Timing of Discharge From the NICU Among Preterm Infants Is Related to Motor Outcome

2021 ◽  
Vol 75 (Supplement_2) ◽  
pp. 7512510281p1-7512510281p1
Author(s):  
Polly Kellner ◽  
Jenny Kwon ◽  
Roberta Pineda
Keyword(s):  
Early Childhood ◽  
High Risk ◽  
Preterm Infants ◽  
Language Delay ◽  
Due Date ◽  
Motor Outcome ◽  
Postmenstrual Age ◽  
Gestational Age At Birth ◽  
Age At Birth ◽  
Primary Author

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The incidence of motor, cognitive, and language delay among children who were born preterm (< 32 weeks gestation) is high. Estimated gestational age at birth appears to influence the timing of discharge, with infants born earlier being discharged later after accounting for the degree of prematurity. Postmenstrual age at discharge appears to be related to motor outcome in early childhood, shedding light on the high-risk nature of this population of infants still hospitalized after their due date. Primary Author and Speaker: Polly Kellner Additional Authors and Speakers: Jenny Kwon Contributing Authors: Roberta Pineda

scholarly journals Population Pharmacokinetics of Metronidazole Evaluated Using Scavenged Samples from Preterm Infants

2012 ◽  
Vol 56 (4) ◽  
pp. 1828-1837 ◽  
Author(s):  
Michael Cohen-Wolkowiez ◽  
Daniele Ouellet ◽  
P. Brian Smith ◽  
Laura P. James ◽  
Ashley Ross ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Minimal Risk ◽  
Dosing Regimen ◽  
Data Set ◽  
Relative Standard ◽  
Population Pk ◽  
Postmenstrual Age ◽  
Gestational Age At Birth ◽  
Age At Birth

ABSTRACTPharmacokinetic (PK) studies in preterm infants are rarely conducted due to the research challenges posed by this population. To overcome these challenges, minimal-risk methods such as scavenged sampling can be used to evaluate the PK of commonly used drugs in this population. We evaluated the population PK of metronidazole using targeted sparse sampling and scavenged samples from infants that were ≤32 weeks of gestational age at birth and <120 postnatal days. A 5-center study was performed. A population PK model using nonlinear mixed-effect modeling (NONMEM) was developed. Covariate effects were evaluated based on estimated precision and clinical significance. Using the individual Bayesian PK estimates from the final population PK model and the dosing regimen used for each subject, the proportion of subjects achieving the therapeutic target of trough concentrations >8 mg/liter was calculated. Monte Carlo simulations were performed to evaluate the adequacy of different dosing recommendations per gestational age group. Thirty-two preterm infants were enrolled: the median (range) gestational age at birth was 27 (22 to 32) weeks, postnatal age was 41 (0 to 97) days, postmenstrual age (PMA) was 32 (24 to 43) weeks, and weight was 1,495 (678 to 3,850) g. The final PK data set contained 116 samples; 104/116 (90%) were scavenged from discarded clinical specimens. Metronidazole population PK was best described by a 1-compartment model. The population mean clearance (CL; liter/h) was determined as 0.0397 × (weight/1.5) × (PMA/32)2.49using a volume of distribution (V) (liter) of 1.07 × (weight/1.5). The relative standard errors around parameter estimates ranged between 11% and 30%. On average, metronidazole concentrations in scavenged samples were 30% lower than those measured in scheduled blood draws. The majority of infants (>70%) met predefined pharmacodynamic efficacy targets. A new, simplified, postmenstrual-age-based dosing regimen is recommended for this population. Minimal-risk methods such as scavenged PK sampling provided meaningful information related to development of metronidazole PK models and dosing recommendations.

Prolonged Episodes of Hypoxemia in Preterm Infants Undetectable by Cardiorespiratory Monitors

PEDIATRICS ◽  
1995 ◽  
Vol 95 (6) ◽  
pp. 860-863 ◽  
Author(s):  
Christian F. Poets ◽  
Valerie A. Stebbens ◽  
David Richard ◽  
David P. Southall
Keyword(s):  
Heart Rate ◽  
Preterm Infants ◽  
Median Duration ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Prolonged Apnea ◽  
Gestational Age At Birth ◽  
Breathing Room ◽  
Age At Birth

Objective. To determine whether episodes of prolonged hypoxemia occur without prolonged apneic pauses (≥20 seconds) and without bradycardia (pulse rate, ≤100 beats per minute) in apparently well preterm infants. Methods. Long-term recordings of arterial oxygen saturation as measured by pulse oximetry (SpO2), photoplethysmographic (pulse) waveforms from the oximeter, and breathing movements were performed in 96 preterm infants (median gestational age at birth, 34 weeks; range, 28 to 36 weeks) who were breathing room air. Recordings started at a median age of 4 days (range, 1 to 60 days). Results. During a median duration of recording of 25 hours, 88 episodes in which SpO2 fell to 80% or less and remained there for 20 seconds or longer were identified in 15 infants. The median duration of these prolonged desaturations was 27 seconds (range, 20 to 81 seconds). In 73 episodes (83%), SpO2 continued to fall to 60% or less. Twenty-three desaturations were associated with prolonged apneic pauses and 54 with bradycardia; 19 of these were associated with both apnea and bradycardia. Thirty desaturations (34%; 10 infants) occurred without bradycardia and without prolonged apnea. Conclusions. These results indicate that a proportion of apparently well preterm infants exhibit episodes of severe prolonged hypoxemia unaccompanied by prolonged apneic pauses or bradycardia. Such episodes, therefore, would be difficult to detect if only breathing movements and heart rate are monitored. Indications for the use of oxygenation monitors in preterm infants should be reconsidered.

Infection and premature rupture of the membranes

1990 ◽  
Vol 2 (1) ◽  
pp. 1-19
Author(s):  
Kyung Seo ◽  
James A McGregor ◽  
Janice I French
Keyword(s):  
Health Care ◽  
Preterm Birth ◽  
Preterm Infants ◽  
Important Determinant ◽  
Premature Rupture ◽  
Neonatal Deaths ◽  
Financial Costs ◽  
The Usa ◽  
Gestational Age At Birth ◽  
Age At Birth

Premature rupture of the membranes (PROM) and preterm birthPreterm birth remains a paramount problem in health care worldwide. In the USA, approximately 6–10% of births occur preterm.1–3Gestational age at birth is the most important determinant of an infant's morbidity and mortality. Preterm infants account for approximately 75% of neonatal deaths,3–5as well as incalculable direct and indirect financial costs and morbidity.6–9

scholarly journals Time to regain birth weight - a marker to predict the severity of retinopathy of prematurity?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ajay Anvekar ◽  
Sam Athikarisamy ◽  
Shripada Rao ◽  
Andy Gill ◽  
Elizabeth Nathan ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Retinopathy Of Prematurity ◽  
Oxygen Therapy ◽  
Control Groups ◽  
Gestational Age At Birth ◽  
And Control ◽  
Type 1 Rop ◽  
Age At Birth

Abstract Background Poor weight gain in the first few weeks of life has been studied as a predictor of retinopathy of prematurity (ROP). Our aim was to assess whether time taken to regain birthweight (BW) be used as an additional marker to identify infants with type 1 ROP. Methods In this retrospective study, preterm infants (< 27 weeks gestational age at birth) born during the period from 1/1/2010–31/12/2015 at a tertiary neonatal intensive care unit in Australia were included. Twenty-seven preterm infants with Type 1 ROP were identified. Controls (No ROP or ROP other than type 1) were matched with cases on gestational age at birth and BW (1:4 ratio). Data were collected from the database and medical records. Results The median (IQR) gestational age for Type 1 ROP and control groups were 24 (24–26) and 25 (24–26) weeks respectively and median (IQR) BW for Type 1 ROP and control groups were 675 (635–810) and 773 (666–884) grams respectively. Preterm infants with Type 1 ROP were more likely to be small for gestational age (SGA) (18.5% vs 3.7%, p = 0.015) and had increased weeks on oxygen therapy (median 11.9 vs 9.1, p = 0.028). Time to regain BW was longer in preterm infants with type 1 ROP than controls but did not reach statistical significance (median 9 vs 7 days, OR 1.08, 95% CI 1.00–1.17, p = 0.059) adjusted for SGA and duration of oxygen therapy. The area under the curve from the time to regain BW model with adjustment for SGA and duration of oxygen therapy was 0.73 (95% CI 0.62–0.83). Conclusion We hypothesize that time to regain BW has potential to aid prediction of Type 1 ROP and this warrants further investigation in a larger prospective study.

scholarly journals Clinical and functional features of the small circle of blood circulation in children with a new form of bronchopulmonary dysplasia

2021 ◽  
Vol 24 (5) ◽  
pp. 292-299
Author(s):  
Milana A. Basargina ◽  
Andrey P. Fisenko ◽  
Irina V. Davydova ◽  
Maksim V. Kondratyev ◽  
Anastasiya S. Petrova ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Group Discussion ◽  
Right Heart ◽  
Functional Features ◽  
Reliable Marker ◽  
The Right ◽  
Gestational Age At Birth ◽  
Age At Birth

The aim of the work is to analyze the data of Echo-CG examination of premature infants who have formed and have not formed bronchopulmonary dysplasia (BPD) to determine the frequency of the formation of pulmonary hypertension (PH). Materials and methods. A total of 199 preterm infants treated in the Department of Pathology of Newborns were examined. The first group included moderate and severe BPD children (n = 117; 59%). The second group consisted of children without BPD within clearly decreed terms (n = 82; 41%). In each group, patients were divided into four subgroups by the gestational age at birth and the timing of the Echo-CG. Results. Only two (1.1%) patients out of 117 BPD children of the first group were diagnosed with pulmonary hypertension (PH). In 3 (2.5%) of 117 infants of the same group, enlargement of the right heart without PH was revealed. Out of 82 children without BPD, two patients had signs of right heart enlargement. PH was not diagnosed in any of the patients in this group. Discussion. To aggravate the efficiency of PH diagnosis, a number of indices of screening echocardiography seem to be increased by additional analysis of changes in the systolic eccentricity index (EI), as a reliable marker of PH in BPD children. Systolic IE should be integrated into screening in preterm infants for the diagnosis of PH. The use of Echo-CG data along with analysis of blood BNP or NT-proBNP blood content be also expanded. Optimizing the diagnosis of PH at the early stages of BPD is necessary to increase the efficacy of targeted therapy and reduce the risk of severe complications of BPD.

scholarly journals Preterm birth alters the development of cortical microstructure and morphology at term-equivalent age

2021 ◽  
Author(s):  
Ralica Dimitrova ◽  
Maximilian Pietsch ◽  
Judit Ciarrusta ◽  
Sean P Fitzgibbon ◽  
Logan ZJ Williams ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Preterm Infants ◽  
Cortical Thickness ◽  
Tissue Water ◽  
Normative Development ◽  
Equivalent Age ◽  
Neurite Density ◽  
Postmenstrual Age ◽  
Cortical Maturation ◽  
Age At Birth

Introduction: The dynamic nature and complexity of the cellular events that take place during the last trimester of pregnancy make the developing cortex particularly vulnerable to perturbations. Abrupt interruption to normal gestation can lead to significant deviations to many of these processes, resulting in atypical trajectory of cortical maturation in preterm birth survivors. Methods: We sought to first map typical cortical micro and macrostructure development using invivo MRI in a large sample of healthy term-born infants scanned after birth (n=270). Then we offer a comprehensive characterisation of the cortical consequences of preterm birth in 78 preterm infants scanned at term-equivalent age (37-44 weeks postmenstrual age). We describe the group-average atypicality, the heterogeneity across individual preterm infants, and relate individual deviations from normative development to age at birth and neurodevelopment at 18 months. Results: In the term-born neonatal brain, we observed regionally specific age-associated changes in cortical morphology and microstructure, including rapid surface expansion, cortical thickness increase, reduction in cortical anisotropy and increase in neurite orientation dispersion. By term-equivalent age, preterm infants had on average increased cortical tissue water content and reduced neurite density index in the posterior parts of the cortex, and greater cortical thickness anteriorly compared to term-born infants. While individual preterm infants were more likely to show extreme deviations (over 3.1 standard deviations) from normative cortical maturation compared to term-born infants, these extreme deviations were highly variable and showed very little spatial overlap between individuals. Measures of regional cortical development were associated with age at birth, but not with neurodevelopment at 18 months. Conclusion: We showed that preterm birth alters cortical micro and macrostructural maturation near the time of full-term birth. Deviations from normative development were highly variable between individual preterm infants.

scholarly journals Gestational age at birth and sleep duration in early childhood in three population-based cohorts

2019 ◽  
Vol 1 ◽  
pp. 100002
Author(s):  
Maartje P.C.M. Luijk ◽  
Desana Kocevska ◽  
Elaine K.H. Tham ◽  
Hélène Gaudreau ◽  
Irwin K.M. Reiss ◽  
...  
Keyword(s):  
Early Childhood ◽  
Sleep Duration ◽  
Gestational Age ◽  
Population Based ◽  
Gestational Age At Birth ◽  
Age At Birth

scholarly journals Nonphysiological anaemia of prematurity.

1978 ◽  
Vol 53 (11) ◽  
pp. 855-860 ◽  
Author(s):  
C A Wardrop ◽  
B M Holland ◽  
K E Veale ◽  
J G Jones ◽  
O P Gray
Keyword(s):  
Preterm Infants ◽  
Clinical Features ◽  
Gestational Age ◽  
Clinical Consequence ◽  
Feeding Difficulties ◽  
High O2 ◽  
Anaemia Of Prematurity ◽  
Hb Concentration ◽  
Gestational Age At Birth ◽  
Age At Birth

Clinical and haematological findings at the nadir of the refractory, early anaemia of prematurity were compared in a study of 95 preterm infants. 53% of 30 babies less than 32 weeks' gestational age at birth had abnormal clinical features resulting from anaemia at its nadir, with a combination of tachycardia, tachypnoea, dyspnoea and feeding difficulties, diminished activity, and pallor. The expression 'available oxygen', derived from the Hb concentration and Hb-O2 affinity, correlated more closely with clinical features of anaemia that did the Hb concentration alone. A formula is presented that predicts the 'available oxygen', provided the Hb concentration and post-conceptual age are known; this avoids the need for direct measurement of Hb-O2 affinity. Clinical anaemia is common in preterm infants with Hb concentrations of up to 10.5 g/dl, consequent on the high O2 affinity of fetal Hb. This is the first description of any common clinical consequence of high Hb-O2 affinity.

scholarly journals Radiographic Imaging to Evaluate Food Passage Rate in Preterm Piglets as a Model for Preterm Infants

2021 ◽  
Vol 8 ◽  
Author(s):  
Susanne Soendergaard Kappel ◽  
Per Torp Sangild ◽  
Thomas Scheike ◽  
Christel Renée Friborg ◽  
Magdalena Gormsen ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Contrast Imaging ◽  
Passage Rate ◽  
Food Passage ◽  
Gut Motility ◽  
X Ray ◽  
Near Term ◽  
Gestational Age At Birth ◽  
Contrast Solution ◽  
Age At Birth

Objectives and study: Gut motility in infants mature with increasing post-menstrual age and is affected by numerous hormonal, immunological and nutritional factors. However, it remains unclear how age and diet influence gut motility and its relation to feeding intolerance and gastric residuals in preterm neonates. Using preterm piglets as a model for infants, we investigated if contrast passage rate, as determined by X-ray contrast imaging, is affected by gestational age at birth, advancing postnatal age and different milk diets.Methods: Contrast passage rate was evaluated using serial abdominal X-ray imaging on postnatal day 4 and 18 in preterm and near-term piglets fed infant formula, colostrum or intact bovine milk, with or without added fortifier (total n = 140).Results: Preterm piglets had a faster small intestinal passage rate of contrast solution at day 4 of life than near-term piglets (SIEmpty, hazard ratio (HR): 0.52, 95%CI [0.15, 0.88], p &lt; 0.01). Formula fed piglets at day 4 had a faster passage rate of contrast to caecum (ToCecum, HR: 0.61, 95%CI [0.25,0.96], p = 0.03), and through the colon region (CaecumToRectum, p &lt; 0.05, day 4) than colostrum fed preterm piglets. The time for contrast to leave the stomach, and passage through the colon in day 4 preterm piglets were slower than in older piglets at day 18 (both, p &lt; 0.05). Adding a nutrient fortifier increased body growth, gastric residuals, intestinal length and weight, but did not affect any of the observed passage rates of the contrast solution.Conclusion: Serial X-ray contrast imaging is a feasible method to assess food passage rate in preterm piglets. Contrast passage rate through different gut segments is affected by gestational age at birth, postnatal age, and milk diet. The preterm piglet could be a good model to investigate clinical and dietary factors that support maturation of gut motility and thereby feeding tolerance and gut health in preterm infants.

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