scholarly journals Short- and Long-Term Neurodevelopmental Outcomes of Very Preterm Infants with Neonatal Sepsis: A Systematic Review and Meta-Analysis

Children ◽  
2019 ◽  
Vol 6 (12) ◽  
pp. 131 ◽  
Author(s):  
Shirley Cai ◽  
Deanne K. Thompson ◽  
Peter J. Anderson ◽  
Joseph Yuan-Mou Yang
Keyword(s):  
Systematic Review ◽  
Preterm Infants ◽  
Neonatal Sepsis ◽  
Meta Analysis ◽  
Continuous Variables ◽  
Neurodevelopmental Outcomes ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Neurodevelopmental Impairment

Sepsis is commonly experienced by infants born very preterm (<32 weeks gestational age and/or <1500 g birthweight), but the long-term functional outcomes are unclear. The objective of this systematic review was to identify observational studies comparing neurodevelopmental outcomes in very preterm infants who had blood culture-proven neonatal sepsis with those without sepsis. Twenty-four studies were identified, of which 19 used prespecified definitions of neurodevelopmental impairment and five reported neurodevelopmental outcomes as continuous variables. Meta-analysis was conducted using 14 studies with defined neurodevelopmental impairment and demonstrated that very preterm infants with neonatal sepsis were at higher risk of impairments, such as cerebral palsy and neurosensory deficits, compared with infants without sepsis (OR 3.18; 95% CI 2.29–4.41). Substantial heterogeneity existed across the studies (I2 = 83.1, 95% CI 73–89). The five studies that reported outcomes as continuous variables showed no significant difference in cognitive performance between sepsis and non-sepsis groups. Neonatal sepsis in very preterm infants is associated with increased risk of neurodevelopmental disability. Due to the paucity of longitudinal follow-up data beyond 36 months, the long-term cognitive effect of neonatal sepsis in very preterm infants could not be conclusively determined. Effects on the development of minor impairment could not be assessed, due to the small numbers of infants included in the studies.

scholarly journals Donor Human Milk Protects against Bronchopulmonary Dysplasia: A Systematic Review and Meta-Analysis

2018 ◽  
Author(s):  
Eduardo Villamor-Martínez ◽  
Maria Pierro ◽  
Giacomo Cavallaro ◽  
Fabio Mosca ◽  
Boris W. Kramer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Human Milk ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Observational Studies ◽  
Meta Analysis ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Donor Human Milk ◽  
Preterm Formula

Bronchopulmonary dysplasia (BPD) is the most common complication after preterm birth. Pasteurized donor human milk (DHM) has increasingly become the standard of care for very preterm infants over the use of preterm formula (PF) if mother&rsquo;s own milk (MOM) is unavailable. Studies have reported beneficial effects of DHM on BPD. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies on the effects of DHM on BPD and other respiratory outcomes. Eighteen studies met the inclusion criteria. Meta-analysis of RCT&rsquo;s could not demonstrate that supplementation of MOM with DHM reduced BPD when compared to PF (3 studies, risk ratio [RR] 0.89, 95% confidence interval [CI] 0.60&ndash;1.32). However, meta-analysis of observational studies showed that DHM supplementation reduced BPD (8 studies, RR 0.78, 95% CI 0.67&ndash;0.90). An exclusive human milk diet reduced the risk of BPD, compared to a diet with PF and/or bovine milk-based fortifier (3 studies, RR 0.80, 95% CI 0.68&ndash;0.95). Feeding raw MOM, compared to feeding pasteurized MOM, protected against BPD (2 studies, RR 0.77, 95% CI 0.62&ndash;0.96). In conclusion, our data suggest that DHM protects against BPD in very preterm infants, but pasteurization of human milk reduces the benefit.

scholarly journals Effect of Family-centered Care Interventions on Motor and Neurobehavior Development of Very Preterm Infants: A Protocol of Systematic Review

2020 ◽  
Author(s):  
Manasa Kolibylu Raghupathy ◽  
Bhamini Krishna Rao ◽  
Shubha R Nayak ◽  
Alicia J Spittle ◽  
Shradha S Parsekar
Keyword(s):  
Systematic Review ◽  
Preterm Infants ◽  
Infant Development ◽  
Data Extraction ◽  
Meta Analysis ◽  
Health Concern ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Very Preterm Infants ◽  
Very Preterm

Abstract Background: Globally, preterm birth is a health concern leading to various developmental difficulties such as poor motor and/or cognitive function. For infants born preterm, FCC promotes developmental skills over the time in an appropriate enriched environment. The purpose of this study is to systematically review and assess the evidence of FCC interventions on motor and neurobehavioral development in very preterm infants. Additionally, this review aims to determine the factors that might affect the infant development.Methods: Systematic review will be carried out by including quasi-experimental controlled trials and randomized controlled trials. Electronic databases such as Scopus, PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, and PsycINFO will be searched using database specific terms. Additionally, searches will be carried out in ProQuest, and references of included studies will be searched. Two review authors, independently, will conduct the screening, data extraction, and critical appraisal of included studies. If possible, meta-analysis will be undertaken to assess the effect of FCC on motor and neurobehavior of premature infants.Conclusion: The review will provide insights regarding the effect of the FCC on preterm infants. This systematic review will guide the clinicians on the feasibility of practicing FCC that might support and promote the integration of parents into various rehabilitation settings.Systematic review registration: Protocol has been submitted to PROSPERO on July 26, 2020.

scholarly journals 42 The Impact of Home Respiratory Support on Developmental Outcomes in Very Preterm Infants

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e17-e18
Author(s):  
Lindsay McRae ◽  
Emily Kieran ◽  
Thuy Mai Luu ◽  
Sandesh Shivananda ◽  
Anne Synnes
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Respiratory Support ◽  
Neurodevelopmental Outcomes ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Neurodevelopmental Impairment ◽  
Grade 3 ◽  
The Impact

Abstract Introduction/Background Bronchopulmonary dysplasia (BPD) is a common complication of extreme prematurity and may require prolonged home respiratory support. BPD is associated with worse neurodevelopmental outcomes but the impact of home respiratory support on neurodevelopmental outcomes, rehospitalization rates and association with caregiver sociodemographics is less well studied. Objectives This study examines the impact of home respiratory support on neurodevelopmental outcomes in very preterm infants at 18-24 months corrected gestational age. Design/Methods This linked Canadian Neonatal Network and Canadian Neonatal Follow-Up Network (CNFUN) multicenter cohort study of infants born April 1, 2009-December 31, 2016 at &lt;29 weeks’ gestational age assessed at 18-24 months corrected age at a CNFUN site compared significant neurodevelopmental impairment rates, rehospitalization rates and sociodemographics in children with and without home respiratory support using Chi-square and student t-tests. Results Of the 3918 infants, 622 (15.9%) received home respiratory support. As expected, infants on home respiratory support had a lower gestational age (mean 25.5 vs 26.5 weeks, p &lt; 0.01), lower birth weight (mean 781 vs 955 grams, p &lt; 0.01), longer NICU stay (mean 118 vs 76 days, p &lt; 0.01) and more comorbidities: late onset sepsis (35.1% vs 22.9%, p &lt; 0.01), NEC ≥ stage 2 (8.9% vs 5.9%, p = 0.01), grade 3-4 IVH or PVL (12.7% vs 8.4%, p &lt; 0.01) and ROP ≥ grade 3 (28% vs 10.8%, p &lt; 0.01). Infants on home respiratory support had higher significant neurodevelopmental impairment rates defined as Bayley-III motor, cognitive, language scores &lt;70, nonambulatory cerebral palsy (GMFCS ≥ 3), hearing and/or visual impairment rates (Table 1), rehospitalization rates (63.3% vs 29.2%, p &lt; 0.01) and &gt;3 rehospitalizations (19.8% vs 5.0%, p &lt; 0.01). With home respiratory support, fewer families had paid employment and more were on social welfare. Conclusion Children born preterm who are discharged home on respiratory support, compared to those without home support, are more likely to experience neurodevelopmental impairment and rehospitalization, and may have an adverse impact on family income. This is important for discharge planning and follow-up care of these high risk children.

Steroid Use for Established Bronchopulmonary Dysplasia: Study Protocol for a Systematic Review and Meta-analysis.

2021 ◽  
Author(s):  
Sabina Strashun ◽  
Joanna Seliga-Siwecka ◽  
Roberto Chioma ◽  
Alessandra Rossi ◽  
Kinga Zielińska ◽  
...  
Keyword(s):  
Systematic Review ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Therapeutic Option ◽  
Meta Analysis ◽  
Grey Literature ◽  
Steroid Treatment ◽  
Brain Maturation ◽  
Neurodevelopmental Outcomes

Abstract BackgroundBronchopulmonary dysplasia (BPD) is a serious chronic respiratory condition that affects approximately 60% of preterm infants born before 27 weeks’ gestation, and leads to both, short and long-term pulmonary and non-pulmonary complications. Infants suffering from BPD are difficult to wean off of respiratory support, delaying feeding advancement and hospital discharge. Postnatal steroids during the first three weeks of life have been demonstrated to be effective in decreasing the incidence of BPD, however concerns in relation to neurodevelopmental outcomes are reported as well. On the contrary, data regarding the use of late postnatal steroids, once BPD is established are sparse and inconsistent. Here, we report a protocol for a systematic review, which aims to determine the efficacy and long-term safety of post-natal steroids for the treatment of established BPD in preterm infants.MethodsMEDLINE, Embase, Cochrane databases and sources of grey literature will be searched with no time or language restriction for studies that evaluated the use of postnatal steroids for preterm infants with established BPD. Odds ratios and 95% confidence intervals will be determined and pooled using a random effects model. For the studies that cannot be combined in the meta-analysis, a narrative synthesis of the results will be provided. DiscussionThe use of steroids as a therapeutic option for established BPD, after reaching the critical phase of the disease, is limited by the concern of possible neurological side effects that were documented for the preventive use of this medication. However, steroid treatment for established BPD may be administered in an attempt to reduce length of stay and home oxygen therapy, which are both associated with high levels of parental stress and healthcare costs. Moreover, a late timing for steroid treatment may show a more favourable safety profile in terms of neurodevelopment outcomes, considering the added postnatal brain maturation of these infants. As BPD is one of the neonatal complications that lack an effective course-modifying treatment approach to-date, the proposed systematic review offers considerable clinical relevance.Systematic review registration The protocol is registered in the PROSPERO register (registration number CRD42021218881).

Outcomes of very preterm infants with neonatal hyperglycaemia: a systematic review and meta-analysis

2021 ◽  
pp. fetalneonatal-2020-321449
Author(s):  
Chandra Prakash Rath ◽  
Madhusudhan Shivamallappa ◽  
Saravanan Muthusamy ◽  
Shripada C Rao ◽  
Sanjay Patole
Keyword(s):  
Systematic Review ◽  
Cohort Studies ◽  
Preterm Infants ◽  
Meta Analysis ◽  
Case Control ◽  
Small Sample ◽  
Adverse Outcomes ◽  
Preterm Neonates ◽  
Very Preterm Infants ◽  
Very Preterm

ObjectiveTo explore the association between hyperglycaemia and adverse outcomes in very preterm infants.DesignSystematic review and meta-analysis. Data were pooled separately for adjusted and unadjusted odds ratios (ORs) using random-effects model. Subgroup analysis was conducted based on study design (cohort and case control).Main outcome measuresAssociation between hyperglycaemia in preterm neonates (<32 weeks or <1500 g) and mortality and morbidities.FindingsForty-six studies (30 cohort and 16 case control) with data from 34 527 infants were included. Meta-analysis of unadjusted ORs from cohort studies found hyperglycaemia to be significantly associated with mortality, any-grade intraventricular haemorrhage (IVH), severe IVH, any-stage retinopathy of prematurity (ROP), severe ROP, sepsis, chronic lung disease and disability. However, pooling of adjusted ORs found significant associations only for mortality (adjusted OR (CI): 2.37 (1.40 to 4.01); I2: 36%; 6 studies), ‘Any grade IVH’ (adjusted OR (CI): 2.60 (1.09 to 6.20); I2: 0%; 2 studies) and ‘Any stage ROP’ (adjusted OR (CI): 3.70 (1.55 to 8.84); I2: 0%; 2 studies). Meta-regression analysis found glucose levels >10 mmol/L to be associated with increased odds of mortality compared with <10 mmol/L. Pooled analysis from case–control studies were similar to cohort studies for most outcomes but limited by small sample size. Longer duration of hyperglycaemia was associated with adverse outcomes. GRADE of evidence was ‘Low’ or ‘Very low’.ConclusionHyperglycaemia in very preterm infants is associated with higher odds of mortality, any-grade IVH and any-stage ROP. A limitation was lack of availability of adjusted ORs from many of the included studies.PROSPERO registration numberCRD42020193016.

scholarly journals Interventions to minimize blood loss in very preterm infants—A systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246353
Author(s):  
Emma Persad ◽  
Greta Sibrecht ◽  
Martin Ringsten ◽  
Simon Karlelid ◽  
Olga Romantsik ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Preterm Infants ◽  
Data Extraction ◽  
Meta Analysis ◽  
Blood Sampling ◽  
Delayed Cord Clamping ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Cord Clamping

Blood loss in the first days of life has been associated with increased morbidity and mortality in very preterm infants. In this systematic review we included randomized controlled trials comparing the effects of interventions to preserve blood volume in the infant from birth, reduce the need for sampling, or limit the blood sampled. Mortality and major neurodevelopmental disabilities were the primary outcomes. Included studies underwent risk of bias-assessment and data extraction by two review authors independently. We used risk ratio or mean difference to evaluate the treatment effect and meta-analysis for pooled results. The certainty of evidence was assessed using GRADE. We included 31 trials enrolling 3,759 infants. Twenty-five trials were pooled in the comparison delayed cord clamping or cord milking vs. immediate cord clamping or no milking. Increasing placental transfusion resulted in lower mortality during the neonatal period (RR 0.51, 95% CI 0.26 to 1.00; participants = 595; trials = 5; I2 = 0%, moderate certainty of evidence) and during first hospitalization (RR 0.70, 95% CI 0.51, 0.96; 10 RCTs, participants = 2,476, low certainty of evidence). The certainty of evidence was very low for the other primary outcomes of this review. The six remaining trials compared devices to monitor glucose levels (three trials), blood sampling from the umbilical cord or from the placenta vs. blood sampling from the infant (2 trials), and devices to reintroduce the blood after analysis vs. conventional blood sampling (1 trial); the certainty of evidence was rated as very low for all outcomes in these comparisons. Increasing placental transfusion at birth may reduce mortality in very preterm infants; However, extremely limited evidence is available to assess the effects of other interventions to reduce blood loss after birth. In future trials, infants could be randomized following placental transfusion to different blood saving approaches. Trial registration: PROSPERO CRD42020159882.

scholarly journals Maternal Vaginal Ureaplasma spp. Colonization in Early Pregnancy Is Associated with Adverse Short- and Long-Term Outcome of Very Preterm Infants

Children ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. 276
Author(s):  
Judith Rittenschober-Böhm ◽  
Tanja Habermüller ◽  
Thomas Waldhoer ◽  
Renate Fuiko ◽  
Stefan M. Schulz ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Early Pregnancy ◽  
Short Term ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Vaginal Colonization ◽  
Short And Long Term

Vaginal colonization with Ureaplasma (U.) spp. has been shown to be associated with adverse pregnancy outcome; however, data on neonatal outcome are scarce. The aim of the study was to investigate whether maternal vaginal colonization with U. spp. in early pregnancy represents a risk factor for adverse short- or long-term outcome of preterm infants. Previously, 4330 pregnant women were enrolled in an observational multicenter study, analyzing the association between vaginal U. spp. colonization and spontaneous preterm birth. U. spp. colonization was diagnosed via PCR analysis from vaginal swabs. For this study, data on short-term outcome were collected from medical records and long-term outcome was examined via Bayley Scales of Infant Development at 24 months adjusted age. Two-hundred-and-thirty-eight children were born <33 weeks gestational age. After exclusion due to asphyxia, malformations, and lost-to-follow-up, data on short-term and long-term outcome were available from 222 and 92 infants, respectively. Results show a significant association between vaginal U. spp. colonization and severe intraventricular hemorrhage (10.4% vs. 2.6%, p = 0.03), retinopathy of prematurity (21.7% vs. 10.3%, p = 0.03), and adverse psychomotor outcome (24.3% vs. 1.8%, OR 13.154, 95%CI 1.6,110.2, p = 0.005). The data suggest an association between vaginal U. spp. colonization in early pregnancy and adverse short- and long-term outcome of very preterm infants.

Sign in / Sign up

Export Citation Format

Share Document