scholarly journals The Effect of Severe Intraventricular Hemorrhage on the Biorhythms of Feeding in Premature Infants

2021 ◽  
Vol 9 ◽  
Author(s):  
Ira H. Gewolb ◽  
Babatunde T. Sobowale ◽  
Frank L. Vice ◽  
Abhijit Patwardhan ◽  
Nino Solomonia ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Premature Infants ◽  
Intraventricular Hemorrhage ◽  
Neurological Injury ◽  
Independent Effect ◽  
Neurologic Injury ◽  
Developmentally Regulated ◽  
Postmenstrual Age ◽  
Feeding Rhythms ◽  
Grade 3

Background: Suck-swallow rhythmicity and the integration of breathing into infant feeding are developmentally regulated. Neurological injury and breathing abnormalities can both impact feeding in preterm infants.Objective: To determine the effects of neurologic injury independent of effects of disordered breathing on feeding biorhythms in premature infants.Methods: Low-risk preterm infants (LRP), infants with Grade 3–4 Intraventricular Hemorrhage (IVH), those with bronchopulmonary dysplasia (BPD), and those with both BPD and IVH (BPD+IVH) were identified. Forty-seven infants, 32–42 weeks Postmenstrual Age (PMA) were evaluated on one or more occasions (131 studies). Of these, 39 infants (81 studies) were performed at >35 weeks PMA. Coefficient of variation (COV) (=standard deviation of the inter-event (e.g., suck-suck, swallow-breath, etc.) interval divided by the mean of the interval) was used to quantify rhythmic stability.Results: To adjust for PMA, only those infants >35–42 weeks were compared. Suck-suck COV was significantly lower (more rhythmically stable) in the LRP group [COV = 0.274 ± 0.051 (S.D.)] compared to all other groups (BPD = 0.325 ± 0.066; IVH = 0.342 ± 0.072; BPD + IVH = 0.314 ± 0.069; all p < 0.05). Similarly, suck-swallow COV was significantly lower in LRP babies (0.360 ± 0.066) compared to the BPD group (0.475 ± 0.113) and the IVH cohort (0.428 ± 0.075) (p < 0.05). The BPD+IVH group (0.424 ± 0.109), while higher, was not quite statistically significant.Conclusions: Severe IVH negatively impacts suck-suck and suck-swallow rhythms. The independent effect of neurological injury in the form of IVH on feeding rhythms suggests that quantitative analysis of feeding may reflect and predict neurological sequelae.

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

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.

The role of intracranial hypotension in neonatal intraventricular hemorrhage

1983 ◽  
Vol 58 (2) ◽  
pp. 204-209 ◽  
Author(s):  
E. Scott Conner ◽  
Antonio V. Lorenzo ◽  
Keasley Welch ◽  
Brent Dorval
Keyword(s):  
Preterm Infants ◽  
Premature Infants ◽  
Intracranial Hypotension ◽  
Intraventricular Hemorrhage ◽  
Rabbit Model ◽  
Germinal Matrix ◽  
Content Type ◽  
Ventricular Hemorrhage ◽  
Fine Print

✓ Most preterm infants develop transient intracranial hypotension, which reaches its lowest level on the 2nd day of life. This corresponds to the time when most neonatal intraventricular hemorrhage (IVH) occurs. In order to test the hypothesis that intracranial hypotension may have an etiological role in the development of IVH in premature infants, the authors induced intracranial hypotension in the preterm rabbit by the intraperitoneal injection of glycerol. The rabbit model is well suited for this study because this animal is at risk of developing spontaneous germinal matrix and ventricular hemorrhage. Compared to control littermates, the glycerol-treated animals exhibited a greater than 3.5-fold incidence of germinal matrix and intraventricular hemorrhage.

Early Detection of Delayed Myelination in Preterm Infants

PEDIATRICS ◽  
1989 ◽  
Vol 84 (3) ◽  
pp. 407-411
Author(s):  
Margot van de Bor ◽  
Gerard L. Guit ◽  
Anneke M. Schreuder ◽  
John Wondergem ◽  
G. Jan Vielvoye
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Preterm Infants ◽  
Intraventricular Hemorrhage ◽  
Periventricular Leukomalacia ◽  
Resonance Imaging ◽  
Term Infants ◽  
Postmenstrual Age ◽  
The Central Nervous System ◽  
Delayed Myelination

Myelination of the central nervous system can be demonstrated with magnetic resonance imaging. The influence of periventricular-intraventricular hemorrhage and periventricular leukomalacia on cerebral myelination was studied using magnetic resonance imaging. The subjects were 33 preterm infants of less than 30 weeks' gestation studied at 44 weeks' postmenstrual age: 11 infants with periventricular-intraventricular hemorrhage, 7 with periventricular leukomalacia, and 15 without periventricular-intraventricular hemorrhage or periventricular leukomalacia. There were no differences in mean gestational age and birth weight between the three groups. However, infants without periventricular-intraventricular hemorrhage or periventricular leukomalacia had significantly less respiratory distress syndrome. At 44 weeks postmenstrual age, infants with periventricular leukomalacia had a significantly delayed myelination pattern (stage M2) in comparison with infants without periventricular-intraventricular hemorrhage or periventricular leukomalacia and infants with periventricular-intraventricular hemorrhage (stages M3 and M4). The latter two groups had myelination stages that were similar to those of healthy term infants at 44 weeks' postmenstrual age. The results demonstrate that periventricular leukomalacia causes delayed myelination of the cerebrum, whereas periventricular-intraventricular hemorrhage does not.

Behavioral Organization in Infants with Intraventricular Hemorrhage: Characteristics and Clinical Implications

2018 ◽  
Vol 37 (5) ◽  
pp. 310-318
Author(s):  
Vanessa Maziero Barbosa ◽  
Jean Powlesland
Keyword(s):  
Preterm Infants ◽  
Intraventricular Hemorrhage ◽  
Brain Lesion ◽  
Clinical Implications ◽  
Behavioral Regulation ◽  
Behavioral Organization ◽  
Postmenstrual Age ◽  
Low Threshold ◽  
Over Time

PurposeThis study examined the neurobehavioral functioning in preterm infants diagnosed with intraventricular hemorrhage (IVH) grades III and IV, using the Assessment of Preterm Infants’ Behavior (APIB).Design and SampleThe APIB was completed on nine infants with IVH III/IV at 36 and 40weeks postmenstrual age to determine the effects of IVH on the neurobehavioral functioning and maturation over time. The APIB neurobehavioral scores (i.e., physiologic, motor, state, attention/interaction, regulatory, and examiner facilitation subsystem scores) were examined in relation to the two different testing times and to infants without lesion.ResultsAPIB scores at 36weeks suggested easily disorganized and poorly modulated behavioral regulation and low threshold of disorganization and stress. At 40 weeks, poor overall behavioral regulation persisted; only motor differences statistically improved between the two ages. Neurobehavior was significantly poor in all but state subsystems when tested at both ages in infants with a brain lesion.

scholarly journals Circulating glucocorticoid bioactivity and serum cortisol concentrations in premature infants: the influence of exogenous glucocorticoids and clinical factors

2007 ◽  
Vol 156 (5) ◽  
pp. 577-583 ◽  
Author(s):  
Päivi Nykänen ◽  
Taneli Raivio ◽  
Kirsti Heinonen ◽  
Olli A Jänne ◽  
Raimo Voutilainen
Keyword(s):  
Preterm Infants ◽  
Premature Infants ◽  
Treatment Strategies ◽  
Serum Cortisol ◽  
Treatment Modalities ◽  
Clinical Factors ◽  
Glucocorticoid Treatment ◽  
Improve Treatment ◽  
Antenatal Steroids ◽  
Postmenstrual Age

Objective: Glucocorticoids are widely used before preterm delivery and in preterm infants may bear serious adverse effects. Better knowledge about the circulating glucocorticoid milieu after glucocorticoid treatment could improve treatment modalities. Therefore, we investigated the influence of exogenous glucocorticoids and clinical factors on serum cortisol (F) levels and circulating glucocorticoid bioactivity (GBA) in preterm infants. Design: Eighty-nine infants (gestational age (GA) 23.6–33.1 weeks at birth) were enrolled in a prospective cohort study in two tertiary neonatal centres. Methods: Cord, day of birth (D0), fourth day (D4) and 36 weeks postmenstrual age serum F and GBA levels were measured. Results: The cord GBA was 5.8-fold and D0 GBA 2.3-fold higher in the infants exposed to antenatal steroids within 12 h before birth when compared with those unexposed or exposed >7 days before birth (95% CI 3.8–8.6; P<0.0001, and 1.8–3.0; P<0.0001 respectively). In the infants treated with early postnatal dexamethasone, D4 GBA was 1.7-fold (1.3–2.2; P<0.0005) higher when compared with levels in the infants without this treatment. Clinical factors indicating perinatal distress, such as Apgar scores <7 and low GA, were associated with higher cord, D0 and D4 serum F levels. Conclusions: Both ante- and postnatally administered glucocorticoids increase circulating GBA not attributable to endogenous F. Perinatal distress and preceding glucocorticoid treatment need to be taken into account when circulating glucocorticoid milieu is evaluated in preterm infants. The GBA assay may prove to be a useful instrument in the development of new glucocorticoid treatment strategies.

scholarly journals Early pulmonary hypertension is a risk factor for bronchopulmonary dysplasia-associated late pulmonary hypertension in extremely preterm infants

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hyun Ho Kim ◽  
Se In Sung ◽  
Mi Sun Yang ◽  
Yea Seul Han ◽  
Hye Seon Kim ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Risk Factor ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Odds Ratio ◽  
Intraventricular Hemorrhage ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Grade 3 ◽  
Ventilator Care

AbstractThis study evaluated whether early pulmonary hypertension (PH) in extremely preterm infants (EPIs) at 22–27 weeks of gestation detected clinically with echocardiography at 4–7 postnatal days (PND) is a risk factor for death before 36 weeks post-menstrual age (PMA) or late PH in moderate or severe (m/s) bronchopulmonary dysplasia (BPD) (BPD-PH). We analyzed risk factors for death before 36 weeks PMA or BPD-PH. Among 247 EPIs enrolled, 74 (30.0%) had early PH. Twenty-one (28.4%) infants with early PH and 18 (10.4%) without early PH died before 36 weeks PMA; 14 (18.9%) infants with early PH and 9 (5.2%) without early PH had BPD-PH at 36–38 weeks PMA. Multivariate analysis revealed that early PH (adjusted odds ratio, 6.55; 95% confidence interval, 3.10–13.82, P < 0.05), clinical chorioamnionitis (2.50; 1.18–5.31), intraventricular hemorrhage (grade 3–4) (3.43; 1.26–9.37), and late sepsis (6.76; 3.20–14.28) independently increased the risk of development of death before 36 weeks PMA or BPD-PH. Subgroup analysis among m/s BPD patients revealed that early PH (4.50; 1.61–12.58) and prolonged invasive ventilator care (> 28 days) (4.91; 1.02–23.68) increased the risk for late PH independently. In conclusion, EPIs with early PH at 4–7 PND should be monitored for BPD-associated late PH development.

Global incidence of intraventricular hemorrhage among extremely preterm infants: a systematic literature review

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Csaba Siffel ◽  
Kristin D. Kistler ◽  
Sujata P. Sarda
Keyword(s):  
North America ◽  
Literature Review ◽  
Preterm Infants ◽  
Systematic Literature Review ◽  
Gestational Age ◽  
Intraventricular Hemorrhage ◽  
Population Based ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Grade 3

Abstract Objectives To conduct a systematic literature review to evaluate the global incidence of intraventricular hemorrhage grade 2–4 among extremely preterm infants. Methods We performed searches in MEDLINE and Embase for intraventricular hemorrhage and prematurity cited in English language observational studies published from May 2006 to October 2017. Included studies analyzed data from infants born at ≤28 weeks’ gestational age and reported on intraventricular hemorrhage epidemiology. Results Ninety-eight eligible studies encompassed 39 articles from Europe, 31 from North America, 25 from Asia, five from Oceania, and none from Africa or South America; both Europe and North America were included in two publications. The reported global incidence range of intraventricular hemorrhage grade 3–4 was 5–52% (Europe: 5–52%; North America: 8–22%; Asia: 5–36%; Oceania: 8–13%). When only population-based studies were included, the incidence range of intraventricular hemorrhage grade 3–4 was 6–22%. The incidence range of intraventricular hemorrhage grade 2 was infrequently documented and ranged from 5–19% (including population-based studies). The incidence of intraventricular hemorrhage was generally inversely related to gestational age. Conclusions Intraventricular hemorrhage is a frequent complication of extremely preterm birth. Intraventricular hemorrhage incidence range varies by region, and the global incidence of intraventricular hemorrhage grade 2 is not well documented.

Anemia of Prematurity and Oral Feeding Milestones in Premature Infants

2019 ◽  
Author(s):  
Sreekanth Viswanathan ◽  
Sudarshan Jadcherla
Keyword(s):  
Hospital Stay ◽  
Study Design ◽  
Premature Infants ◽  
Intraventricular Hemorrhage ◽  
Supplemental Oxygen ◽  
Oral Feeding ◽  
Feeding Problems ◽  
Anemia Of Prematurity ◽  
Postmenstrual Age ◽  
Per Oral

Abstract Objective Anemia of prematurity (AOP) and oral feeding problems are common in premature infants. This study aimed to determine the influence of AOP on aerodigestive outcomes and the duration to full Per Oral (PO). Study Design Prospectively collected data on premature infants who initiated oral feeds at ≤ 34 weeks' postmenstrual age were examined. Infants were categorized into “AOP+” and “AOP−” based on hematocrit at initial PO, that is, < 29 or ≥ 29%. Results Forty-four infants in AOP+ compared with 74 in AOP−. AOP+ infants had lower birth gestation and weight (p < 0.001). The anthropometrics at initial PO were similar. AOP+ had lower mean hematocrit and higher oxygen need at initial PO, and at full PO (p < 0.05). AOP+ reached full PO at a later gestation and took longer days from initial PO to full PO (p < 0.01). BPD, intraventricular hemorrhage (IVH ≤ 2), and hospital stay were greater in the AOP+ (p < 0.05). After adjusting for covariates, initial PO hematocrit was not predictive of time to full PO [hazard ratio 1.3 (CI 0.88–2.0), p = 0.18]. Conclusion AOP is not independently associated with the duration to full PO. Supplemental oxygen for associated comorbidities may have compensated for the underlying anemia.

Value of Cranial Ultrasound and Magnetic Resonance Imaging in Predicting Neurodevelopmental Outcome in Preterm Infants

PEDIATRICS ◽  
1992 ◽  
Vol 90 (2) ◽  
pp. 196-199
Author(s):  
Margot van de Bor ◽  
Lya den Ouden ◽  
Gerard L. Guit
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Preterm Infants ◽  
Predictive Factor ◽  
Intraventricular Hemorrhage ◽  
Periventricular Leukomalacia ◽  
Neurodevelopmental Outcome ◽  
Cranial Ultrasound ◽  
Resonance Imaging ◽  
Postmenstrual Age

In this prospective study, cranial ultrasound was performed to detect periventricular-intraventricular hemorrhage and periventricular leukomalacia in 33 preterm infants of less than 32 weeks' gestation. At 44 weeks postmenstrual age magnetic resonance imaging was performed to detect the stage of myelination. Neurodevelopmental outcome was assessed at 3 years of age in 31 children (2 children died in the first year of life). Significant correlations were found between neurodevelopmental outcome and ultrasound findings (χ2 = 32.8; P &lt; .0001) and stage of myelination (χ2 = 20.5; P &lt; .0005). To establish the criterion with the best predictive factor, multiple regression analysis was performed with outcome as dependent variable and periventricular-intraventricular hemorrhage, periventricular leukomalacia, and stage of myelination as independent variables. It appeared that the detection of periventricular leukomalacia with ultrasound showed the best predictive factor for neurodevelopmental outcome. Routine magnetic resonance imaging at 44 weeks postmenstrual age should not be performed just for the purpose of predicting neurodevelopmental outcome more reliably.

Retinopathy of Prematurity and other Ocular Problems in Premature Infants Weighing less than 1500 g at Birth

2002 ◽  
Vol 12 (6) ◽  
pp. 506-511 ◽  
Author(s):  
I.C. Asproudis ◽  
S.K. Andronikou ◽  
E.A. Hotoura ◽  
C.D. Kalogeropoulos ◽  
G.K. Kitsos ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Premature Infants ◽  
Retinopathy Of Prematurity ◽  
Intraventricular Hemorrhage ◽  
Neonatal Intensive Care ◽  
Ocular Motility ◽  
Refractive Errors ◽  
Ophthalmological Examination ◽  
Retinal Hemorrhages

Purpose To estimate the incidence of retinopathy of prematurity and other ocular problems in a population of preterm infants. Methods This retrospective study included all infants with gestational age (GA) <32 weeks and birth weight (BW) <1500 g cared for in the neonatal intensive care unit (NICU) over a period of nine years (1992–2000). Ophthalmological examination was started the 4th week of life and included refractive examination, examination of the cornea and funduscopy under mydriasis. An ocular motility test was done after the 2nd month. Results The study included 194 infants. Stage I and II retinopathy occurred in 51 infants but regressed spontaneously. Five of the 194 (2.5%) had to undergo cryopexy. Optic disc atrophy was observed in association with peri-intraventricular hemorrhage (PIIVH) (grade IV) in seven infants. Fifteen infants (7.7%) had retinal hemorrhages which were absorbed by three months of age. Almost 20% of the study infants developed high refractive errors and 13.4% strabismus. Conclusions Not only retinopathy of prematurity, but other serious ocular problems were observed in this population of preterm infants. The role of PIIVH III-IV in the pathogenesis of certain ocular problems needs further elucidation.

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