scholarly journals Long-Term Neurodevelopmental Outcome in Twin-to-Twin Transfusion Syndrome: Is there still Room for Improvement?

2019 ◽  
Vol 8 (8) ◽  
pp. 1226 ◽  
Author(s):  
Marjolijn S. Spruijt ◽  
Enrico Lopriore ◽  
Ratna N.G.B. Tan ◽  
Femke Slaghekke ◽  
Frans J.C.M. Klumper ◽  
...  
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Gestational Age ◽  
Motor Development ◽  
Neurodevelopmental Outcome ◽  
Disease Free Survival ◽  
Cerebral Injury ◽  
Cranial Ultrasound

Despite many developments in its management, twin-to-twin transfusion syndrome (TTTS) remains an important risk factor for long-term neurodevelopmental impairment (NDI). Our objective was to compare the incidence of severe NDI in a recent cohort of TTTS survivors, treated with laser surgery from 2011 to 2014, with a previous cohort treated from 2008 to 2010. Neurological, cognitive, and motor development were assessed at two years of age. We determined risk factors associated with Bayley-III scores. Severe NDI occurred in 7/241 (3%) survivors in the new cohort compared to 10/169 (6%) in the previous cohort (p = 0.189). Disease-free survival (survival without severe impairment) did not significantly differ. Low birth weight and being small for gestational age (SGA) were independently associated with lower cognitive scores (both p < 0.01). Severe cerebral injury was related to decreased motor scores (B = −14.10; 95% CI −3.16, −25.04; p = 0.012). Children with severe NDI were born ≥32 weeks’ gestation in 53% of cases and had no evidence of cerebral injury on cranial ultrasound in 59% of cases. Our results suggest that improvement in outcome of TTTS has reached a plateau. Low birth weight, SGA, and cerebral injury are risk factors for poor neurodevelopmental outcome. Neither gestational age above 32 weeks nor the absence of cerebral injury preclude severe NDI.

Neurodevelopmental outcome in infants with esophageal atresia: risk factors in the first year of life

2020 ◽  
Author(s):  
Bevilacqua Francesca ◽  
Ragni Benedetta ◽  
Conforti Andrea ◽  
Braguglia Annabella ◽  
Gentile Simonetta ◽  
...  
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Cognitive Development ◽  
Low Birth Weight ◽  
Multiple Regression ◽  
Esophageal Atresia ◽  
Gestational Age ◽  
Motor Development ◽  
First Year ◽  
First Year Of Life

Summary Data on neurodevelopmental outcomes of infants born with esophageal atresia (EA) are still scarce and controversial. The aims of our study were to evaluate motor and cognitive development during the first year of life, in patients operated on of EA and to investigate potential risk factors for motor and cognitive development both at 6 and 12 months. This is an observational prospective longitudinal study in a selected cohort of type C and D EA infants enrolled in our follow-up program from 2009 to 2017. In order to exclude possible confounding factors, the following exclusion criteria were applied: (i) gestational age ≤ 32 weeks and/or birth weight ≤ 1500 g; (ii) genetic syndrome or chromosomal anomaly known to be associated with neurodevelopmental delay; (iii) neurologic disease; (iv) esophageal gap ≥three vertebral bodies. Patients were evaluated at 6 and 12 months of life (corrected age for infants with a gestational age of 32–37 weeks) with the Bayley Scales of Infant and Toddler Development—3rd Edition. In our selected cohort of EA infants, 82 were evaluated at 6 months and 59 were reevaluated at 12 months. Both Motor and Cognitive average scores were within the norm at both time points. However, we report increased number of infants with motor delay with time: 14% at 6 months and 24% at 12 months. Multiple regression analysis for Motor scores at 6 [F(4,74) = 4.363, P = 0.003] and 12 months [F(6,50) = 2.634, P = 0.027] identified (i) low birth weight, (ii) longer hospital stay and (iii) weight &lt; fifth percentile at 1 year as risk factors. Interestingly, average Cognitive scores also increased with time from 85.2% at 6 months and 96.6% at 12 months. Multiple regression models explaining variance of Cognitive scores at 6 [F(4, 73) = 2.458, P = 0.053] and 12 months [F(6, 49) = 1.232, P = 0.306] were nonsignificant. Our selected cohort of EA patients shows, on the average, Motor and Cognitive scores within the norm both at 6 and 12 months. Nevertheless, the percentage of infants with Motor scores below the average increases regardless gestational age. None of clinical and sociodemographic variables taken into consideration was able to predict cognitive development both at 6 and 12 months whereas risk factors for Motor development change during the first year of life. Healthcare providers should pay particular attention to patients with low birth weight, longer hospital stays and weight under fifth percentile at 1 year. Future studies should include long-term outcomes to reveal possible catch up in motor development and/or possible findings in Cognitive scores.

scholarly journals Influence of the level of maternal education on the long-term neurodevelopmental outcome of Saudi infants with birth weight of 1000-1500 grams at the age of 21-24 months

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Badr Hasan Sobaih
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Gestational Age ◽  
Maternal Education ◽  
Very Low Birth Weight ◽  
Neurodevelopmental Outcome ◽  
University Hospital ◽  
Vlbw Infants

Background: Advancements in perinatal-neonatal care in the last decades has led to improved survival rates of very-low birth weight (VLBW) infants. An association between the level of maternal education and neurodevelopmental outcome has been demonstrated in many European studies. This study evaluates the influence of maternal education level and socio-demographic status on the long-term development of Saudi VLBW infants with birth weight of 1000-1500 grams at a corrected gestational age of 21-24 months. Method: This retrospective cohort study examined prospectively collected data from the period of 2005 to 2016 from the Neonatal Follow-up Program (NFP) at King Khalid University Hospital in Riyadh, Saudi Arabia. Results: A total of 122 VLBW infants with a mean gestational age of 29.57 weeks and mean birth weight 1265 grams were enrolled. There was no statistically significant association between the level of maternal education and neurodevelopmental screening outcome at the age of 21-24 months according to the Bayley Infant Neurodevelopmental Screener (BINS) (p=0.149). Bronchopulmonary dysplasia (BPD) was highly associated with cerebral palsy (p=0.001) and an abnormal BINS score (p=0.010). Conclusion: There was no significant influence of the level of maternal education on the neurodevelopmental screening outcome of VLBW infants at the corrected age of 21-24 months. BPD was the strongest predictor of adverse neurodevelopmental outcome. Keywords: Bayley Infant Neurodevelopmental Screener (BINS), Neurodevelopmental Outcome, Maternal educational level, Neonatal follow-up program (NFP), Very Low Birth Weight (VLBW) infant.

scholarly journals Incidence and Risk Factors of Low Birth Weight Among Babies Delivered at Tertiary Level Teaching Hospital in Nepal

2019 ◽  
Vol 18 (2) ◽  
pp. 29-35
Author(s):  
Pawana Kayastha ◽  
Sunil Raja Manandhar
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Tertiary Level ◽  
Maternal Factors ◽  
Maternal Risk ◽  
Low Birth Weight Babies

Introduction: Low birth weight is directly related to both immediate and long term development and wellbeing of a person. There are numerous maternal and foetal factors contributing to low birth weight. The mortality and morbidity of low birth weight can be reduced if the maternal risk factors are detected early and managed by simple techniques. Methods: 207 low birth weight live newborn babies regardless of gestational age born in a tertiary level teaching institute from September 2015 to September 2016 were enrolled as cases and same number of normal birth weight babies (i.e. 2.5 to 4 kgs) as control. Information was obtained directly from mothers using pretested structured questionnaire and was analysed using SPSS version 20. Results: The incidence of low birth weight was found to be 9.8%. Mean weight of low birth weight babies was 1.98 kg and mean gestational age was 37.34 weeks. Among low birth weight babies, 47.8% were preterm and 52.2% were term. Out of 119 small for gestational age babies, the frequency of symmetrical small for gestational age was 45.3% and asymmetrical small for gestational age was 54.6%. There was significant association of low birth weight with multiple maternal factors like maternal age, education, weight, height, weight gain during pregnancy, ANC visits, parity, antepartum haemorrhage, previous abortion/low birth weight, birth spacing, tobacco/alcohol intake and haemoglobin. Conclusions: Prevalence of low birth weight is likely to be far higher than figure in isolated rural settings of our country. Contribution of SGA is higher than Appropriate for Gestational Age which brings us to a larger burden of long term morbidity and mortality. Various maternal factors are responsible for birth of low birth weight babies.  

scholarly journals A study on neurodevelopmental outcome and its associated risk factors in very low birth weight babies in a tertiary care teaching hospital in Kolkata

2016 ◽  
Vol 7 (5) ◽  
pp. 61-69
Author(s):  
Somen Sur ◽  
Subhasis Das ◽  
Soumitra Masani
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Gestational Age ◽  
Very Low Birth Weight ◽  
Neurodevelopmental Outcome ◽  
Developmental Screening ◽  
Fine Motor ◽  
Low Birth Weight Babies

Background: Very low birth weight babies are very fragile in nature and usually undergone through stormy neonatal period, which affects significantly their neurodevelopmental outcome in long term basis.Aims and Objectives: 1. Assessment of neurodevelopmental outcome in very low birth weight (VLBW) babies at 12 month corrected gestational age. 2. Study of risk factors associated with such outcome.Materials and Methods: VLBW babies without any major congenital anomaly were included in this study. They were followed up in high risk clinic upto 12 month corrected gestational age. In follow up visits, assessment of tone was done by Amiel Tiesonmethod and 180 degree flip test. Developmental screening was done by Denver Developmental Screening Test (DDST II).Data obtained from this study were entered in Microsoft Excel and subsequently analysed with the help of Epi Info (TM) 3.5.3 software.Results: 24.4% among the study population showed neurodevelopmental abnormalities. Of them, 22.2% VLBW infants had muscle tone abnormality; 15.6% were suspect in gross motor development, 8.9% were suspect in fine motor, 11.1% were suspect in personal – social and 8.9% were suspect in language development, which were statistically significant. On assessment of risk factors, it was found that low birth weight, prematurity, non-use of antenatal corticosteroid, hypoglycaemia, intraventricular haemorrhage, sepsis, jaundice, mechanical ventilation, intra uterine growth retardation were significantly associated with various strata of neurodevelopmental outcome.Conclusion: VLBW babies are very prone to develop neurodevelopmental complications. Taking proper care regarding above said risk factors can reduce such complications. Also these babies should follow up properly to detect complication/s at earliest, and take “early intervention’’ steps.Asian Journal of Medical Sciences Vol.7(5) 2016 61-69

scholarly journals Intraventricular haemorrhage in a Ugandan cohort of low birth weight neonates: the IVHU study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
R. MacLeod ◽  
J. N. Paulson ◽  
N. Okalany ◽  
F. Okello ◽  
L. Acom ◽  
...  
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Intraventricular Haemorrhage ◽  
Sub Saharan Africa ◽  
Cranial Ultrasound ◽  
High Grade ◽  
Odds Ratios ◽  
Antenatal Steroids ◽  
Eastern Uganda

Abstract Background Globally, 15 million neonates are born prematurely every year, over half in low income countries (LICs). Premature and low birth weight neonates have a higher risk of intraventricular haemorrhage (IVH). There are minimal data regarding IVH in sub-Saharan Africa. This study aimed to examine the incidence, severity and timing of and modifiable risk factors for IVH amongst low-birth-weight neonates in Uganda. Methods This is a prospective cohort study of neonates with birthweights of ≤2000 g admitted to a neonatal unit (NU) in a regional referral hospital in eastern Uganda. Maternal data were collected from interviews and medical records. Neonates had cranial ultrasound (cUS) scans on the day of recruitment and days 3, 7 and 28 after birth. Risk factors were tabulated and are presented alongside odds ratios (ORs) and adjusted odds ratios (aORs) for IVH incidence. Outcomes included incidence, timing and severity of IVH and 28-day survival. Results Overall, 120 neonates were recruited. IVH was reported in 34.2% of neonates; 19.2% had low grade (Papile grades 1–2) and 15% had high grade (Papile grades 3–4). Almost all IVH (90.2%) occurred by day 7, including 88.9% of high grade IVH. Of those with known outcomes, 70.4% (81/115) were alive on day 28 and survival was not associated with IVH. We found that vaginal delivery, gestational age (GA) < 32 weeks and resuscitation in the NU increased the odds of IVH. Of the 6 neonates who received 2 doses of antenatal steroids, none had IVH. Conclusion In this resource limited NU in eastern Uganda, more than a third of neonates born weighing ≤2000 g had an IVH and the majority of these occurred by day 7. We found that vaginal birth, earlier gestation and need for resuscitation after admission to the NU increased the risk of IVH. This study had a high rate of SGA neonates and the risk factors and relationship of these factors with IVH in this setting needs further investigation. The role of antenatal steroids in the prevention of IVH in LICs also needs urgent exploration.

MODELLING THE RISK FACTORS FOR BIRTH WEIGHT IN TWIN GESTATIONS: A QUANTILE REGRESSION APPROACH

2017 ◽  
Vol 49 (6) ◽  
pp. 744-756 ◽  
Author(s):  
A. John Michael ◽  
Belavendra Antonisamy ◽  
S. Mahasampath Gowri ◽  
Ramasami Prakash
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Quantile Regression ◽  
Gestational Age ◽  
Weight Distribution ◽  
Ordinary Least Squares ◽  
Child Growth ◽  
Birth Weight Distribution ◽  
Different Parts

SummaryBirth weight is used as a proxy for the general health condition of newborns. Low birth weight leads to adverse events and its effects on child growth are both short- and long-term. Low birth weight babies are more common in twin gestations. The aim of this study was to assess the effects of maternal and socio-demographic risk factors at various quantiles of the birth weight distribution for twin gestations using quantile regression, a robust semi-parametric technique. Birth records of multiple pregnancies from between 1991 and 2005 were identified retrospectively from the birth registry of the Christian Medical College and hospitals in Vellore, India. A total of 1304 twin pregnancies were included in the analysis. Demographic and clinical characteristics of the mothers were analysed. The mean gestational age of the twins was 36 weeks with 51% having preterm labour. As expected, the examined risk factors showed different effects at different parts of the birth weight distribution. Gestational age, chroniocity, gravida and child’s sex had significant effects in all quantiles. Interestingly, mother’s age had no significant effect at any part of the birth weight distribution, but both maternal and paternal education had huge impacts in the lower quantiles (10thand 25th), which were underestimated by the ordinary least squares (OLS) estimates. The study shows that quantile regression is a useful method for risk factor analysis and the exploration of the differential effects of covariates on an outcome, and exposes how OLS estimates underestimate and overestimate the effects of risk factors at different parts of the birth weight distribution.

scholarly journals Intraventricular hemorrhage in very low birth weight infants: associated risk factors and outcome in the neonatal period

1999 ◽  
Vol 54 (5) ◽  
pp. 151-154 ◽  
Author(s):  
Monique Catache Mancini ◽  
Naila Elias Barbosa ◽  
Débora Banwart ◽  
Sandra Silveira ◽  
José Luiz Guerpelli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Gestational Age ◽  
Intraventricular Hemorrhage ◽  
Very Low Birth Weight ◽  
Periventricular Leukomalacia ◽  
Associated Risk Factors ◽  
Length Of Hospitalization

Intraventricular hemorrhage (IVH) is a severe complication in very low birth weight (VLBW) newborns (NB). With the purpose of studying the incidence of IVH, the associated risk factors, and the outcomes for these neonates, we studied all the VLBW infants born in our neonatal unit. Birth weight, gestational age, presence of perinatal asphyxia, mechanical ventilation, length of hospitalization, apnea crisis, hydrocephalus, and periventricular leukomalacia were analyzed. The diagnosis of IVH was based on ultrasound scan studies (Papile's classification) performed until the tenth day of life and repeated weekly in the presence of abnormalities. Sixty-seven/101 neonates were studied. The mortality rate was 30.6% (31/101) and the incidence of IVH was 29.8% (20/67) : 70% grade I, 20% grade III and 10% grade IV. The incidence of IVH in NB <1,000 g was 53.8% (p = 0.035) and for gestational age <30 weeks was 47.3% (p = 0.04), both considered risk factors for IVH. The length of hospitalization (p = 0.00015) and mechanical ventilation (p = 0.038) were longer in IHV NB. The IVH NB had a relative risk of 2.3 of developing apnea (p = 0.02), 3.7 of hydrocephalus (p = 0.0007), and 7.7 of periventricular leukomalacia (p < 0.00001). The authors emphasize the importance of knowing the risk factors related to IVH so as to introduce prevention schemes to reduce IVH and to improve outcomes of affected newborns.

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