Validation of an MRI Brain Injury and Growth Scoring System in Very Preterm Infants Scanned at 29- to 35-Week Postmenstrual Age

Introduction: Lung ultrasound (LUS) is useful for respiratory management in very preterm infants (VPI), but little is known about the echographic patterns in bronchopulmonary dysplasia (BPD), the relation between the image findings, and the severity of the disease and its long-term outcomes. We aimed to describe LUS patterns in BPD and analyze the accuracy of LUS to predict the need for respiratory support at 36 weeks postmenstrual age (PMA) in VPI. Methods: Preterm infants ≤30.6 weeks of gestational age were recruited. LUS was performed at admission, at 7th, and 28th day of life (DOL) with a standardized protocol (6 zones: anterior, lateral, and posterior fields). Clinical data, respiratory outcomes, and image findings were recorded. Results: Eighty-nine patients were studied. Infants with BPD had significantly higher LUS score at admission, at 7th, and 28th DOL. Patients with BPD exhibited more consolidations and pleural line abnormalities at 7th and 28th DOL than those without BPD (p < 0.001), regardless of the definition used for BPD. LUS at 7th DOL predicted NICHD 2001-BPD with R2 = 0.522; AUC = 0.87 (0.79–0.94), p < 0.001, and Jensen 2019-BPD with R2 = 0.315 (AUC = 0.80 [0.70–0.90], p < 0.001). A model including mechanical ventilation >5 days, oxygen therapy for 7 days and LUS score at 7th DOL accurately predicted the need for respiratory support at 36 weeks PMA (R2 = 0.655, p < 0.001) with an AUC = 0.90 (0.84–0.97), p < 0.001. Conclusion: LUS score, pleural line abnormalities, and consolidations can be useful to diagnose BPD in VPI and to predict its severity after the first week of life.

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Pulse Oximetry Values in Very Preterm infants Asymtomatic at 34-36 weeks post menstrual age.

10.22541/au.160726775.54268285/v1 ◽

2020 ◽

Author(s):

Ignacio Oyarzún ◽

Marcela Diaz ◽

Paulina Toso ◽

Alejandra Zamorano ◽

Soledad Montes ◽

...

Keyword(s):

Pulse Oximetry ◽

Preterm Infants ◽

Premature Infants ◽

Gestational Age ◽

Oxygen Therapy ◽

Healthy Children ◽

Multicentric Study ◽

Very Preterm Infants ◽

Very Preterm ◽

Postmenstrual Age

Background: Oxygen supplementation is an important component for preterm infants neonatal care. Pulse oximetry (SpO2) is essential to guide oxygen therapy. Evidence on SpO2 values in premature infants previous to discharge is limited. Objectives: To establish SpO2 values in asymptomatic premature infants at 34, 35, and 36 weeks postmenstrual age (PMA). Methods: Longitudinal, multicentric study. From May 2018 to May 2019 premature infants born ≤32 weeks gestational age, from three level III NICUs in Santiago, Chile (altitude 579mt), were enrolled. Healthy children without current apnea of prematurity were included. Continuous SpO2 was obtained with Masimo-Radical 7/8 (USA), averaging time 2-4 seconds. Results: 101 SpO2 recordings (n = 44, 33 and 24 at 34, 35 and 36 weeks PMA respectively) from 62 infants. Twenty eight (45%) male, median (range) gestational age at birth 30 (26-32) weeks, median (range) birth weight 1480 (785-2700) g. Oximetry variables for total recordings: mean SpO2, median (range) 96.9 (93.3-99.3); minimum SpO2, median (range) 74 (51-89); time of SpO2 <90%, median (range) 2% (0-10.6%); time of SpO2 <80%, median (range) 0.1% (0-1.3%); desaturation event by ≥4% (DI4) ≥ 0 and ≥ 10 seconds per sample hour, median (range) 45.2 (5.2-115) and median (range) 15 (3.5-62.5) respectively; desaturation event <80% (DI80), median (range) 0.58 (0-10.8). We found no differences between SpO2 values at different weeks PMA. Conclusions: We described SpO2 values in very preterm infants, asymptomatic at 34, 35 and 36 weeks PMA. These values could be used as a reference to guide oxygen therapy previous to discharge.

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Predictive Value of Cranial Ultrasound for Neurodevelopmental Outcomes of Very Preterm Infants with Brain Injury

Chinese Medical Journal ◽

10.4103/0366-6999.229895 ◽

2018 ◽

Vol 131 (8) ◽

pp. 920-926 ◽

Cited By ~ 2

Author(s):

Xue-Hua Zhang ◽

Shi-Jun Qiu ◽

Wen-Juan Chen ◽

Xi-Rong Gao ◽

Ya Li ◽

...

Keyword(s):

Brain Injury ◽

Preterm Infants ◽

Predictive Value ◽

Cranial Ultrasound ◽

Neurodevelopmental Outcomes ◽

Very Preterm Infants ◽

Very Preterm

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Routine Magnetic Resonance Imaging at Term-Equivalent Age Detects Brain Injury in 25% of a Contemporary Cohort of Very Preterm Infants

PLoS ONE ◽

10.1371/journal.pone.0169442 ◽

2017 ◽

Vol 12 (1) ◽

pp. e0169442 ◽

Cited By ~ 13

Author(s):

Vera Neubauer ◽

Tanja Djurdjevic ◽

Elke Griesmaier ◽

Marlene Biermayr ◽

Elke Ruth Gizewski ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Brain Injury ◽

Magnetic Resonance ◽

Preterm Infants ◽

Resonance Imaging ◽

Very Preterm Infants ◽

Equivalent Age ◽

Very Preterm ◽

Routine Magnetic Resonance Imaging

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Altered neonatal white and gray matter microstructure is associated with neurodevelopmental impairments in very preterm infants with high-grade brain injury

Pediatric Research ◽

10.1038/s41390-019-0461-1 ◽

2019 ◽

Vol 86 (3) ◽

pp. 365-374 ◽

Cited By ~ 2

Author(s):

Rachel E. Lean ◽

Rowland H. Han ◽

Tara A. Smyser ◽

Jeanette K. Kenley ◽

Joshua S. Shimony ◽

...

Keyword(s):

Brain Injury ◽

Preterm Infants ◽

Gray Matter ◽

High Grade ◽

Very Preterm Infants ◽

Very Preterm

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Impaired hippocampal development and outcomes in very preterm infants with perinatal brain injury

NeuroImage Clinical ◽

10.1016/j.nicl.2019.101787 ◽

2019 ◽

Vol 22 ◽

pp. 101787 ◽

Cited By ~ 4

Author(s):

Jennifer M. Strahle ◽

Regina L. Triplett ◽

Dimitrios Alexopoulos ◽

Tara A. Smyser ◽

Cynthia E. Rogers ◽

...

Keyword(s):

Brain Injury ◽

Preterm Infants ◽

Perinatal Brain Injury ◽

Very Preterm Infants ◽

Very Preterm ◽

Hippocampal Development

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Early amplitude-integrated EEG correlates with cord TNF-α and brain injury in very preterm infants

Acta Paediatrica ◽

10.1111/j.1651-2227.2008.00787.x ◽

2008 ◽

Vol 97 (7) ◽

pp. 915-919 ◽

Cited By ~ 42

Author(s):

Sverre Wikström ◽

David Ley ◽

Ingrid Hansen-Pupp ◽

Ingmar Rosén ◽

Lena Hellström-Westas

Keyword(s):

Brain Injury ◽

Preterm Infants ◽

Very Preterm Infants ◽

Very Preterm ◽

Tnf Α

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Simplified bedside assessment of pulmonary gas exchange in very preterm infants at 36 weeks’ postmenstrual age

Thorax ◽

10.1136/thoraxjnl-2020-214659 ◽

2021 ◽

pp. thoraxjnl-2020-214659 ◽

Cited By ~ 1

Author(s):

Benjamin Stoecklin ◽

Y Jane Choi ◽

Abhijeet Rakshasbhuvankar ◽

Jenny Svedenkrans ◽

Gareth Jones ◽

...

Keyword(s):

Lung Disease ◽

Disease Severity ◽

Preterm Infants ◽

Receiver Operating Curve ◽

Very Preterm Infants ◽

Very Preterm ◽

Oxyhaemoglobin Dissociation Curve ◽

Receiver Operating Curve Analysis ◽

Postmenstrual Age ◽

Lung Disease Severity

IntroductionWe aimed to develop and validate a prediction table for a simplified measure of rightward shift of the fetal oxyhaemoglobin saturation (SpO2) versus inspired oxygen pressure (PIO2) curve as an objective marker of lung disease severity in very preterm infants, independent of unit altitude or oxygen prescribing policies.MethodsVery preterm infants (n=219) had an oxygen reduction test at median (IQR) test age of 354 (345–360) weeks’ postmenstrual age (PMA). Shift was derived from at least three paired SpO2 versus PIO2 measurements using a computer algorithm, using the fetal oxyhaemoglobin dissociation curve as the reference. Linear regression of resultant shift values enabled construction of a table to predict shift using a single paired SpO2 versus PIO2 measurement, validated subsequently in a separate infant cohort using Bland-Altman analysis. Receiver operating curve analysis provided threshold values equating to a clinical diagnosis of mild bronchopulmonary dysplasia (BPD) or moderate to severe BPD.ResultsThe median (IQR) age of 63 infants in the validation cohort was 360 (356–362) weeks’ PMA. Mean difference (95% CI) between predicted and measured shift was 2.1 (−0.8% to 4.9%) with wide limits of agreement (−20.7% to 24.8%). Predicted shift >10.1 kPa identified mild BPD with 71% sensitivity and 88% specificity while values>13.0 kPa identified moderate to severe BPD with 81% sensitivity and 100% specificity.DiscussionShift predicted from a single paired SpO2 versus PIO2 measurement using our validated table enables objective bedside screening of lung disease severity in very preterm infant cohorts at 36 weeks’ PMA.

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The Association between Evidence-Based Healthcare Practices and Outcomes among Preterm Births in China

Neonatology ◽

10.1159/000519846 ◽

2021 ◽

pp. 1-7

Author(s):

Di Jin ◽

Xinyue Gu ◽

Siyuan Jiang ◽

Yanchen Wang ◽

Tongling Yang ◽

...

Keyword(s):

Brain Injury ◽

Preterm Infants ◽

Gestational Age ◽

Early Death ◽

Evidence Based ◽

Severe Brain Injury ◽

Evidence Based Practices ◽

Very Preterm Infants ◽

Very Preterm ◽

Evidence Based Healthcare

Introduction: Very preterm infants are at high risk of early death or severe brain injury, with potential for impaired long-term neurodevelopmental function and physical health. There are evidence-based healthcare practices that can reduce the incidence. Materials and Methods: Infants born at 24–316 weeks gestational age and admitted within 24 h to NICUs participating in the Chinese Neonatal Network in 2019 were included. We examined the association between 4 evidence-based practices: inborn (born in a tertiary hospital in the Chinese Neonatal Network), ACS (any antenatal corticosteroid), MgSO4 (prenatal magnesium sulfate), and NT (normothermic temperature [36.0–37.5°C] at admission) and early death and/or severe brain injury in the study population. Results: Of 6,035 eligible infants, the incidence of early death and/or severe brain injury was 10.6%. Exposure to ACS only was associated with significant lower incidence of death and/or severe brain injury than none (aOR, 0.71; 95% CI: 0.57–0.88), but not MgSO4 only (aOR, 0.97; 95% CI: 0.81–1.17), NT only (aOR, 0.91; 95% CI: 0.76–1.08), or inborn only (aOR, 0.91; 95% CI: 0.72–1.15). The association between number of practices and incidence of early death and/or severe brain injury is as follows: none = 23% (31/138), any 1 = 14% (84/592), any 2 = 12% (185/1,538), any 3 = 9% (202/2,285), and all 4 = 9% (140/1,482). Discussion/Conclusion: More comprehensive use of evidence-based practices was associated with improved survival without severe brain injury among very preterm infants born at <32 weeks gestational age.

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When does prone sleeping improve cardiorespiratory status in preterm infants in the NICU?

SLEEP ◽

10.1093/sleep/zsz256 ◽

2019 ◽

Vol 43 (4) ◽

Cited By ~ 2

Author(s):

Kelsee L Shepherd ◽

Stephanie R Yiallourou ◽

Alexsandria Odoi ◽

Emma Yeomans ◽

Stacey Willis ◽

...

Keyword(s):

Preterm Infants ◽

Respiratory Function ◽

Sleep Position ◽

Prone Positioning ◽

Quiet Sleep ◽

Very Preterm Infants ◽

Very Preterm ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Postmenstrual Age

Abstract Study Objectives Preterm infants undergoing intensive care are often placed prone to improve respiratory function. Current clinical guidelines recommend preterm infants are slept supine from 32 weeks’ postmenstrual age, regardless of gestational age at birth. However, respiratory function is also related to gestational and chronological ages and is affected by sleep state. We aimed to identify the optimal timing for adopting the supine sleeping position in preterm infants, using a longitudinal design assessing the effects of sleep position and state on cardiorespiratory stability. Methods Twenty-three extremely (24–28 weeks’ gestation) and 33 very preterm (29–34 weeks’ gestation) infants were studied weekly from birth until discharge, in both prone and supine positions, in quiet and active sleep determined by behavioral scoring. Bradycardia (heart rate ≤100 bpm), desaturation (oxygen saturation ≤80%), and apnea (pause in respiratory rate ≥10 s) episodes were analyzed. Results Prone positioning in extremely preterm infants reduced the frequency of bradycardias and desaturations and duration of desaturations. In very preterm infants, prone positioning only reduced the frequency of desaturations. The position-related effects were not related to postmenstrual age. Quiet sleep in both preterm groups was associated with fewer bradycardias and desaturations, and also reduced durations of bradycardia and desaturations in the very preterm group. Conclusions Cardiorespiratory stability is improved by the prone sleep position, predominantly in extremely preterm infants, and the improvements are not dependent on postmenstrual age. In very preterm infants, quiet sleep has a more marked effect than the prone position. This evidence should be considered in individualizing management of preterm infant positioning.

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