Comparing Standardized and Parent-Reported Motor Outcomes of Extremely Preterm Infants

Extremely preterm infants are at increased risk of motor impairment. The Canadian Neonatal Follow-Up Network (CNFUN) afforded an opportunity to study the outcomes of extremely preterm children. The purpose of this study was to compare 18-month corrected age (CA) motor outcomes of extremely preterm infants with parent-reported functional outcomes at 3 years CA. CNFUN data of 1376 infants were used to conduct chi-square analyses to compare Bayley-III motor scores (composite, gross, and fine motor) at 18 months CA with parent-reported Ages and Stages Questionnaire motor scores (gross and fine motor) at 3 years CA. The correlation of motor scores at 18-months CA with parent-reported gross and fine motor scores at 3 years CA was also examined. We found that 1 in 5 infants scoring within or above the average range on the Bayley-III had parent-reported functional fine and gross motor difficulties at 3 years CA. Bayley-III scores were only moderately correlated with functional motor outcomes. Results of the study suggest that the Bayley-III at 18 months CA was able to detect the majority of infants with motor problems, but not all; therefore, ongoing follow-up of extremely preterm infants is required. The Bayley-III motor composite score has greater clinical utility compared to sub-scale scores.

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The Risk of Necrotizing Enterocolitis following the Administration of Hyperosmolar Enteral Medications to Extremely Preterm Infants

Neonatology ◽

10.1159/000513169 ◽

2021 ◽

pp. 1-7

Author(s):

Faiza Latheef ◽

Hanna Wahlgren ◽

Helene Engstrand Lilja ◽

Barbro Diderholm ◽

Mattias Paulsson

Keyword(s):

Clinical Practice ◽

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Neonatal Intensive Care ◽

Significant Risk ◽

Quality Register ◽

Increased Risk ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Hyperosmolar Solutions

Introduction: Necrotizing enterocolitis (NEC) is a disease predominantly affecting preterm infants. The administration of hyperosmolar solutions could lead to the development of NEC. The objective of this study was to measure the osmolality of enteral medications used in clinical practice and to assess the risk of NEC following exposure to hyperosmolar medications. Methods: A retrospective cohort study in extremely preterm infants (gestational age <28 weeks) born between 2010 and 2016 at a tertiary neonatal intensive care unit in Sweden. 465 infants were identified via the Swedish Neonatal Quality register. Data relating to enteral administrations received during a two-week period were collected from the medical records. The osmolalities of medications were measured using an osmometer. Logistic regression was used to calculate the odds ratio of developing NEC. Results: A total of 253 patients met the inclusion criteria. The osmolalities of 5 commonly used medications significantly exceeded the recommended limit of 450 mOsm/kg set by the American Academy of Paediatrics (AAP). Most patients (94%) received at least one hyperosmolar medication. No significant risk of developing NEC could be found. Conclusion: The medications used in clinical practice can significantly exceed the limit set by the AAP. This study does not indicate an increased risk of developing NEC in extremely preterm infants following exposure to hyperosmolar medications. Further studies in larger cohorts are needed to determine the specific cut-off level of osmolality in relation to the pathogenesis of NEC.

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Neurodevelopmental Outcomes after Neonatal Mechanical Ventilation

QJM ◽

10.1093/qjmed/hcab113.030 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Eman Ahmed Zaky ◽

Hebatallah AM Shaaban ◽

Mohamed OA Dawoud ◽

Kareem SEF Madbouly ◽

Shaymaa M Deifalla

Keyword(s):

Mechanical Ventilation ◽

Rating Scale ◽

Neurodevelopmental Outcomes ◽

Neurodevelopmental Delay ◽

Increased Risk ◽

Study Results ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Significant Difference

Abstract Background A majority of extremely preterm infants are treated with mechanical ventilation, which is associated with an increased risk for future development of chronic lung disease, neonatal brain damage, and neurodevelopmental impairments. Objectives The aim of the current study was to evaluate the current and follow up neurodevelopmental status of an Egyptian sample of newly and previously discharged mechanically ventilated infants following them up for a period of 6 months for the earlier group and a year for the latter. Patients and Methods The current study was designed to be a descriptive study with retrospective (50 infants) and prospective (50 infants) domains. It was carried out on 100 neonates who were recruited from the Pediatric Neonatology Clinic, Children's Hospital and Neonatal Intensive Care Unit, Ain Shams University using clinical evaluation, Bayley Scales of Infant Development, and Childhood Autism Rating Scale (CARS).. Results There was statistically significant negative correlation between CARS score and Bayley Scale by using Composite Score (Cognitive, Language and Motor) on first assessment and follow up in the Prospective group while no correlation was found in the retrospective group. The study results showed that there was no statistical significant difference between two groups as regards gestational age, gender, residency, consanguinity, maternal disease, maturity, mode of delivery, respiratory distress, duration of stay in NICU, duration on mechanical ventilation, weight on admission, audiometry and fundus examination (P > 0.05). Conclusion Using a mechanical ventilator in the neonatal period for a prolonged duration increased the risk for ASD and neurodevelopmental delay. Future studies on large samples are recommended from multicenters to confirm the validity of such findings, Bayley scale is a predicative for neurodevelopmental delay in neonates with long duration stay at NICU especially preterms with low birth weight.

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Pulmonary and Neurological Follow-Up of Extremely Preterm Infants

Neonatology ◽

10.1159/000297771 ◽

2010 ◽

Vol 97 (4) ◽

pp. 388-394 ◽

Cited By ~ 28

Author(s):

Lex W. Doyle ◽

Peter J. Anderson

Keyword(s):

Preterm Infants ◽

Extremely Preterm ◽

Extremely Preterm Infants

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Shape variability of the central sulcus in the developing brain: a longitudinal descriptive and predictive study in preterm infants.

10.1101/2021.12.15.472770 ◽

2021 ◽

Author(s):

Héloïse de Vareilles ◽

Denis Rivière ◽

Zhongyi Sun ◽

Clara Fischer ◽

François Leroy ◽

...

Keyword(s):

Preterm Infants ◽

Developing Brain ◽

Adult Brain ◽

Fine Motor ◽

Age Group ◽

Shape Features ◽

Central Sulcus ◽

Equivalent Age ◽

Extremely Preterm ◽

Extremely Preterm Infants

Despite growing evidence of links between sulcation and function in the adult brain, the folding dynamics, occurring mostly before normal-term-birth, is vastly unknown. Looking into the development of cortical sulci in babies can give us keys to address fundamental questions: what is the sulcal shape variability in the developing brain? When are the shape features encoded? How are these morphological parameters related to further functional development? In this study, we aimed to investigate the shape variability of the developing central sulcus, which is the frontier between the primary somatosensory and motor cortices. We studied a cohort of 71 extremely preterm infants scanned twice using MRI - once around 30 weeks post-menstrual age (w PMA) and once at term-equivalent age, around 40w PMA -, in order to quantify the sulcus's shape variability using manifold learning, regardless of age-group or hemisphere. We then used these shape descriptors to evaluate the sulcus's variability at both ages and to assess hemispheric and age-group specificities. This led us to propose a description of ten shape features capturing the variability in the central sulcus of preterm infants. Our results suggested that most of these features (8/10) are encoded as early as 30w PMA. We unprecedentedly observed hemispheric asymmetries at both ages, and the one captured at term-equivalent age seems to correspond with the asymmetry pattern previously reported in adults. We further trained classifiers in order to explore the predictive value of these shape features on manual performance at 5 years of age (handedness and fine motor outcome). The central sulcus's shape alone showed a limited but relevant predictive capacity in both cases. The study of sulcal shape features during early neurodevelopment may participate to a better comprehension of the complex links between morphological and functional organization of the developing brain.

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Safety of Allogenic Human Cord Blood Derived Mononuclear Cells for Extreme Preterms Infants at High Risk of Death: A Descriptive Study

10.21203/rs.3.rs-72840/v1 ◽

2020 ◽

Author(s):

Jia Chen ◽

Yabo Mei ◽

Xue Du ◽

Qiuping Li ◽

Zizhen Wang ◽

...

Keyword(s):

High Risk ◽

Cord Blood ◽

Preterm Infants ◽

Mononuclear Cells ◽

Human Umbilical Cord ◽

Risk Of Death ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Risk Potential

Abstract Backgroud Extreme preterm infants are at a high risk for developing preterm complications and death. Despite advances in medical care, many survivors face a lifetime of disability. Objective To assess the short term safety of and four-year follow-up outcomes of allogenic, human umbilical cord blood (hUCB) derived mononuclear cells(MNCs) infusion to extreme preterm infants with high risk potential of death. Method This study was a phase I, open-label, single-arm, single-center trial to evaluate the safety of allogenic, hUCB-MNCs infusion for extreme preterm infants with high risk potential of death. HUCB MNCs characteristics, pre- and postinfusion vital signs and laboratory investigations were recorded. Temporal proﬁles of cytokines and growth factors from blood were test. Clinical data including mortality rates, preterm complications and follow-up outcomes were recorded. Results After processing, relatively MNCs mean (1.9±0.8) ×106/kg; volume mean (11.25±2.12)ml/kg were infused to 10 extremely preterm infants with high risk of death. No adverse effects were noticed during treatment. 40% received extubation and weaned to nasal CPAP successfully; 30% received lower FiO2; no infants suffered from late onset sepsis; 30% received poor response to MNCs infusion. 40% infants suffered from ROP and only one infant needed laser surgery. No patients suffered from NEC after MNCs infusion. All ten infants who received hUCB MNCs infusion survived inhospital and prevent deterioration of clinical features, but 4 infants discharged against the advice of the doctor by their parents and lost connection. Regarding the rest 6 infants, no home oxygen therapy and rehospitalization, no suffered from other long-term respiratory complications at visit 1～visit 3. One infant showed cerebral palsy at visit 1, no clinical evidence associated this with MNCs infusion. Blood level of HGF signiﬁcantly increased, but MMP-9, IL-6, IL-8, TNF-α and TGF-β levels were significantly lower at 24h post infusion compared with baseline (P < 0.05).Conclusions Collection, preparation, and infusion of allogenic hUCB MNCs to extreme preterm infants is feasible and safe. Trial registration The study was registered on Chinese Clinical Trials.gov (NO. ChiCTR–OPN - 15006932). Registered 17 August 2015, http://www.chictr.org.cn/edit.aspx?pid=11662&htm=4.

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Use of Vasopressors in Extremely Preterm Infants in First Week of Life

American Journal of Perinatology ◽

10.1055/s-0041-1729558 ◽

2021 ◽

Author(s):

Parul G. Zaveri ◽

Amanda M. Walker ◽

Kirtikumar Upadhyay ◽

Ajay J. Talati

Keyword(s):

Preterm Infants ◽

Neonatal Intensive Care ◽

Chi Square ◽

Key Points ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Early Use ◽

The Mean ◽

Vasopressor Use ◽

Lower Birthweight

Objective A significant variability exists for diagnosis and treatment of hypotension in extremely preterm infants. Benefits of the use of vasopressors remain unclear. We wanted to identify the risk factors associated with use of vasopressors in the first week of life and their impact on outcomes of extremely preterm infants. Study Design Retrospective review of all newborns ≤28 weeks of gestational age (GA) admitted in neonatal intensive care unit from October 1, 2012 to October 31, 2015 done. Data regarding antenatal and neonatal characteristics and outcomes were recorded. Study infants were divided into two cohorts and compared based on vasopressor use. Chi-square, t-test, and multiple logistic regression were performed as appropriate and significance set at p <0.05. Results Of 213 extremely preterm infants, 90 (42.3%) received vasopressors in first week of life. The mean arterial pressure (MAP) at admission in these infants was significantly lower than that of infants who did not require vasopressors (27 ± 8 vs. 30 ± 6 mmHg, p < 0.05). Vasopressors were initiated within 24 hours in 91% of babies. After controlling for other variables, use of vasopressors was significantly higher in infants with lower birthweight (odds ratio [OR]: 3.2, 95% confidence interval [CI]: 1.6–8.3), 5-minute Apgar's score ≤5 (OR: 1.8, 95% CI: 1.2–3.12), and admission hypothermia (OR: 2.7, 95% CI: 1.3–4.9). The use of vasopressors was significantly associated with severe intraventricular hemorrhage (IVH), even after controlling for other significant variables (OR: 5.9, 95% CI: 1.6–9.3). Conclusion Lower birthweight, low 5-minute Apgar's score, and admission hypothermia are characteristics associated with early use of vasopressors in extremely preterm infants. Infants treated with vasopressors are at a higher risk of developing severe IVH. Key Points

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Influence Of Time Under Mechanical Ventilation On Bronchopulmonary Dysplasia Severity In Extremely Preterm Infants: A Pilot Study.

10.21203/rs.2.23724/v1 ◽

2020 ◽

Author(s):

Vanessa Suziane Probst ◽

Victoria Escobar ◽

Darllyana Soares ◽

Jane Kreling ◽

Ligia Ferrari ◽

...

Keyword(s):

Mechanical Ventilation ◽

Logistic Regression ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Roc Curve ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Chi Square ◽

Extremely Preterm ◽

Extremely Preterm Infants

Abstract The relation between mechanical ventilation (MV) and bronchopulmonary dysplasia (BPD) is well stabilished, but is unknown, however, how much time under MV influences the severity of the disease. Aim: To define the duration under MV with greater chance to develop moderate to severe BPD (M/S BPD) in extremely PTNB and to compare clinical outcomes before and during hospitalization among patients with mild and M/S BPD. Methods: 53 PTNB were separated into mild and M/S BPD groups and their data were analyzed. Time under MV with a greater chance of developing M/S BPD was estimated by the ROC curve. Perinatal and hospitalization outcomes were compared between groups. A logistic regression was performed to verify the influence of variables associated to M/S BPD development, such as pulmonary hypertension (PH), gender, gestational age (GA) and weight at birth, as well the time under MV found with ROC curve. The result of ROC curve was validated using an independent sample (n=16) by Chi-square test. Results: Time under MV related to a greater chance of developing M/S BPD was 36 days. M/S BPD group had more males (14 vs 5, p=0,047), longer time under MV (43 vs 19 days, p<0,001), more individuals with PH (12 vs 3, p=0,016), worse retinopathy of prematurity (grade 3, 2 vs 11, p=0,003), longer hospital length of stay (109 vs 81,5 days, p<0,001), greater PMA (41 vs 38 weeks, p<0,001) and weight (2620 vs 2031 grams, p<0,001) at discharge and the mild BPD group had more CPAP use prior to MV (12 vs 7, p=0,043). Among all variables included in logistic regression, only PH and MV<36 days were significant in the model, explaining 72% of variation in M/S BPD development. In the validation sample, prevalence of preterm infants who needed MV for more than 36 days in the M/S BPD group was 100% (n=6) and 0% in mild BPD group (p=0,0001). Conclusion: Time under MV related to moderate to severe BPD development is 36 days, and worst outcomes are related to disease severity. PH and time under MV for more than 36 days are related to development of M/S BPD.

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Impact of a Multifactorial Educational Training on the Management of Preterm Infants in the Central-Eastern European Region

Frontiers in Pediatrics ◽

10.3389/fped.2021.700226 ◽

2021 ◽

Vol 9 ◽

Author(s):

Philipp Steinbauer ◽

Katrin Klebermass-Schrehof ◽

Francesco Cardona ◽

Katharina Bibl ◽

Tobias Werther ◽

...

Keyword(s):

Preterm Infants ◽

Best Practice ◽

Eastern European ◽

Educational Training ◽

Improved Outcomes ◽

Respiratory Management ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Central Eastern

Background: Differences in management and outcomes of extremely preterm infants have been reported across European countries. Implementation of standardized guidelines and interventions within existing neonatal care facilities can improve outcomes of extremely preterm infants. This study evaluated whether a multifactorial educational training (MET) course in Vienna focusing on the management of extremely preterm infants had an impact on the management of extremely preterm infants in Central-Eastern European (CEE) countries.Methods: Physicians and nurses from different hospitals in CEE countries participated in a two-day MET in Vienna, Austria with theoretical lectures, bedside teaching, and simulation trainings. In order to evaluate the benefit of the workshops, participants had to complete pre- and post-workshop questionnaires, as well as follow-up questionnaires three and twelve months after the MET.Results: 162 participants from 15 CEE countries completed the two-day MET at our department. Less invasive surfactant administration (LISA) was only used by 39% (63/162) of the participants. After the MET, 80% (122/152) were planning to introduce LISA, and 66% (101/152) were planning to introduce regular simulation training, which was statistically significantly increased three and twelve months after the MET. Thirty-six percent and 57% of the participants self-reported improved outcomes three and twelve months after the MET, respectively.Conclusion: Our standardized training in Vienna promoted the implementation of different perinatal concepts including postnatal respiratory management using LISA as well as regular simulation trainings at the participants' home departments. Moreover, our MET contributed to dissemination of guidelines, promoted best-practice, and improved self-reported outcomes.

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Mortality and significant neurosensory impairment in preterm infants: an international comparison

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2021-322288 ◽

2021 ◽

pp. fetalneonatal-2021-322288

Author(s):

Marie Chevallier ◽

Thierry Debillon ◽

Brian A Darlow ◽

Anne R Synnes ◽

Véronique Pierrat ◽

...

Keyword(s):

Preterm Infants ◽

Population Based ◽

Preterm Neonates ◽

Composite Outcome ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Observational Cohort ◽

Baseline Characteristics ◽

French Cohort

ObjectiveTo compare mortality and rates of significant neurosensory impairment (sNSI) at 18–36 months’ corrected age in infants born extremely preterm across three international cohorts.DesignRetrospective analysis of prospectively collected neonatal and follow-up data.SettingThree population-based observational cohort studies: the Australian and New Zealand Neonatal Network (ANZNN), the Canadian Neonatal and Follow-up Networks (CNN/CNFUN) and the French cohort Etude (Epidémiologique sur les Petits Ages Gestationnels: EPIPAGE-2).PatientsExtremely preterm neonates of <28 weeks’ gestation in year 2011.Main outcome measuresPrimary outcome was composite of mortality or sNSI defined by cerebral palsy with no independent walking, disabling hearing loss and bilateral blindness.ResultsOverall, 3055 infants (ANZNN n=960, CNN/CNFUN n=1019, EPIPAGE-2 n=1076) were included in the study. Primary composite outcome rates were 21.3%, 20.6% and 28.4%; mortality rates were 18.7%, 17.4% and 26.3%; and rates of sNSI among survivors were 4.3%, 5.3% and 3.3% for ANZNN, CNN/CNFUN and EPIPAGE-2, respectively. Adjusted for gestational age and multiple births, EPIPAGE-2 had higher odds of composite outcome compared with ANZNN (OR 1.71, 95% CI 1.38 to 2.13) and CNN/CNFUN (OR 1.72, 95% CI 1.39 to 2.12). EPIPAGE-2 did have a trend of lower odds of sNDI but far short of compensating for the significant increase in mortality odds. These differences may be related to variations in perinatal approach and practices (and not to differences in infants’ baseline characteristics).ConclusionsComposite outcome of mortality or sNSI for extremely preterm infants differed across high-income countries with similar baseline characteristics and access to healthcare.

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Accuracy of parent-reported ages and stages questionnaire in assessing the motor and language skills of preterm infants

Journal of Neonatal-Perinatal Medicine ◽

10.3233/npm-200449 ◽

2020 ◽

pp. 1-10

Author(s):

G. Y. H. Hwarng ◽

I. L Ereno ◽

S. K. Ho ◽

J. C. Allen ◽

R. B. Moorakonda ◽

...

Keyword(s):

Standardized Tests ◽

Preterm Infants ◽

Language Skills ◽

Fine Motor ◽

Gross Motor ◽

Preschool Language ◽

Singapore General Hospital ◽

High Negative Predictive Value ◽

Ages And Stages Questionnaire

BACKGROUND: Parent-completed tools like the Ages and Stages Questionnaire Third Edition (ASQ-3) are important in developmental screening. As a screening tool, a high negative predictive value (NPV) is critical to avoid missing the diagnosis of developmental delay. This study evaluated the NPV and accuracy of the ASQ-3 in assessing the development of preterm infants. METHODS: Infants born at <32 weeks and/or <1250 grams, presented to the Neonatal Neurodevelopmental Clinic at the Singapore General Hospital for follow-up from January 2014 –June 2017, at 6, 12, and 18 months corrected age, were included. The ASQ-3 and standardized tests –Peabody Developmental Motor Scale –Second Edition (PDMS-2) and Preschool Language Scale, Fourth Edition UK (PLS-4 UK) –were administered. ASQ-3 gross motor and fine motor scores were compared to PDMS-2 at 6 and 12 months, and ASQ-3 communication scores to PLS-4 UK at 18 months. RESULTS: At 6 months (n = 145), NPV for gross motor and fine motor were 96.4% (accuracy 80.0%) and 95.4% (accuracy 77.2%) respectively. At 12 months (n = 127), NPV for gross motor and fine motor were 88.9% (accuracy 79.8%) and 82.8% (accuracy 74.0%) respectively. At 18 months (n = 113), NPV for language was 56.9% (accuracy 63.7%). CONCLUSIONS: The ASQ-3 showed high NPV and accuracy in screening gross motor and fine motor skills at 6 and 12 months, but not in screening language skills at 18 months. Judicious use of the ASQ-3 may allow for more effective utilization of resources.

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