scholarly journals Predicting Long-Term Respiratory Outcomes in Premature Infants: Is It Time to Move beyond Bronchopulmonary Dysplasia?

Children ◽  
2020 ◽  
Vol 7 (12) ◽  
pp. 283
Author(s):  
Deepak Jain ◽  
Alexander Feldman ◽  
Subhasri Sangam
Keyword(s):  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Respiratory Health ◽  
Perinatal Care ◽  
Factors Affecting ◽  
Modifiable Factors ◽  
Definition Of ◽  
Respiratory Outcomes ◽  
The Impact

Premature birth has been shown to be associated with adverse respiratory health in children and adults; children diagnosed with bronchopulmonary dysplasia (BPD) in infancy are at particularly high risk. Since its first description by Northway et al. about half a century ago, the definition of BPD has gone through several iterations reflecting the changes in the patient population, advancements in knowledge of lung development and injury, and improvements in perinatal care practices. One of the key benchmarks for optimally defining BPD has been the ability to predict long-term respiratory and health outcomes. This definition is needed by multiple stakeholders for hosts of reasons including: providing parents with some expectations for the future, to guide clinicians for developing longer term follow-up practices, to assist policy makers to allocate resources, and to support researchers involved in developing preventive or therapeutic strategies and designing studies with meaningful outcome measures. Long-term respiratory outcomes in preterm infants with BPD have shown variable results reflecting not only limitations of the current definition of BPD, but also potentially the impact of other prenatal, postnatal and childhood factors on the respiratory health. In this manuscript, we present an overview of the long-term respiratory outcomes in infants with BPD and discuss the role of other modifiable or non-modifiable factors affecting respiratory health in preterm infants. We will also discuss the limitations of using BPD as a predictor of respiratory morbidities and some of the recent advances in delineating the causes and severity of respiratory insufficiency in infants diagnosed with BPD.

scholarly journals Bronchopulmonary Dysplasia: Can We Agree on a Definition?

2018 ◽  
Vol 35 (06) ◽  
pp. 537-540 ◽  
Author(s):  
Deepak Jain ◽  
Eduardo Bancalari
Keyword(s):  
Respiratory Failure ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Nasal Cannula ◽  
Clinical Practices ◽  
Unique Challenge ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Respiratory Outcomes

AbstractThe advances in obstetric and neonatal care over the last half century have resulted in changes in pathophysiology and clinical presentation of bronchopulmonary dysplasia (BPD). In contrast to the original description of BPD by Northway et al as a severe lung injury in relatively mature preterm infants, the most common form of BPD currently is characterized by chronic respiratory insufficiency in extremely preterm infants. This evolution in the presentation of BPD, along with changes in respiratory support strategies such as increased use of nasal cannula oxygen, has presented a unique challenge to find a definition that describes the severity of lung damage and predict the long-term respiratory outcomes with some accuracy.The limitations of current definitions of BPD include inconsistent correlation with long-term respiratory outcomes, inability to classify infants dying from severe respiratory failure prior to 36 weeks' postmenstrual age, and potential inappropriate categorization of infants on nasal cannula oxygen or with extrapulmonary causes of respiratory failure. In the long term, the aim for a new definition of BPD is to develop a classification based on the pathophysiology and objective lung function evaluation providing a more accurate assessment for individual patients. Until then, a consensus definition that encompasses current clinical practices, provides reasonable prediction of later respiratory outcomes, and is relatively simple to use should be achieved.

scholarly journals Predictors of Developmental and Respiratory Outcomes Among Preterm Infants With Bronchopulmonary Dysplasia

2021 ◽  
Vol 9 ◽  
Author(s):  
Iris Morag ◽  
Efrat Barkai ◽  
Yaara Wazana ◽  
Arnon Elizur ◽  
Orly Levkovitz Stern ◽  
...  
Keyword(s):  
Environmental Factors ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Learning Algorithm ◽  
Medical Center ◽  
Factors Affecting ◽  
Lifestyle Questionnaire ◽  
Severe Group ◽  
Respiratory Outcomes ◽  
Postnatal Factors

Objectives: To examine the importance of perinatal and postnatal environmental factors on developmental and respiratory outcomes among preterm infants with bronchopulmonary dysplasia (BPD).Methods: Preterm infants (<32 weeks of gestation) born at a single tertiary medical center between 2012 and 2015 were included. Development was assessed at 12 months corrected age. Parents retrospectively completed a health and lifestyle questionnaire reviewing their child's health during the first 2 years of life. A linear regression model was applied to assess the effect of various perinatal and postnatal factors on development. A machine-learning algorithm was trained to assess factors affecting inhaler use.Results: Of 398 infants meeting the inclusion criteria, 208 qualified for the study: 152 (73.1%) with no BPD, 40 (19.2%) with mild BPD, and 16 (7.7%) with moderate-severe BPD. Those in the moderate-severe group were more likely to be male, have mothers who were less educated, and require longer ventilation periods and less time to regain birth weight. They were also more likely to have mothers with asthma/allergies and to have a parent who smoked. Those in the moderate-severe BPD group exhibited significantly lower developmental scores (85.2 ± 16.4) than the no-BPD group (99.3 ± 10.9) and the mild BPD group (97.8 ± 11.7, p < 0.008) as well as more frequent inhaler use (p = 0.0014) than those with no or mild BPD. In addition to perinatal factors, exposure to breast milk, income level and daycare attendance positively affected development. Exposure to cigarette smoke, allergies among family members and daycare attendance proved to be important factors in inhaler use frequency.Conclusions: Postnatal environmental factors are important in predicting and modifying early childhood outcomes among preterm infants.

scholarly journals Association of Newer Definitions of Bronchopulmonary Dysplasia with Pulmonary Hypertension and Long-Term Outcomes

2021 ◽  
Author(s):  
Jae Kyoon Hwang ◽  
Seung Han Shin ◽  
Ee-Kyung Kim ◽  
Seh Hyun Kim ◽  
Han-Suk Kim
Keyword(s):  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Multiple Logistic Regression Analysis ◽  
Respiratory Illness ◽  
Long Term Outcomes ◽  
Postmenstrual Age ◽  
Study Population ◽  
Grade 3 ◽  
Definition Of

Abstract The diagnostic criteria of bronchopulmonary dysplasia (BPD) have been reassessed based on current practices and highest accuracy in predicting long-term outcomes. We investigated the association between BPD severity based on different definitions in terms of long-term outcomes and pulmonary arterial hypertension (PAH). This retrospective study enrolled preterm infants born at <32 weeks of gestation. The definition of BPD recommended by the National Institutes of Health in 2001, National Institute of Child Health and Human Development (NICHD) in 2018, and Jensen et al. in 2019 were used. The association between re-hospitalization due to respiratory illness, neurodevelopmental impairment (NDI) at a corrected age of 18–24 months, and PAH at a postmenstrual age (PMA) of 36 weeks with the severity of BPD based on these three definitions were evaluated. Among 354 infants, gestational age (26.9 weeks) and birth weight (730 g) were lowest in severe BPD based on NIH 2001 definition. In total, 14.1% of study population experienced NDI and 19.0% were re-hospitalized due to respiratory illness. Multiple logistic regression analysis showed that the adjusted odds ratio (OR) for re-hospitalization was highest in grade-3 BPD of the Jensen (2019) criteria (7.45). The adjusted OR for NDI (13.23) and PAH (40.37) were also highest in grade-3 of the Jensen (2019) criteria.Conclusion: Based on recently suggested criteria, severity of BPD is associated with long-term outcomes and PAH at PMA of 36 weeks in preterm infants.

scholarly journals Public reporting of performance measures in long-term care in Canada: does it make a difference?

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Poldrugovac ◽  
J E Amuah ◽  
H Wei-Randall ◽  
P Sidhom ◽  
K Morris ◽  
...  
Keyword(s):  
Performance Measures ◽  
Performance Indicators ◽  
Long Term Care ◽  
Public Reporting ◽  
Policy Implications ◽  
Term Care ◽  
Factors Affecting ◽  
Care Facilities ◽  
The Impact

Abstract Background Evidence of the impact of public reporting of healthcare performance on quality improvement is not yet sufficient to draw conclusions with certainty, despite the important policy implications. This study explored the impact of implementing public reporting of performance indicators of long-term care facilities in Canada. The objective was to analyse whether improvements can be observed in performance measures after publication. Methods We considered 16 performance indicators in long-term care in Canada, 8 of which are publicly reported at a facility level, while the other 8 are privately reported. We analysed data from the Continuing Care Reporting System managed by the Canadian Institute for Health Information and based on information collection with RAI-MDS 2.0 © between the fiscal years 2011 and 2018. A multilevel model was developed to analyse time trends, before and after publication, which started in 2015. The analysis was also stratified by key sample characteristics, such as the facilities' jurisdiction, size, urban or rural location and performance prior to publication. Results Data from 1087 long-term care facilities were included. Among the 8 publicly reported indicators, the trend in the period after publication did not change significantly in 5 cases, improved in 2 cases and worsened in 1 case. Among the 8 privately reported indicators, no change was observed in 7, and worsening in 1 indicator. The stratification of the data suggests that for those indicators that were already improving prior to public reporting, there was either no change in trend or there was a decrease in the rate of improvement after publication. For those indicators that showed a worsening trend prior to public reporting, the contrary was observed. Conclusions Our findings suggest public reporting of performance data can support change. The trends of performance indicators prior to publication appear to have an impact on whether further change will occur after publication. Key messages Public reporting is likely one of the factors affecting change in performance in long-term care facilities. Public reporting of performance measures in long-term care facilities may support improvements in particular in cases where improvement was not observed before publication.

scholarly journals Early High-dose Caffeine Improves Respiratory Outcomes in Preterm Infants

Children ◽  
2021 ◽  
Vol 8 (6) ◽  
pp. 501
Author(s):  
Vineet Lamba ◽  
Oscar Winners ◽  
Prem Fort
Keyword(s):  
Mechanical Ventilation ◽  
Preterm Infants ◽  
Regression Models ◽  
High Dose ◽  
Long Term Outcomes ◽  
Logistic Regression Models ◽  
Caffeine Citrate ◽  
Timing Of Initiation ◽  
Respiratory Outcomes

The objective of the study is to determine if early high-dose caffeine (HD) therapy is associated with shorter duration of mechanical ventilation, bronchopulmonary dysplasia (BPD), or decreased need for mechanical ventilation. We conducted a single center, retrospective cohort study of 273 infants less than 32 weeks gestational age (GA). Infants receiving early HD (10 mg/kg/day maintenance) caffeine citrate started within 24 h of life were compared with those receiving LD (6 mg/kg/day) with variable timing of initiation using linear and logistic regression models. The infants in the early HD group had 91.4 (95% confidence interval (CI): −166.6, −16.1; p = 0.018) less hours of mechanical ventilation up to 36 weeks PMA or discharge as compared with the LD group. Moreover, infants in the HD group had 0.37 (95% CI: 0.14, 0.97; p = 0.042) times lower odds of developing moderate/severe BPD compared with the LD group. Infants receiving early HD caffeine had improved respiratory outcomes with no increase in measured comorbidities. Large prospective studies are needed to determine the long-term outcomes of using high-dose caffeine prophylaxis for preterm infants.

Neighborhood Disadvantage and Early Respiratory Outcomes in Very Preterm Infants with Bronchopulmonary Dysplasia.

2021 ◽  
Author(s):  
Juliette Deschamps ◽  
Mohamed Boucekine ◽  
Laurence Fayol ◽  
Jean Christophe Dubus ◽  
Steve Nauleau ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Neighborhood Disadvantage ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Respiratory Outcomes

Perinatal Care at the Threshold of Viability

PEDIATRICS ◽  
1995 ◽  
Vol 96 (5) ◽  
pp. 974-976
Author(s):  
◽  
◽  
◽  
Keyword(s):  
Perinatal Care ◽  
Survival Rates ◽  
Extremely Low Birth Weight ◽  
Low Birth Weight Infants ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Obstetric Management ◽  
The Cost ◽  
The Impact

The survival rate for infants at the threshold of viability has been improving. However, there are insufficient data regarding the cost(s) of initial and ongoing care of these infants and the long-term outcome of survivors. Furthermore, there has been little study of the impact of obstetric management on the survival rates of extremely low birth weight infants and on long-term morbidities. Continued research on these issues is imperative, and physicians need to remain informed of changing statistics.

THE PROBLEMS OF THE INVESTIGATOR’S FORENSIC THINKING FORMATION

2021 ◽  
pp. 68-73
Author(s):  
Руслан Юрьевич Павлов
Keyword(s):  
Cognitive Abilities ◽  
Educational Process ◽  
Criminal Cases ◽  
Factors Affecting ◽  
Factors Associated ◽  
Personal Qualities ◽  
Definition Of ◽  
The Impact ◽  
Objective Investigation

Актуальность статьи связана с поиском новых способов и методов повышения эффективности борьбы с преступностью, оперативного раскрытия преступлений, а также с набирающим популярность среди криминалистов направлением «криминалистического мышления», овладение навыками которого будет способствовать наиболее полноценному и объективному расследованию уголовных дел. Проблемным в настоящее время является недостаточное качество следствия и необходимость повышения когнитивных способностей следователей (дознавателей). Задачей исследования являлось выявление факторов, влияющих на развитие и формирование криминалистического мышления следователей. Цель работы - провести анализ составных частей процесса становления следователя и особенностей его практической деятельности, влияющих на когнитивные способности с точки зрения криминалистики, путем изучения и сравнения имеющихся материалов по данной тематике. Анализу подвергнуты личностные качества следователя, особенности образовательного процесса и влияние опыта на результаты работы, а также факторы, сопутствующие следственной деятельности (организация труда, уровень стресса, нагрузки и т. д.). Результат проведенного исследования выражен в определении проблемных факторов, влияющих на формирование криминалистического мышления следователя (дознавателя) и возможных путей их преодоления, важности такого мышления, которое остается знанием, постоянно сориентированным в сторону практики. The relevance of the article is related to the search for new ways and methods to improve the effectiveness of the fight against crime, the prompt detection of crimes, as well as the trend of «forensic thinking», which is gaining popularity among criminalists, mastering the skills of which will contribute to the most complete and objective investigation of criminal cases. Problems at present are insufficient quality of investigation and the need to improve the cognitive abilities of investigators (inquirers). The task of the study was to identify factors that influence the development and formation of forensic thinking of investigators. The purpose of the work is- to analyze the components of the process of formation of an investigator and features of his practical activities affecting the cognitive abilities in terms of forensics by studying and comparing existing materials on this topic. The analysis is subjected to the personal qualities of an investigator, the peculiarities of the educational process and the impact of experience on the results of work, as well as factors associated with the investigative activity (organization of work, stress and stress levels, etc.). The result of the study is expressed in the definition of problematic factors affecting the formation of forensic thinking of an investigator (inquirer) and possible ways to overcome them, the importance of such thinking, which remains knowledge, constantly oriented towards practice

scholarly journals Studies of the Logistics Services Market: Information and Analytical Support and a System of Statistical Indicators

2020 ◽  
pp. 5-11
Author(s):  
N. HRYNCHAK
Keyword(s):  
Medium Term ◽  
Secondary Sources ◽  
The Core ◽  
Logistics Services ◽  
Rational Management ◽  
Definition Of ◽  
Definition Of Information ◽  
The Impact ◽  
Statistical Indicators

Information and analytical database for the market support is required to prevent communications of contradictory information to higher levels of management, with adverse effects for the process of taking rational management decisions. The article’s objective is to substantiate the information and analytical support for studies of the logistics services market, with constructing a system of statistical indicators for this market assessment, to be laid as the solid basis for elaborating medium-term and long-term strategies and policies of the logistics services market in Ukraine.  A definition of information and analytical support for studies of the logistics services market is given; a review of secondary sources of data for this market studies is made. A conceptual model for information and analytical studies of the logistics services market is proposed. The key statistical indicators for studies of this market are identified, with substantiating the feasibility of their use in computing multivariate indicators for the assessment of performance and capacities of the logistics services market in Ukraine. The core criteria to be met by the abovementioned system of statistical indicators are highlighted. A system of statistical indicators for the assessment of the logistics services market is proposed, containing four modules. It allows for diagnosis of this market performance and tendencies, with accounting for the impact of other related markets and activities, and for forecasting. This system, constructed with consideration to the global practice, is designed for comprehensive studies of the logistics services market.

scholarly journals NEUROPHYSIOLOGICAL AND NEUROPSYCHOLOGICAL FEATURES AT PATIENTS FROM OCCUPATIONAL NOISE-INDUCED HEARING LOSS

2019 ◽  
Vol 98 (10) ◽  
pp. 1068-1073
Author(s):  
Oksana I. Shevchenko ◽  
D. V. Rusanova ◽  
O. L. Lakhman
Keyword(s):  
Latent Period ◽  
Cognitive Activity ◽  
Functional Condition ◽  
Long Term Memory ◽  
Term Memory ◽  
Diagnostic Signs ◽  
Constant Potential ◽  
Definition Of ◽  
The Impact

Introduction. Issues of studying the central origins and development of оccupational pathology in the faces of flight personnel define a need for the application of neurophysiological and neuropsychological methods of research. Material and methods. The levels of constant potential (LCP), characteristics the somatosensory caused potentials (SSVP), neuropsychological features in 95 patients with оccupational neurosensory deafness (ONSD) and 35 cases in a group of comparison are studied. Methods of the statistical analysis with a definition of W-of criterion of Shapiro-Uilka, Mann-Whitney›s U-criterion, coefficient of correlation of Spirmen, the discriminant analysis are applied. Results. in ONSD at patients the quantity of cases with the increased values of average LCP were established to prevail significantly in comparison with those in patients of a group of comparison (39% and 13% respectively, р = 0.03), strengthening of neuropower exchange in right and left frontal, central, left central, left parietal, right temporal assignments, increase in duration of the latent period of N18, N30 components are registered (р < 0.05). The condition of the cognitive sphere was characterized by the easily expressed violations of functions of analytical and synthetic thinking, оral-aural memory, visual, long-term memory, reciprocal coordination, impressive speech. Correlation connection between the index of N13-N20 and indices characterizing a condition of long-term memory, reciprocal coordination, the expressional speech is established (rs=0.45; 0.28; 0.28 at р =0.008; 0.04; 0.03 respectively), an index the between hemispheres of the relations Fd-Fs and latency of P25 and N30 (rs = 0.53 and 0.29 at р =0.009; 0.02 respectively). Diagnostic signs of brain deficiency at patients with ONSD were indices of visual gnosis, reciprocal coordination, LCP in right central, central parietal assignments of a brain, duration of the latent period of N30, N18-N20 (F=9.14; 5.43; 6.08; 4.41 4.77; 4.34 respectively). Conclusions. Violations of power metabolism in the frontal and central and parietal and temporal assignments of a brain, a functional condition of the central carrying-out structures, disorganization of cognitive activity were established to be a consequence of the impact of aviation noise and the reason of brain deficiency.

Sign in / Sign up

Export Citation Format

Share Document