scholarly journals Association Between Blood Gas Within 1week of Life and Bronchopulmonary Dysplasia in Preterm Infants With Less Than 32 Gestational Weeks

2020 ◽  
Author(s):  
Xiaoya Han ◽  
Xiaolin Miao ◽  
Limin Guo ◽  
Na Li ◽  
Cun Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Clinical Characteristics ◽  
Independent Risk Factor ◽  
P Value ◽  
Blood Gas ◽  
Increased Risk ◽  
Close Relationship

Abstract Objective: This study tested wether preterm infants of ＜32 gestational weeks (GWs) with a blood gas derangement within 7days of life are at increased risk for moderate and severe bronchopulmonary dysplasia (BPD). Method: 236 preterm infants with ＜32 GWs from January of 2017 to December of 2019 were included in this study. First, univariate analysing determined wether there existed associations between BPD (moderate and severe) and blood gas values, clinical characteristics, interventions, daily given liquid and eneregy within 7days of life. Then multivarariate regession analysis was performed to know wether there were relationships between BPD (moderate and severe) and risk factors between which and BPD (moderate and severe) univariate analysing showed that P value was less than 0.1. Results: From univariate analysing, we found that PaO2, PaCO2 and HCO3 in 7th day of life, cesarean section (OR=0.508, 95%CI:0.275-0.94), getational age (GA, OR=0.163, 95%CI:0.077-0.344), birth weight (BW, OR=0.122, 95%CI:0.054-0.273), PDA (OR=2.839, 95%CI:1.1463-5.508), early onset infection (OR=3.00, 95%CI:1.483-6.069), and mechanical ventilation (MV, OR=4.562, 95%CI:2.405-8.653) were significantly associated with moderate and severe BPD. Because there existed close relationship between GA and BW (R=0.642, P=0.000) and BW dispersion was big in this group, we excluded BW in multivariate analysing. From multivariate analysing, besides GA (Exp (B)=0.176, 95%CI:0.08-0.389) , MV (Exp (B)=3.515, 95%CI:1.746-7.076), PaO2 (Exp (B)=0.468, 95%CI:0.226-0.969) in 7th day of life was the independent risk factor for moderate and severe BPD in the preterm infants of ＜32 GWs.Conclusion: Preterm infants of ＜32GWs with blood gas derangements within 7days of life could be at risk of moderate and severe BPD.

scholarly journals Hyperkalemia Was an Independent Risk Factor for Death While Under Mechanical Ventilation Among Children Hospitalized With Diarrhea in Bangladesh

2018 ◽  
Vol 5 ◽  
pp. 2333794X1775400 ◽  
Author(s):  
Fahmida Chowdhury ◽  
Probir Kumar Ghosh ◽  
K. M. Shahunja ◽  
Abu S. M. S. B. Shahid ◽  
Lubaba Shahrin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Risk Factor ◽  
Poisson Regression ◽  
Clinical Characteristics ◽  
Independent Risk Factor ◽  
Diarrhoeal Disease ◽  
Disease Research ◽  
Robust Poisson Regression

Objectives. We sought to evaluate the admission and hospital risk factors for death in children with diarrhea requiring mechanical ventilation (MV). Methods. This was a retrospective study. We enrolled children aged 0 to 59 months admitted with diarrhea to the intensive care unit of the Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) between August 2009 and July 2013 and required MV. To evaluate the risk factors for death in MV, we compared the clinical and laboratory characteristics of the children requiring MV. We matched up to the clinical characteristics presented on admission and subsequently developed before MV during hospital stay with the survivors and deaths of children having MV. Results. Among 73 enrolled children, 58 (80%) died. Incidence of death in MV was higher among children having hyperkalemia ( P ≤ .001), hypoglycemia ( P ≤ .001), and metabolic acidosis ( P = .06) on admission and lower in children having tracheal isolates ( P ≤ .001) during hospitalization. After adjusting for covariates by using multivariate robust Poisson regression, children with hyperkalemia (incidence ratio = 1.34; P = .03; confidence interval = 1.02-1.76) on admission was the only independent risk factor for death of children with MV. Conclusion. Children with hyperkalemia on admission and subsequently requiring MV were more likely to die compared with those without hyperkalemia.

scholarly journals Cytokines and Exhaled Nitric Oxide Are Risk Factors in Preterm Infants for Bronchopulmonary Dysplasia

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Zhenjie Zhang ◽  
Wuchen Wu ◽  
Lian Hou ◽  
Jingjing Jiang ◽  
Weilin Wan ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Risk Factors ◽  
Mechanical Ventilation ◽  
High Risk ◽  
Disease Severity ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Exhaled Nitric Oxide ◽  
High Risk Factors ◽  
Tnf Α

Bronchopulmonary dysplasia (BPD) is the most common complication of extremely preterm birth. This study was aimed at detecting cytokine and fractional exhaled nitric oxide (FeNO) levels to evaluate their mechanisms and predicted significance for BPD. Preterm infants born at g e s t a t i o n a l   a g e ≤ 32   w e e k s were recruited, and clinical data were collected. We detected ten cytokines, including IFN-γ, IL-10, IL-12p70, IL-13, IL-1β, IL-2, IL-4, IL-6, IL-8, and TNF-α on Days 1–3, Days 7–14, and Days 21–28 after birth by using the Meso Scale Discovery (MSD) technology. The FeNO levels of infants were measured when they met the discharge criteria. A total of 46 preterm infants were enrolled, consisting of 14 infants in BPD group and 32 infants in the 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) were lower in the BPD group. The following were high-risk factors for BPD, as determined by multivariate logistic regression analysis: g e s t a t i o n a l   a g e < 30   w e e k s , b i r t h   w e i g h t < 1000   g , PDA, longer mechanical ventilation, and higher FeNO. The cytokines of IL-6 and IL-8 on Days 7–14 and IL-4, IL-6, IL-8, and TNF-α on Days 21–28 were also high-risk factors for BPD. IL-6 contributed to BPD disease severity. Conclusion. The preterm infants with PDA and prolonged mechanical ventilation tended to develop BPD. The IL-6 and IL-8 were significantly increased on Days 7–14 and were high-risk factors for BPD. Moreover, the IL-6 level was associated with BPD disease severity. We speculated that NO was related to BPD via Th2 cell-mediated inflammatory responses such as IL-4 and IL-6. Cytokines might predict the occurrence of BPD.

Duration of mechanical ventilation and neurodevelopment in preterm infants

2019 ◽  
Vol 104 (6) ◽  
pp. F631-F635 ◽  
Author(s):  
Roos J S Vliegenthart ◽  
Anton H van Kaam ◽  
Cornelieke S H Aarnoudse-Moens ◽  
Aleid G van Wassenaer ◽  
Wes Onland
Keyword(s):  
Mechanical Ventilation ◽  
Regression Analysis ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Gestational Age ◽  
Invasive Mechanical Ventilation ◽  
Multivariate Logistic Regression Analysis ◽  
Neurodevelopmental Outcomes ◽  
Respiratory Management ◽  
Increased Risk

ObjectiveTo investigate the association between invasive mechanical ventilation (IMV) duration and long-term neurodevelopmental outcomes in preterm infants in an era of restricted IMV.DesignRetrospective cohort study.SettingSingle neonatal intensive care unit in Amsterdam.PatientsAll ventilated patients with a gestational age between 24 and 30 weeks born between 2010 and 2015.Main outcome measuresNeurodevelopmental impairment (NDI) at 24 months corrected age (CA). Data on patient characteristics, respiratory management, neonatal morbidities, mortality and bronchopulmonary dysplasia were collected. The relationship between IMV duration and NDI was determined by multivariate logistic regression analysis.ResultsDuring the study period, 368 admitted infants received IMV for a median duration of 2 days. Moderate and severe bronchopulmonary dysplasia was diagnosed in 33% of the infant. Multivariate regression analysis with adjustment for gestational age, small for gestational age and socioeconomic status showed a significant association between every day of IMV and NDI at 24 months CA (adjusted OR [aOR] 1.08, 95% CI 1.004 to 1.16, p=0.04). This association only reached borderline significance when also adjusting for severe neonatal morbidity (aOR 1.08, 95% CI 1.00 to 1.17, p=0.05).ConclusionEven in an era of restricted IMV, every additional day of IMV in preterm infants is strongly associated with an increased risk of NDI at 24 months CA. Limiting IMV should be an important focus in the treatment of preterm infants.

scholarly journals The association between clinical and biochemical characteristics of late-onset sepsis and bronchopulmonary dysplasia in preterm infants

2021 ◽  
Author(s):  
Melania E. Ebrahimi ◽  
Michelle Romijn ◽  
Roos J. S. Vliegenthart ◽  
Douwe H. Visser ◽  
Anton H. van Kaam ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Gestational Age ◽  
Late Onset ◽  
Multivariate Logistic Regression Analysis ◽  
Biochemical Characteristics ◽  
Late Onset Sepsis ◽  
Early Onset Sepsis ◽  
Increased Risk

AbstractStudies in preterm infants have shown an association between late-onset sepsis (LOS) and the development of bronchopulmonary dysplasia (BPD). It is unknown whether clinical or biochemical characteristics during sepsis modulate the risk for BPD. This single-center retrospective cohort study included all patients with a gestational age < 30 weeks, born between 2009 and 2015, in whom empiric antimicrobial treatment was initiated > 72 h after birth and continued for at least 5 days, independent on microbiological results. The association between clinical and biochemical characteristics of LOS and the development of BPD in survivors were assessed with multivariate logistic regression analysis adjusted for early-onset sepsis, small for gestational age, and gestational age. Of the 756 admitted infants, 256 infants (mean GA: 27.0 weeks; birthweight: 924 grams) had at least one LOS episode, of whom 79 (30.9%) developed BPD. Analyses showed that only the need for and duration of mechanical ventilation during LOS were independently associated with an increased risk for BPD (adjusted OR 2.62, 95% CI 1.38, 4.96, p value 0.003, and OR 1.004, 95% CI 1.00, 1.007, p value 0.045, respectively).Conclusion: During a LOS, the need for and duration of mechanical ventilation are independently associated with the risk of developing BPD in preterm infants. What is Known:• Premature infants diagnosed with a late-onset sepsis are at higher risk of developing bronchopulmonary dysplasia• This association is mainly shown in infants with a positive blood culture What is New:• This study investigates the clinical and biochemical characteristics of late-onset sepsis and the development of bronchopulmonary dysplasia• The need for mechanical ventilation and duration of mechanical ventilation during late-onset sepsis are associated with an increased risk of developing bronchopulmonary dysplasia.

scholarly journals Necrotizing enterocolitis and the microbiome: Current status and future directions

2020 ◽  
Author(s):  
Robert Thänert ◽  
Eric C Keen ◽  
Gautam Dantas ◽  
Barbara B Warner ◽  
Phillip I Tarr
Keyword(s):  
Risk Factors ◽  
Preterm Infant ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Clinical Characteristics ◽  
Gastrointestinal Disorder ◽  
Current Status ◽  
Future Directions ◽  
Barrier Integrity ◽  
Microbial Dysbiosis

Abstract Decades of research have failed to define the pathophysiology of necrotizing enterocolitis (NEC), a devastating pediatric gastrointestinal disorder of preterm infants. However, recent evidence suggests that host-microbiota interactions, in which microbial dysbiosis is followed by loss of barrier integrity, inflammation, and necrosis, are central to NEC development. Thus, greater knowledge of the preterm infant microbiome could accelerate attempts to diagnose, treat, and prevent NEC. Here, we summarize clinical characteristics of and risk factors for NEC, the structure of the pre-event NEC microbiome, how this community interfaces with host immunology, and microbiome-based approaches that might prevent or lessen the severity of NEC in this very vulnerable population.

scholarly journals Examining the possible causal relationship between lung function, COPD and Alzheimer’s disease: a Mendelian randomisation study

2021 ◽  
Vol 8 (1) ◽  
pp. e000759
Author(s):  
Daniel Higbee ◽  
Raquel Granell ◽  
Esther Walton ◽  
Roxanna Korologou-Linden ◽  
George Davey Smith ◽  
...  
Keyword(s):  
Risk Factors ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Lung Function ◽  
Causal Relationship ◽  
Mendelian Randomisation ◽  
P Value ◽  
Unmeasured Confounding ◽  
Increased Risk ◽  
Shared Risk

RationaleLarge retrospective case-control studies have reported an association between chronic obstructive pulmonary disease (COPD), reduced lung function and an increased risk of Alzheimer’s disease. However, it remains unclear if these diseases are causally linked, or due to shared risk factors. Conventional observational epidemiology suffers from unmeasured confounding and reverse causation. Additional analyses addressing causality are required.ObjectivesTo examine a causal relationship between COPD, lung function and Alzheimer’s disease.MethodsUsing two-sample Mendelian randomisation, we used single nucleotide polymorphisms (SNPs) identified in a genome wide association study (GWAS) for lung function as instrumental variables (exposure). Additionally, we used SNPs discovered in a GWAS for COPD in those with moderate to very severe obstruction. The effect of these SNPs on Alzheimer’s disease (outcome) was taken from a GWAS based on a sample of 24 807 patients and 55 058 controls.ResultsWe found minimal evidence for an effect of either lung function (OR: 1.02 per SD; 95% CI 0.91 to 1.13; p value 0.68) or liability for COPD on Alzheimer’s disease (OR: 0.97 per SD; 95% CI 0.92 to 1.03; p value 0.40).ConclusionNeither reduced lung function nor liability COPD are likely to be causally associated with an increased risk of Alzheimer’s, any observed association is likely due to unmeasured confounding. Scientific attention and health prevention policy may be better focused on overlapping risk factors, rather than attempts to reduce risk of Alzheimer’s disease by targeting impaired lung function or COPD directly.

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.

Effects of fetal haemoglobin on systemic oxygenation in preterm infants and the development of retinopathy of prematurity PacIFiHER Report No. 2

2021 ◽  
pp. bjophthalmol-2021-319546
Author(s):  
Kim Jiramongkolchai ◽  
Michael X Repka ◽  
Jing Tian ◽  
Sue W Aucott ◽  
Jennifer Shepard ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Preterm Infants ◽  
Retinopathy Of Prematurity ◽  
Neonatal Intensive Care ◽  
Blood Gas ◽  
Dissociation Curve ◽  
Fetal Haemoglobin ◽  
Oxyhaemoglobin Dissociation Curve ◽  
Increased Risk ◽  
Oxygenation Indices

Background/aimsFetal haemoglobin (HbF) has an oxyhaemoglobin dissociation curve that may affect systemic oxygenation and the development of retinopathy of prematurity (ROP). The study aim is to characterise the effects of HbF levels on systemic oxygenation and ROP development.MethodsProspective study conducted from 1 September 2017 through 31 December 2018 at the Johns Hopkins NICU. Preterm infants with HbF measured at birth, 31, 34 and 37 weeks post-menstrual age (PMA), complete blood gas and SpO2 recorded up to 42 weeks PMA, and at least one ROP exam were included.ResultsSixty-four preterm infants were enrolled. Higher HbF was associated with significantly higher SpO2, lower PCO2, lower FiO2 from birth to 31 weeks PMA and 31 to 34 weeks PMA (rs=0.51, rs=−0.62 and rs=−0.63; p<0.0001 and rs=0.71, rs=−0.58 and rs=−0.79; p<0.0001, respectively). To maintain oxygen saturation goals set by the neonatal intensive care unit, higher median FiO2 was required for HbF in the lowest tercile from birth compared with HbF in the highest tercile to 31 weeks and 31 to 34 weeks PMA; FiO2=35 (21–100) versus 21 (21–30) p<0.006 and FiO2=30 (28–100) versus 21 (21–30) p<0.001, respectively. Preterm infants with ROP had poorer indices of systemic oxygenation, as measured by median levels of SpO2 and PCO2, and lower levels of HbF (p<0.039 and p<0.0001, respectively) up to 34 weeks PMA.ConclusionLow HbF levels correlated with poor oxygenation indices and increased risk for ROP. O2 saturation goals to prevent ROP may need to incorporate relative amount of HbF.

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