scholarly journals Neurodesenvolvimento de Grandes Prematuros ou Recém-Nascidos com Muito Baixo Peso: Comparação de Gémeos Monocoriónicos e Bicoriónicos com Recém-Nascidos de Gestação Unifetal

2016 ◽  
Vol 29 (11) ◽  
pp. 702 ◽  
Author(s):  
Adelaide Taborda ◽  
Guiomar Oliveira
Keyword(s):  
Cerebral Palsy ◽  
Developmental Delay ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Monochorionic Twins ◽  
Logistic Regression Models ◽  
Adjusted Risk ◽  
Neurodevelopmental Delay ◽  
Very Preterm ◽  
Increased Risk

Introduction: Twins are associated with a delayed development and cerebral palsy. The purpose of this work was to compare the neurologic morbidity in very preterm or very low birth weight dichorionic and monochorionic twins with singletons.Material and Methods: We conducted a retrospective cohort study of livebirths lowest through 32 weeks of gestation or very low weight infants admitted to Neonatal Intensive Care Unit of a level III hospital, between 2006 and 2010. Development was evaluated with the Growing Skills II Scale at 24 months of age. Cerebral palsy was defined by predetermined criteria by Surveillance of Cerebral Palsy in Europe. Infants were analyzed as twins and singletons cohort. Within the twin category the infants were further separated as dichorionic and monochorionic and were compared with singletons infants. Logistic regression models were used to control for demographic and clinical factors.Results: The cohort of infants who were assessed for neurodevelopmental impaired, consisted of 194 singletons infants and 89twins (50 dichorionic; 39 monochorionic). Monochorionic twins, when compared with the singletons, showed an increased risk of severe developmental delay in these areas: locomotion (adjusted OR 12.2) language (adjusted OR 6.5) and autonomy (adjusted OR 7.2). Cerebral palsy was diagnosed in 4.1% of singleton infants and 15.4% of monochorionic twins. The adjusted risk of severe developmental delay and cerebral palsy in monochorionic twins was 3.6 and 4.2, respectively.Discussion: This work showed higher rate of moderate and severe neurodevelopment delay including cerebral palsy in monochorionic twins compared to singletons infants. Analysis by groups stratified according to gestational age and comparison of monochorionic and dichorionic twins displayed the role of chorionicity for these neurodevelopmental disorders.Conclusions: In our sample the monochorionic twins are associated with an independent risk of neurodevelopmental delay.

Mechanical Ventilation in Preterm Infants: Neurosonographic and Developmental Studies

PEDIATRICS ◽  
1992 ◽  
Vol 90 (4) ◽  
pp. 515-522 ◽  
Author(s):  
Leonard J. Graziani ◽  
Alan R. Spitzer ◽  
Donald G. Mitchell ◽  
Daniel A. Merton ◽  
Christian Stanley ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Early Childhood ◽  
Cerebral Palsy ◽  
Developmental Delay ◽  
Preterm Infants ◽  
Intracranial Hemorrhage ◽  
Apgar Scores ◽  
Mechanically Ventilated ◽  
Increased Risk ◽  
Grade Iii

Surviving preterm infants of less than 34 weeks' gestation who were selected on the basis of serial cranial ultrasonographic findings during their nursery course had repeated neurologic and developmental examinations during late infancy and early childhood that established the presence (n = 46) or absence (n = 205) of spastic forms of cerebral palsy. Of the 205 infants without cerebral palsy, 22 scored abnormally low on standardized developmental testing during early childhood. The need for mechanical ventilation beginning on the first day of life (n = 92) was significantly related to gestational age, birth weight, Apgar scores, patent ductus arteriosus, grade III/IV intracranial hemorrhage, large periventricular cysts, and the development of cerebral palsy. In the 192 mechanically ventilated infants, vaginal bleeding during the third trimester, low Apgar scores, and maximally low Pco2 values during the first 3 days of life were significantly related to large periventricular cysts (n = 41) and cerebral palsy (n = 43), but not to developmental delay in the absence of cerebral palsy (n = 18). The severity of intracranial hemorrhage in mechanically ventilated infants was significantly associated with gestational age and maximally low measurements of Pco2 and pH, but not with Apgar scores or maximally low measurements of Po2. Logistic regression analyses controlling for possible confounding variables disclosed that Pco2 values of less than 17 mm Hg during the first 3 days of life in mechanically ventilated infants were associated with a significantly increased risk of moderate to severe periventricular echodensity, large periventricular cysts, grade III/IV intracranial hemorrhage, and cerebral palsy. Neurosonographic abnormalities were highly predictive of cerebral palsy independent of Pco2 measurements. However, neither hypocarbia nor neurosonographic abnormalities were associated with a significantly increased risk of developmental delay in the absence of cerebral palsy. In this preterm infant population, therefore, the risk factors for developmental delay differed from those predictive of spastic forms of cerebral palsy. Of the 57 ventilated preterm infants who were exposed to a maximally low Pco2 of less than 20 mm Hg at least once during the first 3 days of life, 21 developed large periventricular cysts or cerebral palsy or both. Those results suggest that prenatal and neonatal factors including the need for mechanical ventilation beginning on the first day of life and marked hypocarbia during the first 3 postnatal days are associated with an increased risk of damage to the periventricular white matter of some preterm infants. However, a causal relationship between hypocarbia and brain damage in preterm infants remains unproven.

scholarly journals Reproductive risks in 35-year-old adults born very preterm and/or with very low birth weight: an observational study

2020 ◽  
Author(s):  
Sylvia M. van der Pal ◽  
Sanne A. van der Meulen ◽  
Sophie M. Welters ◽  
Leonhard A. Bakker ◽  
Christianne J. M. de Groot ◽  
...  
Keyword(s):  
Birth Weight ◽  
Pregnancy Complications ◽  
Very Low Birth Weight ◽  
Reproductive Rate ◽  
Elevated Risk ◽  
Dutch Population ◽  
Very Preterm ◽  
Increased Risk ◽  
General Dutch Population ◽  
Fertility Problems

Abstract Evidence suggests that increased survival over the last decades of very preterm (VPT; gestational age < 32 weeks)– and very low birth weight (VLBW; birth weight < 1500 g)–born infants is not matched by improved outcomes. The objective of our study was to evaluate the reproductive rate, fertility, and pregnancy complications in 35-year-old VPT/VLBW subjects. All Dutch VPT/VLBW infants born alive in 1983 and surviving until age 35 (n = 955) were eligible for a POPS-35 study. A total of 370 (39%) subjects completed a survey on reproductive rate, fertility problems, pregnancy complications, and perinatal outcomes of their offspring. We tested differences in these parameters between the VPT/VLBW subjects and their peers from Dutch national registries. POPS-35 participants had less children than their peers in the CBS registry. They reported more problems in conception and pregnancy complications, including a three times increased risk of hypertension during pregnancy. Conclusion: Reproduction is more problematic in 35-year olds born VPT/VLBW than in the general population, possibly mediated by an increased risk for hypertension, but their offspring have no elevated risk for preterm birth. What is known:At age 28, the Dutch national POPS cohort, born very preterm or with a very low birth in 1983, had lower reproductive rates than the general Dutch population (female 23% versus 32% and male 7% versus 22%).What is new:At age 35, the Dutch POPS cohort still had fewer children than the general Dutch population (female 56% versus 74% and male 40% versus 56%). Females in the POPS cohort had a higher risk of fertility problems and pregnancy complications than their peers in the Dutch national registries, but their offspring had no elevated risk for preterm birth.

23 Pulmonary Hypertension Associated with Bronchopulmonary Dysplasia and Neurodevelopmental Outcomes: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e16-e17
Author(s):  
Soumya Thomas ◽  
Prashanth Murthy ◽  
Amuchou Soraisham ◽  
Abhay Lodha
Keyword(s):  
Systematic Review ◽  
Pulmonary Hypertension ◽  
Cerebral Palsy ◽  
Cohort Studies ◽  
Quality Assessment ◽  
Developmental Delay ◽  
Bronchopulmonary Dysplasia ◽  
Neurodevelopmental Outcomes ◽  
Increased Risk ◽  
The Impact

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Pulmonary Hypertension (PH) is estimated to occur in 1 in 4 infants with Bronchopulmonary Dysplasia (BPD). The impact of PH in infants with BPD on their neurodevelopmental (ND) outcomes is uncertain. Objectives This systematic review aims to evaluate whether PH in infants with BPD is associated with ND delay. Design/Methods A systematic literature search was performed to identify studies that reported ND outcomes of infants with BPD (based on NIH definition) and PH (based on echocardiographic findings of PH at 36 weeks PMA). The primary outcome was ND delay in infants with pulmonary hypertension associated with BPD compared with BPD alone. Standardized developmental tests evaluated ND outcomes at 18-24 months corrected age (CA) and three years of age. Quality assessment of the studies was done using the Newcastle-Ottawa Quality Assessment for Cohort studies. Results Three retrospective cohort studies met the inclusion criteria. Two studies reported ND outcomes based on Bayley Scales of Infant and Toddler Development-III Edition in cognitive, language, and motor domains at 18-24 months CA (Table 1 and Figure 1). One study reported outcomes at 3 years, including overall developmental delay (Kyoto Scale of Psychological Development [KSPD] scores &lt; 70) and cerebral palsy. The quality of all 3 studies was rated between good, fair, and poor. Pooled data from the 2 studies reporting outcomes at 18-24 months showed no difference between the 2 infant groups for Bayley cognitive score &lt; 85 (Odds ratio [OR]: 3.78; 95% CI 0.87-16.52), Bayley language score &lt; 85 (OR: 1.19; 95% CI0.57-2.49), and Bayley motor score &lt; 85 (OR: 2.04; 95% CI 0.89-4.67). At 3 years of age, children in the BPD-PH group had an increased risk of developmental delay (DQ &lt; 70 in all areas) compared with the BPD group (OR: 4.37; 95% CI 1.16-16.46), but no difference in the risk of cerebral palsy (OR: 0.57; 95%0.03-12.39). Conclusion PH in BPD is not associated with a developmental delay compared to BPD alone at 18-24 months CA. However, a single study showed infants in BPD-PH had delayed development at 3 years of age. A large prospective cohort study with longer multidisciplinary follow-up is required to confirm this.

scholarly journals Are Extremely Low Gestational Age Newborns Born to Obese Women at Increased Risk of Cerebral Palsy at 2 Years?

2018 ◽  
Vol 33 (3) ◽  
pp. 216-224 ◽  
Author(s):  
Jelske W. van der Burg ◽  
T. Michael O’Shea ◽  
Karl Kuban ◽  
Elizabeth N. Allred ◽  
Nigel Paneth ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Multinomial Logistic Regression ◽  
Obese Women ◽  
Logistic Regression Models ◽  
Prepregnancy Body Mass Index ◽  
Increased Risk ◽  
Extremely Preterm ◽  
Multicenter Prospective Cohort Study ◽  
Risk Ratios ◽  
Multicenter Prospective Cohort

The authors hypothesized that the risk of cerebral palsy at 2 years in children born extremely preterm to overweight and obese women is increased relative to the risk among children born to neither overweight nor obese women. In a multicenter prospective cohort study, the authors created multinomial logistic regression models of the risk of diparetic, quadriparetic, and hemiparetic cerebral palsy that included the prepregnancy body mass index of mothers of 1014 children born extremely preterm, cerebral palsy diagnoses of children at 2 years, as well as information about potential confounders. Overweight and obese women were not at increased risk of giving birth to a child who had cerebral palsy. The risk ratios associated with overweight varied between 1.1 for quadriparesis (95% CI = 0.5, 2.1) to 2.0 for hemiparesis (95% CI = 0.4, 9.8). The risk ratios associated with obesity varied between 0.7 for diparesis (95% CI = 0.2, 2.5) to 2.5 for hemiparesis (95% CI = 0.4, 13).

scholarly journals Outcomes of intraventricular hemorrhage and posthemorrhagic hydrocephalus in a population-based cohort of very preterm infants born to residents of Nova Scotia from 1993 to 2010

2015 ◽  
Vol 15 (6) ◽  
pp. 580-588 ◽  
Author(s):  
Julia A. E. Radic ◽  
Michael Vincer ◽  
P. Daniel McNeely
Keyword(s):  
Cerebral Palsy ◽  
Nova Scotia ◽  
Preterm Infants ◽  
Selection Bias ◽  
Population Based ◽  
Posthemorrhagic Hydrocephalus ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Increased Risk ◽  
Csf Shunting

OBJECT Intraventicular hemorrhage (IVH) is a common complication of preterm birth, and the prognosis of IVH is incompletely characterized. The objective of this study was to describe the outcomes of IVH in a population-based cohort with minimal selection bias. METHODS All very preterm (≥ 30 completed weeks) patients born in the province of Nova Scotia were included in a comprehensive database. This database was screened for infants born to residents of Nova Scotia from January 1, 1993, to December 31, 2010. Among very preterm infants successfully resuscitated at birth, the numbers of infants who died, were disabled, developed cerebral palsy, developed hydrocephalus, were blind, were deaf, or had cognitive/language scores assessed were analyzed by IVH grade. The relative risk of each outcome was calculated (relative to the risk for infants without IVH). RESULTS Grades 2, 3, and 4 IVH were significantly associated with an increased overall mortality, primarily in the neonatal period, and the risk increased with increasing grade of IVH. Grade 4 IVH was significantly associated with an increased risk of disability (RR 2.00, p < 0.001), and the disability appeared to be primarily due to cerebral palsy (RR 6.07, p < 0.001) and cognitive impairment (difference in mean MDI scores between Grade 4 IVH and no IVH: −19.7, p < 0.001). No infants with Grade 1 or 2 IVH developed hydrocephalus, and hydrocephalus and CSF shunting were not associated with poorer outcomes when controlling for IVH grade. CONCLUSIONS Grades 1 and 2 IVH have much better outcomes than Grades 3 or 4, including a 0% risk of hydrocephalus in the Grade 1 and 2 IVH cohort. Given the low risk of selection bias, the results of this study may be helpful in discussing prognosis with families of very preterm infants diagnosed with IVH.

Association between the number of pulls and adverse neonatal/maternal outcomes in vacuum-assisted delivery

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Kyosuke Kamijo ◽  
Daisuke Shigemi ◽  
Mikio Nakajima ◽  
Richard H Kaszynski ◽  
Satoshi Ohira
Keyword(s):  
Logistic Regression ◽  
Postpartum Hemorrhage ◽  
Neonatal Intensive Care ◽  
Multivariable Logistic Regression Analysis ◽  
Maternal Complications ◽  
Logistic Regression Models ◽  
Vaginal Deliveries ◽  
Increased Risk ◽  
Assisted Delivery ◽  
Nicu Admission

Abstract Objectives To determine the association between the number of pulls during vacuum-assisted deliver and neonatal and maternal complications. Methods This was a single-center observational study using a cohort of pregnancies who underwent vacuum-assisted delivery from 2013 to 2020. We excluded pregnancies transitioning to cesarean section after a failed attempt at vacuum-assisted delivery. The number of pulls to deliver the neonate was categorized into 1, 2, 3, and ≥4 pulls. We used logistic regression models to investigate the association between the number of pulls and neonatal intensive care unit (NICU) admission and maternal composite outcome (severe perineal laceration, cervical laceration, transfusion, and postpartum hemorrhage ≥500 mL). Results We extracted 480 vacuum-assisted deliveries among 7,321 vaginal deliveries. The proportion of pregnancies receiving 1, 2, 3, or ≥4 pulls were 51.9, 28.3, 10.8, and 9.0%, respectively. The crude prevalence of NICU admission with 1, 2, 3, and ≥4 pulls were 10.8, 16.2, 15.4, and 27.9%, respectively. The prevalence of NICU admission, amount of postpartum hemorrhage, and postpartum hemorrhage ≥500 mL were significantly different between the four groups. Multivariable logistic regression analysis found the prevalence of NICU admission in the ≥4 pulls group was significantly higher compared with the 1 pull group (adjusted odds ratio, 3.3; 95% confidence interval, 1.4–7.8). In contrast, maternal complications were not significantly associated with the number of pulls. Conclusions Vacuum-assisted delivery with four or more pulls was significantly associated with an increased risk of NICU admission. However, the number of pulls was not associated with maternal complications.

scholarly journals Ten-year trend of care practices, morbidities and survival of very preterm neonates in the Malaysian National Neonatal Registry: a retrospective cohort study

2021 ◽  
Vol 5 (1) ◽  
pp. e001149
Author(s):  
Nem Yun Boo ◽  
Seok Chiong Chee ◽  
Siew Hong Neoh ◽  
Eric Boon-Kuang Ang ◽  
Ee Lee Ang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Neonatal Intensive Care ◽  
Surfactant Therapy ◽  
Preterm Neonates ◽  
Very Preterm ◽  
Increased Risk ◽  
Care Practices

ObjectivesTo determine a 10-year trend of survival, morbidities and care practices, and predictors of in-hospital mortality in very preterm neonates (VPTN, gestation 22 to <32 weeks) in the Malaysian National Neonatal Registry.DesignRetrospective cohort study.Setting43 Malaysian neonatal intensive care units.Patients29 010 VPTN (without major malformations) admitted between 1 January 2009 and 31 December 2018.Main outcome measuresCare practices, survival, admission hypothermia (AH, <36.5°C), late-onset sepsis (LOS), pneumothorax, necrotising enterocolitis grade 2 or 3 (NEC), severe intraventricular haemorrhage (sIVH, grade 3 or 4) and bronchopulmonary dysplasia (BPD).ResultsDuring this 10-year period, there was increased use of antenatal steroid (ANS), lower segment caesarean section (LSCS) and early continuous positive airway pressure (eCPAP); but decreased use of surfactant therapy. Survival had increased from 72% to -83.9%. The following morbidities had decreased: LOS (from 27.9% to 7.1%), pneumothorax (from 6.0% to 2.7%), NEC (from 8.1% to 4.7%) and sIVH (from 12.2% to 7.5%). However, moderately severe AH (32.0°C–35.9°C) and BPD had increased. Multiple logistic regression analyses showed that lower birth weight, no ANS, no LSCS, admission to neonatal intensive care unit with <100 VPTN admissions/year, no surfactant therapy, no eCPAP, moderate and severe AH, LOS, pneumothorax, NEC and sIVH were significant predictors of mortality.ConclusionSurvival and major morbidities had improved modestly. Failure to use ANS, LSCS, eCPAP and surfactant therapy, and failure to prevent AH and LOS increased risk of mortality.

Improved Survival Accounts for Most, but Not All, of the Increase in Bronchopulmonary Dysplasia

PEDIATRICS ◽  
1992 ◽  
Vol 90 (5) ◽  
pp. 663-668 ◽  
Author(s):  
Robert A. Parker ◽  
Daniel P. Lindstrom ◽  
Robert B. Cotton
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Bronchopulmonary Dysplasia ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Hyaline Membrane Disease ◽  
Logistic Regression Models ◽  
Changes In Risk ◽  
Adjusted Incidence ◽  
Minute Apgar Score

The incidence of bronchopulmonary dysplasia (BPD) increased from 10.6% in 1976 through 1980, to 21.7% (1981 through 1985), and to 32.9% (1986 through 1990) in very low birth weight neonates (1500 g or less) admitted to the Vanderbilt Neonatal Intensive Care Unit, while there was a concurrent decline in incidence of neonatal death (NEOD) during the same periods (26.4%, 18.3%, and 15.9%, respectively). Population changes in risk factors (birth weight, sex, race, location of birth, gestational age, diagnosis of hyaline membrane disease, and 5-minute Apgar score) over time do not account for this increase. To estimate the proportion of the increase in BPD attributable to the concurrent decline in NEOD during these periods, separate logistic regression models for NEOD and BPD were calculated from patients born during 1976 through 1985. These results were used to predict the expected number of cases of NEOD and BPD during 1986 through 1990, assuming that the adjusted incidence of NEOD and BPD remained constant from 1976 through 1985, to 1986 through 1990. The increase in the combined outcome, NEOD/BPD, over the three time periods (34.2%, 36.1%, and 43.5%) remained statistically significant after adjustment for the risk factors listed above. During 1986 through 1990, the predicted number of NEOD was 83 more than the number observed, while the predicted number with BPD was 115 less than the number observed. If all 83 averted cases of NEOD during 1986 through 1990 had developed BPD, then 83 (72%) of the 115 excess cases of BPD could be attributed to averted NEOD. The approximate 95% confidence interval for this estimate was 58% to 87%. These results indicate that while most of the excess cases of BPD in 1986 through 1990 could be explained by neonates who previously would have died, there were still additional cases of BPD that were not explained by the risk factors included in this analysis.

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