The High-Risk Infant Is Going Home: What Now?

2004 ◽  
Vol 23 (1) ◽  
pp. 43-47 ◽  
Author(s):  
Jennifer McMurray
Keyword(s):  
Premature Infants ◽  
Very Low Birth Weight ◽  
Survival Rates ◽  
High Risk Infant ◽  
Vlbw Infants ◽  
The Past ◽  
Technological Advances ◽  
Preterm Newborns ◽  
The U.S

EACH YEAR APPROXIMATELY 460,000 infants—nearly 12 percent of all babies born in the U.S.—are born prematurely.1 Technological advances in the medical and nursing care of premature infants over the past decade have increased survival rates among preterm newborns, especially of very low birth weight (VLBW) infants. Survival rates are as high as 49 percent for infants weighing 501–750 gm at birth, 85 percent for infants weighing 751–1,000 gm, 93 percent for infants weighing 1,001–1,250 gm, and 96 percent for infants weighing 1,251–1,500 gm.2 Although 50–60 percent of VLBW infants have normal outcomes, morbidity rates range from 40 to 50 percent.3 Because of this incidence of morbidity, premature infants require comprehensive primary care follow-up after discharge from the NICU.

Rural Residence and Factors Associated with Attendance at the Second High-Risk Infant Follow-up Clinic Visit for Very Low Birth Weight Infants in California

2021 ◽  
Author(s):  
Martha G. Fuller ◽  
Tianyao Lu ◽  
Erika E. Gray ◽  
Maria A. L. Jocson ◽  
Mary K. Barger ◽  
...  
Keyword(s):  
Birth Weight ◽  
High Risk ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
Rural Residence ◽  
High Risk Infant ◽  
Vlbw Infants ◽  
Factors Associated ◽  
The Impact

Objective This study was aimed to determine factors associated with attendance at the second high-risk infant follow-up (HRIF) visit (V2) by 20 months of corrected age after a successful first visit (V1), and the impact of rural residence on attendance rates in a statewide population of very low birth weight (VLBW; <1,500 g) infants. Study Design Data linked from the California Perinatal Quality of Care Collaborative (CPQCC) Neonatal Intensive Care Unit (NICU) database and CPQCC-California Children's Services (CCS) HRIF database. Multivariable logistic regression evaluated independent associations of sociodemographic, maternal, family, neonatal clinical, and individual HRIF program differences (factors) with successful V2 in VLBW infants born in 2010 to 2012. Results Of 7,295 eligible VLBW infants, 75% (5,475) attended V2. Sociodemographic factors independently associated with nonattendance included maternal race of Black (adjusted odds ratio [aOR] = 0.61; 95% confidence interval [CI]: 0.5–0.75), public insurance (aOR = 0.79; 95% CI: 0.69–0.91), and rural residence (aOR = 0.74; 95% CI: 0.61–0.9). Factors identified at V1that were associated with V2 attendance included attending V1 within the recommended window (aOR = 2.34; 95% CI: 1.99–2.75) and early intervention enrollment (aOR = 1.39; 95% CI: 1.12–1.61). Neonatal factors associated with attendance included birth weight ≤750 g (aOR = 1.83; 95% CI: 1.48–2.5). There were significant program differences with risk-adjusted rates ranging from 43.7 to 99.7%. Conclusion Sociodemographic disparities and HRIF program factors are associated with decreased attendance at V2 among VLBW infants. These findings highlight opportunities for quality and process improvement interventions starting in the NICU and continuing through transition to home and community to assure participation in HRIF. Key Points

scholarly journals Sex-Specific Long-Term Trends in Length of Hospital Stay, Postmenstrual Age at Discharge, and Survival in Very Low Birth Weight Infants

Neonatology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Matthias Fröhlich ◽  
Tatjana Tissen-Diabaté ◽  
Christoph Bührer ◽  
Stephanie Roll
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Hospital Stay ◽  
Very Low Birth Weight ◽  
Survival Rates ◽  
Length Of Hospital Stay ◽  
Mortality Rates ◽  
Vlbw Infants ◽  
Postmenstrual Age ◽  
Over Time

<b><i>Introduction:</i></b> In very low birth weight (&#x3c;1,500 g, VLBW) infants, morbidity and mortality have decreased substantially during the past decades, and both are known to be lower in girls than in boys. In this study, we assessed sex-specific changes over time in length of hospital stay (LOHS) and postmenstrual age at discharge (PAD), in addition to survival in VLBW infants. <b><i>Methods:</i></b> This is a single-center retrospective cohort analysis based on quality assurance data of VLBW infants born from 1978 to 2018. Estimation of sex-specific LOHS over time was based on infants discharged home from neonatal care or deceased. Estimation of sex-specific PAD over time was based on infants discharged home exclusively. Analysis of in-hospital survival was performed for all VLBW infants. <b><i>Results:</i></b> In 4,336 of 4,499 VLBW infants admitted from 1978 to 2018 with complete data (96.4%), survival rates improved between 1978–1982 and 1993–1997 (70.8 vs. 88.3%; hazard ratio (HR) 0.20, 95% confidence interval 0.14, 0.30) and remained stable thereafter. Boys had consistently higher mortality rates than girls (15 vs. 12%, HR 1.23 [1.05, 1.45]). Nonsurviving boys died later compared to nonsurviving girls (adjusted mean survival time 23.0 [18.0, 27.9] vs. 20.7 [15.0, 26.3] days). LOHS and PAD assessed in 3,166 survivors displayed a continuous decrease over time (1978–1982 vs. 2013–2018: LOHS days 82.9 [79.3, 86.5] vs. 60.3 [58.4, 62.1] days); PAD 40.4 (39.9, 40.9) vs. 37.4 [37.1, 37.6] weeks). Girls had shorter LOHS than boys (69.4 [68.0, 70.8] vs. 73.0 [71.6, 74.4] days) and were discharged with lower PAD (38.6 [38.4, 38.8] vs. 39.2 [39.0, 39.4] weeks). <b><i>Discussion/Conclusions:</i></b> LOHS and PAD decreased over the last 40 years, while survival rates improved. Male sex was associated with longer LOHS, higher PAD, and higher mortality rates.

SURVIVAL OF A ONE-POUND FEMALE INFANT BORN IN 1847

PEDIATRICS ◽  
1980 ◽  
Vol 66 (2) ◽  
pp. 253-253
Author(s):  
T. E. C.
Keyword(s):  
Premature Infants ◽  
Literature Search ◽  
Survival Rates ◽  
Newborn Infants ◽  
Female Infant ◽  
Second Child ◽  
The Past ◽  
First Child ◽  
Accepted Practice

After a thorough literature search of the survival rates of premature infants, I believe the infant described below was the smallest to survive until this century.1 I am mindful that the reported birth weights in the past may have been inaccurate because the weighing of newborn infants was not an accepted practice prior to this century. 2 Mrs. A. (aged 30) weaned her first child on the 17th of November 1846, a fortnight after which (1st December) she menstruated naturally. Two days after the catamenia disappeared (7th December), she conceived, having the same sensations post coitu which she felt at her previous conception. At four months she quickened. She was delivered (by a midwife) of her second child, a female, on the 14th of May 1847-on the hundred and fifty-eighth day of gestation. The child had only rudimentary nails, and almost no hair, except a little, of slightly reddish colour, at the lower part of the back of the head. It weighed one pound, and measured eleven inches. It was merely wrapped up at first, laid in a box about a foot long, used by the father (who is a slater) for carrying nails, and set on the kitchen fender, before the fire, to keep it warm. It came on very well, and was subsequently treated very much the same as other children, except perhaps, that it was a little more looked after than usual, being considered a curiosity. She is still of small make but is quite healthy, and takes her food well.

scholarly journals Influence of the level of maternal education on the long-term neurodevelopmental outcome of Saudi infants with birth weight of 1000-1500 grams at the age of 21-24 months

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Badr Hasan Sobaih
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Gestational Age ◽  
Maternal Education ◽  
Very Low Birth Weight ◽  
Neurodevelopmental Outcome ◽  
University Hospital ◽  
Vlbw Infants

Background: Advancements in perinatal-neonatal care in the last decades has led to improved survival rates of very-low birth weight (VLBW) infants. An association between the level of maternal education and neurodevelopmental outcome has been demonstrated in many European studies. This study evaluates the influence of maternal education level and socio-demographic status on the long-term development of Saudi VLBW infants with birth weight of 1000-1500 grams at a corrected gestational age of 21-24 months. Method: This retrospective cohort study examined prospectively collected data from the period of 2005 to 2016 from the Neonatal Follow-up Program (NFP) at King Khalid University Hospital in Riyadh, Saudi Arabia. Results: A total of 122 VLBW infants with a mean gestational age of 29.57 weeks and mean birth weight 1265 grams were enrolled. There was no statistically significant association between the level of maternal education and neurodevelopmental screening outcome at the age of 21-24 months according to the Bayley Infant Neurodevelopmental Screener (BINS) (p=0.149). Bronchopulmonary dysplasia (BPD) was highly associated with cerebral palsy (p=0.001) and an abnormal BINS score (p=0.010). Conclusion: There was no significant influence of the level of maternal education on the neurodevelopmental screening outcome of VLBW infants at the corrected age of 21-24 months. BPD was the strongest predictor of adverse neurodevelopmental outcome. Keywords: Bayley Infant Neurodevelopmental Screener (BINS), Neurodevelopmental Outcome, Maternal educational level, Neonatal follow-up program (NFP), Very Low Birth Weight (VLBW) infant.

scholarly journals Diagnosing and Preventing Hearing Loss in the Genomic Age

2019 ◽  
Vol 23 ◽  
pp. 233121651987898 ◽  
Author(s):  
John H. McDermott ◽  
Leslie P Molina-Ramírez ◽  
Iain A Bruce ◽  
Ajit Mahaveer ◽  
Mark Turner ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Congenital Hearing Loss ◽  
Sequencing Technology ◽  
The Past ◽  
Genomic Knowledge ◽  
Current State ◽  
Technological Advances ◽  
Genetic Hearing Loss ◽  
Genetic Technologies

Over the past two decades, significant technological advances have facilitated the identification of hundreds of genes associated with hearing loss. Variants in many of these genes result in severe congenital hearing loss with profound implications for the affected individual and their family. This review collates these advances, summarizing the current state of genomic knowledge in childhood hearing loss. We consider how current and emerging genetic technologies have the potential to alter our approach to the management and diagnosis of hearing loss. We review approaches being taken to ensure that these discoveries are used in clinical practice to detect genetic hearing loss as soon as possible to reduce unnecessary investigations, provide information about reproductive risks, and facilitate regular follow-up and early treatment. We also highlight how rapid sequencing technology has the potential to identify children susceptible to antibiotic-induced hearing loss and how this adverse reaction can be avoided.

Perinatal outcome and referral age

PEDIATRICS ◽  
1975 ◽  
Vol 56 (2) ◽  
pp. 160-160
Author(s):  
George Cassady
Keyword(s):  
Quality Of Life ◽  
Blood Sugar ◽  
Premature Infants ◽  
Perinatal Outcome ◽  
Attrition Rate ◽  
Control Group ◽  
The Past ◽  
New Knowledge

During the past decade, prompt application of new knowledge of perinatal pathophysiology has dramatically improved the quality of life for surviving tiny premature infants. The results of prompt correction and, when possible, prevention of such potent interrelated insults as hypoglycemia, asphyxia, hyperoxia, jaundice, shock, thirsting, and starvation have led the more optimistic of us to expect the virtual disappearance of neurologic residua, previously considered the unavoidable legacy of surviving premature infants. In contrast, the data reported by Fitzhardinge in this issue1 serve as an important warning that all may not be well with these babies. Certain flaws in this report—the 16% attrition rate (no follow-up), the inadequate description of the control group (no control DQ's), and the failure to objectively document such measureable influences on outcome as serum unconjugated bilirubin, serum osmolality, blood sugar, and Po2 and Pco2—should caution the reader to accept these findings only with liberal "grains of salt."

scholarly journals The Thromboelastographic Profile at Birth in Very Preterm Newborns with Patent Ductus Arteriosus

Neonatology ◽  
2020 ◽  
Vol 117 (3) ◽  
pp. 316-323
Author(s):  
Stefano Ghirardello ◽  
Genny Raffaeli ◽  
Beatrice Letizia Crippa ◽  
Silvia Gulden ◽  
Ilaria Amodeo ◽  
...  
Keyword(s):  
Birth Weight ◽  
Patent Ductus Arteriosus ◽  
Very Low Birth Weight ◽  
Ductus Arteriosus ◽  
Maximum Amplitude ◽  
Treated Group ◽  
Full Blood Count ◽  
Vlbw Infants ◽  
Preterm Newborns ◽  
Patent Ductus

<b><i>Background:</i></b> The role of hemostasis in the closure of patent ductus arteriosus (PDA) in preterm infants is controversial. <b><i>Objective:</i></b> To assess thromboelastography (TEG) at birth in very-low-birth-weight (VLBW) infants affected by PDA. <b><i>Methods:</i></b> This was an ancillary study of a prospective observational study aimed at defining the TEG profile in healthy VLBW infants in the first month of life. In this analysis, we included neonates of &#x3c;33 weeks’ gestational age (GA) with PDA and compared TEG traces based on (1) spontaneous closure versus the need for pharmacological treatment and (2) treatment response. We collected blood samples in the 1st day of life to perform recalcified native-blood TEG (reaction time, maximum amplitude, and lysis at 30 min [Ly30)]), standard coagulation tests, and a full blood count. <b><i>Results:</i></b> We enrolled 151 infants with a PDA at the first echocardiogram; 111 experienced spontaneous PDA closure while 40 required treatment. Mean GA was 29.7 ± 1.7 and 27.6 ± 2.1 weeks, and birth weight was 1,158 ± 256 and 933 ± 263 g in the 2 groups, respectively (<i>p</i> &#x3c; 0.001). The hemostatic profile was similar between groups. Median hematocrit (44.6 and 48.7%; <i>p</i> = 0.01) and platelet count (187 and 216 × 10<sup>3</sup>/μL; <i>p</i> = 0.04) were lower in the treated group, although differences lost significance after controlling for GA and illness severity in the multivariate analysis. Responders to PDA treatment (<i>n</i> = 20) had a significantly lower median Ly30 than nonresponders (0 and 0.7%; <i>p</i> = 0.02). <b><i>Conclusion:</i></b> TEG at birth does not predict spontaneous PDA closure in preterm newborns. Fibrinolysis is enhanced in nonresponders to PDA treatment; this observation warrants further investigation.

Posthemorrhagic Hydrocephalus: A Complication of Intraventricular Hemorrhage

2002 ◽  
Vol 21 (1) ◽  
pp. 59-68 ◽  
Author(s):  
Cindy Kirby
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
Survival Rates ◽  
Antenatal Corticosteroids ◽  
Posthemorrhagic Hydrocephalus ◽  
The Past ◽  
Discharge Rates ◽  
Show Evidence ◽  
Weight Groups

SURVIVAL OF PREMATURE AND LOW birth weight (LBW) neonates has increased in the past decade, and it continues to improve with recent advances in neonatal care. The use of antenatal corticosteroids and surfactant has played a major role in the improved survival of these LBW infants. Stevenson and colleagues documented survival-to-discharge rates of 49 percent for infants weighing 501–750 gm at birth, 85 percent for those 751–1,000 gm, 93 percent for those 1,001–1,250 gm, and 96 percent for those 1,251–1500 gm. With increasing survival rates, developmental outcome remains a concern, particularly in the lowest birth weight groups. Approximately 32 percent of very low birth weight (VLBW) infants (defined as weighing 501–1,500 gm) show evidence of intracrenial hemorrhage.

scholarly journals 366 Follow-Up 25OHD Levels in Preterm Very Low Birth Weight (VLBW) Infants

2010 ◽  
Vol 68 ◽  
pp. 189-189
Author(s):  
R A McCarthy ◽  
M M McKenna ◽  
J F Murphy ◽  
A Twomey ◽  
J Brady ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
Vlbw Infants

scholarly journals Application of Diffusion Tensor Imaging in the Evaluation of Brain Injury in Premature Infants with Low and Very Low Birth Weight

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Dalin Zhu ◽  
Manxia Wang ◽  
Fan Feng ◽  
Nan Nan ◽  
Yuefen Liu ◽  
...  
Keyword(s):  
Birth Weight ◽  
White Matter ◽  
Low Birth Weight ◽  
Premature Infants ◽  
Very Low Birth Weight ◽  
Diffusion Tensor ◽  
Occipital Lobe ◽  
Control Group ◽  
Vlbw Infants ◽  
Adc Values

Background: Brain injury in premature infants (BIPI) is a severe brain damage in premature infants, resulting in a series of neurological sequelae. Diffusion tensor imaging (DTI), as a magnetic resonance imaging (MRI) technique, is more widely used for premature infants. It is of paramount importance to improve the early diagnosis, treatment, and intervention for this population by using DTI. There are few reports on the application of DTI for the evaluation of BIPI in low-birth-weight (LBW) and very-low-birth-weight (VLBW) infants. Objectives: To analyze the clinical characteristics of BIPI in LBW and VLBW infants and to explore the value of MRI-based DTI in the evaluation of BIPI in LBW infants. Patients and Methods: This prospective study was conducted on 31 cases of BIPI (16 LBW and 15 VLBW infants) and 20 normal control premature infants, undergoing MRI-based DTI at the postmenstrual age (PMA). Differences in fractional anisotropy (FA) and apparent diffusion coefficient (ADC) between the BIPI and control groups and also between the LBW and VLBW groups with BIPI were analyzed. Also, differences with normal controls in terms of the FA and ADC values were investigated in different brain regions. Results: The FA values in the central white matter of the frontal lobe, central white matter of the occipital lobe, centrum semiovale, posterior limb of the internal capsule (PLIC), and ventral thalamus were significantly lower in the BIPI group as compared to the control group (P < 0.05). The ADCs were lower in the BIPI group compared to the control group, and there was a significant difference (P < 0.05). Comparison of FA and ADC values in the central white matter of the frontal lobe, central white matter of the occipital lobe, centrum semiovale, PLIC, and ventral thalamus did not show any significant differences between the LBW and VLBW groups with BIPI (P > 0.05). Conclusion: The FA and ADC values of DTI can be used for the quantitative evaluation of BIPI in LBW and VLBW infants. The FA value was found to be more accurate than the ADC. Overall, different FA values in different brain areas reflect differences in the brain development of normal premature infants.

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