent ductus arteriosus (p=0.000), retinopathy of prematurity (p= 0.008), late onset sepsis (p= 0.09). In 197 patients post-discharge clinical follow up at 1, 3 and 24 months of correct age (CA) was performed. Around 88% of all our sample showed normal neurological development. 12% at 1 and 3 months had abnormal general movements (both writhing and fidgety movements) or absent (p = 0.001). At 24 months CA patients with abnormal/absent fidgety movements had neurological disabilities and 83% were EUGR. At 24 months, 17% had weight &lt;10th centile and all were EUGR. 25% showed an overgrowth (weight &gt;75th centile) with a probably increased risk of metabolic disease later in life. The incidence of EUGR increased over the years due to the augmentation in preterm births with lower GA. The first 14 days of life were a critical period and nutrition is known to be mandatory to promote newborns’ growth (Asbury 2019). The EUGR condition negatively affected the neurological (Chien 2018) and auxological (Takayanagi 2018, Wood 2018) outcome of preterm infants and the early recognition of this condition is extremely important in order to implement a careful and prolonged follow-up.

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