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  1. Surgical complications due to postnatal cytomegalovirus infection in a preterm infant with malrotation.

    PubMed

    Torregrossa, Anaïs; Reinberg, Olivier; Alamo, Leonor; Sarro, Rosella; Meylan, Pascal; Roth-Kleiner, Matthias

    2015-10-01

    We report a case of an extremely preterm infant with intestinal malrotation who contracted postnatal systemic cytomegalovirus (CMV) infection with a complicated intestinal evolution requiring repeated surgical interventions and antiviral treatment. This report is to emphasize that prolonged gastrointestinal symptoms in extremely preterm infants fed with non-pasteurized breast milk should lead to suspicion of CMV infection. The importance of preventive measures when feeding very preterm infants with breast milk needs to be considered. Furthermore, the indications for antiviral treatment, in particular in preterm infants, need to be clarified. © 2015 Japan Pediatric Society.

  2. Immunization of preterm infants

    PubMed Central

    Gagneur, Arnaud; Pinquier, Didier; Quach, Caroline

    2015-01-01

    Vaccinations of premature infants are often delayed despite being at an increased risk of contracting vaccine preventable diseases. This article reviews the current knowledge on the immune response to widely used vaccines, on the protection derived from routine immunization and on vaccine safety and tolerability in a population of preterm infants. Available data evaluating the immune response of preterm infants support early immunization without correction for gestational age. For a number of antigens, the antibody response to initial doses of vaccines may be lower than that of term infants, but protective concentrations are often achieved and memory successfully induced. Vaccines are immunogenic, safe and well tolerated in preterm infants. Preterm infants should be vaccinated using the same schedules as those usually recommended for full-term infants, with the exception of the hepatitis B vaccine, where additional doses should be administered in infants receiving the first dose during the first days of life if they weighed less than 2000 g because of a documented reduced immune response. PMID:26291883

  3. Neuroprotection in Preterm Infants

    PubMed Central

    Berger, R.; Söder, S.

    2015-01-01

    Preterm infants born before the 30th week of pregnancy are especially at risk of perinatal brain damage which is usually a result of cerebral ischemia or an ascending intrauterine infection. Prevention of preterm birth and early intervention given signs of imminent intrauterine infection can reduce the incidence of perinatal cerebral injury. It has been shown that administering magnesium intravenously to women at imminent risk of a preterm birth leads to a significant reduction in the likelihood of the infant developing cerebral palsy and motor skill dysfunction. It has also been demonstrated that delayed clamping of the umbilical cord after birth reduces the rate of brain hemorrhage among preterm infants by up to 50%. In addition, mesenchymal stem cells seem to have significant neuroprotective potential in animal experiments, as they increase the rate of regeneration of the damaged cerebral area. Clinical tests of these types of therapeutic intervention measures appear to be imminent. In the last trimester of pregnancy, the serum concentrations of estradiol and progesterone increase significantly. Preterm infants are removed abruptly from this estradiol and progesterone rich environment. It has been demonstrated in animal experiments that estradiol and progesterone protect the immature brain from hypoxic-ischemic lesions. However, this neuroprotective strategy has unfortunately not yet been subject to sufficient clinical investigation. PMID:25650134

  4. Autonomic reflexes in preterm infants.

    PubMed

    Lagercrantz, H; Edwards, D; Henderson-Smart, D; Hertzberg, T; Jeffery, H

    1990-01-01

    Some autonomic nervous reflexes often tested in adult medicine have been studied in 21 preterm infants (25-37 gestational weeks). The aim was to develop such tests for preterm infants and see if there were any differences in babies with recurrent apnea and bradycardia and babies who had been exposed to sympathicolytic drugs before birth. To test sympathetic nervous activity the peripheral vascular resistance was measured before and during 45 degrees of head-up tilting. To test parasympathetic nervous activity the degree of bradycardia was measured in response to cold face test (application of an ice-cube on the fore-head) and laryngeal stimulation with saline. Finally the heart rate changes after a sudden noise (85 dB) were studied as an indicator of both sympathetic and vagal activity. The peripheral resistance was found to be relatively low in these preterm infants, particularly in some infants tested at the postnatal age of about two months. Heart rate and mean blood pressure did not change during tilting, while the peripheral resistance increased significantly mainly due to lowered limb blood flow. The median decrease of the heart rate during the cold face test was 20.0% and during laryngeal receptor stimulation 23.7%. The sudden noise usually caused a biphasic heart rate response. An autonomic nervous reflex score was calculated and found to be negative (parasympathetic) in infants with recurrent prolonged apnea and bradycardia and positive in infants with clinical signs of increased sympathetic nervous activity.

  5. Iron Therapy for Preterm Infants

    PubMed Central

    Rao, Raghavendra; Georgieff, Michael K.

    2009-01-01

    SYNOPSIS Preterm infants are at risk for both iron deficiency and iron overload. The role of iron in multiple organ functions suggests that iron supplementation is essential for the preterm infant. Conversely, the potential for iron overload and the poorly developed anti-oxidant measures in the preterm infant argues against indiscriminate iron supplementation in this population. The purpose of this article is to review the predisposing factors and consequences of iron deficiency and iron overload in the preterm infant, the current recommendation for iron supplementation and its appropriateness, and describe potential management strategies that strike a balance between iron deficiency and iron toxicity. PMID:19161863

  6. Neonatal opiate abstinence syndrome in term and preterm infants.

    PubMed

    Doberczak, T M; Kandall, S R; Wilets, I

    1991-06-01

    Data on 178 term and 34 preterm infants born to methadone-maintained mothers were analyzed to assess the effects of neonatal opiate abstinence in infants of varying gestational ages. More mothers in the term group (79%) than in the preterm group (53%) had abused other drugs during pregnancy (p less than 0.001). Mean (+/- SD) gestational age was 39.5 weeks +/- 1.4 for term infants and 34.3 weeks +/- 2.6 for preterm infants. On the basis of a semiobjective symptom scoring scale, term infants had more severe abstinence symptoms and more prominent central nervous system manifestations than preterm infants. The severity of abstinence symptoms correlated with maternal methadone dosage in both term and preterm infants. Maternal multiple drug abuse (e.g., heroin, cocaine) did not influence severity of abstinence symptoms in either group. More term infants (145/178) than preterm infants (20/34) required treatment for these symptoms (p less than 0.005). In 13 of 178 term infants, compared with 1 of 34 preterm infants, abstinence-related seizures developed. Peak severity occurred 1 to 2 days earlier in term than in preterm infants. A less severe abstinence syndrome in preterm infants may be due to (1) developmental immaturity of either dendritic ramifications, specific opiate receptors, or neurotransmitter function, or (2) reduced total drug exposure during the intrauterine period.

  7. Invulnerable High Risk Preterm Infants.

    ERIC Educational Resources Information Center

    Pederson, David R.; And Others

    In an effort to look at factors moderating the negative effects of preterm low birthweight and perinatal illness, the study followed up (at 7 and 12 months of age) 50 preterm infants whose cumulative morbidity score was greater than 100 and/or who had a life threatening complication. Home visits provided ratings of maternal sensitivity, the…

  8. A preterm infant with secondary carnitine deficiency due to MCT formula--effective treatment of L-carnitine.

    PubMed

    Ishida, A; Goto, A; Takahashi, Y; Nakajima, W; Arai, H; Tazawa, Y; Takada, G

    1994-01-01

    We report a preterm infant who was prescribed an MCT formula and subsequently developed carnitine deficiency with liver dysfunction and an elevation of serum CK level. A male infant who had been born at 24 weeks' gestation with birth weight 799 g, was fed with an MCT formula containing 76.8% of all kinds of lipids, because of his steatorrhea after the 30th day. On the 100th day, he was noted hepatomegaly and elevation of serum levels of AST, ALT and CK. The needle biopsy of the liver indicated the existence of the liver damage. He showed low serum carnitine with high urinary loss of acylcarnitine and dicarboxylic aciduria. Administration of L-carnitine was an effective treatment. The carnitine deficiency might be exaggerated by an increased urinary loss of acylcarnitine. We should be cautious of the risk of carnitine deficiency in preterm infants during prolonged use of MCT formula.

  9. Vocal output in preterm infants.

    PubMed

    Beckwith, L; Sigman, M; Cohen, S E; Parmelee, A H

    1977-11-01

    Data on vocal output of 51 preterm infants and 16 term infants were obtained during naturalistic home observations at 1, 3, and 8 months; during the administration of a preference-for-novelty paradigm in the laboratory at 8 months; and by the administration of the Gesell Developmental Schedules at 9 months. Preterm and term infant groups were found to show both similarities and differences: both groups vocalized a similar amount in the preference-for-novelty situation; both groups earned similar scores on the language subtest of the Gesell; both groups increased the percentage of awake time they spent in nondistress vocalization from 1 to 8 months. Term infants showed an earlier increase than did preterm infants: term infants significantly increased during the 1-3 month period, whereas preterm infants only increased significantly during the 3-8 month period. The developmental differences suggest a link between vocal output and perinatal conditions in that caregiver behavior was not found to be different among groups. Within the preterm groups, some relationships were found between vocal output and later test performance: infants who vocalized more during mutual gazing with the mother earned significantly higher scores on the language subtest of the Gesell.

  10. The Preterm Infant: A High-Risk Situation for Neonatal Hyperbilirubinemia Due to Glucose-6-Phosphate Dehydrogenase Deficiency.

    PubMed

    Kaplan, Michael; Hammerman, Cathy; Bhutani, Vinod K

    2016-06-01

    Prematurity and glucose-6-phosphate dehydrogenase (G6PD) deficiency are risk factors for neonatal hyperbilirubinemia. The 2 conditions may interact additively or synergistically, contributing to extreme hyperbilirubinemia, with the potential for bilirubin neurotoxicity. This hyperbilirubinemia is the result of sudden, unpredictable, and acute episodes of hemolysis in combination with immaturity of bilirubin elimination, primarily of conjugation. Avoidance of contact with known triggers of hemolysis in G6PD-deficient individuals will prevent some, but not all, episodes of hemolysis. All preterm infants with G6PD deficiency should be vigilantly observed for the development of jaundice both in hospital and after discharge home.

  11. Cervical accelerometry in preterm infants.

    PubMed

    Reynolds, Eric W; Vice, Frank L; Bosma, James F; Gewolb, Ira H

    2002-09-01

    The objective of this study was to develop a method to use digital signal processing (DSP) technology to describe quantitatively and statistically swallow-associated sounds in preterm infants and to use this method to analyze changes as infants mature. Twelve recordings of accelerometric and physiological data on bottle-feeding preterm infants between 32 and 39 weeks' postmenstrual age (PMA) were analyzed. Cervical auscultation was performed using an accelerometer attached over the larynx. Acoustic data were recorded and graphically displayed using DSP software. Initial discrete sounds (IDSs) were identified and used to construct an average waveform from which a 'variance index' (VI) was calculated for each infant. The shape of the IDS waveforms became progressively more uniform with advancing PMA, as indicated by a significant inverse correlation between VI and PMA (r=0.739; p=0.006). DSP technology facilitated the development of a new method to quantitatively analyze feeding in preterm infants. This method provides an elegant tool to track maturation of infant feeding and assessing feeding readiness. This technique makes the interpretation of cervical auscultation data less subjective by replacing the verbal description of the sounds of feeding with quantitative numeric values. It is anticipated that this method can be automated to facilitate further the analysis of cervical accelerometry data.

  12. Plasma aminotransferase concentrations in preterm infants.

    PubMed

    Victor, S; Dickinson, H; Turner, M A

    2011-03-01

    The aim of this study was to generate reference ranges for aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in preterm infants by describing the observed plasma concentration of these enzymes in babies born between 22 and 36 weeks' gestation. A service evaluation was conducted in babies admitted to two large neonatal intensive care units in the UK. 7006 blood samples from 1860 infants admitted to the two units between 2004 and 2008 were included. Extremely premature infants had high plasma enzyme activities when compared to babies at a later corrected gestational age. This may be due to more severe illness immediately after birth.

  13. Optimal growth of preterm infants.

    PubMed

    Corpeleijn, Willemijn E; Kouwenhoven, Stefanie M P; van Goudoever, Johannes B

    2013-01-01

    The cause of growth restriction in preterm infants is multifactorial, but it has been estimated that about 50% of the variance in early postnatal growth can be attributed to nutrition. Very low birth weight (VLBW) infants who were born small-for-gestational age (SGA) seem to have the highest risk to become growth restricted. Possibly, the intrauterine growth-retarded preterm infant is metabolically different from its appropriately grown counterpart and therefore has different nutritional needs. Neonatal nutrition and the resulting postnatal growth are major determinants in the short- and long-term outcomes of preterm neonates. Although having favorable effects on neurodevelopmental outcome, rapid postnatal weight gain after a period of nutritional restriction is associated with the development of insulin resistance and metabolic syndrome in later life. It seems likely that minimization of postnatal growth failure will decrease the need for catch-up growth and thereby decrease the risk of developing cardiovascular risk factors. Monitoring postnatal growth with current growth charts is complicated. Most growth charts that are currently being used are a reflection of current (nutritional) practices and are not a prescription of how VLBW should grow under optimal conditions. In addition to body weight, other aspects of growth such as lean body mass and length gain should also be taken into account when assessing the quality of postnatal growth. Noninvasive measurements of infant body composition are useful tools in evaluating the success of different nutritional interventions. However, all currently available methods have substantial drawbacks. A relatively new and promising method is air displacement plethysmography. This method still needs to be validated in preterm neonates. In conclusion, neonatal nutrition is a major determinant in the short- and long-term outcomes of preterm neonates. Monitoring postnatal growth is complicated by the lack of prescriptive growth

  14. Nutrition and kidney in preterm infant.

    PubMed

    De Curtis, Mario; Rigo, Jacques

    2012-04-01

    In pre- and post-natal period nutrition can influence the function of many organs, including the kidneys. Intrauterine growth restriction and low weight at birth are associated with reduced nephron number, a risk factor for later cardiovascular and renal diseases. The development of such adult diseases may be favored, in animals, by additional risk factors, including postnatal overnutrition and/or rapid postnatal growth. In preterm infants, during the first weeks of life, high values of serum urea are presents due to immaturity of the renal function. Thus the urea cannot be used in the first weeks of life as a parameter to evaluate the adequacy of protein intake. In comparison with older infants, healthy preterm infants, fed on human milk and adapted formulas, show a lower renal solute load because the higher growth rate associated with a raised nitrogen and mineral retention rate. Preterm infants are vulnerable to disturbances of acid-base metabolism, with a predisposition to metabolic acidosis due to a transient age-related low renal capacity for net acid excretion.

  15. Advances in the nutrition of preterm infants.

    PubMed

    Marriott, L D; Foote, K D

    2003-09-01

    The greatly improved survival rate of infants born both preterm and low birth weight (LBW) has led to the subsequent growth and development of these infants becoming an important focus for research. Preterm infants begin life with, or acquire as a result of their prematurity, greater morbidity than term born babies, growth deficits, an increased risk of developmental delay and an increased risk of later adult diseases compared with appropriate for gestational age (AGA) term born babies. Research in recent decades has confirmed that there are marked differences in the nutritional requirements of preterm LBW infants compared with their AGA term born counterparts, both in the neonatal period and probably for all of infancy. In addition to the increased requirement for energy and protein, preterm LBW infants demonstrate a greatly increased requirement for some of the mineral elements, particularly iron, zinc and calcium, when compared with the needs of term AGA infants. In the UK, feeding practices for preterm infants in neonatal units and throughout infancy after hospital discharge are variable and many questions remain as to the optimal nutritional regimen for preterm LBW infants (and for subgroups of these infants) at different stages of infancy. There is some concern that the 2002 World Health Organization recommendations on infant feeding may be applied to all infants, including preterm infants, without consideration of their special nutritional needs, which may further compromise their growth and development. A brief résumé of the work of prominent researchers in the field of preterm infant nutrition in the UK, notably Lucas, Cooke and Fewtrell, is included in the review, together with information from papers published by the authors of the review. The review concludes with a summary of the generally accepted recommendations on feeding preterm LBW infants after hospital discharge and information on some practical help available to the parents of these children

  16. Phonotactic Acquisition in Healthy Preterm Infants

    ERIC Educational Resources Information Center

    Gonzalez-Gomez, Nayeli; Nazzi, Thierry

    2012-01-01

    Previous work has shown that preterm infants are at higher risk for cognitive/language delays than full-term infants. Recent studies, focusing on prosody (i.e. rhythm, intonation), have suggested that prosodic perception development in preterms is indexed by maturational rather than postnatal/listening age. However, because prosody is heard…

  17. Lipopolysaccharide binding protein in preterm infants

    PubMed Central

    Behrendt, D; Dembinski, J; Heep, A; Bartmann, P

    2004-01-01

    Objective: To assess serum concentrations of lipopolysaccharide binding protein (LBP) in preterm infants with neonatal bacterial infection (NBI). Methods: Blood samples were analysed of 57 preterm (28+1 to 36+6, median 33+2 weeks gestation) and 17 term infants admitted to the neonatal intensive care unit within the first 72 hours of life with suspicion of NBI. Samples were obtained at first suspicion of sepsis and after 12 and 24 hours. Diagnosis of NBI was confirmed by raised concentrations of C reactive protein and/or interleukin 6. The influence of gestational age and labour was analysed. Results: Maximum LBP concentrations in infants with NBI were greatly increased compared with infants without NBI (13.0–46.0 µg/ml (median 20.0 µg/ml) v 0.6–17.4 µg/ml (median 4.2 µg/ml)). LBP concentrations in infected infants were not yet significantly raised when NBI was first suspected. The LBP concentrations of preterm infants were comparable to those of term infants. Regression analysis revealed no significant effect of labour or gestational age on LBP. Conclusions: Raised LBP concentrations indicate NBI in preterm and term infants. Preterm infants of > 28 weeks gestation seem to be capable of producing LBP as efficiently as term infants. Neonatal LBP concentrations are not influenced by labour. LBP may be a useful diagnostic marker of NBI in preterm infants. PMID:15499153

  18. Suction patterns in preterm infants.

    PubMed

    Martell, M; Martínez, G; González, M; Díaz Rosselló, J L

    1993-01-01

    The suction pattern for breast and bottle feeding in two groups of preterm infants is described. The time elapsed between birth and the moment of suction was longer in preterm neonates born at lower gestational ages for both groups studied, breast and bottle fed (figure 1). The evolution of suckling in breastfeeding was analyzed in a composite study (longitudinal and transverse) in a group of 16 neonates starting from 32 weeks of gestation. The velocity of milk extraction during suckling varied with gestational age. It was uniform at lower gestational ages, then it became faster in the first minutes and at the 36th week, it was very similar to that of mature neonates (figure 2 and table I). The evaluation of bottle feeding was performed in a transverse study in 46 preterm neonates which had been exclusively bottle fed during 1 or 2 weeks. All of them had previously been fed using an orogastric tube. Nourishing time was shorter than in breastfeeding; the average duration was 3.7 minutes (table II). The greatest volume was ingested in the first minute, 40% (range between 44 and 25%) (figure 3). The frequency of suction did not change the duration of feeding, but it was found that the efficiency of suction (number of suctions to ingest 1 cc) was significantly lower in the first minute (Anova, p < 0.05) (figure 4).

  19. Early Discharge of Preterm Infants- An Indian Perspective

    PubMed Central

    Kadam, Sandeep; Pandit, Anand; Patole, Sanjay

    2016-01-01

    Introduction Early home discharge of preterm infants is a priority in developing countries due to bed shortage and poor socio-economic status. There is wide variation in home discharge policies for preterm infants. Limited data exists on optimal timing for discharging such infants. In view of the socio-economic and medico-legal importance of the issue, we aimed to study the outcomes of our ex-preterm infants discharged home ‘early’, to guide our clinical practice. Aim To study the rates of re-admissions/mortality within 4 weeks after discharge in preterm (born <34 weeks) infants. Materials and Methods This was an analysis of retrospectively collected data on all ex-preterm infants (gestation <34 weeks at birth) discharged home from our Neonatal Intensive Care Unit (NICU) during the study period. Infants enrolled were stratified based on their gestation age: Group I (n=54): 26-29 weeks, Group II (n=181): 30-34 weeks. Data on demographic characteristics, hospital course and outcomes were analysed for infants meeting inclusion criteria. Re-admission and/or mortality within 4 weeks after discharge were studied. Results The mean±(SD) duration of stay was 42±19 vs. 19±14 days in group I vs. II infants. Five (2.7%) infants were re-admitted within the first four weeks after discharge in group II; none in group I. Conclusion Early home discharge for preterm infants born <34 weeks was feasible and safe in our set-up. Large prospective studies are required to confirm these benefits. PMID:28208967

  20. Nutritional recommendations for the late-preterm infant and the preterm infant after hospital discharge.

    PubMed

    Lapillonne, Alexandre; O'Connor, Deborah L; Wang, Danhua; Rigo, Jacques

    2013-03-01

    Early nutritional support of preterm infants is critical to life-long health and well being. Numerous studies have demonstrated that preterm infants are at increased risk of mortality and morbidity, including disturbances in brain development. To date, much attention has focused on enhancing the nutritional support of very low and extremely low birth weight infants to improve survival and quality of life. In most countries, preterm infants are sent home before their expected date of term birth for economic or other reasons. It is debatable whether these newborns require special nutritional regimens or discharge formulas. Furthermore, guidelines that specify how to feed very preterm infants after hospital discharge are scarce and conflicting. On the other hand, the late-preterm infant presents a challenge to health care providers immediately after birth when decisions must be made about how and where to care for these newborns. Considering these infants as well babies may place them at a disadvantage. Late-preterm infants have unique and often-unrecognized medical vulnerabilities and nutritional needs that predispose them to greater rates of morbidity and hospital readmissions. Poor or inadequate feeding during hospitalization may be one of the main reasons why late-preterm infants have difficulty gaining weight right after birth. Providing optimal nutritional support to late premature infants may improve survival and quality of life as it does for very preterm infants. In this work, we present a review of the literature and provide separate recommendations for the care and feeding of late-preterm infants and very preterm infants after discharge. We identify gaps in current knowledge as well as priorities for future research. Copyright © 2013 Mosby, Inc. All rights reserved.

  1. Nutrition of preterm infants after discharge.

    PubMed

    Cooke, Richard

    2011-01-01

    The fundamental principle underlying nutritional support is that intake meets needs thereby ensuring the best outcome, which, in the case of the preterm infant, is optimal growth and development. Achieving this goal is problematic. Most, if not all, very-low-birth-weight infants (VLBWI) are undernourished and under-grown when they are first discharged from the hospital. This has important implications for the nutritional care of preterm, particularly the breast-fed, VLBWI after hospital discharge.

  2. Survival and neurodevelopmental outcomes of preterm infants.

    PubMed

    Hack, Maureen

    2007-12-01

    Survival of preterm infants, which increased dramatically during the years after the introduction of neonatal intensive care, reached a plateau in the mid- to late 1990s. Neonatal morbidity, which increased initially, has decreased since 2000 and resulted in a decrease in the rates of cerebral palsy. Follow-up of preterm infants to early childhood and school age reveals higher rates of asthma, cerebral palsy, subnormal cognitive function, poorer academic achievement, and behavioral problems. Although many of the problems persist into adulthood, preterm survivors regard their overall health and quality of life similar to that of normal birth weight controls.

  3. Optimizing nutrition of the preterm infant.

    PubMed

    Hay, William W Jr

    2017-01-01

    The goal of nutrition of the preterm infant is to meet the growth rate of the healthy fetus of the same gestational age and to produce the same body composition of the healthy fetus in terms of organ growth, tissue components, and cell number and structure. Nutritional quantity and quality are fundamental for normal growth and development of preterm infants, including neurodevelopmental outcomes. Failure to provide the necessary amounts of all of the essential nutrients has produced not only growth failure, but also increased morbidity and less than optimal neurodevelopment. Growth velocities during the NICU hospitalization period for preterm infants exert a significant effect on neurodevelopmental and anthropometric outcomes. Despite the obvious need for optimal nutrition, growth failure is almost universal among preterm infants. There is every reason, therefore, to optimize nutrition of the preterm infant, in terms of total energy and protein, but also in terms of individual components such as amino acids, specific carbohydrates and lipids, and even oxygen. This review presents scientific rationale for nutrient requirements and practical guidelines and approaches to intravenous and enteral feeding for preterm infants. Intravenous feeding, including amino acids, should be started right after birth at rates that are appropriate for the gestational age of the infant. Enteral feeding should be started as soon as possible after birth, using mother's colostrum and milk as first choices. Enteral feeding should begin with trophic amounts and advanced as rapidly as tolerated, decreasing IV nutrition accordingly, while maintaining nutrient intakes at recommended rates. Feeding protocols are valuable for improving nutrition and related outcomes. Further research is needed to determine the optimal nutrition and rate of growth in preterm infants that will achieve optimal neurocognitive benefits while minimizing the longer-term risk of chronic diseases.

  4. The Efficiency of Sensory Integration Interventions in Preterm Infants.

    PubMed

    Pekçetin, Serkan; Akı, Esra; Üstünyurt, Zeynep; Kayıhan, Hülya

    2016-10-01

    This study aimed to explore the effects of individualized sensory integration interventions on the sensory processing functions of preterm infants. Thirty-four preterm infants (intervention group) at a corrected age of seven months and 34 term infants (control group) were included. The preterm infants underwent an eight-week sensory integration intervention. Before and after the intervention, the preterm infants' sensory processing functions were evaluated using the Test of Sensory Functions in Infants and compared with those of term infants. Preterm infants had significantly poorer sensory processing function preintervention when compared with term infants. There was a significant improvement in preterm infants' sensory processing functions after the sensory integration intervention. In conclusion, preterm infants should be evaluated for sensory processing disorders and individualized sensory integration interventions should be implemented. © The Author(s) 2016.

  5. Pharmacokinetics of melatonin in preterm infants

    PubMed Central

    Merchant, Nazakat M; Azzopardi, Denis V; Hawwa, Ahmed F; McElnay, James C; Middleton, Benita; Arendt, J; Arichi, Tomoki; Gressens, Pierre; Edwards, A David

    2013-01-01

    Aims Preterm infants are deprived of the normal intra-uterine exposure to maternal melatonin and may benefit from replacement therapy. We conducted a pharmacokinetic study to guide potential therapeutic trials. Methods Melatonin was administered to 18 preterm infants in doses ranging from 0.04–0.6 μg kg−1 over 0.5–6 h. Pharmacokinetic profiles were analyzed individually and by population methods. Results Baseline melatonin was largely undetectable. Infants receiving melatonin at 0.1 μg kg−1 h−1 for 2 h showed a median half-life of 15.82 h and median maximum plasma concentration of 203.3 pg ml−1. On population pharmacokinetics, clearance was 0.045 l h−1, volume of distribution 1.098 l and elimination half-life 16.91 h with gender (P = 0.047) and race (P < 0.0001) as significant covariates. Conclusions A 2 h infusion of 0.1 μg kg−1 h−1 increased blood melatonin from undetectable to approximately peak adult concentrations. Slow clearance makes replacement of a typical maternal circadian rhythm problematic. The pharmacokinetic profile of melatonin in preterm infants differs from that of adults so dosage of melatonin for preterm infants cannot be extrapolated from adult studies. Data from this study can be used to guide therapeutic clinical trials of melatonin in preterm infants. PMID:23432339

  6. Preference for infant-directed speech in preterm infants.

    PubMed

    Butler, Samantha C; O'Sullivan, Laura P; Shah, Bhavesh L; Berthier, Neil E

    2014-11-01

    The current study explores the effects of exposure to maternal voice on infant sucking in preterm infants. Twenty-four preterm infants averaging 35 weeks gestational age were divided randomly into two groups. A contingency between high-amplitude sucking and presentation of maternal voice was instituted for one group while the other group served as a yoked control. No significant differences were observed in sucking of the two groups, but the degree of pitch modulation of the maternal voice predicted an increase in the rate of infant sucking.

  7. NICU noise and the preterm infant.

    PubMed

    Brown, Gemma

    2009-01-01

    Premature infants in the NICU are often exposed to continuous loud noise despite research documenting the presence and damaging effects of noise on the preterm infant's development. Excessive auditory stimulation creates negative physiologic responses such as apnea and fluctuations in heart rate, blood pressure, and oxygen saturation. Preterm infants exposed to prolonged excessive noise are also at increased risk for hearing loss, abnormal brain and sensory development, and speech and language problems. Reducing noise levels in the NICU can improve the physiologic stability of sick neonates and therefore enlarge the potential for infant brain development. Recommendations include covering incubators with blankets, removing noisy equipment from the incubator environment, implementing a quiet hour, educating staff to raise awareness, and encouraging staff to limit conversation near infants.

  8. Neurodevelopmental Outcome in Preterm Infants

    ERIC Educational Resources Information Center

    Bos, Arend F.; Roze, Elise

    2011-01-01

    Aim: To determine the distribution of cognitive and motor scores in preterm children, and to establish the influence of brain lesions and decreasing gestational age thereon. Method: One hundred and six very preterm children (63 males, 43 females; gestational age 24.0-31.6wk; birthweight 480-2275g) were assessed for cognition and motor outcome at 6…

  9. Neurodevelopmental Outcome in Preterm Infants

    ERIC Educational Resources Information Center

    Bos, Arend F.; Roze, Elise

    2011-01-01

    Aim: To determine the distribution of cognitive and motor scores in preterm children, and to establish the influence of brain lesions and decreasing gestational age thereon. Method: One hundred and six very preterm children (63 males, 43 females; gestational age 24.0-31.6wk; birthweight 480-2275g) were assessed for cognition and motor outcome at 6…

  10. Pharmacological Therapy of Gastroesophageal Reflux in Preterm Infants

    PubMed Central

    Corvaglia, Luigi; Monari, Caterina; Martini, Silvia; Aceti, Arianna; Faldella, Giacomo

    2013-01-01

    Although gastroesophageal reflux (GER) is a very common phenomenon among preterm infants, its therapeutic management is still an issue of debate among neonatologists. A step-wise approach should be advisable, firstly promoting nonpharmacological interventions and limiting drugs to selected infants unresponsive to the conservative measures or who are suffering from severe GER with clinical complications. Despite of this, a concerning pharmacological overtreatment has been increasingly reported. Most of the antireflux drugs, however, have not been specifically assessed in preterm infants; moreover, serious adverse effects have been noticed in association to their administration. This review mainly aims to draw the state of the art regarding the pharmacological management of GER in preterm infants, analyzing the best piecies of evidence currently available on the most prescribed anti-reflux drugs. Although further trials are required, sodium alginate-based formulations might be considered promising; however, data regarding their safety are still limited. Few piecies of evidence on the efficacy of histamine-2 receptor blockers and proton pump inhibitors in preterm infants with GER are currently available. Nevertheless, a significantly increased risk of necrotizing enterocolitis and infections has been largely reported in association with their use, thereby leading to an unfavorable risk-benefit ratio. The efficacy of metoclopramide in GER's improvement still needs to be clarified. Other prokinetic agents, such as domperidone and erythromycin, have been reported to be ineffective, whereas cisapride has been withdrawn due to its remarkable cardiac adverse effects. PMID:23878533

  11. Development of exploratory behavior in late preterm infants.

    PubMed

    Soares, Daniele de Almeida; von Hofsten, Claes; Tudella, Eloisa

    2012-12-01

    Exploratory behaviors of 9 late preterm infants and 10 full-term infants were evaluated longitudinally at 5, 6 and 7 months of age. Eight exploratory behaviors were coded. The preterm infants mouthed the object less and had delayed gains in Waving compared to the full-term infants.

  12. Relationships between Preterm Infants and Their Parents: Disruption and Development

    ERIC Educational Resources Information Center

    Talmi, Ayelet; Harmon, Robert J.

    2003-01-01

    The birth and hospitalization of a preterm infant have powerful effects on the emerging parent-infant relationship. Characteristics of parents, infant factors, and factors in the hospital and Neonatal Intensive Care Unit (NICU) environments--in addition to the circumstances surrounding preterm birth--may disrupt parent-infant relationships.…

  13. Relationships between Preterm Infants and Their Parents: Disruption and Development

    ERIC Educational Resources Information Center

    Talmi, Ayelet; Harmon, Robert J.

    2003-01-01

    The birth and hospitalization of a preterm infant have powerful effects on the emerging parent-infant relationship. Characteristics of parents, infant factors, and factors in the hospital and Neonatal Intensive Care Unit (NICU) environments--in addition to the circumstances surrounding preterm birth--may disrupt parent-infant relationships.…

  14. Nonpharmacological Management of Gastroesophageal Reflux in Preterm Infants

    PubMed Central

    Corvaglia, Luigi; Arcuri, Santo; Rossini, Roberto; Faldella, Giacomo

    2013-01-01

    Gastroesophageal reflux (GOR) is very common among preterm infants, due to several physiological mechanisms. Although GOR should not be usually considered a pathological condition, its therapeutic management still represents a controversial issue among neonatologists; pharmacological overtreatment, often unuseful and potentially harmful, is increasingly widespread. Hence, a stepwise approach, firstly promoting conservative strategies such as body positioning, milk thickening, or changes of feeding modalities, should be considered the most advisable choice in preterm infants with GOR. This review focuses on the conservative management of GOR in the preterm population, aiming to provide a complete overview, based on currently available evidence, on potential benefits and adverse effects of nonpharmacological measures. Nonpharmacological management of GOR might represent a useful tool for neonatologists to reduce the use of antireflux medications, which should be limited to selected cases of symptomatic babies. PMID:24073393

  15. Preterm infant massage therapy research: a review.

    PubMed

    Field, Tiffany; Diego, Miguel; Hernandez-Reif, Maria

    2010-04-01

    In this paper, preterm infant massage therapy studies are reviewed. Massage therapy has led to weight gain in preterm infants when moderate pressure massage was provided. In studies on passive movement of the limbs, preterm infants also gained significantly more weight, and their bone density also increased. Research on ways of delivering the massage is also explored including using mothers versus therapists and the added effects of using oils. The use of mothers as therapists was effective in at least one study. The use of oils including coconut oil and safflower oil enhanced the average weight gain, and the transcutaneous absorption of oil also increased triglycerides. In addition, the use of synthetic oil increased vagal activity, which may indirectly contribute to weight gain. The weight gain was associated with shorter hospital stays and, thereby, significant hospital cost savings. Despite these benefits, preterm infant massage is only practiced in 38% of neonatal intensive care units. This may relate to the underlying mechanisms not being well understood. The increases noted in vagal activity, gastric motility, insulin and IGF-1 levels following moderate pressure massage are potential underlying mechanisms. However, those variables combined do not explain all of the variance in weight gain, highlighting the need for additional mechanism studies.

  16. Preterm Infant Massage Therapy Research: A Review

    PubMed Central

    Field, Tiffany; Diego, Miguel; Hernandez-Reif, Maria

    2010-01-01

    In this paper, preterm infant massage therapy studies are reviewed. Massage therapy has led to weight gain in preterm infants when moderate pressure massage was provided. In studies on passive movement of the limbs, preterm infants also gained significantly more weight, and their bone density also increased. Research on ways of delivering the massage is also explored including using mothers versus therapists and the added effects of using oils. The use of mothers as therapists was effective in at least one study. The use of oils including coconut oil and safflower oil enhanced the average weight gain, and the transcutaneous absorption of oil also increased triglycerides. In addition, the use of synthetic oil increased vagal activity, which may indirectly contribute to weight gain. The weight gain was associated with shorter hospital stays and, thereby, significant hospital cost savings. Despite these benefits, preterm infant massage is only practiced in 38% of neonatal intensive care units. This may relate to the underlying mechanisms not being well understood. The increases noted in vagal activity, gastric motility, insulin and IGF-1 levels following moderate pressure massage are potential underlying mechanisms. However, those variables combined do not explain all of the variance in weight gain, highlighting the need for additional mechanism studies. PMID:20137814

  17. Phonotactic acquisition in healthy preterm infants.

    PubMed

    Gonzalez-Gomez, Nayeli; Nazzi, Thierry

    2012-11-01

    Previous work has shown that preterm infants are at higher risk for cognitive/language delays than full-term infants. Recent studies, focusing on prosody (i.e. rhythm, intonation), have suggested that prosodic perception development in preterms is indexed by maturational rather than postnatal/listening age. However, because prosody is heard in-utero, and preterms thus lose significant amounts of prenatal prosodic experience, both their maturation level and their prosodic experience (listening age) are shorter than that of full-terms for the same postnatal age. This confound does not apply to the acquisition of phonetics/phonotactics (i.e. identity and order of consonants/vowels), given that consonant differences in particular are only perceived after birth, which could lead to a different developmental pattern. Accordingly, we explore the possibility that consonant-based phonotactic perception develops according to listening age. Healthy French-learning full-term and preterm infants were tested on the perception of consonant sequences in a behavioral paradigm. The pattern of development for full-term infants revealed that 7-month-olds look equally at labial-coronal (i.e. /pat/) compared to coronal-labial sequences (i.e. /tap/), but that 10-month-olds prefer the labial-coronal sequences that are more frequent in the French lexicon. Preterm 10-month-olds (having 10 months of phonetic listening experience but 7 months of maturational age) behaved as full-term 10-month-olds. These results establish that preterm developmental timing for consonant-based phonotactic acquisition is based on listening age (experience with input). This questions the interpretation of previous results on prosodic acquisition in terms of maturational constraints, and raises the possibility that different constraints apply to the acquisition of different phonological subcomponents. © 2012 Blackwell Publishing Ltd.

  18. Evaluation of postnatal growth of preterm infants.

    PubMed

    Bertino, Enrico; Di Nicola, Paola; Giuliani, Francesca; Coscia, Alessandra; Varalda, Alessia; Occhi, Luciana; Rossi, Claudia

    2011-10-01

    The past two decades have seen a progressive improvement in the survival rates of preterm infants, especially in neonates <30 weeks of gestational age. These neonates constitute the large majority of the population in neonatal intensive care units. The correct evaluation of postnatal growth of these babies is nowadays of primary concern, although the definition of their optimal postnatal growth pattern is still controversial. Concerns have also been raised about the strategies to monitor their growth, specifically in relation to the charts used. At present the available charts in clinical practice are fetal growth charts, neonatal anthropometric charts and postnatal growth charts for term infants. None of these, for different reasons, is suitable to correctly evaluate preterm infant growth. An international multicentric project has recently started a study aiming at building a prescriptive standard for the evaluation of postnatal growth of preterm infants and it will be available in the next years providing a population that is conceptually as close as possible to the prescriptive approach used for the construction of the WHO infant and child growth standards. At present, while an international longitudinal standard for evaluating preterm infant postnatal growth is lacking, in Italy the best compromise in clinical practice is likely to be as follows: new Italian INeS (Italian Neonatal Study) charts up to term; International longitudinal charts WHO 2006 or CDC 2002 from term to two years; finally the Italian Society for Pediatric Endocrinology and Diabetes (SIEDP) 2006 growth charts could be suitable for monitoring the growth of these infants from two years up to 20 years of age.

  19. Donor human milk in preterm infant feeding: evidence and recommendations.

    PubMed

    Arslanoglu, Sertac; Ziegler, Ekhard E; Moro, Guido E

    2010-07-01

    In preterm infants, feeding with human milk (HM) is a very effective intervention for the prevention of infections and necrotizing enterocolitis (NEC), and for potentially improved neurocognitive and cardiovascular outcomes in the long-term. Hospitals and physicians are advised to recommend HM for preterm and other high-risk infants either by direct breastfeeding and/or using the mother's own expressed milk. Donor HM is the preferred feeding when the mother's own milk is not available in sufficient quantity. While in some countries donor HM has been considered an effective tool in the delivery of health care to infants, skepticism regarding its nutritional and immunological quality has limited its distribution in other countries. The purpose of this paper is to summarize the clinical benefits of donor HM in preterm infants, and to discuss common concerns limiting its distribution as standard care. Clinically, the use of donor HM has been shown to prevent NEC, reduce feeding intolerance and improve long-term outcomes in premature infants. Common concerns, such as slow growth and loss of important biological components of donor HM due to storage and pasteurization, should not be a reason for denial of donor milk. Optimization of banking procedures and of HM fortification is available and should be applied. Banked donor milk should be promoted as standard component of health care for premature infants.

  20. Flash visual evoked potentials in preterm infants.

    PubMed

    Feng, Jing-Jing; Wang, Wei-Ping; Guo, Shu-Juan; Liu, Zhi-Wei; Xu, Xiu

    2013-03-01

    To describe the development of flash visual evoked potentials (FVEPs) in preterm infants from 1 to 18 months and to determine if the maturation of FVEPs is similar to that of term infants. Longitudinal follow-up study. Twenty very low birth weight (VLBW) preterm infants, 42 low birth weight (LBW) preterm infants, and 41 term infants underwent FVEP recordings and neurodevelopmental examinations at 1, 3, 6, 9, 12, and 18 months of corrected and chronological ages. The FVEP recordings were carried out with the VikingQuest-IV neuroelectrophysiological device (VikingQuest, Nicolet, WI), and neurodevelopmental assessments were made by the Development Screen Test and Bayley Scales of Infant Development, Second Edition. At 1, 3, 6, and 9 months of age, neurodevelopment was measured with the Mental Index and Developmental Quotient. At 12 and 18 months, neurodevelopment was assessed using the Mental Developmental Index and Psychomotor Developmental Index. Two FVEP values were analyzed: the P2 amplitude (peak to peak from the preceding N2 wave) and the latency of the P2 wave. There was no significant difference for age-dependent decreased pattern of FVEP P2 latency between preterm infants and the control group. This pattern consisted of a rapid decrease in the first 6 months of life, a gradual decline from 6 to 12 months of age, and a steady reduction from 12 to 18 months of age. The P2 latencies were prolonged significantly at all 6 recorded times in the VLBW group compared with the controls and showed a delay in the LBW group at 1 and 3 months of corrected age. The maturation of P2 latency in LBW infants is similar to that of the controls at 3 months of corrected age, but the maturation of P2 latency in VLBW children remained delayed when compared with the controls until 18 months of corrected age. Although the FVEP development pattern of preterm infants was similar to that of healthy full-term infants, the former had deficits in visual electrophysiologic maturation

  1. The Assessment of Preterm Infants' Behavior (APIB): Furthering the Understanding and Measurement of Neurodevelopmental Competence in Preterm and Full-Term Infants

    ERIC Educational Resources Information Center

    Als, Heidelise; Butler, Samantha; Kosta, Sandra; McAnulty, Gloria

    2005-01-01

    The Assessment of Preterm Infants' Behavior (APIB) is a newborn neurobehavioral assessment appropriate for preterm, at risk, and full-term newborns, from birth to 1 month after expected due date. The APIB is based in ethological--evolutionary thought and focuses on the assessment of mutually interacting behavioral subsystems in simultaneous…

  2. The Assessment of Preterm Infants' Behavior (APIB): Furthering the Understanding and Measurement of Neurodevelopmental Competence in Preterm and Full-Term Infants

    ERIC Educational Resources Information Center

    Als, Heidelise; Butler, Samantha; Kosta, Sandra; McAnulty, Gloria

    2005-01-01

    The Assessment of Preterm Infants' Behavior (APIB) is a newborn neurobehavioral assessment appropriate for preterm, at risk, and full-term newborns, from birth to 1 month after expected due date. The APIB is based in ethological--evolutionary thought and focuses on the assessment of mutually interacting behavioral subsystems in simultaneous…

  3. Assessment for oral feeding in preterm infants.

    PubMed

    Bolzan, Geovana de Paula; Berwig, Luana Cristina; Prade, Leila Sauer; Cuti, Lilian Kopp; Yamamoto, Raquel Coube de Carvalho; Silva, Ana Maria Toniolo da; Weinmann, Angela Regina Maciel

    2016-07-04

    To assess the accuracy of the Preterm Oral Feeding Readiness Scale (POFRAS) on the beginning of oral feeding in preterm infants and to verify the concordance between this tool and the Oral Feeding Skill Level. 82 preterm infants were assessed by POFRAS regarding their readiness to initiate oral feeding and by the oral feeding skill level evaluation during the first oral feeding. POFRAS's accuracy was estimated regarding proficiency by a Receiver Operating Characteristics (ROC) curve. The concordance between the tools was obtained by analysis of the Kappa coefficient. POFRAS's global accuracy was of 71.29%. The cut-off value of 29 was the one that presented most optimization of the sensitivity based on specificity. The Kappa coefficient has shown a weak concordance between the instruments to identify infants able and unable to oral feeding (k=0.281). POFRAS's accuracy to initiate oral feeding considering the proficiency was similar to that obtained with the technique of translactation. We observed a weak concordance between the instruments. We suggest that, in clinical practice, both instruments should be used in a complementary manner, since both present important aspects of the preterm feeding behavior that together will better guide the necessary conduct to provide an effective and quick transition to full oral feeding in this population.

  4. Endotracheal resuscitation of preterm infants at birth.

    PubMed

    Hoskyns, E W; Milner, A D; Boon, A W; Vyas, H; Hopkin, I E

    1987-07-01

    The adequacy of initial ventilation in 21 preterm babies (25-36 weeks' gestation), who required endotracheal intubation and positive pressure ventilation, were studied. Pressure and flow were measured at the proximal end of the endotracheal intubation tube and expiratory volume calculated from the flow trace. The results were compared with those from a group of 26 term infants who also required resuscitation. Five of 21 preterm babies (24%) had adequate tidal ventilation with the first inflation. This rose to seven of 21 (33%) by the third inflation. This was significantly less than the results in the term infants (chi 2 = 4.38 p less than 0.05). Respiratory reflex responses to resuscitation were seen in 41% of inflations in preterm and 56% of inflations in term infants. There was a significant correlation between reflex activity and adequate ventilation in the preterm group (chi 2 = 11.83, p less than 0.001) but not in the term group (chi 2 = 0.212, p = NS). No correlation was seen between initial ventilation and outcome.

  5. Development of the preterm infant gut microbiome: A research priority

    SciTech Connect

    Groer, Maureen W.; Luciano, Angel A.; Dishaw, Larry J.; Ashmeade, Terri L.; Miller, Elizabeth; Gilbert, Jack A.

    2014-10-13

    The very low birth weight (VLBW) infant is at great risk for marked dysbiosis of the gut microbiome due to multiple factors, including physiological immaturity and prenatal/postnatal influences that disrupt the development of a normal gut flora. However, little is known about the developmental succession of the microbiota in preterm infants as they grow and mature. This review provides a synthesis of our understanding of the normal development of the infant gut microbiome and contrasts this with dysbiotic development in the VLBW infant. The role of human milk in normal gut microbial development is emphasized, along with the role of the gut microbiome in immune development and gastroenteric health. Current research provides evidence that the gut microbiome interacts extensively with many physiological systems and metabolic processes in the developing infant. However, to the best of our knowledge, there are currently no studies prospectively mapping the gut microbiome of VLBW infants through early childhood. This knowledge gap must be filled to inform a healthcare system that can provide for the growth, health, and development of VLBW infants. In conclusion, the study speculates about how the VLBW infants’ gut microbiome might function through host-microbe interactions to contribute to the sequelae of preterm birth, including its influence on growth, development, and general health of the infant host.

  6. Development of the preterm infant gut microbiome: A research priority

    DOE PAGES

    Groer, Maureen W.; Luciano, Angel A.; Dishaw, Larry J.; ...

    2014-10-13

    The very low birth weight (VLBW) infant is at great risk for marked dysbiosis of the gut microbiome due to multiple factors, including physiological immaturity and prenatal/postnatal influences that disrupt the development of a normal gut flora. However, little is known about the developmental succession of the microbiota in preterm infants as they grow and mature. This review provides a synthesis of our understanding of the normal development of the infant gut microbiome and contrasts this with dysbiotic development in the VLBW infant. The role of human milk in normal gut microbial development is emphasized, along with the role ofmore » the gut microbiome in immune development and gastroenteric health. Current research provides evidence that the gut microbiome interacts extensively with many physiological systems and metabolic processes in the developing infant. However, to the best of our knowledge, there are currently no studies prospectively mapping the gut microbiome of VLBW infants through early childhood. This knowledge gap must be filled to inform a healthcare system that can provide for the growth, health, and development of VLBW infants. In conclusion, the study speculates about how the VLBW infants’ gut microbiome might function through host-microbe interactions to contribute to the sequelae of preterm birth, including its influence on growth, development, and general health of the infant host.« less

  7. Jaundice and kernicterus in the moderately preterm infant.

    PubMed

    Wallenstein, Matthew B; Bhutani, Vinod K

    2013-12-01

    Moderate preterm infants remain at increased risk for adverse outcomes, including acute bilirubin encephalopathy (ABE). Evidence-based guidelines for management of hyperbilirubinemia in preterm infants less than 35 weeks' gestational age are not yet optimized. High concentrations of unconjugated bilirubin can cause permanent posticteric neurologic sequelae (kernicterus). Clinical manifestations of ABE in preterm infants are similar to, but often more subtle than, those of term infants. This review outlines clinical strategies to operationalize management of hyperbilirubinemia in moderately preterm infants to meet recently published consensus-based recommendations.

  8. Calcium and vitamin D requirements of enterally fed preterm infants

    USDA-ARS?s Scientific Manuscript database

    Bone health is a critical concern in managing preterm infants. Key nutrients of importance are calcium, vitamin D, and phosphorus. Although human milk is critical for the health of preterm infants, it is low in these nutrients relative to the needs of the infants during growth. Strategies should be ...

  9. Cot-nursing versus incubator care for preterm infants.

    PubMed

    Gray, P H; Flenady, V

    2003-01-01

    An optimal thermal environment is desirable for preterm infants. These infants are usually nursed in incubators, but cot-nursing may provide an alternative. Measures to assist the maintenance of body temperature for smaller infants in open cots include extra clothing/bedding, warming up the nursery and heating the cot mattress. Recently a heated water-filled mattress has been developed to maintain the temperature of a cot-nursed preterm infant. While there may be benefits of nursing preterm infants in open cots, there may be potential risks such as nosocomial infection caused by more handling due to easier access. Among preterm infants allocated to cot-nursing vs incubator care in neonatal period, to assess effects on their temperature control and weight gain. The standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of electronic databases: Oxford Database of Perinatal Trials; Cochrane Controlled Trials Register (Cochrane Library Issue 4 2001); MEDLINE (1966-2001); and CINAHL (1982-2001), previous reviews including cross references. All trials using random or quasi-random patient allocation in which infants receiving care in standard newborn cots were compared to infants managed in a conventional air heated incubator. The authors independently assessed trial quality and extracted data for the primary outcomes of temperature control and weight gain. Meta-analysis was conducted using a fixed effects model. Results are presented as relative risk (RR) for categorical data and mean difference (MD) and weighted mean differences (WMD) for data measured on a continuous scale. Nine potential studies were identified of which four, involving 173 babies, were included in this review. When compared to incubator care, cot-nursing resulted in a statistically significantly higher mean body temperature (MD 0.30 degrees C; 95% CI 0.10, 0.50, one trial) and a decrease in proportion of infants not breast feeding at hospital discharge (RR 0

  10. Nasal high flow treatment in preterm infants.

    PubMed

    Roberts, Calum T; Hodgson, Kate A

    2017-01-01

    Nasal High Flow (HF) is a mode of 'non-invasive' respiratory support for preterm infants, with several potential modes of action, including generation of distending airway pressure, washout of the nasopharyngeal dead space, reduction of work of breathing, and heating and humidification of inspired gas. HF has several potential advantages over continuous positive airway pressure (CPAP), the most commonly applied form of non-invasive support, such as reduced nasal trauma, ease of use, and infant comfort, which has led to its rapid adoption into neonatal care. In recent years, HF has become a well-established and commonly applied treatment in neonatal care. Recent trials comparing HF and CPAP as primary support have had differing results. Meta-analyses suggest that primary HF results in an increased risk of treatment failure, but that 'rescue' CPAP use in those infants with HF failure results in no greater risk of mechanical ventilation. Even in studies with higher rates of HF failure, the majority of infants were successfully treated with HF, and rates of important neonatal morbidities did not differ between treatment groups. Importantly, these studies have included only infants born at ≥28 weeks' gestational age (GA). The decision whether to apply primary HF will depend on the value placed on its advantages over CPAP by clinicians, the approach to surfactant treatment, and the severity of respiratory disease in the relevant population of preterm infants. Post-extubation HF use results in similar rates of treatment failure, mechanical ventilation, and adverse events compared to CPAP. Post-extubation HF appears most suited to infants ≥28 weeks; there are few published data for infants below this gestation, and available evidence suggests that these infants are at high risk of HF failure, although rates of intubation and other morbidities are similar to those seen with CPAP. There is no evidence that using HF to 'wean' off CPAP allows for respiratory support to

  11. Therapeutic touch with preterm infants: composing a treatment.

    PubMed

    Hanley, Mary Anne

    2008-01-01

    Therapeutic touch (TT), a complementary therapy, has been shown to decrease stress, anxiety, and pain in adults and children, as well as improve mobility in patients with arthritis and fibromyalgia. However, less has been reported about the effectiveness of this therapy with infants, particularly preterm infants. The aims of this research study were to explore the nature of the use of TT with preterm infants and describe a TT treatment process for this vulnerable population. Narrative inquiry and qualitative descriptive methods were used to discover knowledge about how TT is used with preterm infants. Telephone/in-person interviews and written narratives provided the data describing nurses' use of TT with preterm infants. The participants were registered nurses who practiced TT with preterm infants for varying years of experience. The participants described the responses of infants, 25 to 37 weeks postgestational age, whom they treated with TT. The infants' responses to TT included reduced heart and respiratory rates, enhanced ability to rest, improved coordination in sucking, swallowing, and breathing, and a greater ability to engage with the environment. The practitioners described the phases and elements of TT for preterm infants, which revealed unique patterns, for example, the treatment phase included the elements of smoothing and containing. The description that emerged from the practitioners' narratives of the TT treatment process for preterm infants provides preliminary data for the systematic use and evaluation of TT as an adjunct to facilitating preterm infants' physiological, behavioral, energy field development, and well-being.

  12. The sleep protection in the preterm infants.

    PubMed

    Calciolari, Guido; Montirosso, Rosario

    2011-10-01

    The importance of sleep in the development is only now beginning to be understood: sleep and established sleep cycles have an important role in the normal neurosensory and cortex development. The biological basis of sleep organization has been highlighted by several studies however environmental differences can affect the sleep patterns in preterm infants in the NICU. Sleep disorders are related to several physiological conditions but it is important to know the relationship between sleep organization and neurocognitive and socio-emotional outcomes. From the recent literature it is possible to find out potentially better practices that preserve and promote infant sleep in the NICU.

  13. Lower Transplacental Antibody Transport for Measles, Mumps, Rubella and Varicella Zoster in Very Preterm Infants

    PubMed Central

    van den Berg, Jolice P.; Westerbeek, Elisabeth A. M.; Smits, Gaby P.; van der Klis, Fiona R. M.; Berbers, Guy A. M.; van Elburg, Ruurd M.

    2014-01-01

    Background Maternal antibodies, transported over the placenta during pregnancy, contribute to the protection of infants from infectious diseases during the first months of life. In term infants, this protection does not last until the first recommended measles-mumps-rubella vaccination at 14 months in the Netherlands, while these viruses still circulate. The aim of the study was to investigate the antibody concentration against measles, mumps, rubella and varicella (MMRV) in mothers and preterm infants or healthy term infants at birth. Methods Antibody concentrations specific for MMRV were measured in cord blood samples from preterm (gestational age <32 weeks and/or birth weight <1500 g) and term infants, and matched maternal serum samples, using a fluorescent bead-based multiplex immune-assay. Results Due to lower placental transfer ratios of antibodies against MMRV in 96 preterm infants (range 0.75–0.87) compared to 42 term infants (range 1.39–1.65), the preterm infants showed 1.7–2.5 times lower geometric mean concentrations at birth compared to term infants. Maternal antibody concentration is the most important determinant of infant antibody concentration against MMRV. Conclusions Preterm infants benefit to a lesser extent from maternal antibodies against measles, mumps, rubella and varicella than term infants, posing them even earlier at risk for infectious diseases caused by these still circulating viruses. PMID:24728480

  14. Resuscitation of extremely preterm infants - controversies and current evidence

    PubMed Central

    Patel, Pooja N; Banerjee, Jayanta; Godambe, Sunit V

    2016-01-01

    Despite significant advances in perinatal medicine, the management of extremely preterm infants in the delivery room remains a challenge. There is an increasing evidence for improved outcomes regarding the resuscitation and stabilisation of extremely preterm infants but there is a lack of evidence in the periviable (gestational age 23-25 wk) preterm subgroup. Presence of an experienced team during the delivery of extremely preterm infant to improve outcome is reviewed. Adaptation from foetal to neonatal cardiorespiratory haemodynamics is dependent on establishing an optimal functional residual capacity in the extremely preterm infants, thus enabling adequate gas exchange. There is sufficient evidence for a gentle approach to stabilisation of these fragile infants in the delivery room. Evidence for antenatal steroids especially in the periviable infants, delayed cord clamping, strategies to establish optimal functional residual capacity, importance of temperature control and oxygenation in delivery room in extremely premature infants is reviewed in this article. PMID:27170925

  15. Review of Randomized Controlled Trials of Massage in Preterm Infants.

    PubMed

    Niemi, Anna-Kaisa

    2017-04-03

    Preterm birth affects about 10% of infants born in the United States. Massage therapy is being used in some neonatal intensive care units for its potential beneficial effects on preterm infants. This article reviews published randomized controlled trials on the effects of massage in preterm infants. Most studies evaluating the effect of massage in weight gain in premature infants suggest a positive effect on weight gain. Increase in vagal tone has been reported in infants who receive massage and has been suggested as a possible mechanism for improved weight gain. More studies are needed on the underlying mechanisms of the effects of massage therapy on weight gain in preterm infants. While some trials suggest improvements in developmental scores, decreased stress behavior, positive effects on immune system, improved pain tolerance and earlier discharge from the hospital, the number of such studies is small and further evidence is needed. Further studies, including randomized controlled trials, are needed on the effects of massage in preterm infants.

  16. Choroid Development and Feasibility of Choroidal Imaging in the Preterm and Term Infants Utilizing SD-OCT

    PubMed Central

    Moreno, Tomas A.; O'Connell, Rachelle V.; Chiu, Stephanie J.; Farsiu, Sina; Cabrera, Michelle T.; Maldonado, Ramiro S.; Tran-Viet, Du; Freedman, Sharon F.; Wallace, David K.; Toth, Cynthia A.

    2013-01-01

    Purpose. To determine whether choroidal imaging is feasible in preterm and term infants using an 840-nm portable spectral domain optical coherence tomography (SD-OCT) system without the use of enhanced-depth imaging techniques and to assess choroidal development by comparing choroidal thickness of preterm infants, term infants, and adults. Methods. SD-OCT images were obtained from 86 preterm infants, 59 term infants, and nine adults using a portable SD-OCT system plus nine adults using a tabletop system. An unprocessed image across the macula from one randomly selected eye of each participant was selected for determination of whether the choroidal-scleral junction (CSJ) could be visualized and for measurement of choroidal thickness. Results. Subfoveal CSJ was visualized in 96% of young-preterm infants (imaged from 30–36 weeks postmenstrual age [PMA]); 78% of term-aged preterm infants (imaged from 37–42 weeks PMA); 49% of term infants; and 39% of adult subjects. Racial pigmentation did not affect CSJ visibility in young-preterm infants (P = 0.57). Subfoveal choroidal thickness (SFCT) in young-preterm infants, term-aged preterm infants, term infants, and adults was 176 ± 53 μm, 289 ± 92 μm, 329 ± 66 μm, and 258 ± 66 μm, respectively, and these were all statistically significantly different from one another except term-aged preterms to adults. Conclusions. Infant choroid can be imaged with a portable SD-OCT system without enhanced depth imaging. Melanin in the RPE and choroid does not hinder outer choroidal imaging in young-preterm infants without advanced retinopathy of prematurity (ROP). In preterm infants, choroidal thickness increased with age but was thinner when compared to term infants suggesting delayed development due to ROP. PMID:23652488

  17. Choroid development and feasibility of choroidal imaging in the preterm and term infants utilizing SD-OCT.

    PubMed

    Moreno, Tomas A; O'Connell, Rachelle V; Chiu, Stephanie J; Farsiu, Sina; Cabrera, Michelle T; Maldonado, Ramiro S; Tran-Viet, Du; Freedman, Sharon F; Wallace, David K; Toth, Cynthia A

    2013-06-14

    To determine whether choroidal imaging is feasible in preterm and term infants using an 840-nm portable spectral domain optical coherence tomography (SD-OCT) system without the use of enhanced-depth imaging techniques and to assess choroidal development by comparing choroidal thickness of preterm infants, term infants, and adults. SD-OCT images were obtained from 86 preterm infants, 59 term infants, and nine adults using a portable SD-OCT system plus nine adults using a tabletop system. An unprocessed image across the macula from one randomly selected eye of each participant was selected for determination of whether the choroidal-scleral junction (CSJ) could be visualized and for measurement of choroidal thickness. Subfoveal CSJ was visualized in 96% of young-preterm infants (imaged from 30-36 weeks postmenstrual age [PMA]); 78% of term-aged preterm infants (imaged from 37-42 weeks PMA); 49% of term infants; and 39% of adult subjects. Racial pigmentation did not affect CSJ visibility in young-preterm infants (P = 0.57). Subfoveal choroidal thickness (SFCT) in young-preterm infants, term-aged preterm infants, term infants, and adults was 176 ± 53 μm, 289 ± 92 μm, 329 ± 66 μm, and 258 ± 66 μm, respectively, and these were all statistically significantly different from one another except term-aged preterms to adults. Infant choroid can be imaged with a portable SD-OCT system without enhanced depth imaging. Melanin in the RPE and choroid does not hinder outer choroidal imaging in young-preterm infants without advanced retinopathy of prematurity (ROP). In preterm infants, choroidal thickness increased with age but was thinner when compared to term infants suggesting delayed development due to ROP.

  18. Longitudinal changes in adiponectin multimer levels in preterm infants.

    PubMed

    Nakano, Yuya; Itabashi, Kazuo; Dobashi, Kazushige; Mizuno, Katsumi

    2016-04-01

    Preterm infants have altered adiponectin levels at term-equivalent age and have a higher risk of developing components of the metabolic syndrome in later life than term infants. To investigate the longitudinal changes in adiponectin levels in preterm infants and to compare the levels between term and preterm infants. A cohort study. The study subjects were 43 term infants and 42 preterm infants born at ≤ 34-week gestation. Serum levels of total adiponectin (T-Ad) and high-molecular-weight adiponectin (HMW-Ad) were measured in 42 preterm infants at term-, 6 month-, and 12 month-equivalent ages. Moreover, the levels in 43 term infants investigated previously were reviewed. In preterm infants, T-Ad and HMW-Ad levels at the 12 month-equivalent age were lower than at the term- and 6 month-equivalent ages (all values p<0.001), which was consistent with previous results in term infants. The difference in ratios of HMW-Ad to T-Ad between term and preterm infants continued at the 6 month-equivalent age but disappeared at the 12 month-equivalent age. Multiple regression analyses revealed that HMW-Ad levels at term-equivalent age were only a significant determinant of the changes in HMW-Ad between the term- and 12 month-equivalent ages in preterm infants (p<0.001). The HMW-Ad levels decline till the 12 month-equivalent age in both term and preterm infants. The changes in HMW-Ad level during infancy might be determined at least to a certain degree up to term-equivalent age in preterm infants. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  19. Rethinking Stress in Parents of Preterm Infants: A Meta-Analysis

    PubMed Central

    Schappin, Renske; Wijnroks, Lex; Uniken Venema, Monica M. A. T.; Jongmans, Marian J.

    2013-01-01

    Background With improved medical outcome in preterm infants, the psychosocial situation of their families is receiving increasing attention. For parents, the birth of a preterm infant is generally regarded as a stressful experience, and therefore many interventions are based on reducing parental stress. Nevertheless, it remains unclear whether parents of children born preterm experience more stress than parents of term-born children, which would justify these interventions. This meta-analysis provides a comprehensive account of parental stress in parents of preterm infants, from birth of the infant through to their adolescence. Mean levels of stress in specific domains of family functioning were investigated, and stress levels in parents of preterm and term infants, and fathers and mothers of preterm infants, were compared. Furthermore, we investigated moderators of parental stress. Methods and Findings A random-effects meta-analysis was conducted including 38 studies describing 3025 parents of preterm (<37 wk) and low birth weight (<2500 g) infants. Parental stress was measured with two parent-reported questionnaires, the Parenting Stress Index and the Parental Stressor Scale: Neonatal Intensive Care Unit. The results indicate that parents of preterm-born children experience only slightly more stress than parents of term-born children, with small effect sizes. Furthermore, mothers have slightly more stress than fathers, but these effect sizes are also small. Parents report more stress for infants with lower gestational ages and lower birth weights. There is a strong effect for infant birth year, with decreasing parental stress from the 1980s onward, probably due to increased quality of care for preterm infants. Conclusions Based on our findings we argue that prematurity can best be regarded as one of the possible complications of birth, and not as a source of stress in itself. PMID:23405105

  20. Magnetic resonance spectroscopy in preterm infants: association with neurodevelopmental outcomes.

    PubMed

    Hyodo, Reina; Sato, Yoshiaki; Ito, Miharu; Sugiyama, Yuichiro; Ogawa, Chikako; Kawai, Hisashi; Nakane, Toshiki; Saito, Akiko; Hirakawa, Akihiro; Kidokoro, Hiroyuki; Natsume, Jun; Hayakawa, Masahiro

    2017-07-19

    To compare magnetic resonance spectroscopy (MRS) metabolite ratios in preterm infants at term-equivalent age with those in term infants and to evaluate the association between MRS metabolites and neurodevelopmental outcomes at 18 months corrected age in preterm infants. We studied infants born at a gestational age <37 weeks and weighing <1500 g during 2009-2013 using MRS at term-equivalent age. Infants with major brain abnormalities were excluded. The ratios of N-acetylaspartate (NAA) to creatine (Cre), NAA to choline-containing compounds (Cho) and Cho to Cre in the frontal white matter and thalamus were measured using multivoxel point-resolved proton spectroscopy sequence. Neurodevelopmental outcomes were assessed at 18 months corrected age. Thirty-three preterm infants and 16 term infants were enrolled in this study. Preterm infants with normal development at 18 months showed significantly lower NAA/Cho ratios in the frontal white matter than term infants. There were no differences in the Cre/Cho ratios between preterm and term infants. At 18 months corrected age, 9 preterm infants with a mild developmental delay showed significantly lower NAA/Cho ratios in the thalamus than 24 preterm infants with normal development. Preterm infants at term-equivalent age showed reduced MRS metabolites (NAA/Cho) compared with term infants. Decreased NAA/Cho ratios in the thalamus were associated with neurodevelopmental delay at 18 months corrected age in preterm infants. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  1. Neurodevelopmental outcomes of preterm infants in Bangladesh.

    PubMed

    Khan, Naila Z; Muslima, Humaira; Parveen, Monowara; Bhattacharya, Mallika; Begum, Nasreen; Chowdhury, Selim; Jahan, Moshrat; Darmstadt, Gary L

    2006-07-01

    The purpose of this work was to determine neurodevelopmental outcomes of preterm infants followed by a multidisciplinary team in a tertiary hospital in Bangladesh. Infants <33 weeks' gestational age were serially assessed for neurodevelopment by physicians and developmental psychologists. An estimate of "low," "moderate," or "high" risk for neurodevelopmental impairments was made at the first visit. At later assessments, neurodevelopmental impairments were graded by severity as "none," "mild," or "serious." Of the 159 enrolled children, 65% survived, 16% died, and 19% were lost to follow-up. Family income was lowest among those who died, and maternal and paternal literacy was highest among the survivors. At a mean age of 31 months, developmental status of the 85 children followed-up for > or = 12 months was normal in 32%; 45% had mild and 23% had serious neurodevelopmental impairments. Cognitive impairment was the most common deficit (60%). Final outcome was significantly better than estimated initially. Most serious (85%) but fewer mild (37%) problems were identified independently by both child health physicians and psychologists. Parental education and family income had significant influence on postdischarge mortality. Two thirds of infants demonstrated neurodevelopmental impairments. Most mild cognitive impairments would have been missed had either physicians or psychologists alone done the assessments. Preterm infants in this low-resource setting are at high risk for neurodevelopmental impairments, which need to be identified early, preferably by a multidisciplinary team of professionals.

  2. Prenatal pseudocysts of the germinal matrix in preterm infants.

    PubMed

    Ramenghi, L A; Domizio, S; Quartulli, L; Sabatino, G

    1997-05-01

    Sonographic characteristics of germinal-matrix (PGM) pseudocysts of prenatal origin detected on cranial ultrasound in preterm newborns were correlated with their outcomes. PGM cysts were classified as typical or atypical, according to their location. Typical PGM cysts were present at the head of the caudate nucleus or slightly medially, adjacent to the foramen of Monro. Cysts were defined as atypical when they were located subependymally elsewhere. Only one infant of 16 with a typical PGM cyst presented with psychomotor retardation. His cerebral scan also showed subependymal calcifications due to cytomegalovirus infection. Three babies had cysts in the frontal periventricular zones (atypical PGM cyst). They had negative cranial MRI (12-15 months of age) and normal neurological follow-up (24 months). In conclusion, isolated prenatal PGM cysts in preterm infants correlate with a normal outcome.

  3. Early neurodevelopmental outcomes of extremely preterm infants.

    PubMed

    Rogers, Elizabeth E; Hintz, Susan R

    2016-12-01

    Infants born at extreme preterm gestation are at risk for both death and disability. Although rates of survival have improved for this population, and some evidence suggests a trend toward decreased neuromotor impairment over the past decades, a significant improvement in overall early neurodevelopmental outcome has not yet been realized. This review will examine the rates and types of neurodevelopmental impairment seen after extremely preterm birth, including neurosensory, motor, cognitive, and behavioral outcomes. We focus on early outcomes in the first 18-36 months of life, as the majority of large neonatal studies examining neurodevelopmental outcomes stop at this age. However, this early age is clearly just a first glimpse into lifetime outcomes; the neurodevelopmental effects of extreme prematurity may last through school age, adolescence, and beyond. Importantly, prematurity appears to be an independent risk factor for adverse development, but this population demonstrates considerable variability in the types and severity of impairments. Understanding both the nature and prevalence of neurodevelopmental impairment among extremely preterm infants is important because it can lead to targeted interventions that in turn may lead to improved outcomes.

  4. Fortification of human milk for preterm infants.

    PubMed

    Radmacher, Paula G; Adamkin, David H

    2017-02-01

    Human milk is the preferred feeding for all infants, including those of very low birth weight (<1500 g). It has both nutritional and anti-infective properties which are especially important for infants at risk for sepsis and necrotizing enterocolitis. When maternal milk is not available or the amount produced is not sufficient to meet daily needs, donor human milk may (should) be used in its place. However, donor human milk is generally term in quality and likely has insufficient protein to promote appropriate growth. Whether donor or mother's own milk, fortification of human milk is required to meet nutrient requirements for growth and development for these preterm infants who are at high risk for growth faltering during the hospital stay. There are multiple strategies and products that may be employed to support desired growth rates. The advent of human milk analyzers may be helpful in a more customized approach to fortification. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Effects of Early Intervention and Stimulation on the Preterm Infant.

    ERIC Educational Resources Information Center

    Leib, Susan A.; And Others

    1980-01-01

    To test the hypothesis that early intervention can enhance the development of high risk preterm infants, a prescribed multimodal sensory enrichment program, within a regional neonatal intensive care unit, was designed and implemented with 28 preterm infants. Journal Availability: American Academy of Pediatrics, P.O. Box 1034, Evanston, IL 60204…

  6. Temperature Increases in Preterm Infants During Massage Therapy

    PubMed Central

    Diego, Miguel A.; Field, Tiffany; Hernandez-Reif, Maria

    2008-01-01

    Temperature was assessed in 72 preterm infants randomly assigned to a control or a massage therapy group. A greater increase in temperature was noted for preterm infants receiving massage therapy versus a control group, even though the incubator portholes remained open during the 15-minute massage therapy session but not for the control group over an equivalent time period. PMID:17692385

  7. Assessment of kidney function in preterm infants: lifelong implications.

    PubMed

    Abitbol, Carolyn L; DeFreitas, Marissa J; Strauss, José

    2016-12-01

    This educational review will highlight the historical and contemporary references that establish a basic understanding of measurements of kidney function in the neonate and its relevance for the life of an individual. Importantly, the differential renal function of preterm infants relative to term infants has become paramount with the increased viability of preterm infants and the realization that kidney function is associated with gestational age. Moreover, neonatal kidney function is primarily associated with absolute renal mass and hemodynamic stability. Neonatal kidney function and its early developmental progression predict lifelong cardiovascular and renal disease risks. Validation of estimation equations of kidney function in this population has provided important reference data for other investigations and a clinical basis for prospective and longitudinal follow-up. Future research should be directed towards a better understanding of surrogate markers of kidney function from infancy through adulthood. Pediatric nephrologists should be aware of the developmental aspects of kidney function including the importance of the congenital nephron endowment and the preservation of kidney function throughout a lifetime. • Nephrogenesis occurs in utero in concert with other organ systems by branching morphogenesis, including the lungs, pancreas, and vascular tree, with over 60 % of nephrons being formed during the last trimester. • Infants born preterm before 36 weeks' gestation are in active nephrogenesis and are at increased risk of having a decreased nephron endowment from prenatal and postnatal genetic and epigenetic hazards that will impact the patient for a lifetime. • Post-natal adaptation of kidney function is directly proportional to the number of perfused nephrons, estimated by total kidney volume (TKV), mean arterial pressure (MAP), and gestational age. • Accurate measurement of glomerular filtration rate (GFR) in infants is problematic due to the

  8. Vaccination of preterm infants by polyvalent vaccines: immunogenicity and safety- review of literature.

    PubMed

    Czajka, Hanna; Lauterbach, Ryszard; Pawlik, Dorota

    2014-01-01

    The immunization of infants against infectious diseases still raises many controversies, not only with parents, but also among physicians. This refers particularly to preterm infants. Due to the increasing popularity of polyvalent vaccines, a number of studies has recently been conducted to verify their immunogenicity and safety in preterm infants. The aim of the present paper was to review the current literature dealing with the problem in question. The following recommendations regarding the use of polyvalent vaccines in preterm infants and neonates with low birth weight can be formulated on the basis of current evidence (1). Due to sufficient immunogenicity, polyvalent vaccines can be administered to preterm infants in accordance with their calendar age (2). Booster vaccination of preterm infants after completing 12 months of age is vital for achieving complete and persistent immunity against all vaccine antigens (3). In order to reduce the risk of adverse events after the administration of a polyvalent vaccine, it is essential to carefully consider the cardiorespiratory status of preterm infants during preimmunization examination, as well as their history of any cardiorespiratory dysfunctions. In such cases administering the first dose of the vaccine in a hospital setting is strongly advised.

  9. Are late preterm infants as susceptible to RSV infection as full term infants?

    PubMed

    Resch, Bernhard; Paes, Bosco

    2011-03-01

    Preterm infants are at increased risk of being rehospitalised during the first few months of life with severe respiratory syncytial virus (RSV) lower respiratory tract infection (LRTI) that usually manifests as apnea and hypoxemia. This occurs more commonly in preterm infants < 33 weeks gestational age (GA), but recent studies demonstrate that late preterm infants (those born between 34 weeks and 0 days to 36 weeks and 6 days GA) are equally susceptible to RSV LRTI as those with lower GA. Factors associated with severe LRTI include immaturity of both the humoral and cell-mediated immune system and interrupted lung development prior to 36 weeks GA which results in lower functional residual capacity, reduced compliance, diminished forced expiratory air flow and impaired gas exchange. Morbidity and mortality are significantly increased in late preterms compared to their term counterparts. Prophylaxis with palivizumab against RSV infection seems to be crucial. Due to the large number of infants in this age group, additional risk factors have been identified in order to tailor palivizumab prophylaxis effectively to those at highest risk for severe RSV LRTI. Copyright © 2011 Elsevier Ltd. All rights reserved.

  10. Motor development and sensory processing: A comparative study between preterm and term infants.

    PubMed

    Cabral, Thais Invenção; Pereira da Silva, Louise Gracelli; Tudella, Eloisa; Simões Martinez, Cláudia Maria

    2014-10-16

    Infants born preterm and/or with low birth weight may present a clinical condition of organic instability and usually face a long period of hospitalization in the Neonatal Intensive Care Units, being exposed to biopsychosocial risk factors to their development due to decreased spontaneous movement and excessive sensory stimuli. This study assumes that there are relationships between the integration of sensory information of preterm infants, motor development and their subsequent effects.

  11. Risk of Asthma in Late Preterm Infants: A Propensity Score Approach

    PubMed Central

    Voge, Gretchen A; Katusic, Slavica K; Qin, Rui; Juhn, Young J

    2015-01-01

    Background The risk of asthma, specifically in former late preterm infants, has not been well defined. Covariate imbalance and lack of controlling for this has led to inconsistent results in prior studies. Objective Determine the risk of asthma in former late preterm infants using a propensity score approach. Methods The study was a population-based birth cohort study. Study subjects were all children born in Rochester, Minnesota, between 1976 and 1982. Asthma status during the first seven years of life was assessed by applying predetermined criteria. The propensity score was formulated using 15 covariates by fitting a logistic regression model for late preterm birth versus term birth. We applied the propensity score method to match late preterm infants (34 0/7 to 36 6/7 weeks gestation) to term infants (37 0/7 to 40 6/7 weeks gestation) within a caliper of 0.2 standard deviation of logit of propensity score. Results Of the eligible 7,040 infants, 5,915 children had complete data. Before propensity score matching, late preterm infants had a higher risk of asthma (20 of 262, 7.6%) compared to full-term infants (272 of 5,653, 4.8%)(p=0.039). There was significant covariate imbalance between comparison groups. After matching with propensity scores, we found that former late preterm infants had a similar risk of asthma to the matched full-term infants (6.6% vs. 7.7%, respectively, p=0.61), and the result were consistent with covariate-adjustment, Cox regression models controlling for significant covariates (p=0.57). Conclusion A late preterm birth history is not independently associated with childhood asthma, as the reported risk of asthma among former late preterm infants appears to be due to covariate imbalance. PMID:25944734

  12. Inhaled nitric oxide in preterm infants with prolonged preterm rupture of the membranes: a case series.

    PubMed

    Semberova, J; O'Donnell, S M; Franta, J; Miletin, J

    2015-04-01

    The available evidence does not support the routine use of inhaled nitric oxide (iNO) in the care of premature infants. We present a case series of 22 preterm infants born after prolonged preterm premature rupture of membranes and oligohydramnios with respiratory failure. Oxygenation index decreased significantly after commencement of iNO.

  13. Patterns of Psychological Distress in Mothers of Preterm Infants

    PubMed Central

    Santos, Hudson; Levy, Janet; White-Traut, Rosemary; O’Shea, T. Michael; Geraldo, Victoria; David, Richard

    2015-01-01

    Mothers of preterm infants experience significant psychological distress, with elevated levels of inter-correlated depressive symptoms, stress, anxiety and post-traumatic stress symptoms. In a sample of racially and ethnically diverse mothers of preterm infants, we identified differing patterns of psychological distress during infant hospitalization and examined the effect of these psychological distress patterns on longitudinal trajectories of each psychological distress measure and on maternal perceptions of the child over the first year of the infant’s life. Mothers of preterm infants (N = 232) completed five questionnaires assessing depressive symptoms, anxiety, post-traumatic stress symptoms, stress due to infant appearance, and stress due to parental role alteration during enrollment in the neonatal hospitalization, discharge, and at 2, 6, and 12 months of age adjusted for prematurity. Latent class analysis on the enrollment psychological distress variables allowed us to identify five sub-groups of mothers exhibiting similar patterns of psychological distress, differing primarily in degree and type: low distress, moderate distress, high NICU-related distress, high depressive and anxiety symptoms, and extreme distress. These classes continued to show different longitudinal trajectories for the psychological distress measures through 12 months corrected age. Mothers in the extreme distress class and, to a lesser degree, mothers in the high depressive and anxiety symptom class remained at risk of significant psychological distress one year after discharge and had less positive perceptions of their child (greater worry and higher perceptions of child vulnerability). In conclusion, distinctive subgroups of mothers during hospitalization had different patterns of psychological distress throughout the 12-month period and may require different interventions in the NICU. PMID:26495909

  14. Human milk and the nutritional needs of preterm infants.

    PubMed

    Tudehope, David I

    2013-03-01

    Key principles underpinning feeding guidelines for preterm infants include support for developmental care, breastfeeding, milk expression, and creating feeding plans. Early trophic feeding with colostrum and transitional milk improves immune protection and promotes gut maturation. Studies of preterm infants demonstrate that feeding mother's milk (MM) decreases the incidence of infection and necrotizing enterocolitis and improves neurodevelopmental outcome but may decrease ponderal and linear growth. Standard practice in neonatal units is to promote mother's own milk as the feed of choice for all infants. However, it is not feasible or prudent to do so for all preterm infants. Mothers of preterm infants have lower rates of successful breastfeeding compared with those of term infants. MM can contain harmful bacterial or viral pathogens. Although preterm human milk (HM) contains higher concentrations of protein, sodium, zinc, and calcium than mature HM, it falls short of supplying adequate quantities of nutrients required by preterm infants. Therefore, HM supplemented with nutrients is recommended for all infants born before 32 weeks gestation and for certain infants born at 32-36 weeks of gestation. HM is the preferred feed, but preterm formula is an appropriate option when there is an inadequate supply of MM.

  15. The biobehavioral effects of gentle human touch on preterm infants.

    PubMed

    Modrcin-Talbott, Mary Anne; Harrison, Lynda Law; Groer, Maureen W; Younger, Mary Sue

    2003-01-01

    This study examined the physiological and behavioral effects of a gentle human touch nursing intervention on medically fragile preterm infants (27 to 32 weeks gestational age). The Roy adaptation model of nursing was the framework for the study. The results of this study suggest that the immediate and short-term effects of a gentle human touch nursing intervention were not aversive or stressful to preterm infants of 27 to 32 weeks gestational age; furthermore, the findings document several positive, beneficial behavioral effects of the intervention on preterm infants and indicate this type of touching may be appropriate for infants in the neonatal intensive care unit.

  16. Longchain polyunsaturated fatty acid supplementation in preterm infants.

    PubMed

    Simmer, K; Patole, S

    2004-01-01

    The n-3 and n-6 essential fatty acids alpha linolenic acid (ALA) and linoleic acid (LA) are the precursors of the n-3 and n-6 longchain polyunsaturated fatty acids (LCPUFA). Controversy exists over whether LCPUFA are essential nutrients for preterm infants who may not be able to synthesise sufficient amounts of LCPUFA to satisfy the needs of the developing brain and retina. The aim of this review is to assess whether supplementation of formula with LCPUFA is safe and of benefit to preterm infants. Trials were identified by MEDLINE (October 2003), Oxford Database of Perinatal Trials, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2003) and by checking reference lists of relevant articles and conference proceedings. All randomised trials of formula supplemented with LCPUFA and with clinical endpoints were reviewed. Eleven randomised trials assessing the clinical effects of feeding formula supplemented with LCPUFA were included in the review. Of the eleven randomised trials included in the review, two of these were not classified as of high quality despite blinded assessment and complete follow-up, due to problems with assessment methodology. VISUAL ACUITY: Visual acuity over the first year was measured by Teller acuity cards in six studies, by VEP in four studies and by ERG in two studies. Most studies found no significant differences in any visual assessment between supplemented and control infants. Most of the trials have used Bayley Scales of Infant Development (BSID) at 12 to 24 months postterm and shown no significant effect following supplementation. Meta-analysis of BSID of three studies (Fewtrell 2002, O'Connor 2001, van Wezel 2002) shows no significant effect of supplementation on development. Carlson 1993 and Carlson 1996 demonstrated lower novelty preferences (possibly predictive of lower intelligence) in the supplemented compared with the control group. The investigators however concluded that supplemented infants

  17. Short and Long-Term Outcomes for Extremely Preterm Infants

    PubMed Central

    Patel, Ravi Mangal

    2016-01-01

    Prematurity is the leading cause of infant mortality worldwide. In developed countries, extremely preterm infants contribute disproportionately to both neonatal and infant mortality. Survival of this high-risk population has incrementally improved in recent years. Despite these improvements, approximately 1 in 4 extremely preterm infants dies during the birth hospitalization. Among those who survive, respiratory and other morbidities are common, although their effect on quality of life is variable. In addition, long-term neurodevelopmental impairment is a large concern for patients, clinicians and families. However, the interplay of multiple factors contribute to neurodevelopmental impairment, with measures that change over time and outcomes that can be difficult to define and predict. Understanding outcomes of extremely preterm infants can help better counsel families regarding antenatal and postnatal care and guide strategies to improve survival without morbidity. This review summarizes recent evidence to provide an overview into the short- and long-term outcomes for extremely preterm infants. PMID:26799967

  18. Quality Improvement Project to Reduce Delayed Vaccinations in Preterm Infants.

    PubMed

    Cuna, Alain; Winter, Lindy

    2017-08-01

    Preterm infants are especially vulnerable to infectious diseases. Although vaccinations are a safe and effective measure to protect preterm infants from vaccine-preventable diseases, delays in vaccinations are not uncommon. The goal of this quality improvement project was to improve on time vaccinations of preterm infants hospitalized in the neonatal intensive care unit. The Plan-Do-Study-Act model of quality improvement was adopted to develop, test, and implement interventions aimed at improving timely vaccination of preterm infants. The primary outcome measure of interest was the rate of on time vaccination, which was defined as the proportion of medically eligible preterm infants who received vaccinations within 2 weeks of the recommended schedule. Baseline on time vaccination rate was only 36%. Following several Plan-Do-Study-Act cycles, a steady increase in on time vaccinations of eligible infants was observed, and a new baseline on time vaccination rate of 82% was achieved. Simple interventions implemented within the context of Plan-Do-Study-Act cycles are effective in improving timely vaccinations among preterm infants. Future research that focuses on vaccinations in preterm infants is needed to further reinforce the safety and efficacy of vaccines. Effective methods on how to disseminate and apply this knowledge to practice should also be studied.Video Abstract available at http://links.lww.com/ANC/A27.

  19. The development of cardiovascular and cerebral vascular control in preterm infants.

    PubMed

    Fyfe, Karinna L; Yiallourou, Stephanie R; Wong, Flora Y; Horne, Rosemary S C

    2014-08-01

    Over the past three decades there has been a steady increase in the incidence of preterm birth. The worldwide rate of preterm birth is estimated to be 9.6% of all births, a total of almost 13 million births annually. Preterm birth is associated with a range of adverse cardiovascular and central nervous system outcomes, which may be attributed to altered development of these systems following preterm birth. Preterm birth has a considerable impact on cardiovascular parameters with preterm infants displaying higher heart rates and reduced blood pressure when compared to term born infants at matched ages. Furthermore, premature infants have altered autonomic control of cardiovascular parameters which manifests as abnormalities in heart rate variability and baroreflex mediated control of heart rate and blood pressure. As a result, systemic cardiovascular parameters can be unstable following preterm birth which may place stress on the neonatal brain. The brain of a preterm infant is particularly vulnerable to these fluctuations due to immature cerebral haemodynamics. Preterm infants, particularly those who are very preterm or unwell, display fluctuating pressure-passivity between systemic blood pressure and cerebral blood flow representing a considerably increased risk of cerebral haemorrhage or hypoxia. This is further compounded by immaturity of cerebral blood flow-metabolism coupling, which means increased metabolic demand cannot adequately be met by increased cerebral blood flow. It has been suggested that adverse long-term outcomes following preterm birth may occur as a result of exposure to physiological stress either in-utero or early in infancy. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

  20. Oxygen saturation and outcomes in preterm infants.

    PubMed

    Stenson, Ben J; Tarnow-Mordi, William O; Darlow, Brian A; Simes, John; Juszczak, Edmund; Askie, Lisa; Battin, Malcolm; Bowler, Ursula; Broadbent, Roland; Cairns, Pamela; Davis, Peter Graham; Deshpande, Sanjeev; Donoghoe, Mark; Doyle, Lex; Fleck, Brian W; Ghadge, Alpana; Hague, Wendy; Halliday, Henry L; Hewson, Michael; King, Andrew; Kirby, Adrienne; Marlow, Neil; Meyer, Michael; Morley, Colin; Simmer, Karen; Tin, Win; Wardle, Stephen P; Brocklehurst, Peter

    2013-05-30

    The clinically appropriate range for oxygen saturation in preterm infants is unknown. Previous studies have shown that infants had reduced rates of retinopathy of prematurity when lower targets of oxygen saturation were used. In three international randomized, controlled trials, we evaluated the effects of targeting an oxygen saturation of 85 to 89%, as compared with a range of 91 to 95%, on disability-free survival at 2 years in infants born before 28 weeks' gestation. Halfway through the trials, the oximeter-calibration algorithm was revised. Recruitment was stopped early when an interim analysis showed an increased rate of death at 36 weeks in the group with a lower oxygen saturation. We analyzed pooled data from patients and now report hospital-discharge outcomes. A total of 2448 infants were recruited. Among the 1187 infants whose treatment used the revised oximeter-calibration algorithm, the rate of death was significantly higher in the lower-target group than in the higher-target group (23.1% vs. 15.9%; relative risk in the lower-target group, 1.45; 95% confidence interval [CI], 1.15 to 1.84; P=0.002). There was heterogeneity for mortality between the original algorithm and the revised algorithm (P=0.006) but not for other outcomes. In all 2448 infants, those in the lower-target group for oxygen saturation had a reduced rate of retinopathy of prematurity (10.6% vs. 13.5%; relative risk, 0.79; 95% CI, 0.63 to 1.00; P=0.045) and an increased rate of necrotizing enterocolitis (10.4% vs. 8.0%; relative risk, 1.31; 95% CI, 1.02 to 1.68; P=0.04). There were no significant between-group differences in rates of other outcomes or adverse events. Targeting an oxygen saturation below 90% with the use of current oximeters in extremely preterm infants was associated with an increased risk of death. (Funded by the Australian National Health and Medical Research Council and others; BOOST II Current Controlled Trials number, ISRCTN00842661, and Australian New Zealand

  1. Short-Term Outcomes and Mortality of Late Preterm Infants

    PubMed Central

    Bulut, Cahide; Gürsoy, Tuğba; Ovalı, Fahri

    2016-01-01

    Background: Late preterm infants have increased rates of morbidity and mortality compared to term infants. Determining the risk factors in these infants leads to more comprehensive preventive and treatment strategies. Aims: Our aim was to analyse the morbidity rates such as respiratory system diseases, infections, congenital anomalies, hypoglycemia and hematologic abnormalities and mortality rates in a large group of patients at a referral center. Study Design: Retrospective cross-sectional study. Methods: Medical records of late preterm and term infants who were managed at the referral center were analysed. Results: 41752 births were analysed in 3 years. 71.9% of all births were between 37–42 gestational weeks (i.e. term) and 16.1% were between 34–37 weeks (i.e. late preterm). Compared to term infants, late preterm infants had increased rates of short-term problems. The rate of mortality increased with decreased gestational age. The duration of hospitalization was significantly higher in the smallest late preterm infants. Conclusion: This study demonstrated the need that late preterm infants who have higher risk for morbidity and mortality, compared to term infants require close monitoring. The rate of mortality and hospitalization increased with decreased gestational age. PMID:27403390

  2. Long-chain polyunsaturated fatty acid supplementation in preterm infants.

    PubMed

    Simmer, K; Schulzke, S M; Patole, S

    2008-01-23

    The n-3 and n-6 essential fatty acids alpha linolenic acid (ALA) and linoleic acid (LA) are the precursors of the n-3 and n-6 longchain polyunsaturated fatty acids (LCPUFA). Controversy exists over whether LCPUFA are essential nutrients for preterm infants, who may not be able to synthesise sufficient amounts of LCPUFA to satisfy the needs of the developing brain and retina. The aim of this review is to assess whether supplementation of formula with LCPUFA is safe and of benefit to preterm infants. Trials were identified by MEDLINE (February 2007), Oxford Database of Perinatal Trials, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2007) and by checking reference lists of relevant articles and conference proceedings. All randomised trials of formula supplemented with LCPUFA and with clinical endpoints were reviewed. Fifteen randomised trials assessing the clinical effects of feeding formula supplemented with LCPUFA were included in the review. Of the fifteen randomised trials included in the review, four of these were not classified as of high quality, due to low follow-up, uncertainty regarding concealment of patient allocation and randomisation, and problems with assessment methodology. VISUAL ACUITY: Visual acuity over the first year was measured by Teller or Lea acuity cards in eight studies, by VEP in six studies and by ERG in two studies. Most studies found no significant differences in any visual assessment between supplemented and control infants. Most of the trials have used Bayley Scales of Infant Development (BSID) at 12 to 24 months post-term with three out of seven studies reporting some benefit of LCPUFA in different populations of supplemented infants at different postnatal ages. Meta-analysis of BSID of four studies at 12 months (N = 364) and three studies at 18 months (N = 494) post-term showed no significant effect of supplementation on neurodevelopment. Carlson 1992 and Carlson 1996 demonstrated lower

  3. Development of salivary cortisol circadian rhythm in preterm infants.

    PubMed

    Ivars, Katrin; Nelson, Nina; Theodorsson, Annette; Theodorsson, Elvar; Ström, Jakob O; Mörelius, Evalotte

    2017-01-01

    To investigate at what age preterm infants develop a salivary cortisol circadian rhythm and identify whether it is dependent on gestational age and/or postnatal age. To evaluate whether salivary cortisol circadian rhythm development is related to behavioral regularity. To elucidate salivary cortisol levels in preterm infants during the first year of life. This prospective, longitudinal study included 51 preterm infants. 130 healthy full-term infants served as controls. Monthly salivary cortisol levels were obtained in the morning (07:30-09:30), at noon (10:00-12:00), and in the evening (19:30-21:30), beginning at gestational age week 28-32 and continuing until twelve months corrected age. Behavioral regularity was studied using the Baby Behavior Questionnaire. A salivary cortisol circadian rhythm was established by one month corrected age and persisted throughout the first year. The preterm infants showed a cortisol pattern increasingly more alike the full-term infants as the first year progressed. The preterm infants increase in behavioral regularity with age but no correlation was found between the development of salivary cortisol circadian rhythm and the development of behavior regularity. The time to establish salivary cortisol circadian rhythm differed between preterm and full-term infants according to postnatal age (p = 0.001) and was dependent on gestational age. Monthly salivary cortisol levels for preterm infants from birth until twelve months are presented. Additional findings were that topical corticosteroid medication was associated with higher concentrations of salivary cortisol (p = 0.02) and establishment of salivary cortisol circadian rhythm occurred later in infants treated with topical corticosteroid medication (p = 0.02). Salivary cortisol circadian rhythm is established by one month corrected age in preterm infants. Establishment of salivary cortisol circadian rhythm is related to gestational age rather than to postnatal age. Salivary cortisol

  4. Lactobacillus Sepsis following a Laparotomy in a Preterm Infant: A Note of Caution.

    PubMed

    Brecht, Marcus; Garg, Alka; Longstaff, Karen; Cooper, Celia; Andersen, Chad

    2016-01-01

    Probiotics for preterm infants have been shown to reduce the incidence of necrotising enterocolitis and all-cause mortality in a recent meta-analysis. It has been argued, however, that some of these results may not be applicable to specific subgroups, e.g. infants with a birth weight of <1,000 g. The specific role of probiotics in improving health outcomes in preterm and term infants following intestinal surgery is not well defined. We report a case of a premature infant diagnosed with late-onset sepsis due to Lactobacillus rhamnosus following a laparotomy. We review pertinent published cases. This case highlights the importance of considering preterm infants as being at a higher risk of systemic probiotic infection following intestinal surgery.

  5. Tracheobronchomalacia in preterm infants with chronic lung disease

    PubMed Central

    Doull, I.; Mok, Q.; Tasker, R.

    1997-01-01

    Tracheobronchomalacia is a treatable cause of persisting ventilatory requirements in the preterm neonate, and warrants a high index of suspicion. Five preterm infants with persisting ventilatory requirements with evidence of tracheobronchomalacia are reported. Four were diagnosed by tracheobronchogram and one by flexible endoscopy. All were successfully managed by continuous positive airway pressure (CPAP) via a tracheostomy. One infant died of unrelated causes. The oldest child in this series at the age of 2 years requires no further ventilatory support. Tracheobronchial anomalies should be considered in all preterm infants with persisting ventilatory requirements.

 Keywords: tracheobronchomalacia; continuous positive airway pressure PMID:9175954

  6. Use of inhaled nitric oxide in preterm infants.

    PubMed

    Kumar, Praveen

    2014-01-01

    Nitric oxide, an important signaling molecule with multiple regulatory effects throughout the body, is an important tool for the treatment of full-term and late-preterm infants with persistent pulmonary hypertension of the newborn and hypoxemic respiratory failure. Several randomized controlled trials have evaluated its role in the management of preterm infants ≤ 34 weeks' gestational age with varying results. The purpose of this clinical report is to summarize the existing evidence for the use of inhaled nitric oxide in preterm infants and provide guidance regarding its use in this population.

  7. Developmental Outcomes of Late Preterm Infants From Infancy to Kindergarten.

    PubMed

    Shah, Prachi; Kaciroti, Niko; Richards, Blair; Oh, Wonjung; Lumeng, Julie C

    2016-08-01

    To compare developmental outcomes of late preterm infants (34-36 weeks' gestation) with infants born at early term (37-38 weeks' gestation) and term (39-41 weeks' gestation), from infancy through kindergarten. Sample included 1000 late preterm, 1800 early term, and 3200 term infants ascertained from the Early Childhood Longitudinal Study, Birth Cohort. Direct assessments of development were performed at 9 and 24 months by using the Bayley Short Form-Research Edition T-scores and at preschool and kindergarten using the Early Childhood Longitudinal Study, Birth Cohort reading and mathematics θ scores. Maternal and infant characteristics were obtained from birth certificate data and parent questionnaires. After controlling for covariates, we compared mean developmental outcomes between late preterm and full-term groups in serial cross-sectional analyses at each timepoint using multilinear regression, with pairwise comparisons testing for group differences by gestational age categories. With covariates controlled at all timepoints, at 9 months late preterm infants demonstrated less optimal developmental outcomes (T = 47.31) compared with infants born early term (T = 49.12) and term (T = 50.09) (P < .0001). This association was not seen at 24 months, (P = .66) but reemerged at preschool. Late preterm infants demonstrated less optimal scores in preschool reading (P = .0006), preschool mathematics (P = .0014), and kindergarten reading (P = .0007) compared with infants born at term gestation. Although late preterm infants demonstrate comparable developmental outcomes to full-term infants (early term and full-term gestation) at 24 months, they demonstrate less optimal reading outcomes at preschool and kindergarten timepoints. Ongoing developmental surveillance for late preterm infants is warranted into preschool and kindergarten. Copyright © 2016 by the American Academy of Pediatrics.

  8. Developmental Outcomes of Late Preterm Infants From Infancy to Kindergarten

    PubMed Central

    Kaciroti, Niko; Richards, Blair; Oh, Wonjung; Lumeng, Julie C.

    2016-01-01

    OBJECTIVE: To compare developmental outcomes of late preterm infants (34–36 weeks’ gestation) with infants born at early term (37–38 weeks’ gestation) and term (39–41 weeks’ gestation), from infancy through kindergarten. METHODS: Sample included 1000 late preterm, 1800 early term, and 3200 term infants ascertained from the Early Childhood Longitudinal Study, Birth Cohort. Direct assessments of development were performed at 9 and 24 months by using the Bayley Short Form–Research Edition T-scores and at preschool and kindergarten using the Early Childhood Longitudinal Study, Birth Cohort reading and mathematics θ scores. Maternal and infant characteristics were obtained from birth certificate data and parent questionnaires. After controlling for covariates, we compared mean developmental outcomes between late preterm and full-term groups in serial cross-sectional analyses at each timepoint using multilinear regression, with pairwise comparisons testing for group differences by gestational age categories. RESULTS: With covariates controlled at all timepoints, at 9 months late preterm infants demonstrated less optimal developmental outcomes (T = 47.31) compared with infants born early term (T = 49.12) and term (T = 50.09) (P < .0001). This association was not seen at 24 months, (P = .66) but reemerged at preschool. Late preterm infants demonstrated less optimal scores in preschool reading (P = .0006), preschool mathematics (P = .0014), and kindergarten reading (P = .0007) compared with infants born at term gestation. CONCLUSIONS: Although late preterm infants demonstrate comparable developmental outcomes to full-term infants (early term and full-term gestation) at 24 months, they demonstrate less optimal reading outcomes at preschool and kindergarten timepoints. Ongoing developmental surveillance for late preterm infants is warranted into preschool and kindergarten. PMID:27456513

  9. Evolution of left ventricular function in the preterm infant.

    PubMed

    Hirose, Akiko; Khoo, Nee S; Aziz, Khalid; Al-Rajaa, Najlaa; van den Boom, Jutta; Savard, Winnie; Brooks, Paul; Hornberger, Lisa K

    2015-03-01

    The aim of this study was to evaluate left ventricular function in preterm infants from 28 days to near term using echocardiography. Thirty clinically stable preterm infants delivered at <30 weeks' gestational age were prospectively enrolled. At 28 days, conventional, tissue Doppler, and speckle-tracking echocardiography evaluations of left ventricular function were performed, with comparison made to findings in 30 healthy term infants of similar postnatal age. Sixteen preterm infants underwent repeat examinations near term. Compared with controls, preterm infants at 28 days had decreased peak mitral valve (MV) E-wave velocities (P < .01), E/A ratios (P < .0001), annular e' velocities (P < .0001), and e'/a' ratios (P < .0001); increased MV E/e' ratios (P < .01); and lower basal circumferential early diastolic and higher late diastolic strain rates. No significant differences were found in fractional shortening, ejection fraction, and longitudinal or circumferential strain and strain rate between preterm infants and controls. Although preterm infants at 28 days had higher heart rates compared with controls (161 ± 15 vs 142 ± 16 beats/min), no significant correlations existed between heart rate and MV E, E/A ratio, e', e'/a' ratio, and E/e' ratio. Near term, the differences in diastolic function persisted, including decreased MV e'/a' ratio (P < .05), increased E/e' ratio (P < .01), and increased late diastolic strain rate. Clinically stable preterm infants have normal left ventricular systolic function but altered diastolic function, with greater dependence on atrial contraction, the latter of which persists despite nearing term. These findings may be relevant to the management of preterm infants and may relate to the longer term myocardial dysfunction observed in affected adults. Copyright © 2015 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

  10. Kangaroo care for the preterm infant and family.

    PubMed

    Jefferies, Ann L

    2012-03-01

    Kangaroo care (KC) is the practice of skin-to-skin contact between infant and parent. In developing countries, KC for low-birthweight infants has been shown to reduce mortality, severe illness, infection and length of hospital stay. KC is also beneficial for preterm infants in high-income countries. Cardiorespiratory and temperature stability, sleep organization and duration of quiet sleep, neurodevelopmental outcomes, breastfeeding and modulation of pain responses appear to be improved for preterm infants who have received KC during their hospital stay. No detrimental effects on physiological stability have been demonstrated for infants as young as 26 weeks' gestational age, including those on assisted ventilation. Mothers show enhanced attachment behaviours and describe an increased sense of their role as a mother. The practice of KC should be encouraged in nurseries that care for preterm infants. Information is available to assist in developing guidelines and protocols.

  11. Predicting Developmental Delay from Cry Analysis in Preterm Infants.

    ERIC Educational Resources Information Center

    Sepkoski, Carol M.; And Others

    This study examined whether cry acoustics enhance the prediction of developmental outcome in preterm infants, after accounting for medical and social variables. Selection criteria for 149 preterm subjects included being born at less than 35 weeks gestational age and less than 1,500 grams; for 25 term subjects, selection criteria included being…

  12. Preterm formula use in the preterm very low birth weight infant.

    PubMed

    Hay, William W; Hendrickson, Kendra C

    2017-02-01

    Whereas human milk is the recommended diet for all infants, preterm formulas are indicated for enteral feeding of preterm very low birth weight infants when sufficient maternal breast milk and donor human milk are not available. Feeding with preterm formulas helps to ensure consistent delivery of nutrients. The balance of risks and benefits of feeding preterm formulas versus supplemented maternal and donor breast milk for preterm infants, however, is uncertain. Numerous studies and extensive practice have shown improved growth with preterm formulas, but there is concern for increased risks of necrotizing enterocolitis, possibly from cow milk antigen in the formulas or from different gut microbiomes, increased duration of total parenteral nutrition, and increased rates of sepsis in infants receiving preterm formulas. Furthermore, whereas preterm formulas improve neurodevelopmental outcomes compared to term formulas and unfortified donor milk, they do not produce neurodevelopmental outcomes better than fortified human milk, again indicating that maternal milk has unique properties that formulas need to mimic as closely as possible.

  13. Optimizing Nutrition in Preterm Low Birth Weight Infants-Consensus Summary.

    PubMed

    Kumar, R Kishore; Singhal, Atul; Vaidya, Umesh; Banerjee, Saswata; Anwar, Fahmina; Rao, Shashidhar

    2017-01-01

    Preterm birth survivors are at a higher risk of growth and developmental disabilities compared to their term counterparts. Development of strategies to lower the complications of preterm birth forms the rising need of the hour. Appropriate nutrition is essential for the growth and development of preterm infants. Early administration of optimal nutrition to preterm birth survivors lowers the risk of adverse health outcomes and improves cognition in adulthood. A group of neonatologists, pediatricians, and nutrition experts convened to discuss and frame evidence-based recommendations for optimizing nutrition in preterm low birth weight (LBW) infants. The following were the primary recommendations of the panel: (1) enteral feeding is safe and may be preferred to parenteral nutrition due to the complications associated with the latter; however, parenteral nutrition may be a useful adjunct to enteral feeding in some critical cases; (2) early, fast, or continuous enteral feeding yields better outcomes compared to late, slow, or intermittent feeding, respectively; (3) routine use of nasogastric tubes is not advisable; (4) preterm infants can be fed while on ventilator or continuous positive airway pressure; (5) routine evaluation of gastric residuals and abdominal girth should be avoided; (6) expressed breast milk (EBM) is the first choice for feeding preterm infants due to its beneficial effects on cardiovascular, neurological, bone health, and growth outcomes; the second choice is donor pasteurized human milk; (7) EBM or donor milk may be fortified with human milk fortifiers, without increasing the osmolality of the milk, to meet the high protein requirements of preterm infants; (8) standard fortification is effective and safe but does not fulfill the high protein needs; (9) use of targeted and adjustable fortification, where possible, helps provide optimal nutrition; (10) optimizing weight gain in preterm infants prevents long-term cardiovascular complications; (11

  14. Predicting transition to the supine sleep position in preterm infants.

    PubMed

    McMullen, Sherri L; Carey, Mary G

    2014-01-01

    The purpose of this secondary analysis was to determine what factors predict the transition of preterm infants to the supine sleep position prior to hospital discharge (N = 286). The supine position reduces the risk of sudden infant death syndrome. Factors found to predict a greater than 1-week transition to the supine sleep position were hospital policy (P < .001), gestational age (P < .001), and birth weight (P < .01). Transition to the supine position during hospitalization potentially reduces the risk of preterm infants being placed in nonsupine positions after hospitalization and, ultimately, the risk of untimely death by sudden infant death syndrome.

  15. Visuo-manual coordination in preterm infants without neurological impairments.

    PubMed

    Petkovic, Maja; Chokron, Sylvie; Fagard, Jacqueline

    2016-01-01

    The extent of and reasons for visuo-manual coordination deficits in moderate and late preterm born infants without neurological impairments are not well known. This paper presents a longitudinal study on the visuo-manual development of twelve preterm infants, born after 33-36 weeks of gestation without neurological complications, between the ages of 6 and 12 months. Visuo-manual integration and grasping were assessed using the Peabody Developmental Motor Scales, along with bimanual coordination and handedness tests. Visual function was examined once prior to the beginning of the study. Gross motor development was also evaluated every month. Preterm infants were compared to a control group of ten full-term infants according to corrected age. Compared to full-terms, the visual perception of preterm infants was close to normal, with only a measure of visual fixation lower than in full-terms. In contrast, preterm infants had delayed development of visuo-manual integration, grasping, bimanual coordination, and handedness even when compared using corrected age. Tonicity and gestational age at birth were the main variables associated to the delays. These results are discussed in terms of the possible factors underlying such delays. They need to be confirmed on a larger sample of preterm born children, and to be correlated with later development. This would allow developing markers of future neuropsychological impairments during childhood.

  16. Biotin and carnitine profiles in preterm infants in Japan.

    PubMed

    Tokuriki, Shuko; Hayashi, Hisako; Okuno, Takashi; Yoshioka, Kikuko; Okazaki, Shintaro; Kawakita, Akiko; Ohta, Genrei; Hata, Ikue; Shigematsu, Yosuke; Ohshima, Yusei

    2013-06-01

    Biotin plays an important role as a covalently bound coenzyme for carboxylases. Carnitine is essential in β-oxidation to transport long-chain fatty acids across the inner mitochondrial membrane. The present study was conducted to assess the risk of biotin and carnitine deficiencies in preterm infants who received enteral feeding with maternal milk and/or standard infant formula made in Japan. Forty-six infants were enrolled in the study. Urine and serum samples and dried blood spots were collected at 1 week and 1 month of age. Additionally, samples were collected at 40 and 44 weeks post-menstrual age (PMA) in preterm infants. Free carnitine and C5-OH acylcarnitine, which consist of 3-hydroxyisovalerylcarnitine as a major isomer, were measured in serum samples and dried blood spots using tandem mass spectrometry. Urine 3-hydroxyisovaleric acid (3-HIVA) was measured using gas chromatography/mass spectrometry. The free carnitine levels in preterm infants were significantly lower than those in term infants, but increased with PMA in serum samples and dried blood spots. C5-OH acylcarnitine and urinary 3-HIVA levels, which were very low in term infants, were increased with PMA in preterm infants. The present results may indicate chronic biotin deficiency in preterm infants fed maternal milk and/or standard infant formula. Analyses of carnitine profiles of dried blood spots and urine 3-HIVA are relatively non-invasive and useful for the early detection of biotin deficiency in preterm infants. © 2013 The Authors. Pediatrics International © 2013 Japan Pediatric Society.

  17. The Emergence of Tool Use in Preterm Infants

    PubMed Central

    Petkovic, Maja; Rat-Fischer, Lauriane; Fagard, Jacqueline

    2016-01-01

    Preterm born children without neurological impairments have been shown to present some visual-manual coordination deficits, more or less depending on their tonicity and the degree of prematurity. In this paper, we compare the development of tool use in 15–23-month-old preterm infants born after 33–36 weeks of gestation without neurological complications with that of full-term infants according to corrected age. Understanding the affordance of a tool is an important cognitive milestone in early sensorimotor period. Using a tool to bring within reach an out-of-reach object, for instance, has been shown to develop during the 2nd year in full-term infants. Here we presented preterm infants with an attractive toy out of reach and with a rake-like tool within reach in five conditions of spatial relationships between the toy and the tool. Like full-terms, preterm infants used the tool with success in conditions of spatial contiguity around 15–17 months. In conditions of a spatial gap between tool and toy, i.e., the only conditions which shows without ambiguity that the infant understands the affordance of the tool, preterm infants as a group showed no delay for tool use: the frequency of spontaneous successes started to increase after 18 months, and demonstration became effective after that age. However, further analyses showed that only the preterm infants without hypotonia and born after 36 weeks of pregnancy developed tool use without delay. Hypotonic preterm infants were still largely unsuccessful in the conditions of spatial gap, even at the end of the study. The degree of prematurity also influenced the performance at tool use. These results, following the observation of a delay in the development of bimanual coordination and of handedness in the same infants at 10–12 months in a previous study, show that low risk preterm infants can still be impaired for the development of new manual skills beyond the 1st year. Thus, hypotonic preterm infants and infants

  18. The Emergence of Tool Use in Preterm Infants.

    PubMed

    Petkovic, Maja; Rat-Fischer, Lauriane; Fagard, Jacqueline

    2016-01-01

    Preterm born children without neurological impairments have been shown to present some visual-manual coordination deficits, more or less depending on their tonicity and the degree of prematurity. In this paper, we compare the development of tool use in 15-23-month-old preterm infants born after 33-36 weeks of gestation without neurological complications with that of full-term infants according to corrected age. Understanding the affordance of a tool is an important cognitive milestone in early sensorimotor period. Using a tool to bring within reach an out-of-reach object, for instance, has been shown to develop during the 2nd year in full-term infants. Here we presented preterm infants with an attractive toy out of reach and with a rake-like tool within reach in five conditions of spatial relationships between the toy and the tool. Like full-terms, preterm infants used the tool with success in conditions of spatial contiguity around 15-17 months. In conditions of a spatial gap between tool and toy, i.e., the only conditions which shows without ambiguity that the infant understands the affordance of the tool, preterm infants as a group showed no delay for tool use: the frequency of spontaneous successes started to increase after 18 months, and demonstration became effective after that age. However, further analyses showed that only the preterm infants without hypotonia and born after 36 weeks of pregnancy developed tool use without delay. Hypotonic preterm infants were still largely unsuccessful in the conditions of spatial gap, even at the end of the study. The degree of prematurity also influenced the performance at tool use. These results, following the observation of a delay in the development of bimanual coordination and of handedness in the same infants at 10-12 months in a previous study, show that low risk preterm infants can still be impaired for the development of new manual skills beyond the 1st year. Thus, hypotonic preterm infants and infants born

  19. Oral Motor Intervention Improved the Oral Feeding in Preterm Infants

    PubMed Central

    Tian, Xu; Yi, Li-Juan; Zhang, Lei; Zhou, Jian-Guo; Ma, Li; Ou, Yang-Xiang; Shuai, Ting; Zeng, Zi; Song, Guo-Min

    2015-01-01

    Abstract Oral feeding for preterm infants has been a thorny problem worldwide. To improve the efficacy of oral feeding in preterm infants, oral motor intervention (OMI), which consists of nonnutritive sucking, oral stimulation, and oral support, was developed. Published studies demonstrated that OMI may be as an alternative treatment to solve this problem; however, these results remain controversial. We conducted a meta-analysis with trial sequential analysis (TSA) to objectively evaluate the potential of OMI for improving the current status of oral feeding in preterm infants. A search of PubMed, EMBASE, Web of Science, the Cochrane Library, and China National Knowledge Infrastructure was performed to capture relevant citations until at the end of October, 2014. Lists of references of eligible studies and reviews were also hand-checked to include any latent studies. Two independent investigators screened literature, extracted data, and assessed the methodology, and then a meta-analysis and TSA was performed by using Reviewer Manager (RevMan) 5.3 and TSA 0.9 beta, respectively. A total of 11 randomized controlled trials (RCTs), which included 855 participants, were incorporated into our meta-analysis. The meta-analyses suggested that OMI is associated with the reduced transition time (ie, the time needed from tube feeding to totally oral feeding) (mean difference [MD], −4.03; 95% confidence interval [CI], −5.22 to −2.84), shorten hospital stays (MD, −3.64; 95% CI, −5.57 to −1.71), increased feeding efficiency (MD, 0.08; 95% CI, 0.36–1.27), and intake of milk (MD, 0.14; 95% CI, 0.06–0.21) rather than weight gain. Results of TSA for each outcomes of interest confirmed these pooled results. With present evidences, OMI can be as an alternative to improve the condition of transition time, length of hospital stays, feeding efficiency, and intake of milk in preterm infants. However, the pooled results may be impaired due to low quality included, and thus

  20. Implementation of a Nutrition Program Reduced Post-Discharge Growth Restriction in Thai Very Low Birth Weight Preterm Infants.

    PubMed

    Japakasetr, Suchada; Sirikulchayanonta, Chutima; Suthutvoravut, Umaporn; Chindavijak, Busba; Kagawa, Masaharu; Nokdee, Somjai

    2016-12-17

    Very low birth weight (VLBW) preterm infants are vulnerable to growth restriction after discharge due to cumulative protein and energy deficits during their hospital stay and early post-discharge period. The current study evaluated the effectiveness of the preterm infant, post-discharge nutrition (PIN) program to reduce post-discharge growth restriction in Thai VLBW preterm infants. A prospective, non-randomized interventional cohort study was undertaken to assess the growth of 22 VLBW preterm infants who received the PIN program and compared them with 22 VLBW preterm infants who received conventional nutrition services. Infant's growth was recorded monthly until the infants reached six months' corrected age (6-moCA). Intervention infants had significantly greater body weights (p = 0.013) and head circumferences (p = 0.009). Also, a greater proportion of the intervention group recovered their weight to the standard weight at 4-moCA (p = 0.027) and at 6-moCA (p = 0.007) and their head circumference to the standard head circumference at 6-moCA (p = 0.004) compared to their historical comparison counterparts. Enlistment in the PIN program thus resulted in significantly reduced post-discharge growth restriction in VLBW preterm infants. Further research on longer term effects of the program on infant's growth and development is warranted.

  1. Outcome Trajectories in Extremely Preterm Infants

    PubMed Central

    Carlo, Waldemar A.; Tyson, Jon E.; Langer, John C.; Walsh, Michele C.; Parikh, Nehal A.; Das, Abhik; Van Meurs, Krisa P.; Shankaran, Seetha; Stoll, Barbara J.; Higgins, Rosemary D.

    2012-01-01

    OBJECTIVE: Methods are required to predict prognosis with changes in clinical course. Death or neurodevelopmental impairment in extremely premature neonates can be predicted at birth/admission to the ICU by considering gender, antenatal steroids, multiple birth, birth weight, and gestational age. Predictions may be improved by using additional information available later during the clinical course. Our objective was to develop serial predictions of outcome by using prognostic factors available over the course of NICU hospitalization. METHODS: Data on infants with birth weight ≤1.0 kg admitted to 18 large academic tertiary NICUs during 1998–2005 were used to develop multivariable regression models following stepwise variable selection. Models were developed by using all survivors at specific times during hospitalization (in delivery room [n = 8713], 7-day [n = 6996], 28-day [n = 6241], and 36-week postmenstrual age [n = 5118]) to predict death or death/neurodevelopmental impairment at 18 to 22 months. RESULTS: Prediction of death or neurodevelopmental impairment in extremely premature infants is improved by using information available later during the clinical course. The importance of birth weight declines, whereas the importance of respiratory illness severity increases with advancing postnatal age. The c-statistic in validation models ranged from 0.74 to 0.80 with misclassification rates ranging from 0.28 to 0.30. CONCLUSIONS: Dynamic models of the changing probability of individual outcome can improve outcome predictions in preterm infants. Various current and future scenarios can be modeled by input of different clinical possibilities to develop individual “outcome trajectories” and evaluate impact of possible morbidities on outcome. PMID:22689874

  2. Outcome trajectories in extremely preterm infants.

    PubMed

    Ambalavanan, Namasivayam; Carlo, Waldemar A; Tyson, Jon E; Langer, John C; Walsh, Michele C; Parikh, Nehal A; Das, Abhik; Van Meurs, Krisa P; Shankaran, Seetha; Stoll, Barbara J; Higgins, Rosemary D

    2012-07-01

    Methods are required to predict prognosis with changes in clinical course. Death or neurodevelopmental impairment in extremely premature neonates can be predicted at birth/admission to the ICU by considering gender, antenatal steroids, multiple birth, birth weight, and gestational age. Predictions may be improved by using additional information available later during the clinical course. Our objective was to develop serial predictions of outcome by using prognostic factors available over the course of NICU hospitalization. Data on infants with birth weight ≤ 1.0 kg admitted to 18 large academic tertiary NICUs during 1998-2005 were used to develop multivariable regression models following stepwise variable selection. Models were developed by using all survivors at specific times during hospitalization (in delivery room [n = 8713], 7-day [n = 6996], 28-day [n = 6241], and 36-week postmenstrual age [n = 5118]) to predict death or death/neurodevelopmental impairment at 18 to 22 months. Prediction of death or neurodevelopmental impairment in extremely premature infants is improved by using information available later during the clinical course. The importance of birth weight declines, whereas the importance of respiratory illness severity increases with advancing postnatal age. The c-statistic in validation models ranged from 0.74 to 0.80 with misclassification rates ranging from 0.28 to 0.30. Dynamic models of the changing probability of individual outcome can improve outcome predictions in preterm infants. Various current and future scenarios can be modeled by input of different clinical possibilities to develop individual "outcome trajectories" and evaluate impact of possible morbidities on outcome.

  3. Cot-nursing versus incubator care for preterm infants.

    PubMed

    Gray, Peter H; Flenady, Vicki

    2011-08-10

    Preterm infants are usually nursed in incubators, but cot-nursing may provide an alternative. While there may be benefits of nursing preterm infants in open cots, there may be potential risks such as nosocomial infection caused by more handling due to easier access. To assess effects of cot-nursing versus incubator care on temperature control and weight gain in preterm infants. The standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of electronic databases including the Cochrane Central Register of Controlled Trials (The Cochrane Library), Oxford Database of Perinatal Trials, MEDLINE, CINAHL, and EMBASE, as well as previous reviews including cross references through November 2009. All trials using random or quasi-random patient allocation in which infants receiving care in standard newborn cots were compared to infants managed in a conventional air heated incubator. The authors independently assessed trial quality and extracted data for the primary outcomes of temperature control and weight gain. Meta-analysis was conducted using a fixed-effect model. Eleven potential studies were identified of which five, involving 247 infants, were included in this review. When compared to incubator care, cot-nursing resulted in no significant difference in mean body temperature (MD 0.02 degrees C; 95% CI -0.02 to 0.07, four trials), though the one trial that reported on episodes of hyperthermia found this to be statistically more common in the cot-nursing group (RR 1.48; 95% CI 1.04 to 2.09). There were no statistically significant differences in weight gain. In the cot-nursing group, fewer infants were breast fed on discharge (typical RR 0.74; 95% CI 0.48 to 1.14, three trials, 150 infants) and fewer infants died prior to hospital discharge (typical RR 0.59, 95% CI 0.28 to 1.25, four trials, 235 infants) but these results failed to reach statistical significance. The comparison of cot-nursing using a heated water-filled mattress

  4. Perinatal Risk, Mother-Infant Interaction, and Early Developmental Outcome of Preterm and Fullterm Infants.

    ERIC Educational Resources Information Center

    Bakeman, Roger; Brown, Josephine V.

    This study investigated: (1) the effects of early mother-infant interaction on the infant's cognitive and social development during the first year of life; (2) the impact of perinatal factors on that development; and (3) the differences, if any, in the impact of mother-infant interaction and perinatal factors on preterm and full term infants.…

  5. Patterns of Distress in African American Mothers of Preterm Infants

    PubMed Central

    Holditch-Davis, Diane; Miles, Margaret Shandor; Weaver, Mark A.; Black, Beth; Beeber, Linda; Thoyre, Suzanne; Engelke, Stephen

    2009-01-01

    Objective To examine inter-relationships among stress due to infant appearance and behavior in the NICU, parental role alteration stress in the NICU, depressive symptoms, state anxiety, post-traumatic stress symptoms, and daily hassles exhibited by African American mothers of preterm infants and to determine whether there were sub-groups of mothers based on patterns of psychological distress. Method 177 African American mothers completed questionnaires on their psychological distress at enrollment during infant hospitalization and 2, 6, 12, 18, and 24 months after term. Results Psychological distress measures were inter-correlated. There were four latent classes of mothers: the low distress class with low scores on all measures; the high NICU-related stress class with high infant appearance and parental role stress and moderate scores on other measures; the high depressive symptoms class with high depressive symptoms and state anxiety and moderately elevated scores on NICU-related stress and post-traumatic stress symptoms; the extreme distress class with the highest means on all measures. Infants in the high stress class were sicker than infants in the other classes. The extreme distress class mothers averaged the lowest educational level. The classes differed on distress measures, worry about the child, and parenting stress through 24 months with the extreme distress class having the highest values. Conclusion Although different types of maternal psychological distress were substantially related, there were distinct sub-groups of mothers that were identifiable in the NICU. Moreover, these sub-groups continued to differ on trajectories of distress and on their perceptions of the infants and parenting through 24 months after term. PMID:19412125

  6. [Postnatal corticosteroids in preterm infants with immature lung disease].

    PubMed

    Hinriksdottir, Erna; Brynjarsson, Hrolfur; Thorkelsson, Thordur

    2016-05-01

    Corticosteroids have been used in preterm infants with immature lungs to decrease their need for supplemental oxygen and mechanical ventilation. Whether the benefits of the treatment outweigh possible adverse effects remains controversial. The main objective of the study was to evaluate the effects of intravenous and inhalation corticosteroids on preterm infants' need for supplemental oxygen and mechanical ventilation and potential adverse effects. This was a retrospective cohort study on preterm infants at the Neonatal Intensive Care Unit of Children's Hospital Iceland, born between 2000-2014 and treated with intravenous (n=28) or inhalation (n=30) corticosteroids for immature lung disease. For each infant receiving steriods one infant who did not receive steriods was selected as control, matched on gestational age. There was a significant decrease in the need for supplemental oxygen following intravenous and inhalation corticosteroids administration, and a significant decrease in the need for mechanical ventilation following intravenous corticosteroids administration, but not in controls. Infants receiving intravenous corticosteroids gained significantly less weight than controls during treatment, but no significant difference in weight between groups was found at 35 weeks postmenstrual age, or in other possible adverse effects such as the prevalence of cerebral palsy. Intravenous and inhalation corticosteroids decrease the need for supplemental oxygen in preterm infants with immature lung disease and intravenous steriods facilitate earlier weaning from mechanical ventilation, without significant adverse effects. Therefore, it seems justifiable in selected cases to use corticosteroids in treatment of preterm infants with severe immature lung disease. Corticosteroids, preterm infants, chronic lung disease, mechanical ventilation. Correspondence: Thorður Thorkelsson, thordth@landspitali.is.

  7. Antibiotic resistance potential of the healthy preterm infant gut microbiome

    PubMed Central

    Shaw, Alexander G.; Sim, Kathleen; Wooldridge, David J.; Li, Ming-Shi; Gharbia, Saheer; Misra, Raju; Kroll, John Simon

    2017-01-01

    Background Few studies have investigated the gut microbiome of infants, fewer still preterm infants. In this study we sought to quantify and interrogate the resistome within a cohort of premature infants using shotgun metagenomic sequencing. We describe the gut microbiomes from preterm but healthy infants, characterising the taxonomic diversity identified and frequency of antibiotic resistance genes detected. Results Dominant clinically important species identified within the microbiomes included C. perfringens, K. pneumoniae and members of the Staphylococci and Enterobacter genera. Screening at the gene level we identified an average of 13 antimicrobial resistance genes per preterm infant, ranging across eight different antibiotic classes, including aminoglycosides and fluoroquinolones. Some antibiotic resistance genes were associated with clinically relevant bacteria, including the identification of mecA and high levels of Staphylococci within some infants. We were able to demonstrate that in a third of the infants the S. aureus identified was unrelated using MLST or metagenome assembly, but low abundance prevented such analysis within the remaining samples. Conclusions We found that the healthy preterm infant gut microbiomes in this study harboured a significant diversity of antibiotic resistance genes. This broad picture of resistances and the wider taxonomic diversity identified raises further caution to the use of antibiotics without consideration of the resident microbial communities. PMID:28149696

  8. Non-Nutritive Suck Parameter in Preterm Infants with RDS

    PubMed Central

    Estep, Meredith; Barlow, Steven M.; Vantipalli, Rajesh; Finan, Donald; Lee, Jaehoon

    2008-01-01

    Objective To characterize the integrity of non-nutritive suck (NNS) parameters among three groups of preterm infants ranging from normal to those with progressive degrees of respiratory distress syndrome (RDS). Study Design NNS compression waveforms were sampled from 55 infants in the neonatal intensive care unit using a silicone pacifier electronically instrumented for intraluminal pressure. Seven select NNS parameters were measured at two different sessions, and statistically analyzed using a General Linear Model Analysis of Covariance. Results and Conclusions Preterm infants with a more extensive history of RDS and oxygen therapy manifest significantly (p≤0.001) degraded performance on six of the seven NNS measures. This trend was disproportionately amplified in preterm infants with moderate-to-severe RDS. Prolonged periods of RDS requiring oxygen therapy may cause maladaptive orosensory experiences, and restrict oral movements which may contribute to delayed NNS development. PMID:19190723

  9. Echocardiographic Evaluation of Patent Ductus Arteriosus in Preterm Infants

    PubMed Central

    Arlettaz, Romaine

    2017-01-01

    Patent ductus arteriosus (PDA) is part of the typical morbidity profile of the preterm infant, with a high incidence of 80–90% in extremely low birth weight infants born before 26 weeks of gestation. Whereas spontaneous closure of the ductus arteriosus (DA) is likely in term infants, it is less so in preterm ones. PDA is associated with increased mortality and various comorbidities including cardiac failure, need for respiratory support, bronchopulmonary dysplasia, pulmonary or intracranial hemorrhage, and necrotizing enterocolitis; however, there is no proven causality between these morbidities and the presence of DA. Thus, the indication to close PDA remains highly controversial. This paper focuses on echocardiographic evaluation of PDA in the preterm infant and particularly on the echocardiographic signs of hemodynamic significance. PMID:28680875

  10. Clinical neuroimaging in the preterm infant: Diagnosis and prognosis.

    PubMed

    Hinojosa-Rodríguez, Manuel; Harmony, Thalía; Carrillo-Prado, Cristina; Van Horn, John Darrell; Irimia, Andrei; Torgerson, Carinna; Jacokes, Zachary

    2017-01-01

    Perinatal care advances emerging over the past twenty years have helped to diminish the mortality and severe neurological morbidity of extremely and very preterm neonates (e.g., cystic Periventricular Leukomalacia [c-PVL] and Germinal Matrix Hemorrhage - Intraventricular Hemorrhage [GMH-IVH grade 3-4/4]; 22 to < 32 weeks of gestational age, GA). However, motor and/or cognitive disabilities associated with mild-to-moderate white and gray matter injury are frequently present in this population (e.g., non-cystic Periventricular Leukomalacia [non-cystic PVL], neuronal-axonal injury and GMH-IVH grade 1-2/4). Brain research studies using magnetic resonance imaging (MRI) report that 50% to 80% of extremely and very preterm neonates have diffuse white matter abnormalities (WMA) which correspond to only the minimum grade of severity. Nevertheless, mild-to-moderate diffuse WMA has also been associated with significant affectations of motor and cognitive activities. Due to increased neonatal survival and the intrinsic characteristics of diffuse WMA, there is a growing need to study the brain of the premature infant using non-invasive neuroimaging techniques sensitive to microscopic and/or diffuse lesions. This emerging need has led the scientific community to try to bridge the gap between concepts or ideas from different methodologies and approaches; for instance, neuropathology, neuroimaging and clinical findings. This is evident from the combination of intense pre-clinical and clinicopathologic research along with neonatal neurology and quantitative neuroimaging research. In the following review, we explore literature relating the most frequently observed neuropathological patterns with the recent neuroimaging findings in preterm newborns and infants with perinatal brain injury. Specifically, we focus our discussions on the use of neuroimaging to aid diagnosis, measure morphometric brain damage, and track long-term neurodevelopmental outcomes.

  11. Cerebral vascular regulation and brain injury in preterm infants.

    PubMed

    Brew, Nadine; Walker, David; Wong, Flora Y

    2014-06-01

    Cerebrovascular lesions, mainly germinal matrix hemorrhage and ischemic injury to the periventricular white matter, are major causes of adverse neurodevelopmental outcome in preterm infants. Cerebrovascular lesions and neuromorbidity increase with decreasing gestational age, with the white matter predominantly affected. Developmental immaturity in the cerebral circulation, including ongoing angiogenesis and vasoregulatory immaturity, plays a major role in the severity and pattern of preterm brain injury. Prevention of this injury requires insight into pathogenesis. Cerebral blood flow (CBF) is low in the preterm white matter, which also has blunted vasoreactivity compared with other brain regions. Vasoreactivity in the preterm brain to cerebral perfusion pressure, oxygen, carbon dioxide, and neuronal metabolism is also immature. This could be related to immaturity of both the vasculature and vasoactive signaling. Other pathologies arising from preterm birth and the neonatal intensive care environment itself may contribute to impaired vasoreactivity and ineffective CBF regulation, resulting in the marked variations in cerebral hemodynamics reported both within and between infants depending on their clinical condition. Many gaps exist in our understanding of how neonatal treatment procedures and medications have an impact on cerebral hemodynamics and preterm brain injury. Future research directions for neuroprotective strategies include establishing cotside, real-time clinical reference values for cerebral hemodynamics and vasoregulatory capacity and to demonstrate that these thresholds improve long-term outcomes for the preterm infant. In addition, stimulation of vascular development and repair with growth factor and cell-based therapies also hold promise.

  12. Nosocomial outbreak of colonization and infection with Stenotrophomonas maltophilia in preterm infants associated with contaminated tap water.

    PubMed Central

    Verweij, P. E.; Meis, J. F.; Christmann, V.; Van der Bor, M.; Melchers, W. J.; Hilderink, B. G.; Voss, A.

    1998-01-01

    Between March and May 1996 Stenotrophomonas maltophilia was cultured from endotracheal aspirate samples from five preterm infants in a neonatal intensive care unit (NICU). Four infants were superficially colonized, but a fifth died due to S. maltophilia septicaemia. S. maltophilia was cultured from tap water from three outlets in the NICU including one with a previously unnoticed defective sink drain. Water from these outlets was used to wash the preterm infants. Environmental and clinical S. maltophilia isolates yielded identical banding patterns on random arbitrary polymorphic DNA (RAPD) PCR analysis. The outbreak was controlled by reinforcement of hand disinfection, limitation of the use of tap water for hand washing and by using sterile water to wash the preterm infants. We conclude that tap water should not be used for washing preterm infants in the NICU, unless steps are taken to prevent microbial growth in the outlets. PMID:9692603

  13. Procedural Pain Heart Rate Responses in Massaged Preterm Infants

    PubMed Central

    Diego, Miguel A.; Field, Tiffany; Hernandez-Reif, Maria

    2009-01-01

    Heart rate (HR) responses to the removal of a monitoring lead were assessed in 56 preterm infants who received moderate pressure, light pressure or no massage therapy. The infants who received moderate pressure massage therapy exhibited lower increases in HR suggesting an attenuated pain response. The heart rate of infants who received moderate pressure massage also returned to baseline faster than the heart rate of the other two groups, suggesting a faster recovery rate. PMID:19185352

  14. Kangaroo care compared to incubators in maintaining body warmth in preterm infants.

    PubMed

    Ludington-Hoe, S M; Nguyen, N; Swinth, J Y; Satyshur, R D

    2000-07-01

    Many preterm infants cared for in incubators do not experience Kangaroo Care (KC), skin-to-skin contact with their mothers, due to fear of body heat loss when being held outside the incubator. A randomized clinical trial of 16 KC and 13 control infants using a pretest-test-posttest design of three consecutive interfeeding intervals of 2.5 to 3.0 h duration each was conducted over 1 day. Infant abdominal and toe temperatures were measured in and out of the incubator; maternal breast temperature was measured during KC. Repeated measures ANOVA showed no change in abdominal temperature across all periods and between groups. Toe temperatures were significantly higher during KC than incubator periods, and maternal breast temperature met each infant's neutral thermal zone requirements within 5 min of onset of KC. Preterm infants similar to those studied here will maintain body warmth with up to 3 h of KC.

  15. Biomarkers for Bronchopulmonary Dysplasia in the Preterm Infant

    PubMed Central

    Rivera, Lidys; Siddaiah, Roopa; Oji-Mmuo, Christiana; Silveyra, Gabriela R.; Silveyra, Patricia

    2016-01-01

    Bronchopulmonary dysplasia (BPD) is a chronic inflammatory lung disease of very-low-birth-weight (VLBW) preterm infants, associated with arrested lung development and a need for supplemental oxygen. Over the past few decades, the incidence of BPD has significantly raised as a result of improved survival of VLBW infants requiring mechanical ventilation. While early disease detection is critical to prevent chronic lung remodeling and complications later in life, BPD is often difficult to diagnose and prevent due to the lack of good biomarkers for identification of infants at risk, and overlapping symptoms with other diseases, such as pulmonary hypertension (PH). Due to the current lack of effective treatment available for BPD and PH, research is currently focused on primary prevention strategies, and identification of biomarkers for early diagnosis, that could also represent potential therapeutic targets. In addition, novel histopathological, biochemical, and molecular factors have been identified in the lung tissue and in biological fluids of BPD and PH patients that could associate with the disease phenotype. In this review, we provide an overview of biomarkers for pediatric BPD and PH that have been identified in clinical studies using various biological fluids. We also present a brief summary of the information available on current strategies and guidelines to prevent and diagnose BPD and PH, as well as their pathophysiology, risk factors, and experimental therapies currently available. PMID:27065351

  16. Improving preterm infants' immunisation status: a follow-up audit.

    PubMed

    Crawford, Nigel W; Barfield, Charles; Hunt, Rod W; Pitcher, Helen; Buttery, Jim P

    2014-04-01

    Preterm infants are at increased risk of vaccine preventable diseases. An audit in 2007 identified suboptimal immunisation status of preterm infants. The aim of this study was to complete the 'audit loop', reviewing preterm infants' immunisation status at a single tertiary paediatric hospital. A retrospective follow-up immunisation audit was conducted at The Royal Children's Hospital, Melbourne, neonatal unit. The 'audit loop' included a preterm infants' reminder sticker and feedback of the original audit findings to Royal Children's Hospital health-care professionals. Immunisation status was determined using the Australian Childhood Immunisation Register record for all admitted preterm infants born <32 weeks gestation (July 2008-June 2009). Conducted in March 2011, the median age of participants (n = 57) was 2.5 years (range 1.7-3.1 years). Forty-four per cent (25/57) had a history of chronic lung disease, 86% (49/57) were <1500 g and 42% (24/57) <28 weeks gestation. The majority (96% (55/57)) were up to date with routine immunisations at 12 months of age. There was a 2.4-fold increase, compared with the original audit, for receipt of the additional recommended hepatitis B vaccine at 12 months of age, as well as influenza vaccine in infants with chronic lung disease. This study showed that a simple reminder combined with education strategies can improve vaccine delivery in special risk groups such as preterm infants. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  17. Implementation of a Nutrition Program Reduced Post-Discharge Growth Restriction in Thai Very Low Birth Weight Preterm Infants

    PubMed Central

    Japakasetr, Suchada; Sirikulchayanonta, Chutima; Suthutvoravut, Umaporn; Chindavijak, Busba; Kagawa, Masaharu; Nokdee, Somjai

    2016-01-01

    Very low birth weight (VLBW) preterm infants are vulnerable to growth restriction after discharge due to cumulative protein and energy deficits during their hospital stay and early post-discharge period. The current study evaluated the effectiveness of the preterm infant, post-discharge nutrition (PIN) program to reduce post-discharge growth restriction in Thai VLBW preterm infants. A prospective, non-randomized interventional cohort study was undertaken to assess the growth of 22 VLBW preterm infants who received the PIN program and compared them with 22 VLBW preterm infants who received conventional nutrition services. Infant’s growth was recorded monthly until the infants reached six months’ corrected age (6-moCA). Intervention infants had significantly greater body weights (p = 0.013) and head circumferences (p = 0.009). Also, a greater proportion of the intervention group recovered their weight to the standard weight at 4-moCA (p = 0.027) and at 6-moCA (p = 0.007) and their head circumference to the standard head circumference at 6-moCA (p = 0.004) compared to their historical comparison counterparts. Enlistment in the PIN program thus resulted in significantly reduced post-discharge growth restriction in VLBW preterm infants. Further research on longer term effects of the program on infant’s growth and development is warranted. PMID:27999313

  18. Post-hemorrhagic hydrocephalus and diabetes insipidus in preterm infants.

    PubMed

    Borenstein-Levin, Liron; Koren, Ilana; Kugelman, Amir; Bader, David; Toropine, Arina; Riskin, Arieh

    2014-11-01

    We present two cases of transient central diabetes insipidus in preterm neonates with post-hemorrhagic hydrocephalus. Although the association between intraventricular hemorrhage and diabetes insipidus has been described in preterm infants, the association between diabetes insipidus and hydrocephalus, and the fact that such central diabetes insipidus could be reversible with the reduction of ventricular size, either because of spontaneous resolution or the placement of ventriculo-peritoneal shunt is first described here in neonates.

  19. [Antenatal corticosteroid therapy and late preterm infant morbidity and mortality].

    PubMed

    Gázquez Serrano, I M; Arroyos Plana, A; Díaz Morales, O; Herráiz Perea, C; Holgueras Bragado, A

    2014-12-01

    Late preterm infants (34-36 weeks gestation) have a morbidity rate significantly higher than those born at term. However, few interventions have been undertaken to reduce this increased morbidity and mortality. Antenatal corticosteroid administration could be an effective preventive measure. The aim of this study was to describe the morbidity associated with late prematurity in our institution, and determine if there are differences between those who received antenatal corticosteroids. A prospective observational study was conducted on late preterm infants born in a tertiary hospital from October 2011 until September 2012. Two groups were formed according to whether or not they had received antenatal steroids. The rates of morbidity and mortality for each of the groups were analysed and compared. There was a total of 4127 live newborns during the study period, of whom 3795 were term and 332 were preterm (the overall prematurity rate was 8.04%). There were 247 late preterm deliveries, representing 6% of live born infants, and 74.4% of all premature infants. Of late preterm infants, 63.2% were admitted to the Neonatal Unit and 29.6% had received antenatal steroids. The incidence of admission to the Neonatal Unit and Neonatal Intensive Care, transient tachypnea, need for respiratory support in the form of continuous positive pressure airway and oxygen therapy, incidence of hypoglycemia, feeding difficulty, and jaundice requiring phototherapy were significantly higher (P<.05) in the late preterm group that did not receive antenatal steroids. Our finding suggests that the administration of antenatal corticosteroids to patients at risk of 34-36 weeks delivery could significantly reduce the cost and acute morbidity associated with late preterm birth. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  20. The temperament of preterm infant in preschool age

    PubMed Central

    2011-01-01

    Background The study deals with the characteristics of temperament of preterm infants during their preschool age in order to not only investigate likely "difficult or problematic profiles", guided by impairments driven by their preterm birth, but also to provide guidelines for the activation of interventions of prevention, functional to improve the quality of preterm infant's life. Methods The study involved a group of 105 children where 50 preterm children at the average age of 5 years and 2 months, enrolled in preschools of Palermo. The research planned the child reference teachers to be administered a specific questionnaire, the QUIT, made up of 60 items investigating six specific typical dimensions of temperament (Motor control activity - related to the ability of practicing motor control activity; Attention - related to the ability of guiding and keeping the focus of attention on a certain stimulus; Inhibition to novelty - regarding with emotional reactivity in front of environmental stimuli; Social orientation - meant in terms of attention and interest towards social stimuli; Positive and negative emotionality - regarding the tendency to mainly express positive or negative emotions. Results The results show in general how preschool-aged preterm infants, identified by such a study, compared with full-term children, are characterized by "normal" temperament based on a strong inclination and orientation in mainly expressing positive feelings. Yet, an impairment of the areas most relating to attention and motor control activity seems to emerge. Conclusions The data suggest specific interventions for preterm infant development and their reference systems and, at the same time, can guide paediatrician and neonatologist dealing with preterm infants, in focalizing and monitoring, even since health status assessments, specific areas of development that, since preschool age, can highlight the presence of real forerunners of maladjustments and likely configurations of

  1. Association between anemia and bronchopulmonary dysplasia in preterm infants.

    PubMed

    Duan, Jun; Kong, Xiangyong; Li, Qiuping; Hua, Shaodong; Zhang, Sheng; Zhang, Xiaoying; Feng, Zhichun

    2016-03-03

    Anemia is commonly seen in preterm infants. It may reduce the capacity of hemoglobin to transport oxygen throughout the body and may result in tissue and organ dysfunction. This study aimed to investigate the effect of anemia on the development of bronchopulmonary dysplasia (BPD) in preterm infants. 243 infants who were admitted to BaYi Children's Hospital Affiliated to Clinical Medical College in Beijing Military General Hospital with gestational age (GA) less than 32 weeks from February, 2014 to February, 2015 were included in the study. Maternal and infant data were recorded. Multivarariate logistic regression analysis was performed to determine the association between anemia and BPD. Of 243 preterm infants, the incidence of anemia was higher in BPD patients than non-BPD patients (p < 0.001). Mean Hct in BPD patients was lower than non-BPD patients at different time points in 1d, 7d, 14d, and 21d. Controlling for other confounding factors, early anemia was associated with an increased risk of BPD. Number of transfusions is also a significant risk factor for BPD (p = 0.001). Therefore, prevention and treatment of early anemia is necessary and reducing number of transfusions may reduce the incidence of BPD in preterm infants.

  2. Postnatal growth of preterm infants: which reference charts?

    PubMed

    Bertino, E; Gilli, G; Occhi, L; Giuliani, F; Di Nicola, P; Spada, E; Fabris, C

    2010-06-01

    Preterm Infants' survival has greatly increased in the last few decades thanks to the improvement in obstetrical and neonatal care. These neonates constitute the large majority of the population in neonatal intensive care units. The correct evaluation of postnatal growth of these babies is nowadays of primary concern, although the definition of their optimal postnatal growth pattern is still controversial. Concerns have also been raised about the strategies to monitor their growth,specifically in relation to the charts used. At present the available charts in clinical practice are fetal growth charts, neonatal anthropometric charts and postnatal growth charts for term infants. None of these, for different reasons, is suitable to correctly evaluate preterm infant growth. An international multicentric project has recently started a study aiming at building a prescriptive standard for the evaluation of postnatal growth of preterm infants and it will be available in the next years. At present, while an international longitudinal standard for evaluating preterm infant postnatal growth is lacking, in Italy the best compromise in clinical practice is likely to be as follows: new Italian INeS (Italian Neonatal Study) charts up to term; International longitudinal charts WHO 2006 or CDC 2002 from term to two years; finally, the Italian Society for Pediatric Endocrinology and Diabetes (SIEDP) 2006 growth charts could be suitable for monitoring the growth of these infants from two years up to 20 years of age.

  3. Exposure to maternal voice in preterm infants: a review.

    PubMed

    Krueger, Charlene

    2010-02-01

    The mother's voice, along with other developmentally appropriate sensory events (ie, touch, light, smells), stimulates maturation of the sensory systems and helps shape normal fetal development. While vast changes in the neonatal intensive care unit have occurred over the last 2 decades, little research has addressed the loss of exposure to maternal voice for the preterm infant. To address this gap, we compared studies that directly investigated effects of exposure to maternal voice on preterm infants. Studies reviewed were conducted between 1972 and 2007. All presented recordings of maternal voice at sound levels above current recommendations, and few of the findings reached statistical significance. Some potentially positive developmental effects were indicated. Future study of the effects of exposure to maternal voice on preterm infants using recommended sound levels is needed.

  4. The Importance of Human Milk for Immunity in Preterm Infants.

    PubMed

    Lewis, Erin D; Richard, Caroline; Larsen, Bodil M; Field, Catherine J

    2017-03-01

    The immune system of preterm infants is immature, placing them at increased risk for serious immune-related complications. Human milk provides a variety of immune protective and immune maturation factors that are beneficial to the preterm infant's poorly developed immune system. The most studied immune components in human milk include antimicrobial proteins, maternal leukocytes, immunoglobulins, cytokines and chemokines, oligosaccharides, gangliosides, nucleotides, and long-chain polyunsaturated fatty acids. There is growing evidence that these components contribute to the lower incidence of immune-related conditions in the preterm infant. Therefore, provision of these components in human milk, donor milk, or formula may provide immunologic benefits. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Home Visiting and Outcomes of Preterm Infants: A Systematic Review

    PubMed Central

    Teeters, Angelique; Ammerman, Robert T.

    2013-01-01

    BACKGROUND AND OBJECTIVES: Home visiting is 1 strategy to improve child health and parenting. Since implementation of home visiting trials 2 decades ago, US preterm births (<37 weeks) have risen by 20%. The objective of this study was to review evidence regarding home visiting and outcomes of preterm infants METHODS: Searches of Medline, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, Cochrane Controlled Trial Register, PsycINFO, and Embase were conducted. Criteria for inclusion were (1) cohort or controlled trial designs; (2) home-based, preventive services for infants at medical or social risk; and (3) outcomes reported for infants born preterm or low birth weight (<2500 g). Data from eligible reports were abstracted by 2 reviewers. Random effects meta-analysis was used to synthesize data for developmental and parent interaction measures. RESULTS: Seventeen studies (15 controlled trials, 2 cohort studies) were reviewed. Five outcome domains were identified: infant development, parent-infant interaction, morbidity, abuse/neglect, and growth/nutrition. Six studies (n = 336) demonstrated a pooled standardized mean difference of 0.79 (95% confidence interval 0.57 to 1.02) in Home Observation for Measurement of the Environment Inventory scores at 1 year in the home-visited groups versus control. Evidence for other outcomes was limited. Methodological limitations were common. CONCLUSIONS: Reviewed studies suggest that home visiting for preterm infants promotes improved parent-infant interaction. Further study of interventions targeting preterm infants within existing programs may strengthen the impact and cost benefits of home visiting in at-risk populations. PMID:23940238

  6. Home visiting and outcomes of preterm infants: a systematic review.

    PubMed

    Goyal, Neera K; Teeters, Angelique; Ammerman, Robert T

    2013-09-01

    Home visiting is 1 strategy to improve child health and parenting. Since implementation of home visiting trials 2 decades ago, US preterm births (<37 weeks) have risen by 20%. The objective of this study was to review evidence regarding home visiting and outcomes of preterm infants Searches of Medline, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, Cochrane Controlled Trial Register, PsycINFO, and Embase were conducted. Criteria for inclusion were (1) cohort or controlled trial designs; (2) home-based, preventive services for infants at medical or social risk; and (3) outcomes reported for infants born preterm or low birth weight (<2500 g). Data from eligible reports were abstracted by 2 reviewers. Random effects meta-analysis was used to synthesize data for developmental and parent interaction measures. Seventeen studies (15 controlled trials, 2 cohort studies) were reviewed. Five outcome domains were identified: infant development, parent-infant interaction, morbidity, abuse/neglect, and growth/nutrition. Six studies (n = 336) demonstrated a pooled standardized mean difference of 0.79 (95% confidence interval 0.57 to 1.02) in Home Observation for Measurement of the Environment Inventory scores at 1 year in the home-visited groups versus control. Evidence for other outcomes was limited. Methodological limitations were common. Reviewed studies suggest that home visiting for preterm infants promotes improved parent-infant interaction. Further study of interventions targeting preterm infants within existing programs may strengthen the impact and cost benefits of home visiting in at-risk populations.

  7. Umbilical Cord Milking Versus Delayed Cord Clamping in Preterm Infants

    PubMed Central

    Truong, Giang; Cousins, Larry; Oshiro, Bryan; Finer, Neil N.

    2015-01-01

    BACKGROUND AND OBJECTIVE: Delayed cord clamping (DCC) is recommended for premature infants to improve blood volume. Most preterm infants are born by cesarean delivery (CD), and placental transfusion may be less effective than in vaginal delivery (VD). We sought to determine whether infants <32 weeks born by CD who undergo umbilical cord milking (UCM) have higher measures of systemic blood flow than infants who undergo DCC. METHODS: This was a 2-center trial. Infants delivered by CD were randomly assigned to undergo UCM or DCC. Infants delivered by VD were also randomly assigned separately. UCM (4 strippings) or DCC (45–60 seconds) were performed. Continuous hemodynamic measurements and echocardiography were done at site 1. RESULTS: A total of 197 infants were enrolled (mean gestational age 28 ± 2 weeks). Of the 154 infants delivered by CD, 75 were assigned to UCM and 79 to DCC. Of the infants delivered by CD, neonates randomly assigned to UCM had higher superior vena cava flow and right ventricular output in the first 12 hours of life. Neonates undergoing UCM also had higher hemoglobin, delivery room temperature, blood pressure over the first 15 hours, and urine output in the first 24 hours of life. There were no differences for the 43 infants delivered by VD. CONCLUSIONS: This is the first randomized controlled trial demonstrating higher systemic blood flow with UCM in preterm neonates compared with DCC. UCM may be a more efficient technique to improve blood volume in premature infants delivered by CD. PMID:26122803

  8. Umbilical Cord Milking Versus Delayed Cord Clamping in Preterm Infants.

    PubMed

    Katheria, Anup C; Truong, Giang; Cousins, Larry; Oshiro, Bryan; Finer, Neil N

    2015-07-01

    Delayed cord clamping (DCC) is recommended for premature infants to improve blood volume. Most preterm infants are born by cesarean delivery (CD), and placental transfusion may be less effective than in vaginal delivery (VD). We sought to determine whether infants <32 weeks born by CD who undergo umbilical cord milking (UCM) have higher measures of systemic blood flow than infants who undergo DCC. This was a 2-center trial. Infants delivered by CD were randomly assigned to undergo UCM or DCC. Infants delivered by VD were also randomly assigned separately. UCM (4 strippings) or DCC (45-60 seconds) were performed. Continuous hemodynamic measurements and echocardiography were done at site 1. A total of 197 infants were enrolled (mean gestational age 28 ± 2 weeks). Of the 154 infants delivered by CD, 75 were assigned to UCM and 79 to DCC. Of the infants delivered by CD, neonates randomly assigned to UCM had higher superior vena cava flow and right ventricular output in the first 12 hours of life. Neonates undergoing UCM also had higher hemoglobin, delivery room temperature, blood pressure over the first 15 hours, and urine output in the first 24 hours of life. There were no differences for the 43 infants delivered by VD. This is the first randomized controlled trial demonstrating higher systemic blood flow with UCM in preterm neonates compared with DCC. UCM may be a more efficient technique to improve blood volume in premature infants delivered by CD. Copyright © 2015 by the American Academy of Pediatrics.

  9. Brain development in infants born preterm: looking beyond injury.

    PubMed

    Duerden, Emma G; Taylor, Margot J; Miller, Steven P

    2013-06-01

    Infants born very preterm are high risk for acquired brain injury and disturbances in brain maturation. Although survival rates for preterm infants have increased in the last decades owing to improved neonatal intensive care, motor disabilities including cerebral palsy persist, and impairments in cognitive, language, social, and executive functions have not decreased. Evidence from neuroimaging studies exploring brain structure, function, and metabolism has indicated abnormalities in the brain development trajectory of very preterm-born infants that persist through to adulthood. In this chapter, we review neuroimaging approaches for the identification of brain injury in the preterm neonate. Advances in medical imaging and availability of specialized equipment necessary to scan infants have facilitated the feasibility of conducting longitudinal studies to provide greater understanding of early brain injury and atypical brain development and their effects on neurodevelopmental outcome. Improved understanding of the risk factors for acquired brain injury and associated factors that affect brain development in this population is setting the stage for improving the brain health of children born preterm.

  10. Antenatal magnesium sulfate: Neuro-protection for preterm infants.

    PubMed

    Oddie, S; Tuffnell, D J; McGuire, W

    2015-11-01

    The neuro-protective effect of antenatal magnesium sulfate on very preterm infants has been demonstrated in good-quality randomised controlled trials and meta-analyses. Magnesium administered prior to preterm delivery crosses over to the foetal circulation and acts via several pathways to reduce perinatal neuronal damage. Meta-analysis of the trial data indicates that antenatal magnesium sulfate reduces the risk of cerebral palsy by one-third, and results in one fewer case in every 50 women treated. Treatment is associated with discomfort and flushing in some women, but maternal side-effects are mostly transient and manageable. Magnesium sulfate has also been found to be without any serious adverse consequences in newborn infants. Consensus recommendations and guidelines have been developed and implemented internationally, and endorsed by the UK Royal College of Obstetricians and Gynaecologists. However, magnesium sulfate for neuro-protection of very preterm infants has not yet become established widely in UK practice. Paediatricians, neonatologists and advocacy groups for preterm infants and their families could contribute to raising awareness and engage in dissemination activities and implementation initiatives to develop local protocols for adoption of this safe, effective and cost-effective intervention to reduce the burden of cerebral palsy in children born very preterm. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  11. Assessment of vessel tortuosity in retinal images of preterm infants.

    PubMed

    Oloumi, Faraz; Rangayyan, Rangaraj M; Ells, Anna L

    2014-01-01

    Diagnosis of plus disease is crucial for timely treatment and management of retinopathy of prematurity. An indicator of the presence of plus disease is an increase in the tortuosity of blood vessels in the retina. In this work, we propose a new angle-variation-based measure for quantification of tortuosity in retinal fundus images of preterm infants. The methods include the use of Gabor filters to detect vessels as well as to obtain their orientation at each pixel. Morphological image processing methods are used to obtain a skeleton image of the vessels for measurement of tortuosity. Out of 11 vessel segments, marked by an expert ophthalmologist as showing high levels of tortuosity due to plus disease, all were correctly identified using the proposed methods.

  12. An allometric scaling relationship in the brain of preterm infants

    PubMed Central

    Paul, Rachel A; Smyser, Christopher D; Rogers, Cynthia E; English, Ian; Wallendorf, Michael; Alexopoulos, Dimitrios; Meyer, Erin J; Van Essen, David C; Neil, Jeffrey J; Inder, Terrie E

    2014-01-01

    Allometry has been used to demonstrate a power–law scaling relationship in the brain of premature born infants. Forty-nine preterm infants underwent neonatal MRI scans and neurodevelopmental testing at age 2. Measures of cortical surface area and total cerebral volume demonstrated a power–law scaling relationship (α = 1.27). No associations were identified between these measures and investigated clinical variables. Term equivalent cortical surface area and total cerebral volume measures and scaling exponents were not related to outcome. These findings confirm a previously reported allometric scaling relationship in the preterm brain, and suggest that scaling is not a sensitive indicator of aberrant cortical maturation. PMID:25540808

  13. Choline and polyunsaturated fatty acids in preterm infants' maternal milk.

    PubMed

    Maas, Christoph; Franz, Axel R; Shunova, Anna; Mathes, Michaela; Bleeker, Christine; Poets, Christian F; Schleicher, Erwin; Bernhard, Wolfgang

    2017-06-01

    Choline, docosahexaenoic acid (DHA), and arachidonic acid (ARA) are essential to fetal development, particularly of the brain. These components are actively enriched in the fetus. Deprivation from placental supply may therefore result in impaired accretion in preterm infants. To determine choline, choline metabolites, DHA, and ARA in human breast milk (BM) of preterm infants compared to BM of term born infants. We collected expressed BM samples from 34 mothers (N = 353; postnatal day 6-85), who had delivered 35 preterm infants undergoing neonatal intensive care (postmenstrual age 30 weeks, range 25.4-32.0), and from mothers after term delivery (N = 9; postnatal day 6-118). Target metabolites were analyzed using tandem mass spectrometry and gas chromatography and reported as medians and 25th/75th percentiles. In BM, choline was mainly present in the form of phosphocholine and glycerophosphocholine, followed by free choline, phosphatidylcholine, sphingomyelin, and lyso-phosphatidylcholine. In preterm infants' BM total choline ranged from 61 to 360 mg/L (median: 158 mg/L) and was decreased compared to term infants' BM (range 142-343 mg/L; median: 258 mg/L; p < 0.01). ARA and DHA comprised 0.81 (range: 0.46-1.60) and 0.43 (0.15-2.42) % of total preterm BM lipids, whereas term BM values were 0.68 (0.52-0.88) and 0.35 (0.18-0.75) %, respectively. Concentrations of all target parameters decreased after birth, and frequently 150 ml/kg/d BM did not meet the estimated fetal accretion rates. Following preterm delivery, BM choline concentrations are lower, whereas ARA and DHA levels are comparable versus term delivery. Based on these findings we suggest a combined supplementation of preterm infants' BM with choline, ARA and DHA combined to improve the nutritional status of preterm infants. This study was registered at www.clinicaltrials.gov. Identifier: NCT01773902.

  14. An allometric scaling relationship in the brain of preterm infants.

    PubMed

    Paul, Rachel A; Smyser, Christopher D; Rogers, Cynthia E; English, Ian; Wallendorf, Michael; Alexopoulos, Dimitrios; Meyer, Erin J; Van Essen, David C; Neil, Jeffrey J; Inder, Terrie E

    2014-11-01

    Allometry has been used to demonstrate a power-law scaling relationship in the brain of premature born infants. Forty-nine preterm infants underwent neonatal MRI scans and neurodevelopmental testing at age 2. Measures of cortical surface area and total cerebral volume demonstrated a power-law scaling relationship (α = 1.27). No associations were identified between these measures and investigated clinical variables. Term equivalent cortical surface area and total cerebral volume measures and scaling exponents were not related to outcome. These findings confirm a previously reported allometric scaling relationship in the preterm brain, and suggest that scaling is not a sensitive indicator of aberrant cortical maturation.

  15. Brain injury and development in preterm infants exposed to fentanyl

    PubMed Central

    McPherson, Christopher; Haslam, Matthew; Pineda, Roberta; Rogers, Cynthia; Neil, Jeffrey J.; Inder, Terrie E.

    2015-01-01

    Background Fentanyl is commonly utilized in preterm infants. Relatively little is known regarding the neurodevelopmental outcomes of preterm infants exposed to fentanyl. Objective To investigate the association between cumulative fentanyl dose and brain injury and diameters in a cohort of preterm infants Methods Data on demographics, perinatal course, and neonatal course, including total fentanyl exposure prior to term equivalent age, were retrospectively evaluated for 103 infants born at ≤ 30 weeks gestational age who underwent magnetic resonance imaging at term equivalent age (mean gestational age 26.9 ± 1.8 weeks). Magnetic resonance images were evaluated for brain injury and regional brain diameters. Developmental testing was conducted at term equivalent and 2 years of age. Results Seventy-eight infants (76%) received fentanyl (median cumulative dose 3 μg/kg, interquartile range 1 – 441 μg/kg). Cumulative fentanyl dose in the first week of life correlated with the incidence of cerebellar hemorrhage after correction for covariates (OR 2.1, 95% confidence interval 1.1 – 4.1). Cumulative fentanyl dose before term equivalent age correlated with reductions in transverse cerebellar diameter after correction for covariates including the presence of cerebellar hemorrhage (r = 0.461, p = 0.002). No correlation was detected between cumulative fentanyl dose and development at 2 years of age. Conclusions Higher cumulative fentanyl dose in preterm infants correlated with a higher incidence of cerebellar injury and lower cerebellar diameter at term equivalent age. Our findings must be taken with caution, but emphasize the need for future prospective trials examining the risks and benefits of commonly utilized analgesic agents in preterm infants. PMID:26369570

  16. Population pharmacokinetics of intravenous acyclovir in preterm and term infants.

    PubMed

    Sampson, Mario R; Bloom, Barry T; Lenfestey, Robert W; Harper, Barrie; Kashuba, Angela D; Anand, Ravinder; Benjamin, Daniel K; Capparelli, Edmund; Cohen-Wolkowiez, Michael; Smith, P Brian

    2014-01-01

    Acyclovir is used to treat herpes infections in preterm and term infants; however, the influence of maturation on drug disposition and dosing requirements is poorly characterized in this population. We administered intravenous acyclovir to preterm and term infants <31 days postnatal age and collected plasma samples. We performed a population pharmacokinetic analysis. The primary pharmacodynamic target was acyclovir concentration ≥3 mg/L for ≥50% of the dosing interval. The final model was simulated using infant data from a clinical database. The analysis included 28 infants (median 30 weeks gestation). Acyclovir pharmacokinetics was described by a 1-compartment model: clearance (L/h/kg) = 0.305 × [postmenstrual age (PMA)/31.3 weeks]. This equation predicts a 4.5-fold increase in clearance from 25 to 41 weeks PMA. With proposed dosing, the pharmacodynamic target was achieved in 91% of infants: 20 mg/kg every 12 hours in infants <30 weeks PMA; 20 mg/kg every 8 hours in infants 30 to <36 weeks PMA and 20 mg/kg every 6 hours in infants 36-41 weeks PMA. Acyclovir clearance increased with infant maturation. A dosing strategy based on PMA accounted for developmental changes in acyclovir disposition to achieve the surrogate pharmacodynamic target in many infants.

  17. Chromatic and luminance contrast sensitivity in fullterm and preterm infants

    PubMed Central

    Bosworth, Rain G.; Dobkins, Karen R.

    2010-01-01

    In order to investigate the contributions of visual experience vs. preprogrammed mechanisms on visual development, the current study compared contrast sensitivity in preterm vs. fullterm infants. If development is tied to time since conception, preterm infants should match the developmental trajectories of fullterm infants when plotted in postterm age. By contrast, if development is influenced by visual experience, preterm and fullterm infants should match when plotted in postnatal age. Luminance (light/dark) and chromatic (red/green) contrast sensitivities (CS) were measured in 25 preterm (born, on average, 6.6 weeks early) and 77 fullterm infants, between 1 and 6 months postterm. In the first few months, luminance CS was found to be predicted by postterm age, suggesting that preprogrammed development is sufficient to account for luminance CS. By contrast, chromatic CS exceeded that predicted by postterm age, which suggests that time since birth confers a benefit on chromatic CS. The preterms’ 6.6 weeks of additional time since birth is roughly equivalent to 3.7 weeks of development in chromatic CS. In sum, these results suggest that chromatic CS is more influenced by early postnatal visual experience than luminance CS, which may have implications for development of parvocellular and magnocellular pathways. PMID:20055548

  18. Neurobehavior related to epigenetic differences in preterm infants

    PubMed Central

    Lester, Barry M; Marsit, Carmen J; Giarraputo, James; Hawes, Katheleen; LaGasse, Linda L; Padbury, James F

    2015-01-01

    Preterm birth is associated with medical problems affecting the neuroendocrine system, altering cortisol levels resulting in negative effects on newborn neurobehavior. Newborn neurobehavior is regulated by DNA methylation of NR3C1 and HSD11B2. Aim: Determine if methylation of HSD11B2 and NR3C1 is associated with neurobehavioral profiles in preterm infants. Patients & methods: Neurobehavior was measured before discharge from the hospital in 67 preterm infants. Cheek swabs were collected for DNA extraction. Results: Infants with the high-risk neurobehavioral profile showed more methylation than infants with the low-risk neurobehavioral profile at CpG3 for NR3C1 and less methylation of CpG3 for HSD11B2. Infants with these profiles were more likely to have increased methylation of NR3C1 and decreased methylation of HSD11B2 at these CpG sites. Conclusion: Preterm birth is associated with epigenetic differences in genes that regulate cortisol levels related to high-risk neurobehavioral profiles. PMID:26585459

  19. Oral sucrose and pain relief for preterm infants.

    PubMed

    Mitchell, Anita; Waltman, Patricia A

    2003-06-01

    The frequency of painful procedures performed on preterm infants in the neonatal intensive care unit (NICU) presents a challenge to nurses who are attempting to provide effective pain relief, and to the infants themselves who may suffer adverse consequences in response to repeated painful procedures. One new pain relief intervention under study is the administration of oral sucrose, which may activate endogenous opioid systems within the body. Studies with preterm infants that have examined the use of oral sucrose as an analgesic during heelsticks and venipunctures have shown that sucrose is effective in reducing pain. Sucrose may also be combined with nonnutritive sucking to provide significant pain relief. The use of oral sucrose is now recommended with a wide range of painful procedures in the NICU. Promising results have been observed in studies with both term and preterm infants, but less research has occurred with preterm infants. Additional research is warranted to determine the most effective approaches for the administration of sucrose, to examine the effectiveness of sucrose with additional types of painful procedures, and to examine the effects of long-term repeated use of sucrose.

  20. Selenium deficiency and the effects of supplementation on preterm infants

    PubMed Central

    Freitas, Renata Germano B. O. N.; Nogueira, Roberto José N.; Antonio, Maria Ângela R. G. M.; Barros-Filho, Antonio de Azevedo; Hessel, Gabriel

    2014-01-01

    Objective: This study aimed to review the literature about blood concentrations of selenium associated with gestational age, feeding, supplementation and related clinical features in preterm infants. Data sources: Systematic review in the following databases: MEDLINE, PubMed, Google academics, SciELO. org, ScienceDirect (Elsevier) and CINAHL-Plus with Full Text (EBSCO). Articles published up to January 2013 with the keywords "selenium deficiency", "selenium supplementation", "neonates", "infants", "newborn" and "preterm infants" were selected. Data synthesis: The studies reported that low blood selenium levels are associated with increased risk of respiratory diseases. Preterm infants, especially with low birth weight, presented lower selenium levels. Selenium deficiency has also been associated with the use of oral infant formula, enteral and parenteral nutrition (with or without selenium addition). The optimal dose and length of selenium supplementation is not well-established, since they are based only on age group and selenium ingestion by breastfed children. Furthermore, the clinical status of the infant affected by conditions that may increase oxidative stress, and consequently, selenium requirements is not taken into account. Conclusions: Prematurity and low birth weight can contribute to low blood selenium in premature infants. Selenium supplementation seems to minimize or prevent clinical complications caused by prematurity. PMID:24676200

  1. Professional Nurses' Perceptions of Skills Required for Performing Preterm Infants' Follow-up Assessments.

    PubMed

    Cordewener, Debbie; Lubbe, Welma

    2017-02-14

    Improved perinatal and neonatal care enhances preterm infant survival rates, but the adverse outcomes remain high. Nurses play vitally important roles regarding the follow-up assessments, treatment, and care of preterm infants. This explorative, descriptive study aimed to describe nurses' perceptions of skills required to perform effective preterm infant assessments. Thirteen semistructured interviews were conducted. Identified themes included the role of the professional nurse, the importance of preterm infant assessments, lack of skills and knowledge to conduct quality assessments, formal and continuous development training needs, the absence of assessment tools and physical resources to perform standardized assessments of preterm infants, and the required support and referral systems.

  2. Abnormal cerebral hemodynamics in preterm infants with patent ductus arteriosus.

    PubMed

    Lipman, B; Serwer, G A; Brazy, J E

    1982-06-01

    Blood flow patterns in the anterior cerebral arteries were studied in eight preterm infants with patent ductus arteriosus and left-to-right shunts. A noninvasive Doppler technique was used to obtain the blood flow patterns and to calculate a pulsatility index. Advancing diastolic blood flow was decreased in all eight infants, and two demonstrated retrograde anterior cerebral artery flow during diastole. Following ductal closure, the diastolic flow in the anterior cerebral arteries increased significantly, reaching levels seen in normal infants. These observations demonstrate that infants with patent ductus arteriosus and left-to-right shunts may have abnormal cerebral hemodynamics which return to normal following ductal closure.

  3. Evaluation of recent New Vaccine Surveillance Network data regarding respiratory syncytial virus hospitalization rates in US preterm infants.

    PubMed

    DeVincenzo, John P; Ambrose, Christopher S; Makari, Doris; Weiner, Leonard B

    2016-04-02

    In July 2014, the Committee on Infectious Diseases (COID) updated their guidance on the use of palivizumab, recommending against use in preterm infants 29 to 35 weeks' gestational age (wGA). A primary data source cited to support this significant change was the low respiratory syncytial virus (RSV) hospitalization rate observed in the subpopulation of preterm (<37 wGA) infants evaluated from 2000 to 2005 through the New Vaccine Surveillance Network (NVSN). Here we critically appraise the preterm infant data from the NVSN in the context of data regarding the use of palivizumab in this same time period. Data from the NVSN, an analysis of Florida Medicaid data, and a national survey of US in-hospital palivizumab administration demonstrated that during 2001 to 2007, palivizumab was administered to 59% to 83% of preterm infants born at <32 wGA and 21% to 27% of all preterm infants (<37 wGA). When the NVSN data regarding incidence of RSV hospitalization in preterm infant subgroups were evaluated as a function of chronologic age, preterm infants <32 wGA showed a paradoxical increase in RSV hospitalization with older age, with the highest risk of RSV hospitalization occurring at 18 to 23 months of age. This pattern is most consistent with a reduction in RSV hospitalizations in <32 wGA infants in the first 12 to 18 months of life due to high palivizumab use at these young ages. The NVSN data were not designed to and cannot accurately describe RSV disease burden in preterm infants given the small size of the analyzed subpopulation and the high use of palivizumab during the study period.

  4. 'Resuscitation' of extremely preterm and/or low-birth-weight infants - time to 'call it'?

    PubMed

    O'Donnell, Colm P F

    2008-01-01

    Since ancient times, various methods have been used to revive apparently stillborn infants; many were of dubious efficacy and had the potential to cause harm. Based largely on studies of acutely asphyxiated term animal models, clinical assessment and positive pressure ventilation have become the cornerstones of neonatal resuscitation over the last 40 years. Over the last 25 years, care of extremely preterm infants in the delivery room has evolved from a policy of indifference to one of increasingly aggressive support. The survival of these infants has improved considerably in recent years; this has not, however, necessarily been due to more aggressive resuscitation. Urban myths have evolved that all extremely preterm infants died before they were intubated, and that all such infants need to immediately intubated or they will quickly die. This has never been true. Clinical assessment of infants at birth is subjective. Also, many techniques used to support preterm infants at birth have not been well studied and there is evidence that they may be harmful. It may thus be argued that many of our well-intentioned resuscitation interventions are of dubious efficacy and have the potential to cause harm. 'Resuscitation' is an emotive term which means 'restoration of life'. Death, thankfully, is a rare presentation in the delivery room. Therefore, concerning neonatal 'resuscitation', it is time to 'call it' something else. This will allow us to dispassionately distinguish preterm infants who are dead, or nearly dead, from those who are merely at high risk of parenchymal lung disease. We may then be able to refine our interventions and determine what methods of support benefit these infants most. (c) 2008 S. Karger AG, Basel.

  5. Ventilator-induced lung injury in preterm infants

    PubMed Central

    Carvalho, Clarissa Gutierrez; Silveira, Rita C; Procianoy, Renato Soibelmann

    2013-01-01

    In preterm infants, the need for intubation and mechanical ventilation is associated with ventilator-induced lung injuries and subsequent bronchopulmonary dysplasia. The aim of the present review was to improve the understanding of the mechanisms of injury that involve cytokine-mediated inflammation to contribute to the development of new preventive strategies. Relevant articles were retrieved from the PubMed database using the search terms "ventilator-induced lung injury preterm", "continuous positive airway pressure", "preterm", and "bronchopulmonary dysplasia". The resulting data and other relevant information were divided into several topics to ensure a thorough, critical view of ventilation-induced lung injury and its consequences in preterm infants. The role of pro-inflammatory cytokines (particularly interleukins 6 and 8 and tumor necrosis factor alpha) as mediators of lung injury was assessed. Evidence from studies conducted with animals and human newborns is described. This evidence shows that brief periods of mechanical ventilation is sufficient to induce the release of pro-inflammatory cytokines. Other forms of mechanical and non-invasive ventilation were also analyzed as protective alternatives to conventional mechanical ventilation. It was concluded that non-invasive ventilation, intubation followed by early surfactant administration and quick extubation for nasal continuous positive airway pressure, and strategies that regulate tidal volume and avoid volutrauma (such as volume guarantee ventilation) protect against ventilator-induced lung injury in preterm infants. PMID:24553514

  6. Skinfold thickness of preterm newborns when they become late preterm infants.

    PubMed

    Simsek, Meral; Ergenekon, Ebru; Beken, Serdar; Kulalı, Ferit; Unal, Sezin; Kazancı, Ebru; Aktas, Selma; Altuntas, Nilgun; Hirfanoglu, Ibrahim; Turkyılmaz, Canan; Koç, Esin; Atalay, Yıldız

    2015-04-01

    Nutrition of very low-birth-weight newborns is important for a good physical and neurologic outcome. Body composition assessment, together with anthropometric measurements, is considered necessary to monitor adequate nutrition and growth. Objectives of this study were to assess body fat changes in newborns ≤32 weeks gestation by weekly skinfold thickness (SFT) measurements and to compare them with those of late preterm infants born at 34, 35, and 36 weeks once they reached 34, 35, and 36 weeks corrected age (CA). Preterm infants ≤32 weeks gestation had SFT measured from 4 body sites, including biceps, triceps, and subscapulary and suprailiac regions, by a Holtain caliper starting from 48 hours of age at weekly intervals until 34, 35, and 36 weeks CA. The measurements were compared with those of late preterm controls born at 34, 35, and 36 weeks gestation. There were 37 preterm infants in the patient group. When reaching 34, 35, and 36 weeks CA, preterm infants had higher SFT values compared with controls in all body sites. Median and range of total SFT were 14.6 mm (9.6-18.9 mm) in patients and 11 mm (7.8-16.4 mm) in controls at 34 weeks CA, 15.5 mm (10.7-21.8 mm) in patients and 12.3 mm (7-17 mm) in controls at 35 weeks CA, and 16.4 mm (11.8-23.7 mm) in patients and 12.9 mm (7-17.8 mm) in controls at 36 weeks CA (P = .001 in all). No sex difference was observed at 34 and 35 weeks. These results show that preterm infants start accumulating excess fat even from early weeks of life. Careful assessment of growth by tools other than simple anthropometric measurements is essential to avoid future complications. © 2015 American Society for Parenteral and Enteral Nutrition.

  7. Use of baclofen for withdrawal in a preterm infant.

    PubMed

    Duncan, S D; Devlin, L A

    2013-04-01

    Baclofen is a gamma-aminobutyric acid agonist used primarily as a muscle relaxant to treat spasticity in children and adults. Withdrawal of oral baclofen is known to cause a withdrawal syndrome in adults. Only one previous case describes a withdrawal syndrome in a term infant, manifested by seizures, associated with the use of oral baclofen in the mother. This case describes a withdrawal syndrome and the unique use of baclofen for withdrawal in a preterm infant.

  8. Influence of holding practice on preterm infant development

    PubMed Central

    Neu, Madalynn; Robinson, JoAnn; Schmiege, Sarah J.

    2012-01-01

    Purpose The purpose of this randomized, controlled trial was to determine if nurse supported kangaroo holding of healthy preterm infants in the first eight weeks of the infant's life facilitates early behavioral organization and development. Methods We randomized 87 infants born between 32 to 35 weeks gestation and their mothers to one of three holding groups: kangaroo (skin-to-skin between mother's breasts), blanket (held in mother's arms), or control (no holding restrictions). Nurse supported groups (kangaroo and blanket) received 8 weekly visits from a registered nurse who encouraged holding and provided education about infant development. The control group received brief social visits. Mothers recorded time held in a daily diary. The Assessment of Preterm Infant Behavior was administered when infants were 40 to 44 weeks postconceptional age. Results Total holding time averaged four to five hours per day and did not differ among groups. Mothers held kangaroo style an average of 59 minutes per day in the kangaroo group, and 5 and 9 minutes per day in the blanket and control groups respectively (p <.001). Infants in the kangaroo and blanket groups had more optimal scores than the control group in Robust Crying (p = .015) indicating that they could arouse to vigorous crying and calm. Scores, except for Attention and State Regulation, were at least as high as those of full term infants. Clinical Implications When kangaroo holding is compared to blanket holding, both methods may provide equal early behavioral organization and developmental benefit to the infant. PMID:23625100

  9. Recombinant human erythropoietin improves neurological outcomes in very preterm infants

    PubMed Central

    Song, Juan; Sun, Huiqing; Xu, Falin; Kang, Wenqing; Gao, Liang; Guo, Jiajia; Zhang, Yanhua; Xia, Lei; Wang, Xiaoyang

    2016-01-01

    Objective To evaluate the efficacy and safety of repeated low‐dose human recombinant erythropoietin (rhEPO) in the improvement of neurological outcomes in very preterm infants. Methods A total of 800 infants of ≤32‐week gestational age who had been in an intensive care unit within 72 hours after birth were included in the trial between January 2009 and June 2013. Preterm infants were randomly assigned to receive rhEPO (500IU/kg; n = 366) or placebo (n = 377) intravenously within 72 hours after birth and then once every other day for 2 weeks. The primary outcome was death or moderate to severe neurological disability assessed at 18 months of corrected age. Results Death and moderate/severe neurological disability occurred in 91 of 338 very preterm infants (26.9%) in the placebo group and in 43 of 330 very preterm infants (13.0%) in the rhEPO treatment group (relative risk [RR] = 0.40, 95% confidence interval [CI] = 0.27–0.59, p < 0.001) at 18 months of corrected age. The rate of moderate/severe neurological disability in the rhEPO group (22 of 309, 7.1%) was significantly lower compared to the placebo group (57 of 304, 18.8%; RR = 0.32, 95% CI = 0.19–0.55, p < 0.001), and no excess adverse events were observed. Interpretation Repeated low‐dose rhEPO treatment reduced the risk of long‐term neurological disability in very preterm infants with no obvious adverse effects. Ann Neurol 2016;80:24–34 PMID:27130143

  10. Glutamine supplementation to prevent morbidity and mortality in preterm infants.

    PubMed

    Moe-Byrne, Thirimon; Brown, Jennifer V E; McGuire, William

    2016-04-18

    Glutamine is a conditionally essential amino acid. Endogenous biosynthesis may be insufficient for tissue needs in states of metabolic stress. Evidence exists that glutamine supplementation improves clinical outcomes in critically ill adults. It has been suggested that glutamine supplementation may also benefit preterm infants. To determine the effects of glutamine supplementation on mortality and morbidity in preterm infants. We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, 2015, Issue 12), MEDLINE, EMBASE and Maternity and Infant Care (to December 2015), conference proceedings and previous reviews. Randomised or quasi-randomised controlled trials that compared glutamine supplementation versus no glutamine supplementation in preterm infants at any time from birth to discharge from hospital. We extracted data using the standard methods of the Cochrane Neonatal Review Group, with separate evaluation of trial quality and data extraction by two review authors. We synthesised data using a fixed-effect model and reported typical relative risk, typical risk difference and weighted mean difference. We identified 12 randomised controlled trials in which a total of 2877 preterm infants participated. Six trials assessed enteral glutamine supplementation and six trials assessed parenteral glutamine supplementation. The trials were generally of good methodological quality. Meta-analysis did not find an effect of glutamine supplementation on mortality (typical relative risk 0.97, 95% confidence interval 0.80 to 1.17; risk difference 0.00, 95% confidence interval -0.03 to 0.02) or major neonatal morbidities including the incidence of invasive infection or necrotising enterocolitis. Three trials that assessed neurodevelopmental outcomes in children aged 18 to 24 months and beyond did not find any effects. The available trial data do not provide evidence that glutamine

  11. Glutamine supplementation to prevent morbidity and mortality in preterm infants.

    PubMed

    Moe-Byrne, Thirimon; Brown, Jennifer V E; McGuire, William

    2016-01-12

    Glutamine is a conditionally essential amino acid. Endogenous biosynthesis may be insufficient for tissue needs in states of metabolic stress. Evidence exists that glutamine supplementation improves clinical outcomes in critically ill adults. It has been suggested that glutamine supplementation may also benefit preterm infants. To determine the effects of glutamine supplementation on mortality and morbidity in preterm infants. We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, 2015, Issue 12), MEDLINE, EMBASE and Maternity and Infant Care (to December 2015), conference proceedings and previous reviews. Randomised or quasi-randomised controlled trials that compared glutamine supplementation versus no glutamine supplementation in preterm infants at any time from birth to discharge from hospital. We extracted data using the standard methods of the Cochrane Neonatal Review Group, with separate evaluation of trial quality and data extraction by two review authors. We synthesised data using a fixed-effect model and reported typical relative risk, typical risk difference and weighted mean difference. We identified 12 randomised controlled trials in which a total of 2877 preterm infants participated. Six trials assessed enteral glutamine supplementation and six trials assessed parenteral glutamine supplementation. The trials were generally of good methodological quality. Meta-analysis did not find an effect of glutamine supplementation on mortality (typical relative risk 0.97, 95% confidence interval 0.80 to 1.17; risk difference 0.00, 95% confidence interval -0.03 to 0.02) or major neonatal morbidities including the incidence of invasive infection or necrotising enterocolitis. Three trials that assessed neurodevelopmental outcomes in children aged 18 to 24 months and beyond did not find any effects. The available trial data do not provide evidence that glutamine

  12. Diaphragmatic activity during weaning from respiratory support in preterm infants.

    PubMed

    Kraaijenga, Juliette V; de Waal, Cornelia G; Hutten, Gerard J; de Jongh, Frans H; van Kaam, Anton H

    2017-07-01

    To determine if weaning from nasal continuous positive airway pressure (nCPAP) to lesser supportive low flow nasal cannula (LFNC) results in a change in electrical activity of the diaphragm in preterm infants. Prospective observational study. Neonatal intensive care unit. Stable preterm infants weaned from nCPAP to LFNC (1 L/min). Change in diaphragmatic activity, expressed as amplitude, peak and tonic activity, measured by transcutaneous electromyography (dEMG) from 30 min before (baseline) until 180 min after weaning. Subgroup analysis was performed based on success or failure of the weaning attempt. Fifty-nine preterm infants (gestational age: 29.0±2.4 weeks, birth weight: 1210±443 g) accounting for 74 weaning attempts were included. A significant increase in dEMG amplitude (median, IQR: 21.3%, 3.6-41.4), peak (22.1%, 8.7-40.5) and tonic activity (14.3%, -1.9-38.1) was seen directly after weaning. This effect slowly decreased over time. Infants failing the weaning attempt tended to have a higher diaphragmatic activity than those successfully weaned. Weaning from nCPAP to LFNC leads to an increase in diaphragmatic activity measured by dEMG and is most prominent in preterm infants failing the weaning attempt. dEMG monitoring might be a useful parameter to guide weaning from respiratory support in preterm infants. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  13. Stress in Fathers of Moderately and Late Preterm Infants: A Randomised Controlled Trial

    ERIC Educational Resources Information Center

    Ravn, Ingrid Helen; Lindemann, Rolf; Smeby, Nina Aarhus; Bunch, Eli Haugen; Sandvik, Leiv; Smith, Lars

    2012-01-01

    The atypical behaviour of preterm infants can elicit stress in fathers and influence their ability to perceive and interpret infants' cues. This study investigated whether fathers of moderately and late preterm infants were more stressed than fathers of term infants. In a randomised controlled trial, we also studied the effect of the Mother-Infant…

  14. Maturation of oral feeding skills in preterm infants

    USDA-ARS?s Scientific Manuscript database

    Safe and successful oral feeding requires proper maturation of sucking, swallowing and respiration. We hypothesized that oral feeding difficulties result from different temporal development of the musculatures implicated in these functions. Sixteen medically stable preterm infants (26 to 29 weeks ge...

  15. Prevention of intraventricular hemorrhage by indomethacin in male preterm infants.

    PubMed

    Ment, Laura R; Vohr, Betty R; Makuch, Robert W; Westerveld, Michael; Katz, Karol H; Schneider, Karen C; Duncan, Charles C; Ehrenkranz, Richard; Oh, William; Philip, Alistair G S; Scott, David T; Allan, Walter C

    2004-12-01

    Our multicenter Indomethacin Intraventricular Hemorrhage (IVH) Prevention Trial demonstrated a reduction of IVH in preterm infants. Analysis of our cohort by sex showed indomethacin halved the incidence of IVH, eliminated parenchymal hemorrhage, and was associated with higher verbal scores at 3 to 8 years in boys.

  16. Handicap in the Preterm Small-for-Gestational Age Infant.

    ERIC Educational Resources Information Center

    Commey, J. O. O.; Fitzhardinge, P. M.

    1979-01-01

    A prospective study of growth and development during the first 2 years of life was performed on 71 preterm SGA (small-for-gestational-age) infants. Journal Availability: C.V. Mosby Company, 11830 Westline Industrial Drive, St. Louis, Missouri 63141. (Author/SBH)

  17. Mothers of Pre-Term Infants in Neonate Intensive Care

    ERIC Educational Resources Information Center

    MacDonald, Margaret

    2007-01-01

    In this study, eight mothers of pre-term infants under the care of nursing staff and neonatologists in the Neonatal Intensive Care Unit (NICU) of Children's Hospital in Vancouver, British Columbia, were observed and interviewed about their birth experience and their images of themselves as mothers during their stay. Patterns and themes in the…

  18. Mothers of Pre-Term Infants in Neonate Intensive Care

    ERIC Educational Resources Information Center

    MacDonald, Margaret

    2007-01-01

    In this study, eight mothers of pre-term infants under the care of nursing staff and neonatologists in the Neonatal Intensive Care Unit (NICU) of Children's Hospital in Vancouver, British Columbia, were observed and interviewed about their birth experience and their images of themselves as mothers during their stay. Patterns and themes in the…

  19. Probability distributions of the electroencephalogram envelope of preterm infants.

    PubMed

    Saji, Ryoya; Hirasawa, Kyoko; Ito, Masako; Kusuda, Satoshi; Konishi, Yukuo; Taga, Gentaro

    2015-06-01

    To determine the stationary characteristics of electroencephalogram (EEG) envelopes for prematurely born (preterm) infants and investigate the intrinsic characteristics of early brain development in preterm infants. Twenty neurologically normal sets of EEGs recorded in infants with a post-conceptional age (PCA) range of 26-44 weeks (mean 37.5 ± 5.0 weeks) were analyzed. Hilbert transform was applied to extract the envelope. We determined the suitable probability distribution of the envelope and performed a statistical analysis. It was found that (i) the probability distributions for preterm EEG envelopes were best fitted by lognormal distributions at 38 weeks PCA or less, and by gamma distributions at 44 weeks PCA; (ii) the scale parameter of the lognormal distribution had positive correlations with PCA as well as a strong negative correlation with the percentage of low-voltage activity; (iii) the shape parameter of the lognormal distribution had significant positive correlations with PCA; (iv) the statistics of mode showed significant linear relationships with PCA, and, therefore, it was considered a useful index in PCA prediction. These statistics, including the scale parameter of the lognormal distribution and the skewness and mode derived from a suitable probability distribution, may be good indexes for estimating stationary nature in developing brain activity in preterm infants. The stationary characteristics, such as discontinuity, asymmetry, and unimodality, of preterm EEGs are well indicated by the statistics estimated from the probability distribution of the preterm EEG envelopes. Copyright © 2014 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  20. Trends in preterm-related infant mortality by race and ethnicity, United States, 1999-2004.

    PubMed

    MacDorman, Marian F; Callaghan, William M; Mathews, T J; Hoyert, Donna L; Kochanek, Kenneth D

    2007-01-01

    Trends in preterm-related causes of death were examined by maternal race and ethnicity. A grouping of preterm-related causes of infant death was created by identifying causes that were a direct cause or consequence of preterm birth. Cause-of-death categories were considered to be preterm-related when 75 percent or more of total infant deaths attributed to that cause were deaths of infants born preterm, and the cause was considered to be a direct consequence of preterm birth based on a clinical evaluation and review of the literature. In 2004, 36.5 percent of all infant deaths in the United States were preterm-related, up from 35.4 percent in 1999. The preterm-related infant mortality rate for non-Hispanic black mothers was 3.5 times higher and the rate for Puerto Rican mothers was 75 percent higher than for non-Hispanic white mothers. The preterm-related infant mortality rate for non-Hispanic black mothers was higher than the total infant mortality rate for non-Hispanic white, Mexican, and Asian or Pacific Islander mothers. The leveling off of the U.S. infant mortality decline since 2000 has been attributed in part to an increase in preterm and low-birthweight births. Continued tracking of preterm-related causes of infant death will improve our understanding of trends in infant mortality in the United States.

  1. Effects of infant massage on state anxiety in mothers of preterm infants prior to hospital discharge.

    PubMed

    Afand, Nahid; Keshavarz, Maryam; Fatemi, Naiemeh Seyed; Montazeri, Ali

    2017-07-01

    This study evaluated the effect of infant massage on anxiety in mothers of preterm infants who discharged from the neonatal intensive care unit. Birth of preterm infants commonly leads to great levels of distress and anxiety in mothers. Although various methods have been suggested to help mothers cope with such stressful conditions, the effects of infant massage have not been adequately studied in mothers. This was a quasi-experimental clinical trial. Overall, in 70 mothers and their preterm infants who scheduled to be discharged within 24 hours, State-Trait Anxiety Inventory scale (Spielberger) was completed for mothers in both groups in the morning of the day before discharge. The experimental group received eight minutes of massage including two standard similar parts (each part four minutes). The massage was repeated in two parts on the day of discharge, and then, state anxiety was re-measured using Spielberg's scale for all mothers. The control group received no intervention. The results showed that on the day of discharge, there was a significant difference in the overall mean score of maternal state anxiety between the two groups (p < 0·002), although not in the severity of maternal state anxiety. In both groups, the mean score of maternal state anxiety was significantly decreased on the day of discharge (p < 0·001). The findings provide evidence that infant massage by mother has an effect on the state anxiety of mothers of preterm infants, so it is recommended that mothers apply massage for preterm infants to improve their mental health. Mothers of preterm infants can promote mental health by continuing massage of their infants at home. © 2016 John Wiley & Sons Ltd.

  2. Airway Microbial Community Turnover Differs by BPD Severity in Ventilated Preterm Infants.

    PubMed

    Wagner, Brandie D; Sontag, Marci K; Harris, J Kirk; Miller, Joshua I; Morrow, Lindsey; Robertson, Charles E; Stephens, Mark; Poindexter, Brenda B; Abman, Steven H; Mourani, Peter M

    2017-01-01

    Preterm birth exposes the developing lung to an environment with direct exposure to bacteria, often facilitated by endotracheal intubation. Despite evidence linking bacterial infections to the pathogenesis of bronchopulmonary dysplasia (BPD), systematic studies of airway microbiota are limited. The objective was to identify specific patterns of the early respiratory tract microbiome from tracheal aspirates of mechanically ventilated preterm infants that are associated with the development and severity of BPD. Infants with gestational age ≤34 weeks, and birth weight 500-1250g were prospectively enrolled. Mechanically ventilated infants had tracheal aspirate samples collected at enrollment, 7, 14, and 21 days of age. BPD was determined by modified NIH criteria with oxygen reduction tests; infants without BPD were excluded due to low numbers. Aspirates were processed for bacterial identification by 16S rRNA sequencing, and bacterial load by qPCR. Cross-sectional analysis was performed using 7 day samples and longitudinal analysis was performed from subjects with at least 2 aspirates. Microbiome analysis was performed on tracheal aspirates from 152 infants (51, 49, and 52 with mild, moderate, and severe BPD, respectively). Seventy-nine of the infants were included in the cross-sectional analysis and 94 in the longitudinal. Shannon Diversity, bacterial load, and relative abundance of individual taxa were not strongly associated with BPD status. Longitudinal analysis revealed that preterm infants who eventually developed severe BPD exhibited greater bacterial community turnover with age, acquired less Staphylococcus in the first days after birth, and had higher initial relative abundance of Ureaplasma. In conclusion, longitudinal changes in the airway microbial communities of mechanically ventilated preterm infants may be associated with BPD severity, whereas cross-sectional analysis of airway ecology at 7 days of age did not reveal an association with BPD severity

  3. Airway Microbial Community Turnover Differs by BPD Severity in Ventilated Preterm Infants

    PubMed Central

    Wagner, Brandie D.; Sontag, Marci K.; Harris, J. Kirk; Miller, Joshua I.; Morrow, Lindsey; Robertson, Charles E.; Stephens, Mark; Poindexter, Brenda B.; Abman, Steven H.; Mourani, Peter M.

    2017-01-01

    Preterm birth exposes the developing lung to an environment with direct exposure to bacteria, often facilitated by endotracheal intubation. Despite evidence linking bacterial infections to the pathogenesis of bronchopulmonary dysplasia (BPD), systematic studies of airway microbiota are limited. The objective was to identify specific patterns of the early respiratory tract microbiome from tracheal aspirates of mechanically ventilated preterm infants that are associated with the development and severity of BPD. Infants with gestational age ≤34 weeks, and birth weight 500–1250g were prospectively enrolled. Mechanically ventilated infants had tracheal aspirate samples collected at enrollment, 7, 14, and 21 days of age. BPD was determined by modified NIH criteria with oxygen reduction tests; infants without BPD were excluded due to low numbers. Aspirates were processed for bacterial identification by 16S rRNA sequencing, and bacterial load by qPCR. Cross-sectional analysis was performed using 7 day samples and longitudinal analysis was performed from subjects with at least 2 aspirates. Microbiome analysis was performed on tracheal aspirates from 152 infants (51, 49, and 52 with mild, moderate, and severe BPD, respectively). Seventy-nine of the infants were included in the cross-sectional analysis and 94 in the longitudinal. Shannon Diversity, bacterial load, and relative abundance of individual taxa were not strongly associated with BPD status. Longitudinal analysis revealed that preterm infants who eventually developed severe BPD exhibited greater bacterial community turnover with age, acquired less Staphylococcus in the first days after birth, and had higher initial relative abundance of Ureaplasma. In conclusion, longitudinal changes in the airway microbial communities of mechanically ventilated preterm infants may be associated with BPD severity, whereas cross-sectional analysis of airway ecology at 7 days of age did not reveal an association with BPD severity

  4. Taste-Mediated Calming in Premature, Preterm, and Full-Term Human Infants.

    ERIC Educational Resources Information Center

    Smith, Barbara A.; Blass, Elliott M.

    1996-01-01

    Preterm and term infants were given a sucrose solution, a glucose solution, or water during a test period in which the amount of their crying was measured. Sucrose reduced crying in preterm and term infants by 91% and 93%, respectively, and glucose by 86% and 81%, respectively. Water was ineffective in reducing crying in both preterm and term…

  5. Taste-Mediated Calming in Premature, Preterm, and Full-Term Human Infants.

    ERIC Educational Resources Information Center

    Smith, Barbara A.; Blass, Elliott M.

    1996-01-01

    Preterm and term infants were given a sucrose solution, a glucose solution, or water during a test period in which the amount of their crying was measured. Sucrose reduced crying in preterm and term infants by 91% and 93%, respectively, and glucose by 86% and 81%, respectively. Water was ineffective in reducing crying in both preterm and term…

  6. Reliability of Neurobehavioral Assessments from Birth to Term Equivalent Age in Preterm and Term Born Infants.

    PubMed

    Eeles, Abbey L; Olsen, Joy E; Walsh, Jennifer M; McInnes, Emma K; Molesworth, Charlotte M L; Cheong, Jeanie L Y; Doyle, Lex W; Spittle, Alicia J

    2017-02-01

    Neurobehavioral assessments provide insight into the functional integrity of the developing brain and help guide early intervention for preterm (<37 weeks' gestation) infants. In the context of shorter hospital stays, clinicians often need to assess preterm infants prior to term equivalent age. Few neurobehavioral assessments used in the preterm period have established interrater reliability.

  7. Multi-nutrient fortification of human milk for preterm infants.

    PubMed

    Brown, Jennifer V E; Embleton, Nicholas D; Harding, Jane E; McGuire, William

    2016-05-08

    Exclusively breast milk-fed preterm infants may accumulate nutrient deficits leading to extrauterine growth restriction. Feeding preterm infants with multi-nutrient fortified human breast milk rather than unfortified breast milk may increase nutrient accretion and growth rates and may improve neurodevelopmental outcomes. To determine whether multi-nutrient fortified human breast milk improves important outcomes (including growth and development) over unfortified breast milk for preterm infants without increasing the risk of adverse effects (such as feed intolerance and necrotising enterocolitis). We used the standard search strategy of the Cochrane Neonatal Review Group. This included electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 2), MEDLINE, EMBASE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (until February 2016), as well as conference proceedings and previous reviews. Randomised and quasi-randomised controlled trials that compared feeding preterm infants with multi-nutrient (protein and energy plus minerals, vitamins or other nutrients) fortified human breast milk versus unfortified (no added protein or energy) breast milk. We extracted data using the standard methods of the Cochrane Neonatal Review Group. We separately evaluated trial quality, data extracted by two review authors and data synthesised using risk ratios (RRs), risk differences and mean differences (MDs). We assessed the quality of evidence at the outcome level using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We identified 14 trials in which a total of 1071 infants participated. The trials were generally small and weak methodologically. Meta-analyses provided low-quality evidence that multi-nutrient fortification of breast milk increases in-hospital rates of growth (MD 1.81 g/kg/d, 95% confidence interval (CI) 1.23 to 2.40); length (MD 0.12 cm/wk, 95% CI 0.07 to 0.17); and

  8. Frequency of respiratory deterioration after immunisation in preterm infants.

    PubMed

    Hacking, Douglas F; Davis, Peter G; Wong, Ester; Wheeler, Kevin; McVernon, Jodie

    2010-12-01

    To determine the relationship between the initiation of respiratory support and the first routine immunisation of neonates at 2 months of age during primary hospitalisation. An historical cohort study design was used to study the neonatal factors associated with the initiation of respiratory support within 7 days of immunisation in a cohort of 7629 preterm and term infants admitted to the Neonatal Unit of the Royal Women's Hospital between 2001 and 2008. The 411 infants who received their first immunisations in hospital were both very preterm and of extremely low birth weight (ELBW, below 1000 g). Twenty-two infants experienced post-immunisation apnoea of sufficient severity to warrant the initiation of either intermittent positive pressure ventilation (two cases) or continuous positive airway pressure (20 cases). Infants exhibiting a respiratory deterioration following immunisation had a higher incidence of previous septicaemia (Odds ratio 2.5, 95% confidence interval 1.0, 6.1; P = 0.04) and received CPAP for a longer period prior to vaccination (P = 0.03). Apnoea following immunisation may be an aetiological factor in the requirement of respiratory support in a small number of preterm, ELBW infants particularly those with significant lung disease and those who have previously experienced septicaemia. © 2010 The Authors. Journal of Paediatrics and Child Health © 2010 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  9. Blood spot glucocorticoid concentrations in ill preterm infants.

    PubMed Central

    Hughes, D; Murphy, J F; Dyas, J; Robinson, J A; Riad-Fahmy, D; Hughes, I A

    1987-01-01

    The adrenocortical response to stress was studied longitudinally in 10 ill preterm infants using measurements of cortisol and 170H-progesterone concentrations in filter paper blood spots. Mean cortisol and 170H-progesterone concentrations reached a peak of 2200 nmol/l and 65 nmol/l, respectively, between the third and fifth days of life. These concentrations far exceeded those observed in older children and adults subjected to stress as a result of surgery. Further pulses of endogenous cortisol production of 4000 nmol/l or more occurred in association with clinical complications such as intraventricular haemorrhage. These results indicate that infants undergoing intensive care are unduly stressed. Consideration should be given to providing enough sedation and appropriate analgesia for ill preterm infants during painful procedures such as insertion of venous cannulae and arterial puncture. PMID:3674921

  10. The car seat: a challenge too far for preterm infants?

    PubMed

    Pilley, E; McGuire, W

    2005-11-01

    Physiological monitoring studies have shown that some preterm infants who are otherwise ready for hospital discharge experience episodes of oxygen desaturation, apnoea, or bradycardia when seated in standard car safety seats. The American Academy of Pediatrics recommends that all preterm infants are assessed for cardiorespiratory stability in their car seat before discharge: the "car seat challenge". This screening test has been incorporated into discharge assessments in most neonatal units in North America and is being increasingly used in the United Kingdom and elsewhere. The evidence base for the use of the car seat challenge in discharge assessment, the possible implications for infants, their families, and health services of adopting the practice, and the issues that may be resolved with further research are discussed.

  11. Preterm Infants Have Deficient Monocyte and Lymphocyte Cytokine Responses to Group B Streptococcus▿

    PubMed Central

    Currie, Andrew J.; Curtis, Samantha; Strunk, Tobias; Riley, Karen; Liyanage, Khemanganee; Prescott, Susan; Doherty, Dorota; Simmer, Karen; Richmond, Peter; Burgner, David

    2011-01-01

    Group B streptococcus (GBS) is an important cause of early- and late-onset sepsis in the newborn. Preterm infants have markedly increased susceptibility and worse outcomes, but their immunological responses to GBS are poorly defined. We compared mononuclear cell and whole-blood cytokine responses to heat-killed GBS (HKGBS) of preterm infants (gestational age [GA], 26 to 33 weeks), term infants, and healthy adults. We investigated the kinetics and cell source of induced cytokines and quantified HKGBS phagocytosis. HKGBS-induced tumor necrosis factor (TNF) and interleukin 6 (IL-6) secretion was significantly impaired in preterm infants compared to that in term infants and adults. These cytokines were predominantly monocytic in origin, and production was intrinsically linked to HKGBS phagocytosis. Very preterm infants (GA, <30 weeks) had fewer cytokine-producing monocytes, but nonopsonic phagocytosis ability was comparable to that for term infants and adults. Exogenous complement supplementation increased phagocytosis in all groups, as well as the proportion of preterm monocytes producing IL-6, but for very preterm infants, responses were still deficient. Similar defective preterm monocyte responses were observed in fresh whole cord blood stimulated with live GBS. Lymphocyte-associated cytokines were significantly deficient for both preterm and term infants compared to levels for adults. These findings indicate that a subset of preterm monocytes do not respond to GBS, a defect compounded by generalized weaker lymphocyte responses in newborns. Together these deficient responses may increase the susceptibility of preterm infants to GBS infection. PMID:21300777

  12. Development of fine motor skills in preterm infants.

    PubMed

    Bos, Arend F; Van Braeckel, Koenraad N J A; Hitzert, Marrit M; Tanis, Jozien C; Roze, Elise

    2013-11-01

    Fine motor skills are related to functioning in daily life and at school. We reviewed the status of knowledge, in preterm children, on the development of fine motor skills, the relation with gross motor skills, and risk factors for impaired fine motor skills. We searched the past 15 years in PubMed, using ['motor skills' or 'fine motor function' and 'preterm infant'] as the search string. Impaired gross and fine motor skills are among the most frequently occurring problems encountered by preterm children who do not develop cerebral palsy. The prevalence is around 40% for mild to moderate impairment and 20% for moderate impairment. Fine motor skill scores on the Movement Assessment Battery for Children are about 0.62 of a standard deviation lower compared with term children. Risk factors for fine motor impairments include moderately preterm birth (odds ratio [OR] 2.0) and, among very preterm children (<32 wk gestation), intra-uterine growth restriction (ORs 2-3), inflammatory conditions (late-onset sepsis and necrotizing enterocolitis, ORs 3-5), and dexamethasone therapy for bronchopulmonary dysplasia (OR 2.7). A better understanding of factors that play a role in the development of and recovery from brain injury could guide future intervention attempts aimed at improving fine motor skills of preterm children.

  13. Does early nutrition program later bone health in preterm infants?

    PubMed

    Fewtrell, Mary S

    2011-12-01

    Preterm infants are at risk of metabolic bone disease (MBD) because of an inadequate mineral intake. Although infants with MBD are frequently asymptomatic during the neonatal period, we previously reported that MBD predicted reduced linear growth in infancy and midchildhood. Nevertheless, some studies suggest that preterm infants undergo catch-up growth in bone mineralization during infancy. To examine the hypothesis that early nutrition programs affect later bone health and peak bone mass, we studied 20-y-old subjects who were born preterm and who were randomly assigned to a diet during the neonatal period; the diets used varied markedly in nutrient and mineral content, and phosphate supplements were not provided. Despite large variations in early nutrient and mineral intakes (and the occurrence of MBD) during the neonatal period, the randomly assigned diets did not influence peak bone mass or turnover. However, the proportion of (unsupplemented) human milk in the neonatal diet was significantly positively associated with later whole-body bone size and mineral content. Compared with population reference data, preterm subjects were significantly shorter and had lower lumbar spine bone mineral density; the deficits were greatest in those born small for gestational age (ie, a birth weight <1250 g). The lack of effect of the randomly assigned diets on peak bone mass suggests that the observed deficits in height and lumbar spine bone mass may not be related to suboptimal early nutrient or mineral intake. The higher whole-body bone mass associated with human milk intake, despite its very low nutrient content, may instead reflect nonnutritive factors in breast milk. These findings are relevant to discussions on the mineral requirements of preterm infants.

  14. Multi-sensory intervention for preterm infants improves sucking organization

    PubMed Central

    Medoff-Cooper, Barbara; Rankin, Kristin; Li, Zhuoying; Liu, Li; White-Traut, Rosemary

    2015-01-01

    Objective The aim of this RCT was to evaluate sucking organization in premature infants following a preterm infant multi-sensory intervention, the Auditory, Tactile, Visual, and Vestibular (ATVV). Study Design A convenience sample of 183 healthy premature infants born 29 - 34 weeks post-menstrual age (PMA) enrolled. Sucking organization was measured at baseline, then weekly assessments, during the infant's hospital stay. Results A quadratic trend was observed for number of sucks, sucks per burst, and maturity index, with the intervention group increasing significantly faster by day 7 (Model estimates for group*day: β = 13.69, p < 0.01; β = 1.16, p < 0.01; and β = 0.12, p < 0.05, respectively). Sucking pressure increased linearly over time, with significant between-group differences at day 14 (β = 45.66, p < 0.01). Conclusion ATVV infants exhibited improved sucking organization during hospitalization, suggestive that ATVV intervention improves oral feeding. PMID:25822519

  15. Calcium and phosphorus supplementation of human milk for preterm infants.

    PubMed

    Harding, Jane E; Wilson, Jess; Brown, Julie

    2017-02-26

    Preterm infants are born with low skeletal stores of calcium and phosphorus. Preterm human milk provides insufficient calcium and phosphorus to meet the estimated needs of preterm infants for adequate growth. Supplementation of human milk with calcium and phosphorus may improve growth and development of preterm infants. To determine whether addition of calcium and phosphorus supplements to human milk leads to improved growth and bone metabolism of preterm infants without significant adverse effects. We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 3), MEDLINE via PubMed (1966 to 14 April 2016), Embase (1980 to 14 April 2016) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 14 April 2016). We also searched clinical trials databases (11 May 2016) and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. Randomised and quasi-randomised trials comparing supplementation of human milk with calcium and/or phosphorus versus no supplementation in hospitalised preterm infants were eligible for inclusion in this review. Two review authors (JB, JW) independently extracted data and assessed trial quality using standard methods of the Cochrane Neonatal Review Group. We reported dichotomous data as risk ratios (RRs) and continuous data as mean differences (MDs) with 95% confidence intervals (CIs). We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the quality of evidence. This is an update of a 2001 review that identified no eligible trials. One trial including 40 infants met the inclusion criteria for this review. Using GRADE criteria, we judged the quality of the evidence as low owing to risk of bias (inadequate reporting of methods of randomisation, allocation concealment and/or blinding) and imprecision (wide confidence intervals and

  16. Preterm milk.

    PubMed

    Baum, J D

    1980-03-01

    This editorial addresses the question of how best to feed the low birth weight infant. A study by Atkinson et al. on the composition of preterm mothers' milk found the nitrogen concentration in preterm milk to be considerably higher than in term milk. Preterm milk may be uniquely suited to the growth requirements of preterm infants. With the exception of calcium and phosphorus, preterm milk fits the requirements for preterm infant growth. Because of the difficulties of sustaining lactation without the infant sucking at the breast, partly due to the mother's motivation in the face of all the difficulties of having a baby in a Special Care Baby Unit, and partly due to the associated socioeconomic disadvantages, it is not possible for all mothers who deliver preterm babies to sustain their lactation. The composition of preterm milk should be used as a guide for the preparation of a human milk formula built from human milk products from a milk bank. The development of a human milk formula must take into account variations in the absorption of nutrients in low birth weight infants which may be affected by the processing of the milk, and variations in fat absorption in preterm infants which occur even when they are fed their mothers' fresh unprocessed milk.

  17. The Assessment of Preterm Infants' Behavior (APIB): furthering the understanding and measurement of neurodevelopmental competence in preterm and full-term infants.

    PubMed

    Als, Heidelise; Butler, Samantha; Kosta, Sandra; McAnulty, Gloria

    2005-01-01

    The Assessment of Preterm Infants' Behavior (APIB) is a newborn neurobehavioral assessment appropriate for preterm, at risk, and full-term newborns, from birth to 1 month after expected due date. The APIB is based in ethological-evolutionary thought and focuses on the assessment of mutually interacting behavioral subsystems in simultaneous interaction with the environment. The subsystems of functioning assessed include the autonomic (respiration, digestion, color), motor (tone, movement, postures), state organization (range, robustness, transition patterns), attention (robustness, transitions), and self-regulation (effort, success) systems as well as the degree of facilitation required to support reorganization and subsystem balance. The environment is represented by a sequence of distal, proximal, tactile, and vestibular challenges, derived from the BNBAS. The APIB conceptualizes infant competence as the degree of differentiation of subsystem function and degree of modulation of subsystem balance at any stage in infant development. Infants are understood as actively seeking their next differentiation, while counting on good enough environments to assure progressing developmental competence. In the case of interference such as premature birth, the mismatch of expectation and actual experience causes misalignment, which may become developmentally costly. The assessment is a finely tuned dialogue between examiner and infant, which requires training, skill and self-knowledge. The APIB has well established inter-rater-reliability, concurrent and construct validity, and is clinically relevant for behavioral intervention and individually appropriate and supportive care. Copyright 2005 Wiley-Liss, Inc

  18. The Assessment of Preterm Infants' Behavior (APIB): Furthering the Understanding and Measurement of Neurodevelopmental Competence in Preterm and Full-Term Infants

    PubMed Central

    Als, Heidelise; Butler, Samantha; Kosta, Sandra; McAnulty, Gloria

    2014-01-01

    The Assessment of Preterm Infants' Behavior (APIB) is a newborn neurobehavioral assessment appropriate for preterm, at risk, and full-term newborns, from birth to 1 month after expected due date. The APIB is based in ethological–evolutionary thought and focuses on the assessment of mutually interacting behavioral subsystems in simultaneous interaction with the environment. The subsystems of functioning assessed include the autonomic (respiration, digestion, color), motor (tone, movement, postures), state organization (range, robustness, transition patterns), attention (robustness, transitions), and self-regulation (effort, success) systems as well as the degree of facilitation required to support reorganization and subsystem balance. The environment is represented by a sequence of distal, proximal, tactile, and vestibular challenges, derived from the BNBAS. The APIB conceptualizes infant competence as the degree of differentiation of subsystem function and degree of modulation of subsystem balance at any stage in infant development. Infants are understood as actively seeking their next differentiation, while counting on good enough environments to assure progressing developmental competence. In the case of interference such as premature birth, the mismatch of expectation and actual experience causes misalignment, which may become developmentally costly. The assessment is a finely tuned dialogue between examiner and infant, which requires training, skill and self-knowledge. The APIB has well established inter-rater-reliability, concurrent and construct validity, and is clinically relevant for behavioral intervention and individually appropriate and supportive care. PMID:15856436

  19. Daytime Sleep and Parenting Interactions in Infants Born Preterm

    PubMed Central

    Schwichtenberg, A. J.; Anders, Thomas F.; Vollbrecht, Melissa; Poehlmann, Julie

    2010-01-01

    Objective Following a transactional perspective, this longitudinal study assessed concurrent and time-lagged associations between infant daytime sleep behaviors and maternal play interactions within a sample of infants born preterm. Method Data were collected from 134 families recruited from 3 Wisconsin NICUs. Multiple methods were used to collect data at infant NICU discharge and when infants were 4, 9, and 24 months postterm, including parent-report infant sleep logs, family sociodemographic assets and a 15 minute video-taped play session. Results Within time points, infants who napped more had mothers who were rated as more positive and communicative or less negative during play interactions at 4, 9 and 24 months compared to infants who napped less. Time-lagged findings indicated that infants who took more naps experienced more optimal maternal interactive behaviors later in development than infants who took fewer naps. Additionally, mothers who expressed more negative affect at 4 months or 9 months predicted more infant daytime sleep later in development. Conclusion Previous studies document that nighttime parent-child interactions influence nighttime sleep. This study presents the natural extension that daytime sleep influences daytime interactions. The present study draws attention to the understudied area of daytime naps in young children and provides support for the longitudinal bi-directional processes between sleep and parenting interactions. PMID:20978444

  20. Growth patterns and their implications for preterm infants in a culture of rapid modernization.

    PubMed

    Ahn, Youngmee; Sohn, Min; Jun, Yonghoon; Lee, Sangmi

    2013-09-01

    This prospective longitudinal study explored the growth patterns of preterm infants and the implications of rearing them in an advancing culture. The study measured the weight, length, and head circumference of 343 Korean preterm infants over 12 months corrected age. Data were analyzed using a generalized estimation equation for growth patterns of preterm infants by the degree of prematurity (mild, moderate, or severe). Results showed that the early 'catch-up phenomenon', accelerated growth rate, occurred around 11 months corrected age, although the mild preterm group weighed less, was shorter, and had a smaller head circumference than the moderate and severe preterm groups. This may reflect the Asian culture's preference for big babies and draws special attention to the influence of cultural values and childrearing practices in the growth of preterm infants. Pediatric nurses should be alert to accelerated growth in preterm infants in societies in cultural transition.

  1. Body positioning for spontaneously breathing preterm infants with apnoea.

    PubMed

    Ballout, Rami A; Foster, Jann P; Kahale, Lara A; Badr, Lina

    2017-01-09

    It has been proposed that body positioning in preterm infants, as compared with other, more invasive measures, may be an effective method of reducing clinically significant apnoea. To determine effects of body positioning on cardiorespiratory parameters in spontaneously breathing preterm infants with clinically significant apnoea.Subgroup analyses examined effects of body positioning of spontaneously breathing preterm infants with apnoea from the following subgroups.• Gestational age < 28 weeks or birth weight less than 1000 grams.• Apnoea managed with methylxanthines.• Frequent apnoea (> 10 events/d).• Type of apnoea measured (central vs mixed vs obstructive) We used the standard search strategy of the Cochrane Neonatal Review Group (CNRG) to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 10), MEDLINE via PubMed (1966 to 14 November 2016), Embase (1980 to 14 November 2016) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 2016 November 14). We also searched clinical trials databases and conference proceedings for randomised controlled trials and quasi-randomised trials. Randomised and quasi-randomised controlled clinical trials with parallel, factorial or cross-over design comparing the impact of different body positions on apnoea in spontaneously breathing preterm infants were eligible for our review. We assessed trial quality, data extraction and synthesis of data using standard methods of the CNRG. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the quality of evidence. The search conducted in November 2016 identified no new studies. Five studies (N = 114) were eligible for inclusion. None of the individual studies nor meta-analyses showed a reduction in apnoea, bradycardia, oxygen desaturation or oxygen saturation with body positioning (supine vs prone; prone vs right lateral; prone vs left lateral; right lateral vs left lateral

  2. Can infant lung function predict respiratory morbidity during the first year of life in preterm infants?

    PubMed

    Proietti, Elena; Riedel, Thomas; Fuchs, Oliver; Pramana, Isabelle; Singer, Florian; Schmidt, Anne; Kuehni, Claudia; Latzin, Philipp; Frey, Urs

    2014-06-01

    Compared with term-born infants, preterm infants have increased respiratory morbidity in the first year of life. We investigated whether lung function tests performed near term predict subsequent respiratory morbidity during the first year of life and compared this to standard clinical parameters in preterms. The prospective birth cohort included randomly selected preterm infants with and without bronchopulmonary dysplasia. Lung function (tidal breathing and multiple-breath washout) was measured at 44 weeks post-menstrual age during natural sleep. We assessed respiratory morbidity (wheeze, hospitalisation, inhalation and home oxygen therapy) after 1 year using a standardised questionnaire. We first assessed the association between lung function and subsequent respiratory morbidity. Secondly, we compared the predictive power of standard clinical predictors with and without lung function data. In 166 preterm infants, tidal volume, time to peak tidal expiratory flow/expiratory time ratio and respiratory rate were significantly associated with subsequent wheeze. In comparison with standard clinical predictors, lung function did not improve the prediction of later respiratory morbidity in an individual child. Although associated with later wheeze, noninvasive infant lung function shows large physiological variability and does not add to clinically relevant risk prediction for subsequent respiratory morbidity in an individual preterm.

  3. Disparities in perinatal medicine: preterm birth, stillbirth, and infant mortality.

    PubMed

    Spong, Catherine Y; Iams, Jay; Goldenberg, Robert; Hauck, Fern R; Willinger, Marian

    2011-04-01

    Infant mortality, stillbirths, and preterm births are major public health priorities with significant disparities based on race and ethnicity. Interestingly, when evaluating the rates over the past 30 to 50 years, the disparity persists in all three and is remarkably consistent. In the United States, the infant mortality rate is 6.7 deaths per 1,000 live births, the stillbirth rate is 6.2 per 1,000 deliveries, and the preterm birth rate is 12.8% of live births. The rates among non-Hispanic African Americans are dramatically higher, nearly double the infant mortality at 13.4 infant deaths per 1,000 live births, nearly double the stillbirth rate at 11.1 stillbirths per 1,000 deliveries, and one third higher with preterm births at 18.4% of live births. Despite numerous conferences, workshops, articles, and investigators focusing on this line of work, the disparities persist and, in some cases, are growing. In this article, we summarize a Eunice Kennedy Shriver National Institute of Child Health and Human Development workshop that focused on these disparities to identify the associated factors to determine their relative contributions, identify gaps in knowledge, and develop specific strategies to address the disparities in the short-term and long-term.

  4. Diagnosis of acute renal failure in very preterm infants.

    PubMed

    Choker, G; Gouyon, J B

    2004-01-01

    This study was designed to improve the definition of acute renal failure (ARF) in very preterm infants. Twenty-eight newborn infants with gestational age < or =32 weeks were prospectively studied in the first 5 days of life and made up a control group as they did not present risk factors for vasomotor renal insufficiency. Renal insufficiency was defined as an increase in daily serum creatinine concentration above the 99th interval limit obtained in this control group, i.e., 43 micromol/l on day 1 and/or 21 micromol/l on day 2 and/or 14 micromol/l/day on day 3 and/or 22 micromol/l/day on day 4. According to this definition, 20 very preterm infants with ARF were identified. As compared with the control group, the ARF group showed more prolonged oliguric episodes, lower diuresis, insufficient weight loss (in spite of a reduction in water intake) and also more episodes with natremia <130 mEq/l (35 vs. 0%; p <0.05) and/or kalemia >6 mEq/l (40 vs. 11%; p <0.05). Therefore, assessment of daily changes in serum creatinine concentration in very preterm infants allows the diagnosis of clinically significant reduction in glomerular filtration rate.

  5. Dilute versus full strength formula in exclusively formula-fed preterm or low birth weight infants.

    PubMed

    Basuki, Fauziah; Hadiati, Diah R; Turner, Tari; McDonald, Steve; Hakimi, Mohammad

    2013-11-05

    Preterm infants have fewer nutrient reserves at birth than full term infants and often receive artificial formula feeds in the absence of expressed breast milk. Although it is generally agreed that feeding must be initiated slowly and advanced with much greater deliberation than in a healthy, full term infant, the way in which feeds are introduced and advanced in preterm infants varies widely. This review focuses on whether dilute or full strength formula is the preferable mode of introducing feeds in preterm infants. To assess the effects of dilute versus full strength formula on the incidence of necrotising enterocolitis, feeding intolerance, weight gain, length of stay and time to achieve full calorie intake in exclusively formula-fed preterm or low birth weight infants. A secondary objective was to assess the effects of different dilution strategies. We used the standard search methods of the Cochrane Neonatal Review Group. This included searches of the Cochrane Central Register of Controlled Trials (The Cochrane Library 2013, Issue 1), MEDLINE (1946 to February 2013) and EMBASE (1974 to February 2013). Randomised or quasi-randomised trials comparing strengths of formula milk in exclusively formula-fed preterm or low birth weight infants. Studies were excluded if infants received formula as a supplement to breast milk. We independently assessed studies for inclusion. We collected data using the standard methods of the Cochrane Neonatal Review Group, with independent assessment of risk of bias and data extraction. We synthesised mean differences using a fixed-effect meta-analysis model. Three studies involving 102 preterm or low birth weight infants were included in the review. The studies compared dilute (double volume, half strength) formula with full strength (20 kcal/oz) formula. We assessed all three studies as being at unclear risk of bias due to the likely absence of blinding of study personnel and the potential for selection bias in the largest trial

  6. MRI and Ultrasound Injury in Preterm Infants with Seizures

    PubMed Central

    Glass, Hannah C.; Bonifacio, Sonia L.; Sullivan, Joseph; Rogers, Elizabeth; Ferriero, Donna M.; Goldstein, Ruth; Barkovich, A. James

    2010-01-01

    The utility of magnetic resonance imaging (MRI) as a universal screening tool in preterm infants has been contested; however, MR is increasingly used in investigation of neonatal seizures. We evaluated 236 infants <34 weeks gestation at birth. Seizures were documented according to clinical standard of care. Infants were imaged using MRI and head ultrasound during the neonatal period. A neuroradiologist and ultrasonologist performed detailed reviews of the images. Nine infants (3.8%) had clinical suspicion of seizures during the hospital course. MRI was abnormal in each case (three with intraventricular hemorrhage (IVH) and periventricular hemorrhagic infarct, two with findings of hypoxia-ischemia, three with white matter injury (WMI) and one each with schizencephaly and dysplasia –one infant had two lesions). Periventricular hemorrhagic infarct was more common in infants with seizures (33% vs 6% of those without seizures, OR 8.23, 95% CI 1.8-36.7). Infants with seizures were more likely to have WMI, though the difference was not significant (RR 2.4, 95% CI 0.54-11.1, P=0.3). Head ultrasound failed to detect the extent of brain abnormality in eight (89%) of the infants. In this large cohort, infants with clinical suspicion of seizures had a high rate of MRI abnormalities that were not as well characterized by head ultrasound. MRI may be the study of choice for evaluating preterm infants with seizures. Further studies using better seizure monitoring are necessary to evaluate electrographic seizures and their relationship to brain injury on MRI. PMID:19745086

  7. Intraventricular hemorrhage and neurodevelopmental outcomes in extreme preterm infants.

    PubMed

    Bolisetty, Srinivas; Dhawan, Anjali; Abdel-Latif, Mohamed; Bajuk, Barbara; Stack, Jacqueline; Lui, Kei

    2014-01-01

    Not many large studies have reported the true impact of lower-grade intraventricular hemorrhages in preterm infants. We studied the neurodevelopmental outcomes of extremely preterm infants in relation to the severity of intraventricular hemorrhage. A regional cohort study of infants born at 23 to 28 weeks' gestation and admitted to a NICU between 1998 and 2004. Primary outcome measure was moderate to severe neurosensory impairment at 2 to 3 years' corrected age defined as developmental delay (developmental quotient >2 SD below the mean), cerebral palsy, bilateral deafness, or bilateral blindness. Of the 1472 survivors assessed, infants with grade III-IV intraventricular hemorrhage (IVH; n = 93) had higher rates of developmental delay (17.5%), cerebral palsy (30%), deafness (8.6%), and blindness (2.2%). Grade I-II IVH infants (n = 336) also had increased rates of neurosensory impairment (22% vs 12.1%), developmental delay (7.8% vs 3.4%), cerebral palsy (10.4% vs 6.5%), and deafness (6.0% vs 2.3%) compared with the no IVH group (n = 1043). After exclusion of 40 infants with late ultrasound findings (periventricular leukomalacia, porencephaly, ventricular enlargement), isolated grade I-II IVH (n = 296) had increased rates of moderate-severe neurosensory impairment (18.6% vs 12.1%). Isolated grade I-II IVH was also independently associated with a higher risk of neurosensory impairment (adjusted odds ratio 1.73, 95% confidence interval 1.22-2.46). Grade I-II IVH, even with no documented white matter injury or other late ultrasound abnormalities, is associated with adverse neurodevelopmental outcomes in extremely preterm infants.

  8. Maternal Perceptions of the Preterm Infant.

    ERIC Educational Resources Information Center

    Chatwin, Sara L.; MacArthur, Barton A.

    1993-01-01

    Examined mothers' perceptions of low birthweight infants, neonatal hospital environment, and general parenting attitudes during the perinatal period. Maternal age and socioeconomic status were associated with maternal perceptions of hospital environment. Variables including maternal health, smoking, and length of infant hospitalization contributed…

  9. Estimating the Dietary Intake of Breastfeeding Preterm Infants

    PubMed Central

    Greenslade, Sarah; Miller, Jacqueline; Tonkin, Emma; Marshall, Peter; Collins, Carmel T.

    2015-01-01

    Aim: To determine how accurately the daily prescribed feed volume (mL/day) estimates the actual intake of breastfeeding preterm infants and to characterise the volume taken during a breastfeed at differing gestational and postmenstrual ages. Methods: A cross sectional study was conducted on preterm infants born <37 weeks gestation from two Australian neonatal units. To determine the volume taken in a 24-h period infants were weighed before and after each breastfeed. This volume was added to the charted intake to determine the total intake and then compared to the prescribed feed volume. Bland Altman analyses were used to assess the level of agreement between the two methods. Results: Fifty six infants were studied on 206 breastfeeding occasions. There was a small bias (27 mLs/day) but large 95% limits of agreement (–76 to 130 mL/day). The volume taken during a single breastfeed ranged from 0 to 101 mL (median 23 mL, IQR 9 to 31 mL) and was greater in more mature infants. Conclusions: Using the prescribed feed volume to estimate total intake has limited clinical utility for the individual infant, however the relatively small bias means that it may be useful within a population or for comparison between groups in which population means are compared. There was a large variation in volume taken during a breastfeed across all gestational and postmenstrual ages. PMID:26006120

  10. Visual Habituation and Dishabituation in Preterm Infants: A Review and Meta-Analysis

    ERIC Educational Resources Information Center

    Kavsek, Michael; Bornstein, Marc H.

    2010-01-01

    We review comparative studies of infant habituation and dishabituation performance focusing on preterm infants. Habituation refers to cognitive encoding, and dishabituation refers to discrimination and memory. If habituation and dishabituation constitute basic information-processing skills, and preterm infants suffer cognitive disadvantages, then…

  11. Responses to a Modified Visual Cliff by Pre-Walking Infants Born Preterm and at Term

    ERIC Educational Resources Information Center

    Lin, Yuan-Shan; Reilly, Marie; Mercer, Vicki S.

    2010-01-01

    The purpose of this study was to examine, using a modified visual cliff apparatus, possible perceptual differences at crawling age between infants born preterm and infants born at term without documented visual or motor impairments. Sixteen infants born at term and 16 born preterm were encouraged to crawl to their caregivers on a modified visual…

  12. Predicting Individual Differences in Recall by Infants Born Preterm and Full Term

    ERIC Educational Resources Information Center

    Cheatham, Carol L.; Bauer, Patricia J.; Georgieff, Michael K.

    2006-01-01

    A heterogeneous sample of infants with preterm histories and infants born full term participated in a study of declarative memory and rate of encoding, as measured in an imitation task and an examining task, respectively. Here we report the comparisons of the performances of infants born very preterm (27-34 weeks gestation) and moderately preterm…

  13. Evaluating Preterm Infants with the Bayley-III: Patterns and Correlates of Development

    ERIC Educational Resources Information Center

    Greene, Michelle M.; Patra, Kousiki; Nelson, Michael N.; Silvestri, Jean M.

    2012-01-01

    This study investigates the Third Edition of the Bayley Scales of Infant and Toddler Development (Bayley-III) and: (1) early patterns of neurodevelopmental performance among preterm infants 8-12 months of age; and (2) correlations between known risk factors and neurodevelopmental outcome of preterm infants in this cohort. Mean Language Index (LI;…

  14. Responses to a Modified Visual Cliff by Pre-Walking Infants Born Preterm and at Term

    ERIC Educational Resources Information Center

    Lin, Yuan-Shan; Reilly, Marie; Mercer, Vicki S.

    2010-01-01

    The purpose of this study was to examine, using a modified visual cliff apparatus, possible perceptual differences at crawling age between infants born preterm and infants born at term without documented visual or motor impairments. Sixteen infants born at term and 16 born preterm were encouraged to crawl to their caregivers on a modified visual…

  15. Evaluating Preterm Infants with the Bayley-III: Patterns and Correlates of Development

    ERIC Educational Resources Information Center

    Greene, Michelle M.; Patra, Kousiki; Nelson, Michael N.; Silvestri, Jean M.

    2012-01-01

    This study investigates the Third Edition of the Bayley Scales of Infant and Toddler Development (Bayley-III) and: (1) early patterns of neurodevelopmental performance among preterm infants 8-12 months of age; and (2) correlations between known risk factors and neurodevelopmental outcome of preterm infants in this cohort. Mean Language Index (LI;…

  16. Temperature Probe Placement during Preterm Infant Resuscitation: A Randomised Trial.

    PubMed

    Bensouda, Brahim; Mandel, Romain; Mejri, Abdelwaheb; Lachapelle, Jean; St-Hilaire, Marie; Ali, Nabeel

    2017-09-22

    Hypothermia on admission to intensive care is associated with poor outcomes in preterm infants. The neonatal resuscitation program recommends the use of servo-control thermoregulation during resuscitation. Very little evidence exists to guide optimal temperature probe placement in the delivery room. The aim of this work was to determine, in moderately preterm infants, if temperature probe placement in the dorsal, thoracic, or axillary area during delivery room resuscitation would result in differing temperatures on admission to the neonatal intensive care unit (NICU). A randomised trial with 3 arms was conducted. In total, 122 inborn preterm infants born between 280/7 and 356/7 weeks of gestational age were recruited. The infants were randomly assigned to thermal probe placement in the left lower back, left upper thorax, or left axilla immediately after birth. Temperature was servo-controlled using an infant resuscitation table set to 36.5°C. The primary outcome was axillary temperature at admission to the NICU before transfer to a closed isolette, recorded with a digital thermometer. The secondary outcomes assessed were temperature within the target range (36.5-37.5°C), hypothermia (<36.5°C), and hyperthermia (>37.5°C). All 122 infants were available for outcome analysis. The groups were comparable for birthweight, gestational age, and sex. The mean admission temperature was comparable between the 3 probe positions (mean, 95% CI): dorsum (36.7°C, 36.6-36.8), thorax (36.8°C, 36.7-36.9), and axilla (36.7°C, 36.6-36.9), p = 0.43. The proportion of infants with admission temperatures in the target range was comparable (87.2, 81.4, and 72.5% respectively), p = 0.44. Dorsal, thoracic, or axillary temperature probe positioning during resuscitation yield similar admission temperatures in moderately preterm infants. Further studies are required in infants below 28 weeks of gestation to determine the best practice. © 2017 S. Karger AG, Basel.

  17. Measurements from preterm infants to guide face mask size.

    PubMed

    O'Shea, Joyce E; Thio, Marta; Owen, Louise S; Wong, Connie; Dawson, Jennifer A; Davis, Peter G

    2016-07-01

    International guidelines recommend that an appropriately sized face mask for providing positive pressure ventilation should cover the mouth and nose but not the eyes and should not overlap the chin. This study aimed to measure the dimensions of preterm infants' faces and compare these with the size of the most commonly available face masks (external diameter 50 mm) and the smallest masks available (external diameters 35 and 42 mm). Infants 24-33 weeks' postmenstrual age (PMA) were photographed in a standardised manner. Images were analysed using ImageJ software (National Institute of Health, USA) to calculate the distance from the nasofrontal groove to the mental protuberance. This facial measurement corresponds to the external diameter of an optimally fitting mask. A cohort of 107 infants between 24 and 33 weeks' gestational age, including at least 10 infants per week of gestation, was photographed within 72 h after birth and weekly until 33 weeks' PMA. 347 photographs were analysed. Infants of 24, 26, 28, 30 and 32 weeks' PMA had mean (SD) facial measurements of 32 (2), 36 (3), 38 (4), 41 (2) and 43 (4) mm, respectively. There were no significant differences when examined by gender or when small for gestational age infants were excluded. The smallest size of some brands of mask is too large for many preterm infants. Masks of 35 mm diameter are suitable for infants <29 weeks' PMA or 1000 g. Masks of 42 mm diameter are suitable for infants 27-33 weeks' PMA or 750-2500 g. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  18. Reference ranges for sonographic renal dimensions in preterm infants.

    PubMed

    Erdemir, Aydin; Kahramaner, Zelal; Cicek, Ebru; Turkoglu, Ebru; Cosar, Hese; Sutcuoglu, Sumer; Ozer, Esra Arun

    2013-11-01

    Ultrasonographic measurement of kidney dimensions is important in evaluation of renal disease in preterm infants who have multiple comorbidities that affect renal function. The purpose of this study was to determine the reference ranges of kidney dimensions in preterm newborns and to provide a chart to use easily in daily practice. We evaluated renal dimensions in 498 preterm infants with a gestational age of <37 weeks using sonography within the first week of life. We statistically analyzed the relationships between all dimensions and gender, gestational age (based on the last menstrual period), height and weight. Minimum and maximum values of dimensions were defined. All dimensions of the kidneys were statistically different in boys and girls (P < 0.05). Both longitudinal and anteroposterior dimensions of the right and left kidneys showed high correlation with gestational age, weight and height in girls and boys. Weight correlated best with dimensions. Nomograms from these data can be used to determine an abnormality in kidneys of preterm newborns.

  19. Effect of repeated Kangaroo Mother Care on repeated procedural pain in preterm infants: A randomized controlled trial.

    PubMed

    Gao, Haixia; Xu, Guihua; Gao, Honglian; Dong, Rongzhi; Fu, Hongjie; Wang, Danwen; Zhang, Heng; Zhang, Hua

    2015-07-01

    Preterm infants' repeated exposure to painful procedures may lead to negative consequences. Thus, non-pharmacological pain management is essential due to medication side effects. Kangaroo Mother Care, which aims at offering human care to neonates, has been established for the treatment of a single painful procedure, but the effectiveness of Kangaroo Mother Care across repeated painful procedures is unknown. To test the effectiveness of repeated Kangaroo Mother Care on repeated heel-stick pain in preterm neonates. Randomized controlled trial. Level III Neonatal Intensive Care Unit at a large teaching hospital in northeast China. Preterm infants (gestational age less than 37 weeks) (n=80) were recruited and randomly assigned using a random table format to either an incubator group (n=40) or Kangaroo Mother Care group (n=40). Pain assessments were carried out during four routine heel stick procedures. For the first heel stick, preterm infants in each group received no intervention (routinely stayed in incubator). During the next three heel sticks, the infants in Kangaroo Mother Care group received heel sticks during Kangaroo Mother Care, while infants in the incubator group received heel sticks in incubator. The procedure of each heel stick included 3 phases: baseline, blood collection and recovery. Crying, grimacing and heart rate in response to pain were evaluated at each phase across four heel sticks by three trained independent observers who were blinded to the purpose of the study. Data were analyzed by analysis of variance (ANOVA), with repeated measures at different evaluation phases of heel stick. 75 preterm infants completed the protocol. Between-group comparison revealed that preterm infants' heart rate was significantly lower, and the duration of crying and facial grimacing were both significantly shorter in the Kangaroo Mother Care group (n=38) than the incubator group (n=37) from the blood collection phase to recovery phase during repeated heel sticks. No

  20. Cortical vision, MRI and developmental outcome in preterm infants.

    PubMed

    Atkinson, J; Braddick, O; Anker, S; Nardini, M; Birtles, D; Rutherford, M A; Mercuri, E; Dyet, L E; Edwards, A D; Cowan, F M

    2008-07-01

    To test two measures of visual cortical function in the first year of life as early markers of functionally significant brain damage in infants born preterm: orientation-reversal visual event-related potentials (OR-VERP) and a behavioural test of cortically controlled visual attention-fixation shifts under competition (FS). Also to examine how these measures relate to (1) perinatal brain insults identified by MRI, and (2) later neurodevelopmental status. After neonatal and term-age-equivalent MRI, 26 preterm infants (<32 weeks of gestational age, mean 28.1 weeks) were given the OR-VERP and FS tests before 12 months post-term age and a neurodevelopmental assessment (Griffiths Scales) at 2 years. MRI scans examined for parenchymal lesions, intraventricular haemorrhage, ventricular dilatation and diffuse excessive high signal intensity were classified into three categories of severity. Cortical visual test results were compared across these categories and examined as predictors of developmental status at 2 years. 26 infants were studied. 13/25 infants showed significant OR-VERP responses. 12/26 showed normal FS performance. On both tests, the proportion of infants meeting these criteria decreased significantly with MRI severity. As predictors of Griffiths developmental quotient < or =80, the FS test had a sensitivity of 100%, a specificity of 61%, and positive and negative predictive values of 50% and 100%, respectively; corresponding values for OR-VERP were 86%, 65%, 50% and 92% . Visual cortical tests can provide early indicators of the functional impact of perinatal brain damage in the preterm infant.

  1. A Test of Kangaroo Care on Preterm Infant Breastfeeding

    PubMed Central

    Tully, Kristin P.; Holditch-Davis, Diane; White-Traut, Rosemary C.; David, Richard; O’Shea, T. Michael; Geraldo, Victoria

    2015-01-01

    Objective To test the effects of kangaroo care (KC) on breastfeeding outcomes in preterm infants compared to two control groups and to explore whether maternal-infant characteristics and the mother’s choice to use KC were related to breastfeeding measures. Design Secondary analysis of a multisite, stratified, and randomized 3-arm trial. The treatment groups used KC, auditory-tactile-visual-vestibular (ATVV) intervention, or preterm infant care information. Setting Neonatal intensive care units from 4 hospitals in the United States from 2006–2011. Participants Racially diverse mothers (N=231) and their preterm infants born weighing < 1750 grams. Methods Mothers and their infants were enrolled once the infants were no longer critically ill, weighed at least 1000 grams, and could be safely held outside of the incubator by parents. Participants were instructed by study nurses; those allocated to either KC or ATVV were asked to engage in these interactions for a minimum of 3 times a week in the hospital and at home until 2 months adjusted age. Results Feeding at the breast during hospitalization, the duration of post-discharge breastfeeding, and breastfeeding exclusivity after hospital discharge did not differ statistically among the treatment groups. Regardless of group assignment, married, older, and more educated women were more likely to feed at the breast during hospitalization. Mothers who practiced KC, regardless of randomly allocated group, were more likely to provide their milk than those who did not practice KC. Breastfeeding duration was greatest among more educated women. Conclusion As implemented in this study, assignment to KC did not appear to influence the measured breastfeeding outcomes. PMID:26815798

  2. Transition from hospital to home for parents of preterm infants.

    PubMed

    Boykova, Marina; Kenner, Carole

    2012-01-01

    Research on the phenomenon of transition spans several decades. This article discusses the transition from hospital to home and the challenges parents of preterm infants experience during a neonatal intensive care unit stay and after discharge. The article explores the link between parental problems and rehospitalizations and the need for accurate measures of transitional concerns. An example of a theoretical model and instrument is described.

  3. Nutrition in the preterm infant: what’s new?

    PubMed

    Cleminson, Jemma S; Zalewski, Stefan P; Embleton, Nicholas D

    2016-05-01

    The increasing recognition of the role of nutritional care for preterm infants continues to result in a proliferation of review articles, systematic reviews, observational studies and trials. In this article, we review a selection of important studies published in the last 12–18 months. The selected studies demonstrate the potential importance of light protecting parenteral nutrition solutions, the benefits of standardized concentrated parenteral nutrition solutions and the importance of insulin-like growth factor I in early life. Trials of immunonutrients (such as bile salt-stimulated lipase) and other bioactive peptides such as lactoferrin are in progress, and emerging data highlight the importance of vitamin D for immune regulation, and therefore its role in sepsis and gut function. Early oro-pharyngeal administration of colostrum appears to safely improve early immune development, and supports the increasingly common practice of immediate commencement of mothers’ own breast milk. Despite this, studies continue to show that breastfeeding continuation rates could be improved. Data also highlight the potential role of macronutrient supply on other functional outcomes, such as retinopathy of prematurity. Finally, the importance of the unique nutritional needs of late and moderately preterm infants is starting to be recognized – a much larger group than the extremely preterm infants in whom many studies are focused. Earlier, more aggressive nutrient supply and feeding regimes, including optimal support of breastfeeding mothers to ensure adequate provision of own mother’s milk, appear to improve growth and neurodevelopmental outcomes. The addition of bioactive proteins shows promise. Special focus needs to be reestablished for late and moderately preterm infants, who have particular nutritional and feeding support requirements. This review has highlighted the need for further research particularly in the areas of early parenteral nutrition, the optimal regime

  4. Fecal Calprotectin Excretion in Preterm Infants during the Neonatal Period

    PubMed Central

    Rougé, Carole; Butel, Marie-José; Piloquet, Hugues; Ferraris, Laurent; Legrand, Arnaud; Vodovar, Michel; Voyer, Marcel; de la Cochetière, Marie-France; Darmaun, Dominique; Rozé, Jean-Christophe

    2010-01-01

    Background Fecal calprotectin has been proposed as a non-invasive marker of intestinal inflammation in inflammatory bowel disease in adults and children. Fecal calprotectin levels have been reported to be much higher in both healthy full-term and preterm infants than in children and adults. Objective To determine the time course of fecal calprotectin (f-calprotectin) excretion in preterm infants from birth until hospital discharge and to identify factors influencing f-calprotectin levels in the first weeks of life, including bacterial establishment in the gut. Methodology F-calprotectin was determined using an ELISA assay in 147 samples obtained prospectively from 47 preterm infants (gestational age, and birth-weight interquartiles 27–29 weeks, and 880–1320 g, respectively) at birth, and at 2-week intervals until hospital discharge. Principal Findings Although median f-calprotectin excretion was 138 µg/g, a wide range of inter- and intra-individual variation in f-calprotectin values (from day 3 to day 78) was observed (86% and 67%, respectively). In multivariate regression analysis, f-calprotectin correlated negatively with ante and per natal antibiotic treatment (p = 0.001), and correlated positively with the volume of enteral feeding (mL/kg/d) (p = 0.009), the need to interrupt enteral feeding (p = 0.001), and prominent gastrointestinal colonization by Clostridium sp (p = 0.019) and Staphylococcus sp (p = 0.047). Conclusion During the first weeks of life, the high f-calprotectin values observed in preterm infants could be linked to the gut bacterial establishment. PMID:20552029

  5. Maternal and paternal infant representations: a comparison between parents of term and preterm infants.

    PubMed

    Tooten, Anneke; Hall, Ruby A S; Hoffenkamp, Hannah N; Braeken, Johan; Vingerhoets, Ad J J M; van Bakel, Hedwig J A

    2014-08-01

    Research on parental attachment representations after preterm birth is limited and inconclusive. The present study is the first in which maternal and paternal attachment representations after term, moderately and very preterm birth are compared. In addition, special attention was directed toward disrupted attachment representations. Mothers and fathers of term infants (≥ 37 weeks of gestational age, n=71), moderately preterm infants (≥ 32-37 weeks of gestational age, n=62) and very preterm infants (<32 weeks of gestational age, n=56) participated in the present study. Attachment representations (balanced, disengaged, distorted) about their infants were evaluated with the Working Model of the Child Interview (WMCI). To asses disrupted representations the coding of the WMCI was extended with the disrupted scale (WMCI-D). The three main classifications of attachment representations were not affected by preterm birth. In addition, there were no gender differences in the rate of balanced representations. In case of non-balanced representations however, maternal representations were more often distorted, whereas fathers showed more often disengaged representations. Results further revealed that maternal disrupted attachment representations were marked by role/boundary confusion or disorientation, whereas paternal disrupted attachment representations were characterized by withdrawal. Given the gender differences it is essential to tailor interventions according to the attachment representations of the parent, in order to be able to alter their non-balanced and/or disrupted attachment representations. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Oral stimulation for promoting oral feeding in preterm infants.

    PubMed

    Greene, Zelda; O'Donnell, Colm Pf; Walshe, Margaret

    2016-09-20

    Preterm infants (< 37 weeks' postmenstrual age) are often delayed in attaining oral feeding. Normal oral feeding is suggested as an important outcome for the timing of discharge from the hospital and can be an early indicator of neuromotor integrity and developmental outcomes. A range of oral stimulation interventions may help infants to develop sucking and oromotor co-ordination, promoting earlier oral feeding and earlier hospital discharge. To determine the effectiveness of oral stimulation interventions for attainment of oral feeding in preterm infants born before 37 weeks' postmenstrual age (PMA).To conduct subgroup analyses for the following prespecified subgroups.• Extremely preterm infants born at < 28 weeks' PMA.• Very preterm infants born from 28 to < 32 weeks' PMA.• Infants breast-fed exclusively.• Infants bottle-fed exclusively.• Infants who were both breast-fed and bottle-fed. We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via PubMed (1966 to 25 February 2016), Embase (1980 to 25 February 2016) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 25 February 2016). We searched clinical trials databases, conference proceedings and the reference lists of retrieved articles. Randomised and quasi-randomised controlled trials comparing a defined oral stimulation intervention with no intervention, standard care, sham treatment or non-oral intervention in preterm infants and reporting at least one of the specified outcomes. One review author searched the databases and identified studies for screening. Two review authors screened the abstracts of these studies and full-text copies when needed to identify trials for inclusion in the review. All review authors independently extracted the data and analysed each study for risk of bias across the five domains of bias. All review authors discussed and analysed the data and

  7. Enteral nutrition for optimal growth in preterm infants

    PubMed Central

    2016-01-01

    Early, aggressive nutrition is an important contributing factor of long-term neurodevelopmental outcomes. To ensure optimal growth in premature infants, adequate protein intake and optimal protein/energy ratio should be emphasized rather than the overall energy intake. Minimal enteral nutrition should be initiated as soon as possible in the first days of life, and feeding advancement should be individualized according to the clinical course of the infant. During hospitalization, enteral nutrition with preterm formula and fortified human milk represent the best feeding practices for facilitating growth. After discharge, the enteral nutrition strategy should be individualized according to the infant's weight at discharge. Infants with suboptimal weight for their postconceptional age at discharge should receive supplementation with human milk fortifiers or nutrient-enriched feeding, and the enteral nutrition strategy should be reviewed and modified continuously to achieve the target growth parameters. PMID:28194211

  8. Benefits of donor milk in the feeding of preterm infants.

    PubMed

    Bertino, Enrico; Giuliani, Francesca; Baricco, Marta; Di Nicola, Paola; Peila, Chiara; Vassia, Cristina; Chiale, Federica; Pirra, Alice; Cresi, Francesco; Martano, Claudio; Coscia, Alessandra

    2013-10-01

    Mother's own milk is widely recognized as the optimal feeding for term infants, but also provides health benefits that are of vital importance for sick and preterm infants in neonatal intensive care units (NICUs), even though the growth and neurodevelopmental needs of very premature infants are best met by appropriate fortification of human milk (HM). When mother's milk is unavailable or in short supply, donor milk (DM) represents the second best alternative and, although some nutritional elements are inactivated by the pasteurization process, it still has documented advantages compared to formula. Occasionally, the concern that the use of DM might decrease breastfeeding is being raised, but reports exist in literature showing that the use of donor HM in the NICU increases breastfeeding rates at discharge for VLBW infants. The demonstrated benefits of HM highlight the importance of educating health care professionals in breastfeeding support.

  9. Umbilical cord clamping and preterm infants: a randomised trial.

    PubMed Central

    Kinmond, S; Aitchison, T C; Holland, B M; Jones, J G; Turner, T L; Wardrop, C A

    1993-01-01

    OBJECTIVE--To investigate the clinical effects of regulating umbilical cord clamping in preterm infants. DESIGN--A prospective randomised study. SETTING--The Queen Mother's Hospital, Glasgow. SUBJECTS--36 vaginally delivered infants over 27 and under 33 weeks' gestation. INTERVENTION--Holding the infant 20 cm below the introitus for 30 seconds before clamping the umbilical cord ("regulated" group, 17 patients), or conventional management ("random" group, 19 patients). MAIN OUTCOME MEASURES--Initial packed cell volume, peak serum bilirubin concentrations, red cell transfusion requirements, and respiratory impairment (assessed by ventilatory requirements, arterial-alveolar oxygen tension ratio over the first day in ventilated infants, and duration of dependence on supplemental oxygen). RESULTS--There were statistically significant differences between the two groups in mean initial packed cell volume (regulated group 0.564, random group 0.509) and median red cell transfusion requirements (regulated group zero, random group 23 ml/kg). 13 infants from each group underwent mechanical ventilation and showed significant differences in mean minimum arterial-alveolar oxygen tension ratio on the first day (regulated group 0.42, random group 0.22) and in median duration of dependence on supplemental oxygen (regulated group three days, random group 10 days). Differences in final outcome measures such as duration of supplemental oxygen dependence and red cell transfusion requirements were mediated primarily through arterial-alveolar oxygen tension ratio and also packed cell volume. CONCLUSIONS--This intervention at preterm deliveries produces clinical and economic benefits. PMID:8443480

  10. Vitamin E levels during early iron supplementation in preterm infants.

    PubMed

    Arnon, Shmuel; Regev, Rivka H; Bauer, Sofia; Shainkin-Kestenbaum, Ruth; Shiff, Yakov; Bental, Yoram; Dolfin, Tzipora; Litmanovitz, Ita

    2009-05-01

    On the basis of preliminary data, this larger bi-institutional continuation trial evaluating the efficacy and safety of early iron supplementation in preterm infants calls attention to the levels of vitamin E, a marker of antioxidant activity, during iron treatment. A total of 116 preterm infants were randomly assigned to receive at 2 or 4 weeks of age ( N = 62, N = 54, respectively) 5 mg/kg/d of nonionic iron polymaltose complex concomitantly with a daily dose of 25 IU vitamin E (as dl-alpha-tocopherol acetate) from 2 weeks of age. Vitamin E (alpha-tocopherol) levels, iron, ferritin, hemoglobin concentration, and reticulocyte count were recorded from 2 to 8 weeks of age. The morbidities of prematurity associated with free radicals formation were also documented. A gradual increase of alpha-tocopherol levels within physiological range (0.8 to 3.5 mg/dL) was found in the 2-week and 4-week groups during the study period with no difference among the groups ( P > 0.05 for all comparisons). At 8 weeks of age, iron and ferritin levels, hemoglobin concentration, and reticulocyte count were higher in the 2-week group. No correlation was observed between timing of both iron and vitamin E supplement and hemolysis or morbidities associated with prematurity. Thus, treatment of iron with vitamin E supplement at 2 weeks of age is, in our experience, an efficacious and safe treatment for improving anemia in preterm infants.

  11. Economics of Home Monitoring for Apnea in Late Preterm Infants.

    PubMed

    Montenegro, Brian L; Amberson, Michael; Veit, Lauren; Freiberger, Christina; Dukhovny, Dmitry; Rhein, Lawrence M

    2017-01-01

    Apnea of prematurity affects a small proportion but large absolute number of late preterm infants, with out-patient management variably utilized despite relative clinical equipoise and potential for improved cost-effectiveness. Over a 5-y period, from 2009 to 2013, infants born at ≥34 weeks gestational age at a level IIIB academic center in Boston, Massachusetts, with discharge-delaying apnea, bradycardia, and desaturation (ABD) events were identified. In-patient costs for discharge-delaying ABD events were compared with hypothetical out-patient management. Out-patient costs took into account 4-10 d of in-patient observation for ABD events before caffeine initiation, 3-5 d of additional in-patient observation before discharge, daily caffeine until 43 weeks corrected gestational age, home pulse oximetry monitoring until 44 weeks corrected gestational age, and consideration of variable readmission rates ranging from 0 to 10%. A total of 425 late preterm and term infants were included in our analysis. Utilization of hypothetical out-patient management resulted in cost savings per eligible patient ranging from $2,422 to $62, dependent upon variable periods of in-patient observation. Sensitivity analysis demonstrated few instances of decreased relative cost-effectiveness. Out-patient management of discharge-delaying ABD events in a late preterm and term population was a cost-effective alternative to prolonged in-patient observation. Copyright © 2017 by Daedalus Enterprises.

  12. Randomised controlled trial of cisapride in preterm infants

    PubMed Central

    McClure, R; Kristensen, J; Grauaug, A

    1999-01-01

    AIM—To determine the effect of cisapride on gastrointestinal motility in preterm infants.
METHODS—Cisapride (0.2 mg/kg, 8 hourly ) or placebo was given first for seven days in a double blind randomised crossover study of 10 preterm infants. Gastrointestinal motility was assessed on day 3 of each treatment. The half gastric emptying time (GET1/2) was determined by using ultrasonography to measure the decrease in the gastric antral cross sectional area after a feed. The whole gastrointestinal transit time (WGTT) was assessed by timing the transit of carmine red through the gut. Treatments were compared using the Wilcoxon matched pairs signed ranks test.
RESULTS—Median (range) birthweight was 1200 (620, 1450) g and postconceptional age 33 (29, 34) weeks at recruitment. GET1/2 was significantly longer during cisapride treatment than during placebo; the median of the differences (95% confidence interval) was 19.2 (11, 30minutes, p=0.008). WGTT was also longer during cisapride treatment, but the difference was not significant; the median of the differences was 11(−18, 52 hours, p=0.1).
CONCLUSIONS—Cisapride delays gastric emptying and may delay WGTT in preterm infants. Its use to promote gastrointestinal motility in this group cannot be recommended.

 PMID:10212076

  13. Efficacy and Safety of Acupuncture in Preterm and Term Infants

    PubMed Central

    Raith, Wolfgang; Urlesberger, Berndt; Schmölzer, Georg M.

    2013-01-01

    The aim of the paper was to review the literature about safety and efficiency of acupuncture therapy in term and preterm infants. We searched Medline, EMBASE, and Cochrane Central Register of Controlled Trials using a predefined algorithm, reviewed abstracts from the Pediatric Academic Society annual meetings (2000–2012), and performed a manual search of references in narrative and systematic reviews. A total of 26 studies identified met our search criteria. Only 6 of these studies met our inclusion criteria; however, two studies had to be excluded because the manuscripts were published in Chinese. Hence, only four studies were included in our analysis. Three of the four studies evaluated the effects of acupuncture on infantile colic, and one assessed pain reduction during minor painful procedures in preterm babies. The limited data available suggests that acupuncture could be a safe nonpharmacologic treatment option for pain reduction in term and preterm infants and could also be a non-pharmacologic treatment option to treat infantile colic. Currently acupuncture in infants should be limited to clinical trials and studies evaluating short- and long-term effects and should be performed only by practitioners with adequate training and experience in neonatal/pediatric acupuncture. PMID:23878607

  14. Basal ganglia perfusion in the preterm infant during transition.

    PubMed

    Schindler, Tim; Gilbert, Yasmin; Jayatilake, Sonali; Stevenson, Gordon; Oei, Ju Lee; Welsh, Alec

    2016-10-01

    The preterm brain is susceptible to changes in blood flow. Using power Doppler images, digital imaging techniques have been developed to measure the total amount of blood flow in a defined area, giving the index: fractional moving blood volume (FMBV). The aim of this study was to investigate temporal changes in basal ganglia perfusion during the transitional period after birth. Twenty-four preterm infants were examined with serial cranial ultrasounds at four time points during the first 48 h of life. FMBV was calculated using power Doppler images at each time point. All infants had analyzable data and FMBV was successfully calculated at all time points. Twenty-three of the 24 infants had an increasing trend in FMBV over time. The median FMBV increased from 17% at 6 h to 25% at 48 h. One-way repeated measures ANOVA showed a significant increase in values at P < 0.001 at each of the four time points. We have demonstrated changes in basal ganglia blood flow as the cerebral circulation adapts to extrauterine life. With further investigation, this technique may be useful in the assessment of preterm circulatory adaptation, either alone or in conjunction with other modes of evaluating cerebral blood flow.

  15. Plasma bilirubin level and oxidative stress in preterm infants

    PubMed Central

    Dani, C; Martelli, E; Bertini, G; Pezzati, M; Filippi, L; Rossetti, M; Rizzuti, G; Rubaltelli, F

    2003-01-01

    Objective: To assess the hypothesis that changes in plasma total bilirubin levels (Btot) can influence the antioxidant system and oxidative stress in preterm infants. Methods: Twenty two healthy preterm infants who presented with visible non-haemolytic hyperbilirubinaemia were studied at the mean (SD) age of 3.7 (1.5) days. Btot, plasma total hydroperoxide concentration (TH), plasma protein SH group concentration, and total antioxidant capacity of the plasma (TAC) were measured at study entry and after 24 hours. Results: Btot did not correlate with TH, TAC, or protein SH group concentration, but a significant correlation was found between TH and TAC, TH and protein SH groups, and TAC and protein SH groups, both at study entry and after 24 hours. Conclusion: The decrease in plasma bilirubin was contemporary with an increase in plasma antioxidant capacity and decrease in oxidative stress in preterm infants. This may be the result of the pro-oxidant effect of haem oxygenase, mediated by iron release, which may outcompete the antioxidant properties of bilirubin. PMID:12598500

  16. Plasma bilirubin level and oxidative stress in preterm infants.

    PubMed

    Dani, C; Martelli, E; Bertini, G; Pezzati, M; Filippi, L; Rossetti, M; Rizzuti, G; Rubaltelli, F F

    2003-03-01

    To assess the hypothesis that changes in plasma total bilirubin levels (Btot) can influence the antioxidant system and oxidative stress in preterm infants. Twenty two healthy preterm infants who presented with visible non-haemolytic hyperbilirubinaemia were studied at the mean (SD) age of 3.7 (1.5) days. Btot, plasma total hydroperoxide concentration (TH), plasma protein SH group concentration, and total antioxidant capacity of the plasma (TAC) were measured at study entry and after 24 hours. Btot did not correlate with TH, TAC, or protein SH group concentration, but a significant correlation was found between TH and TAC, TH and protein SH groups, and TAC and protein SH groups, both at study entry and after 24 hours. The decrease in plasma bilirubin was contemporary with an increase in plasma antioxidant capacity and decrease in oxidative stress in preterm infants. This may be the result of the pro-oxidant effect of haem oxygenase, mediated by iron release, which may outcompete the antioxidant properties of bilirubin.

  17. Tocolysis with the β-2-sympathomimetic hexoprenaline increases occurrence of infantile haemangioma in preterm infants.

    PubMed

    Mayer, Michael; Minichmayr, Alexander; Klement, Franziska; Hroncek, Katarina; Wertaschnigg, Dagmar; Arzt, Wolfgang; Wiesinger-Eidenberger, Gabriele; Lechner, Evelyn

    2013-03-01

    Infantile haemangioma (IH) is the most commonly observed tumour in children. Off-label pharmacological treatment of IH with the beta-blocker propranolol induces regression of IH. Based on the fact that IH are more frequently observed in premature babies than in mature babies and the evidence that beta-blocker therapy leads to regression of IH, the authors generated the hypothesis that the use of β-2-sympathomimetics during pregnancy for inhibiting premature labour might increase occurrence of IH in preterm infants. For group comparison t test, Mann-Whitney U test and Fisher's exact test were used. Logistic regression was carried out by the forward stepwise method with Wald statistics. Data of 328 preterm infants (<32 gestational weeks) or with a birth weight of less than 1500 g (<36 gestational weeks) born between January 2006 and December 2008 were analysed. A total of 15 were excluded due do death within the 1st month of life, 38 because of lost to follow-up and six due to incomplete data. Complete data of 269 preterm infants were retrospectively analysed. During the follow-up period of median 1.6 years, 50 infants developed one or more IH within their first 6 months of life. IH occurred in 40/181 patients with intrauterine exposure to the β-2-sympathomimetic hexoprenaline and in 10/88 without exposure (OR=4.3; 95% CI 1.4 to 13.8). Furthermore, the influence of antenatal exposure to glucocorticosteroids for induction of lung development was analysed. Prenatally exposed subjects showed reduced occurrence of IH (OR=0.2; 95% CI 0.05 to 0.8). Intrauterine exposure to the β-2-sympathomimetic hexoprenaline might increase the occurrence of IH in preterm infants.

  18. Developmental Outcomes of Very Preterm Infants with Tracheostomies

    PubMed Central

    DeMauro, Sara B.; D'Agostino, Jo Ann; Bann, Carla; Bernbaum, Judy; Gerdes, Marsha; Bell, Edward F.; Carlo, Waldemar A.; D'Angio, Carl; Das, Abhik; Higgins, Rosemary; Hintz, Susan R.; Laptook, Abbot R.; Natarajan, Girija; Nelin, Leif; Poindexter, Brenda B.; Sanchez, Pablo J.; Shankaran, Seetha; Stoll, Barbara J.; Truog, William; Van Meurs, Krisa P.; Vohr, Betty; Walsh, Michele C.; Kirpalani, Haresh

    2014-01-01

    Objectives To evaluate the neurodevelopmental outcomes of very preterm (<30 weeks) infants who underwent tracheostomy. Study design Retrospective cohort study from 16 centers of the NICHD Neonatal Research Network over 10 years (2001-2011). Infants who survived to at least 36 weeks (N=8,683), including 304 infants with tracheostomies, were studied. Primary outcome was death or neurodevelopmental impairment (NDI, a composite of one or more of: developmental delay, neurologic impairment, profound hearing loss, severe visual impairment) at a corrected age of 18-22 months. Outcomes were compared using multiple logistic regression. We assessed impact of timing, by comparing outcomes of infants who underwent tracheostomy before and after 120 days of life. Results Tracheostomies were associated with all neonatal morbidities examined, and with most adverse neurodevelopmental outcomes. Death or NDI occurred in 83% of infants with tracheostomies and 40% of those without [odds ratio (OR) adjusted for center 7.0 (95%CI, 5.2-9.5)]. After adjustment for potential confounders, odds of death or NDI remained higher [OR 3.3 (95%CI, 2.4-4.6)], but odds of death alone were lower [OR 0.4 (95%CI, 0.3-0.7)], among infants with tracheostomies. Death or NDI was lower in infants who received their tracheostomies before, rather than after, 120 days of life [adjusted OR 0.5 (95%CI, 0.3-0.9)]. Conclusions Tracheostomy in preterm infants is associated with adverse developmental outcomes, and cannot mitigate the significant risk associated with many complications of prematurity. These data may inform counseling about tracheostomy in this vulnerable population. PMID:24472229

  19. Developmental outcomes of very preterm infants with tracheostomies.

    PubMed

    DeMauro, Sara B; D'Agostino, Jo Ann; Bann, Carla; Bernbaum, Judy; Gerdes, Marsha; Bell, Edward F; Carlo, Waldemar A; D'Angio, Carl T; Das, Abhik; Higgins, Rosemary; Hintz, Susan R; Laptook, Abbot R; Natarajan, Girija; Nelin, Leif; Poindexter, Brenda B; Sanchez, Pablo J; Shankaran, Seetha; Stoll, Barbara J; Truog, William; Van Meurs, Krisa P; Vohr, Betty; Walsh, Michele C; Kirpalani, Haresh

    2014-06-01

    To evaluate the neurodevelopmental outcomes of very preterm (<30 weeks) infants who underwent tracheostomy. Retrospective cohort study from 16 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network over 10 years (2001-2011). Infants who survived to at least 36 weeks (N = 8683), including 304 infants with tracheostomies, were studied. Primary outcome was death or neurodevelopmental impairment (NDI; a composite of ≥1 of developmental delay, neurologic impairment, profound hearing loss, severe visual impairment) at a corrected age of 18-22 months. Outcomes were compared using multiple logistic regression. We assessed the impact of timing by comparing outcomes of infants who underwent tracheostomy before and after 120 days of life. Tracheostomies were associated with all neonatal morbidities examined and with most adverse neurodevelopmental outcomes. Death or NDI occurred in 83% of infants with tracheostomies and 40% of those without (OR adjusted for center 7.0, 95% CI 5.2-9.5). After adjustment for potential confounders, odds of death or NDI remained higher (OR 3.3, 95% CI 2.4-4.6), but odds of death alone were lower (OR 0.4, 95% CI 0.3-0.7) among infants with tracheostomies. Death or NDI was lower in infants who received their tracheostomies before, rather than after, 120 days of life (aOR 0.5, 95% CI 0.3-0.9). Tracheostomy in preterm infants is associated with adverse developmental outcomes and cannot mitigate the significant risk associated with many complications of prematurity. These data may inform counseling about tracheostomy in this vulnerable population. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Effect of delayed cord clamping on very preterm infants.

    PubMed

    Chiruvolu, Arpitha; Tolia, Veeral N; Qin, Huanying; Stone, Genna Leal; Rich, Diana; Conant, Rhoda J; Inzer, Robert W

    2015-11-01

    Despite significant proposed benefits, delayed umbilical cord clamping (DCC) is not practiced widely in preterm infants largely because of the question of feasibility of the procedure and uncertainty regarding the magnitude of the reported benefits, especially intraventricular hemorrhage (IVH) vs the adverse consequences of delaying the neonatal resuscitation. The objective of this study was to determine whether implementation of the protocol-driven DCC process in our institution would reduce the incidence of IVH in very preterm infants without adverse consequences. We implemented a quality improvement process for DCC the started in August 2013 in infants born at ≤32 weeks' gestational age. Eligible infants were left attached to the placenta for 45 seconds after birth. Neonatal process and outcome data were collected until discharge. We compared infants who received DCC who were born between August 2013 and August 2014 with a historic cohort of infants who were born between August 2012 and August 2013, who were eligible to receive DCC, but whose cord was clamped immediately after birth, because they were born before the protocol implementation. DCC was performed on all the 60 eligible infants; 88 infants were identified as historic control subjects. Gestational age, birthweight, and other demographic variables were similar between both groups. There were no differences in Apgar scores or admission temperature, but significantly fewer infants in the DCC cohort were intubated in delivery room, had respiratory distress syndrome, or received red blood cell transfusions in the first week of life compared with the historic cohort. A significant reduction was noted in the incidence of IVH in the DCC cohort compared with the historic control group (18.3% vs 35.2%). After adjustment for gestational age, an association was found between the incidence of IVH and DCC with IVH was significantly lower in the DCC cohort compared with the historic cohort; an odds ratio of 0

  1. Cord blood hematopoietic cells from preterm infants display altered DNA methylation patterns.

    PubMed

    de Goede, Olivia M; Lavoie, Pascal M; Robinson, Wendy P

    2017-01-01

    Premature infants are highly vulnerable to infection. This is partly attributable to the preterm immune system, which differs from that of the term neonate in cell composition and function. Multiple studies have found differential DNA methylation (DNAm) between preterm and term infants' cord blood; however, interpretation of these studies is limited by the confounding factor of blood cell composition. This study evaluates the epigenetic impact of preterm birth in isolated hematopoietic cell populations, reducing the concern of cell composition differences. Genome-wide DNAm was measured using the Illumina 450K array in T cells, monocytes, granulocytes, and nucleated red blood cells (nRBCs) isolated from cord blood of 5 term and 5 preterm (<31 weeks gestational age) newborns. DNAm of hematopoietic cells was compared globally across the 450K array and through site-specific linear modeling. Nucleated red blood cells (nRBCs) showed the most extensive changes in DNAm, with 9258 differentially methylated (DM) sites (FDR < 5%, |Δβ| > 0.10) discovered between preterm and term infants compared to the <1000 prematurity-DM sites identified in white blood cell populations. The direction of DNAm change with gestational age at these prematurity-DM sites followed known patterns of hematopoietic differentiation, suggesting that term hematopoietic cell populations are more epigenetically mature than their preterm counterparts. Consistent shifts in DNAm between preterm and term cells were observed at 25 CpG sites, with many of these sites located in genes involved in growth and proliferation, hematopoietic lineage commitment, and the cytoskeleton. DNAm in preterm and term hematopoietic cells conformed to previously identified DNAm signatures of fetal liver and bone marrow, respectively. This study presents the first genome-wide mapping of epigenetic differences in hematopoietic cells across the late gestational period. DNAm differences in hematopoietic cells between term

  2. Topical emollient for preventing infection in preterm infants.

    PubMed

    Cleminson, Jemma; McGuire, William

    2016-01-29

    Breakdown of the developmentally immature epidermal barrier may permit entry for micro-organisms leading to invasive infection in preterm infants. Topical emollients may improve skin integrity and barrier function and thereby prevent invasive infection, a major cause of mortality and morbidity in preterm infants. To assess the effect of topical application of emollients (ointments, creams, or oils) on the incidence of invasive infection, other morbidity, and mortality in preterm infants. We used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 7), MEDLINE via PubMed (1966 to August 2015), EMBASE (1980 to August 2015), and CINAHL (1982 to August 2015). We also searched clinical trials databases, conference proceedings, previous reviews and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. Randomised or quasi-randomised controlled trials that assessed the effect of prophylactic application of topical emollient (ointments, creams, or oils) on the incidence of invasive infection, mortality, other morbidity, and growth and development in preterm infants. Two review authors assessed trial eligibility and risk of bias and undertook data extraction independently. We analysed the treatment effects in the individual trials and reported the risk ratio and risk difference for dichotomous data and mean difference for continuous data, with respective 95% confidence intervals. We used a fixed-effect model in meta-analyses and explored the potential causes of heterogeneity in subgroup analyses. We identified 18 eligible primary publications (21 trial reports). A total of 3089 infants participated in the trials. The risk of bias varied with lack of clarity on methods to conceal allocation in half of the trials and lack of blinding of caregivers or investigators in all of the trials being the main potential sources of bias

  3. Effect of bronchopulmonary dysplasia on early intellectual development in preterm infants.

    PubMed

    Lin, Fatao; Dong, Haipeng; Song, Yanyan; Zhang, Tengwei; Qi, Junye; Xiao, Xuwen; Cai, Yueju

    2017-06-01

    The aim of this study was to investigate the effect of bronchopulmonary dysplasia (BPD) on the early intellectual development of preterm infants. From 2011 to 2015, 83 preterm infants diagnosed with BPD were recruited to the BPD group, and 89 preterm infants without BPD and 98 healthy term infants were randomly recruited to the non-BPD and term group, respectively. Neural and intellectual development according to the Gesell Development Scale were evaluated and compared between groups at 0-3 months, 3-6 months, 6-9 months, and 9-12 months of adjusted age for preterm infants and real age for term infants. Multivariate logistic regression was used to determine the associations between BPD and adverse neurological outcomes at 9-12 months of adjusted age. Compared with term infants, preterm infants had significantly lower developmental quotients for adaptability, gross motor, fine motor, language and social skills. At follow up, deficits in one or more neurofunctions related to adaptability, gross motor, fine motor, language and social skills were significantly more frequent in preterm children with BPD than in those with no history of BPD. BPD was independently associated with adverse neurological outcome at 9-12 months of adjusted age in preterm infants. Early intelligence disturbances occurred significantly more frequently in BPD infants than in non-BPD infants. Monitoring of the development of the nervous system in BPD infants should be strengthened. © 2017 Japan Pediatric Society.

  4. Visual Habituation and Dishabituation in Preterm Infants: A Review and Meta-analysis

    PubMed Central

    Kavšek, Michael; Bornstein, Marc H.

    2010-01-01

    We review comparative studies of infant habituation and dishabituation performance focusing on preterm infants. Habituation refers to cognitive encoding, and dishabituation refers to discrimination and memory. If habituation and dishabituation constitute basic information-processing skills, and preterm infants suffer cognitive disadvantages, then preterms should show diminished habituation and dishabituation performance. Our review provides evidence that preterm infants’ habituation and dishabituation are impoverished relative to term infants. On the whole, effect sizes indicated that the differences between preterms and terms are of a medium magnitude. We also find that preterms’ performance is moderated by risk factors, stimulus materials, procedural variables, and age. These factors need to be taken into account in the construction of tests in which habituation-dishabituation tasks are employed. Overall, the habituation-dishabituation paradigm presents a promising approach in the diagnosis of cognitive status and development in preterm infants. PMID:20488657

  5. Neurobehavioral Assessment Predicts Motor Outcome in Preterm Infants

    PubMed Central

    Stephens, Bonnie E; Liu, Jing; Lester, Barry; Lagasse, Linda; Shankaran, Seetha; Bada, Henrietta; Bauer, Charles; Das, Abhik; Higgins, Rosemary

    2011-01-01

    Objective To determine whether Neonatal Intensive Care Unit Network Neurobehavior Scales (NNNS) at 44 weeks predict motor outcome at 2 years in preterm infants from the Maternal Lifestyles Study (MLS). Study design Data were collected on all preterm infants (<36 weeks) in the MLS who had an NNNS at 44 weeks (n=395) and neurologic exam at 12–36 months or Bayley Psychomotor Development Index (PDI) at 24 months (n=270). Logistic regression analyzed NNNS summary scores associated with Cerebral Palsy (CP) or PDI <70, while controlling for birth weight 1250g. Results Eighteen of 395 infants (5%) had CP; 24 of 270 infants (9%) had PDI <70. CP was associated with low quality of movement (OR 1.95, 95% CI 1.24–3.06, p=0.004) and high lethargy (OR 1.67, 95% CI 1.01–2.76, p=0.045). The model contributed 19% of the variance in CP diagnosis at 12–36 months (R2=0.19, p<0.001). Low PDI was associated with low handling (OR 1.83; 95% CI 1.12–2.99, p=0.017), low quality of movement (OR 2.16; 95%CI 1.38–3.38, p=0.001), and hypotonia (OR 1.63; 95% CI 1.14–2.32, p=0.007). The model contributed 26% of the variance in PDI <70 at 24 months (R2=0.26, p<0.001). Conclusions The neurobehavioral profile of underarousal in 44 week preterm infants may predict poor motor outcome. PMID:19880137

  6. Late Preterm Infants and Neurodevelopmental Outcomes at Kindergarten.

    PubMed

    Woythaler, Melissa; McCormick, Marie C; Mao, Wen-Yang; Smith, Vincent C

    2015-09-01

    Late preterm infants (LPIs) (gestation 34 weeks and 0 days to 36 weeks and 6 days) compared with full-term infants (FTIs) are at increased risk for mortality and short- and long-term morbidity. The objective of this study was to assess the neurodevelopmental outcomes in a longitudinal cohort study of LPIs from infancy to school age and determine predictive values of earlier developmental testing compared with school-age testing. We used general estimating equations to calculate the odds of school readiness in a nationally representative cohort of 4900 full-term and 950 late preterm infants. We generated positive and negative predictive values of the ability of the 24-month Mental Developmental Index (MDI) scores of the Bayley Short Form, Research Edition, to predict Total School Readiness Score (TSRS) at kindergarten age. In multivariable analysis, late preterm infants had higher odds of worse TSRSs (adjusted odds ratio 1.52 [95% confidence interval 1.06-2.18], P = .0215). The positive predictive value of a child having an MDI of <70 at 24 months and a TSRS <5% at kindergarten was 10.4%. The negative predictive value of having an MDI of >70 at 24 months and a TSRS >5% was 96.8%. Most infants improved score ranking over the study interval. LPIs continue to be delayed at kindergarten compared with FTIs. The predictive validity of having a TSRS in the bottom 5% given a MDI <70 at 24 months was poor. A child who tested within the normal range (>85) at 24 months had an excellent chance of testing in the normal range at kindergarten. Copyright © 2015 by the American Academy of Pediatrics.

  7. Caregiving behaviors and early cognitive development as related to ordinal position in preterm infants.

    PubMed

    Cohen, S E; Beckwith, L

    1977-03-01

    Naturalistic home observations of 54 preterm infants and their caregivers were made when the infants were 1, 3 and 8 months of age. Differences were found in the kinds of everyday transactions which occur with preterm infants raised with and without siblings. At 1 month of age the care of firstborn and later-born infants was similar in most ways. At 3 months and 8 months firstborn infants clearly received more responsive care and more stimulation from their mothers than later-born infants. Furthermore, the firstborn infant received more social transactions from anybody. Firstborn preterm infants obtained higher Gesell developmental scores than later-born infants, replicating results reported with infant test performance of full-term infants.

  8. Preterm infants have significantly longer telomeres than their term born counterparts

    PubMed Central

    Turner, Kara J.; George, Shermi; Greenall, John; Slijepcevic, Predrag; Griffin, Darren K.

    2017-01-01

    There are well-established morbidities associated with preterm birth including respiratory, neurocognitive and developmental disorders. However several others have recently emerged that characterise an ‘aged’ phenotype in the preterm infant by term-equivalent age. These include hypertension, insulin resistance and altered body fat distribution. Evidence shows that these morbidities persist into adult life, posing a significant public health concern. In this study, we measured relative telomere length in leukocytes as an indicator of biological ageing in 25 preterm infants at term equivalent age. Comparing our measurements with those from 22 preterm infants sampled at birth and from 31 term-born infants, we tested the hypothesis that by term equivalent age, preterm infants have significantly shorter telomeres (thus suggesting that they are prematurely aged). Our results demonstrate that relative telomere length is highly variable in newborn infants and is significantly negatively correlated with gestational age and birth weight in preterm infants. Further, longitudinal assessment in preterm infants who had telomere length measurements available at both birth and term age (n = 5) suggests that telomere attrition rate is negatively correlated with increasing gestational age. Contrary to our initial hypothesis however, relative telomere length was significantly shortest in the term born control group compared to both preterm groups and longest in the preterm at birth group. In addition, telomere lengths were not significantly different between preterm infants sampled at birth and those sampled at term equivalent age. These results indicate that other, as yet undetermined, factors may influence telomere length in the preterm born infant and raise the intriguing hypothesis that as preterm gestation declines, telomere attrition rate increases. PMID:28658264

  9. Probiotics for prevention of necrotizing enterocolitis in preterm infants.

    PubMed

    AlFaleh, Khalid; Anabrees, Jasim

    2014-09-01

    Necrotizing enterocolitis (NEC) and nosocomial sepsis are associated with increased morbidity and mortality in preterm infants. Through prevention of bacterial migration across the mucosa, competitive exclusion of pathogenic bacteria, and enhancing the immune responses of the host, prophylactic enteral probiotics (live microbial supplements) may play a role in reducing NEC and the associated morbidity. To compare the efficacy and safety of prophylactic enteral probiotics administration versus placebo or no treatment in the prevention of severe NEC or sepsis, or both, in preterm infants. For this update, searches were made of MEDLINE (1966 to October 2013), EMBASE (1980 to October 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2013, Issue 10), and abstracts of annual meetings of the Society for Pediatric Research (1995 to 2013). Only randomized or quasi-randomized controlled trials that enrolled preterm infants < 37 weeks gestational age or < 2500 g birth weight, or both, were considered. Trials were included if they involved enteral administration of any live microbial supplement (probiotics) and measured at least one prespecified clinical outcome. Standard methods of The Cochrane Collaboration and its Neonatal Group were used to assess the methodologic quality of the trials and for data collection and analysis. Twenty-four eligible trials were included. Included trials were highly variable with regard to enrolment criteria (that is birth weight and gestational age), baseline risk of NEC in the control groups, timing, dose, formulation of the probiotics, and feeding regimens. In a meta-analysis of trial data, enteral probiotics supplementation significantly reduced the incidence of severe NEC (stage II or more) (typical relative risk (RR) 0.43, 95% confidence interval (CI) 0.33 to 0.56; 20 studies, 5529 infants) and mortality (typical RR 0.65, 95% CI 0.52 to 0.81; 17 studies, 5112 infants). There was no evidence of

  10. SENSORY PROCESSING DURING CHILDHOOD IN PRETERM INFANTS: A SYSTEMATIC REVIEW.

    PubMed

    Machado, Ana Carolina Cabral de Paula; Oliveira, Suelen Rosa de; Magalhães, Lívia de Castro; Miranda, Débora Marques de; Bouzada, Maria Cândida Ferrarez

    2017-01-01

    To conduct a systematic search for grounded and quality evidence of sensory processing in preterm infants during childhood. The search of the available literature on the theme was held in the following electronic databases: Medical Literature Analysis and Retrieval System Online (Medline)/PubMed, Latin American and Caribbean Literature in Health Sciences (Lilacs)/Virtual Library in Health (BVS), Índice Bibliográfico Español de Ciencias de la Salud (IBECS)/BVS, Scopus, and Web of Science. We included only original indexed studies with a quantitative approach, which were available in full text on digital media, published in Portuguese, English, or Spanish between 2005 and 2015, involving children aged 0-9years. 581 articles were identified and eight were included. Six studies (75%) found high frequency of dysfunction in sensory processing in preterm infants. The association of sensory processing with developmental outcomes was observed in three studies (37.5%). The association of sensory processing with neonatal characteristics was observed in five studies (62.5%), and the sensory processing results are often associated with gestational age, male gender, and white matter lesions. The current literature suggests that preterm birth affects the sensory processing, negatively. Gestational age, male gender, and white matter lesions appear as risk factors for sensoryprocessing disorders in preterm infants. The impairment in the ability to receivesensory inputs, to integrateand to adapt to them seems to have a negative effect on motor, cognitive, and language development of these children. We highlight the feasibility of identifying sensory processing disorders early in life, favoring early clinical interventions.

  11. SENSORY PROCESSING DURING CHILDHOOD IN PRETERM INFANTS: A SYSTEMATIC REVIEW

    PubMed Central

    Machado, Ana Carolina Cabral de Paula; de Oliveira, Suelen Rosa; Magalhães, Lívia de Castro; de Miranda, Débora Marques; Bouzada, Maria Cândida Ferrarez

    2017-01-01

    ABSTRACT Objective: To conduct a systematic search for grounded and quality evidence of sensory processing in preterm infants during childhood. Data source: The search of the available literature on the theme was held in the following electronic databases: Medical Literature Analysis and Retrieval System Online (Medline)/PubMed, Latin American and Caribbean Literature in Health Sciences (Lilacs)/Virtual Library in Health (BVS), Índice Bibliográfico Español de Ciencias de la Salud (IBECS)/BVS, Scopus, and Web of Science. We included only original indexed studies with a quantitative approach, which were available in full text on digital media, published in Portuguese, English, or Spanish between 2005 and 2015, involving children aged 0-9years. Data synthesis: 581 articles were identified and eight were included. Six studies (75%) found high frequency of dysfunction in sensory processing in preterm infants. The association of sensory processing with developmental outcomes was observed in three studies (37.5%). The association of sensory processing with neonatal characteristics was observed in five studies (62.5%), and the sensory processing results are often associated with gestational age, male gender, and white matter lesions. Conclusions: The current literature suggests that preterm birth affects the sensory processing, negatively. Gestational age, male gender, and white matter lesions appear as risk factors for sensoryprocessing disorders in preterm infants. The impairment in the ability to receivesensory inputs, to integrateand to adapt to them seems to have a negative effect on motor, cognitive, and language development of these children. We highlight the feasibility of identifying sensory processing disorders early in life, favoring early clinical interventions.

  12. Feasibility of transferring intensive cared preterm infants from incubator to open crib at 1600 grams

    PubMed Central

    2014-01-01

    Background Ability to maintain a normal body temperature in an open crib is an important physiologic competency generally requested to discharge preterm infants from the hospital. The aim of this study is to assess the feasibility of an early weaning protocol from incubator in preterm newborns in a Neonatal Intensive Care Unit. Methods 101 infants with birth weight < 1600 g were included in this feasibility study. We compared 80 newborns successfully transferred from an incubator to open crib at 1600 g with 21 infants transferred at weight ≥ 1700 g. The primary outcome was to evaluate feasibility of the protocol and the reasons for the eventual delay. Secondary outcomes were the identification of factors that would increase the likelihood of early weaning, the impact of an earlier weaning on discharge timing, and the incidence of adverse outcomes. Newborns in the study period were then compared with an historical control group with similar characteristics. Results Early weaning was achieved in 79.2% of infants without significant adverse effects on temperature stability or weight gain. Delayed weaning was mainly due to the need of respiratory support. Gestational age affected the likelihood of early weaning (OR 1.7282 95% CI: 1.3071 - 2.2850). In the multivariate linear regression, early weaning reduced length of stay (LOS) by 25.8 days (p < 0.0001). Conclusions Preterm infants can be weaned successfully from an incubator to an open crib at weight as low as 1600 grams without significant adverse effect. Early weaning significantly reduces LOS in preterm newborns. PMID:24886971

  13. Phycomycotic abscesses in a preterm infant.

    PubMed Central

    Ng, P C; Dear, P R

    1989-01-01

    We report a case of neonatal infection with rhizopus, one of the Mucoraceae family. Human infection is rare but the mortality is high without prompt, correct treatment. The infant had a simultaneous candida septicaemia secondary to colonisation of a central venous line. Serial C reactive protein estimations are valuable in monitoring treatment. Images Figure PMID:2774619

  14. Methods of enteral feeding in preterm infants.

    PubMed

    Maggio, L; Costa, S; Zecca, C; Giordano, L

    2012-05-01

    Whenever possible, oral feeding is the preferred method in neonatal feeding. However, many premature infants are unable to suck and swallow effectively; in these cases alternative methods of nutrient delivery must be used. We briefly review the different feeding methods used in neonatal units, with particular attention to their theoretical advantages, disadvantages and to the current best evidence available.

  15. A Rare Case of Ovarian Hyperstimulation Syndrome in a Preterm Infant

    PubMed Central

    Tabatabai, Shahrzad; Shakiba, Marjan; Alaei, Mohammad Reza; Saneifard, Hedieh

    2016-01-01

    Ovarian hyperstimulation syndrome is a rare disease among preterm infants. This syndrome was first described in 1985 in four infants with a gestational age of <30 weeks. Several explanations for this syndrome have been suggested namely the immaturity of Hypothalamic-Pituitary-Gonadal (HPG) axis, lack of negative feedback, increased sensitivity of Follicle Stimulating Hormone (FSH) receptors due to mutation and high level of estradiol. In this report, a case of hyperstimulation syndrome in a newborn with gestational age of 30 weeks is presented and the probable mechanisms in the literature are discussed. PMID:28050466

  16. Reference intervals for common coagulation tests of preterm infants (CME).

    PubMed

    Christensen, Robert D; Baer, Vickie L; Lambert, Diane K; Henry, Erick; Ilstrup, Sarah J; Bennett, Sterling T

    2014-03-01

    Fresh-frozen plasma (FFP) is sometimes administered to nonbleeding preterm neonates who are judged to be at risk for bleeding because they have abnormal coagulation tests. The benefits/risks of this practice are not well defined. One limitation to progress is lack of reference intervals for the common coagulation tests, thus limiting precision about whether coagulation tests are indeed abnormal. In a sequential observational study, fetal blood was drawn at preterm birth (≤ 34 weeks) from the umbilical vein near the placenta. Fibrinogen, prothrombin time, activated partial thromboplastin time, D-dimer, platelet (PLT) count, and mean PLT volume were measured. Reference intervals were constructed using 5th and 95th percentile values. Associations were then sought between abnormal coagulation values at birth and bleeding problems identified during the first week. Coagulation tests were drawn at 175 preterm deliveries and the results were organized into reference intervals by gestational age. No abnormal coagulation value, either alone or in combination, predicted hemorrhage (intraventricular, gastrointestinal, or pulmonary) during the first week. However, fibrinogen exceeding the 95th percentile was associated with evidence of in utero infection/inflammation (correlations with elevated C-reactive protein, p<0.01, and elevated immature to total neutrophil ratio, p<0.001). Abnormal coagulation values at preterm birth do not predict bleeding during the first week. This suggests to us that bleeding in the days after preterm birth is not generally the result of in utero coagulopathy. These findings bring into question the value of coagulation screening of nonbleeding preterm infants and prophylactic FFP administration to those with abnormal values. © 2013 American Association of Blood Banks.

  17. Very long apnea events in preterm infants

    PubMed Central

    Vergales, Brooke D.; Lee, Hoshik; Clark, Matthew T.; Lake, Douglas E.; Mennen, Anne C.; Kattwinkel, John; Sinkin, Robert A.; Moorman, J. Randall; Fairchild, Karen D.; Delos, John B.

    2014-01-01

    Apnea is nearly universal among very low birth weight (VLBW) infants, and the associated bradycardia and desaturation may have detrimental consequences. We describe here very long (>60 s) central apnea events (VLAs) with bradycardia and desaturation, discovered using a computerized detection system applied to our database of over 100 infant years of electronic signals. Eighty-six VLAs occurred in 29 out of 335 VLBW infants. Eighteen of the 29 infants had a clinical event or condition possibly related to the VLA. Most VLAs occurred while infants were on nasal continuous positive airway pressure, supplemental oxygen, and caffeine. Apnea alarms on the bedside monitor activated in 66% of events, on average 28 s after cessation of breathing. Bradycardia alarms activated late, on average 64 s after cessation of breathing. Before VLAs oxygen saturation was unusually high, and during VLAs oxygen saturation and heart rate fell unusually slowly. We give measures of the relative severity of VLAs and theoretical calculations that describe the rate of decrease of oxygen saturation. A clinical conclusion is that very long apnea (VLA) events with bradycardia and desaturation are not rare. Apnea alarms failed to activate for about one-third of VLAs. It appears that neonatal intensive care unit (NICU) personnel respond quickly to bradycardia alarms but not consistently to apnea alarms. We speculate that more reliable apnea detection systems would improve patient safety in the NICU. A physiological conclusion is that the slow decrease of oxygen saturation is consistent with a physiological model based on assumed high values of initial oxygen saturation. PMID:25549762

  18. Very long apnea events in preterm infants.

    PubMed

    Mohr, Mary A; Vergales, Brooke D; Lee, Hoshik; Clark, Matthew T; Lake, Douglas E; Mennen, Anne C; Kattwinkel, John; Sinkin, Robert A; Moorman, J Randall; Fairchild, Karen D; Delos, John B

    2015-03-01

    Apnea is nearly universal among very low birth weight (VLBW) infants, and the associated bradycardia and desaturation may have detrimental consequences. We describe here very long (>60 s) central apnea events (VLAs) with bradycardia and desaturation, discovered using a computerized detection system applied to our database of over 100 infant years of electronic signals. Eighty-six VLAs occurred in 29 out of 335 VLBW infants. Eighteen of the 29 infants had a clinical event or condition possibly related to the VLA. Most VLAs occurred while infants were on nasal continuous positive airway pressure, supplemental oxygen, and caffeine. Apnea alarms on the bedside monitor activated in 66% of events, on average 28 s after cessation of breathing. Bradycardia alarms activated late, on average 64 s after cessation of breathing. Before VLAs oxygen saturation was unusually high, and during VLAs oxygen saturation and heart rate fell unusually slowly. We give measures of the relative severity of VLAs and theoretical calculations that describe the rate of decrease of oxygen saturation. A clinical conclusion is that very long apnea (VLA) events with bradycardia and desaturation are not rare. Apnea alarms failed to activate for about one-third of VLAs. It appears that neonatal intensive care unit (NICU) personnel respond quickly to bradycardia alarms but not consistently to apnea alarms. We speculate that more reliable apnea detection systems would improve patient safety in the NICU. A physiological conclusion is that the slow decrease of oxygen saturation is consistent with a physiological model based on assumed high values of initial oxygen saturation.

  19. Eosinophilia in Preterm Born Infants Infected with Chlamydia trachomatis.

    PubMed

    López-Hurtado, Marcela; Arteaga-Troncoso, Gabriel; Sosa-González, Irma E; de Haro-Cruz, Maria de Jesus; Flores-Salazar, Veronica R; Guerra-Infante, Fernando Martín

    2016-01-01

    A higher than 350 eosinophils/mm(3) is strongly associated with Chlamydia trachomatis in term born babies coursing with respiratory distress. However, in preterm newborns infected with this pathogen, the levels of eosinophils are unknown. Forty newborn infants with clinical data of respiratory problems and/or sepsis were analyzed. DNA of leukocytes from peripheral blood was used to identify C. trachomatis. Detection of chlamydial infection was performed by amplifying the ompA gene by an in-house PCR, and eosinophil levels were evaluated in an XT-2000-hematology analyzer. Eighteen infants showed chlamydial infection and 14 of them showed pneumonia (RR = 2.6; CI95% 1.03-6.5; p =.027). Their eosinophil levels were 719 ± 614 cells/mm(3). A significant association between eosinophilia ≥1250 cells/mm(3) and gestational age of less than 29 weeks (RR = 5.8; 1.35; CI95% [1.4-24.5], p <.008) was observed. The preterm infants with chlamydial infection did not show higher eosinophil levels than uninfected infants.

  20. Very preterm infants show earlier emergence of 24-hour sleep-wake rhythms compared to term infants.

    PubMed

    Guyer, Caroline; Huber, Reto; Fontijn, Jehudith; Bucher, Hans Ulrich; Nicolai, Heide; Werner, Helene; Molinari, Luciano; Latal, Beatrice; Jenni, Oskar G

    2015-01-01

    Previous studies show contradictory results about the emergence of 24-h rhythms and the influence of external time cues on sleep-wake behavior in preterm compared to term infants. To examine whether very preterm infants (<32 weeks of gestational age) differ in their emergence of the 24-h sleep-wake rhythm at 5, 11 and 25 weeks corrected age compared to term infants and whether cycled light conditions during neonatal intermediate care affects postnatal 24-h sleep-wake rhythms in preterm infants. Prospective cohort study with nested interventional trial. 34 preterm and 14 control term infants were studied. During neonatal hospitalization, preterm infants were randomly assigned to cycled light [7 am-7 pm lights on, 7 pm-7 am lights off, n=17] or dim light condition [lights off whenever the child is asleep, n=17]. Sleep and activity behavior recorded by parental diary and actigraphy at 5, 11 and 25 weeks corrected age. Sleep at nighttime and the longest consolidated sleep period between 12 pm-6 am was longer (mixed model analysis, factor group: p=0.02, resp. p=0.01) and activity at nighttime was lower (p=0.005) at all ages in preterm compared to term infants. Cycled light exposed preterm infants showed the longest nighttime sleep duration. Dim light exposed preterm infants were the least active. Preterm infants show an earlier emergence of the 24-h sleep-wake rhythm compared to term infants. Thus, the length of exposure to external time cues such as light may be important for the maturation of infant sleep-wake rhythms. Trial registry number: This trial has been registered at www.clinicaltrials.gov (identifier NCT01513226). Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. Metabolic maturation of white matter is altered in preterm infants.

    PubMed

    Blüml, Stefan; Wisnowski, Jessica L; Nelson, Marvin D; Paquette, Lisa; Panigrahy, Ashok

    2014-01-01

    Significant physiological switches occur at birth such as the transition from fetal parallel blood flow to a two-circuit serial system with increased arterial oxygenation of blood delivered to all organs including the brain. In addition, the extra-uterine environment exposes premature infants to a host of stimuli. These events could conceivably alter the trajectory of brain development in premature infants. We used in vivo magnetic resonance spectroscopy to measure absolute brain metabolite concentrations in term and premature-born infants without evidence of brain injury at equivalent post-conceptional age. Prematurity altered the developmental time courses of N-acetyl-aspartate, a marker for axonal and neuronal development, creatine, an energy metabolite, and choline, a membrane metabolite, in parietal white matter. Specifically, at term-equivalency, metabolic maturation in preterm infants preceded development in term infants, but then progressed at a slower pace and trajectories merged at ≈340-370 post-conceptional days. In parieto/occipital grey matter similar trends were noticed but statistical significance was not reached. The timing of white matter development and synchronization of white matter and grey matter maturation in premature-born infants is disturbed. This may contribute to the greater risk of long-term neurological problems of premature infants and to their higher risk for white matter injury.

  2. Neonatology oxidative status in preterm infants with premature preterm rupture of membranes and fetal inflammatuar response syndrome.

    PubMed

    Özalkaya, Elif; Karatekin, Güner; Topçuoğlu, Sevilay; Karatepe, Hande Özgün; Hafızoğlu, Taner; Baran, Pervin; Ovalı, Fahri

    2017-10-01

    The aim of this study, to determine an index of oxidative stress index in preterm infants less than 34 weeks gestational age with premature preterm rupture of membrane (PPROM) and fetal inflammatory response syndrome (FIRS). This study was designed as a prospective study. Fifty-one premature infants less than 35 weeks of gestational age were included in the study. The umbilical cord blood concentrations of IL-6, TAC (total antioxidant capacity) and PON-1 (paraoxonase-1) levels and TOS (total oxidative stress) were studied. The oxidative stress index (OSI = TAC/TOS) was calculated in all of prematüre infants. PPROM was defined as rupture of membranes at least 24 hours before the onset of labor. FIRS was defined by an umbilical cord IL-6 level greater than 11 pg/mL. Premature infants included in the study were divided into 4 groups. Group 1 included preterm infants without FIRS and with PPROM (n = 16), while Group 2 included preterm infants without PPROM and with FIRS (n = 9), Group 3 consisted of premature infants with PPROM and FIRS (n = 21) and Group 4 included premature infants without PPROM or FIRS (n = 5). Umbilical cord TOS level was found to be higher in the preterm infants without FIRS and with PPROM (36.1 μmol H2O2 Equiv./L) compared to the preterm infants without PPROM or FIRS (11.9 μmol H2O2 Equiv./L) (p = 0.03). Umbilical cord PON-1 level was found to be lower in the preterms without FIRS and with PPROM (32 U/L), preterms without PPROM and with FIRS (30. 3 U/L) and the preterm infants with both PPROM and FIRS (48.6 U/L) compared to the preterm infants having no PPROM or FIRS (85.6 U/L) (p = 0.001). High pro-oxidant capacity was found in PPROM and low antioxidant capacity in PPROM and FIRS. Copyright © 2017. Published by Elsevier B.V.

  3. Are parenting interventions effective in improving the relationship between mothers and their preterm infants?

    PubMed

    Evans, Tracey; Whittingham, Koa; Sanders, Matthew; Colditz, Paul; Boyd, Roslyn N

    2014-05-01

    To systematically review the efficacy of parenting interventions in improving the quality of the relationship between mothers and preterm infants. Randomized or quasi-randomized controlled trials (RCT) of parenting interventions for mothers of preterm infants where mother-infant relationship quality outcomes were reported. Databases searched: The Cochrane Library, PubMed, CINAHL, PsycINFO and Web of Science. Seventeen studies met the inclusion criteria, 14 with strong methodological quality. Eight parenting interventions were found to improve the quality of the mother-preterm infant relationship. Heterogeneity of the interventions calls for an integrated new parenting program focusing on cue-based, responsive care from the mother to her preterm infant to improve the quality of the relationship for these mother-preterm infant dyads. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Increased postnatal inflammation in mechanically ventilated preterm infants born to mothers with early-onset preeclampsia.

    PubMed

    Turunen, Riikka; Andersson, Sture; Laivuori, Hannele; Kajantie, Eero; Siitonen, Sanna; Repo, Heikki; Nupponen, Irmeli

    2011-01-01

    Preeclampsia and preterm labor often underlie preterm birth, and are associated with maternal inflammation. In preterm infants, respiratory distress syndrome (RDS) and mechanical ventilation are associated with systemic inflammation. We aimed to study whether early-onset preeclampsia or preterm labor modulate the systemic inflammation affecting preterm infants with RDS. We recruited mechanically ventilated infants with gestational ages <32 weeks; 11 infants were born after early-onset preeclampsia and 25 after preterm labor. Blood was drawn during postnatal days 1-7, and the mean values of days 1-2, 3-4 and 5-6 were used. Phagocyte CD11b expression was analyzed with flow cytometry, and plasma C-reactive protein (CRP) concentrations with immunoturbidimetry. As compared with infants born after preterm labor, infants born after early-onset preeclampsia had higher CD11b expression on days 1-6 on both neutrophils and monocytes. In addition, infants born after early-onset preeclampsia had higher CRP concentrations on days 2-6 (all p < 0.05). As compared with infants born after preterm labor to mothers without preeclampsia, infants born after early-onset preeclampsia presented with a stronger postnatal systemic inflammatory reaction. Antenatal exposure to preeclampsia may induce fetal leukocyte priming and regulation of inflammation, and thereby modify postnatal inflammatory reactions and morbidity. Copyright © 2011 S. Karger AG, Basel.

  5. Management of the late preterm infant: not quite ready for prime time.

    PubMed

    Horgan, Michael J

    2015-04-01

    Preterm births account for 12.5% of all births in the United States. The preterm birth rate has increased by 33% over the last 2 decades. Late and premature infants do not develop the serious and chronic conditions of the extreme premature infant. However, there is growing evidence that these infants are not as healthy as previously thought and do in fact have an increase in morbidity and mortality compared with term infants. This article summarizes the epidemiology of late preterm infants and the associated morbidities associated with their prematurity. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Vertically transmitted cytomegalovirus infection in newborn preterm infants.

    PubMed

    Balcells, Carla; Botet, Francesc; Gayete, Sònia; Marcos, M Ángeles; Dorronsoro, Izaskun; de Alba, Concepción; Figueras-Aloy, Josep

    2016-07-01

    To determine the epidemiology of congenital and acquired cytomegalovirus (CMV) infections in preterm infants and to analyze the efficacy of breast milk freezing in decreasing the vertical transmission rate of CMV. During 2013 and 2014, preterm newborns who weighed ≤1500 g and were admitted to 22 Spanish neonatal units were included and screened for CMV infection according to the Spanish Neonatology Society recommendations. Each hospital treated the breast milk according to its own protocols. Among the 1236 preterm neonates included, 10 had a congenital infection (0.8%) and 49 had an acquired infection (4.0%) (82% demonstrated positive PCR-CMV in breast milk). The neonates who received only frozen milk presented less frequently with acquired infection (1.2%) than those fed fresh milk (5.5%) (RR=0.22; 95% CI 0.05-0.90; P=0.017). The newborns who received bank milk followed by frozen or fresh breast milk more frequently had an acquired infection (2.1% or 2.2%, respectively) than those fed only frozen breast milk. The incidence of congenital CMV infection in our sample is low, as described in the literature. To reduce acquired CMV infection, freezing breast milk might be an advisable procedure for preterm neonates born from seropositive mothers, either from the beginning of lactation or after a period of bank milk administration.

  7. Impaired oligodendrocyte maturation in preterm infants: Potential therapeutic targets.

    PubMed

    van Tilborg, Erik; Heijnen, Cobi J; Benders, Manon J; van Bel, Frank; Fleiss, Bobbi; Gressens, Pierre; Nijboer, Cora H

    2016-01-01

    Preterm birth is an evolving challenge in neonatal health care. Despite declining mortality rates among extremely premature neonates, morbidity rates remain very high. Currently, perinatal diffuse white matter injury (WMI) is the most commonly observed type of brain injury in preterm infants and has become an important research area. Diffuse WMI is associated with impaired cognitive, sensory and psychological functioning and is increasingly being recognized as a risk factor for autism-spectrum disorders, ADHD, and other psychological disturbances. No treatment options are currently available for diffuse WMI and the underlying pathophysiological mechanisms are far from being completely understood. Preterm birth is associated with maternal inflammation, perinatal infections and disrupted oxygen supply which can affect the cerebral microenvironment by causing activation of microglia, astrogliosis, excitotoxicity, and oxidative stress. This intricate interplay of events negatively influences oligodendrocyte development, causing arrested oligodendrocyte maturation or oligodendrocyte cell death, which ultimately results in myelination failure in the developing white matter. This review discusses the current state in perinatal WMI research, ranging from a clinical perspective to basic molecular pathophysiology. The complex regulation of oligodendrocyte development in healthy and pathological conditions is described, with a specific focus on signaling cascades that may play a role in WMI. Furthermore, emerging concepts in the field of WMI and issues regarding currently available animal models are put forward. Novel insights into the molecular mechanisms underlying impeded oligodendrocyte maturation in diffuse WMI may aid the development of novel treatment options which are desperately needed to improve the quality-of-life of preterm neonates.

  8. Cerebral Hemodynamic Changes During Intensive Care of Preterm Infants

    PubMed Central

    Limperopoulos, Catherine; Gauvreau, Kimberlee K.; O'Leary, Heather; Moore, Marianne; Bassan, Haim; Eichenwald, Eric C.; Soul, Janet S.; Ringer, Steven A.; Di Salvo, Donald N.; du Plessis, Adré J.

    2009-01-01

    OBJECTIVES The objectives of this study were to examine the circulatory changes experienced by the immature systemic and cerebral circulations during routine events in the critical care of preterm infants and to identify clinical factors that are associated with greater hemodynamic-oxygenation changes during these events. METHODS We studied 82 infants who weighed <1500 g at birth and required intensive care management and continuous blood pressure monitoring from an umbilical arterial catheter. Continuous recording of cerebral and systemic hemodynamic and oxygenation changes was performed. We studied 6 distinct types of caregiving events during 10-minute epochs: (1) quiet baseline periods; (2) minor manipulation; (3) diaper changes; (4) endotracheal tube suctioning; (5) endotracheal tube repositioning; and (6) complex events. Each event was matched with a preceding baseline. We examined the effect of specific clinical factors and cranial ultrasound abnormalities on the systemic and cerebral hemodynamic oxygenation changes that were associated with the various event types. RESULTS There were highly significant differences in hemodynamics and oxygenation between events overall and baseline epochs. The magnitude of these circulatory changes was greatest during endotracheal tube repositioning and complex caregiving events. Lower gestational age, higher illness severity, chorioamnionitis, low Apgar scores, and need for pressor-inotropes all were associated with circulatory changes of significantly lower magnitude. Cerebral hemodynamic changes were associated with early parenchymal ultrasound abnormalities. CONCLUSIONS Routine caregiving procedures in critically ill preterm infants are associated with major circulatory fluctuations that are clinically underappreciated and underdetected by current bedside monitoring. Our data underscore the importance of continuous cerebral hemodynamic monitoring in critically ill preterm infants. PMID:18931348

  9. Systemic inflammation and cerebral palsy risk in extremely preterm infants

    PubMed Central

    Kuban, KCK; O’Shea, TM; Allred, EN; Paneth, N; Hirtz, D; Fichorova, RN; Leviton, A

    2013-01-01

    We hypothesized that among extremely preterm infants, elevated concentrations of inflammation-related proteins in neonatal blood are associated with cerebral palsy (CP) at 24 months. Methods In 939 infants born before 28 weeks gestation, we measured blood concentrations of 25 proteins on postnatal days 1, 7, and 14 and evaluated associations between elevated protein concentrations and CP diagnosis. Results Protein elevations within three days of birth were not associated with CP. Elevations of TNF-α, TNF-R1, IL-8, ICAM-1, on at least two days were associated with diparesis. Recurrent-persistent elevations of IL-6, E-SEL, or IGFBP-1 were associated with hemiparesis. Diparesis and hemiparesis were more likely among infants who had at least four of nine proteins elevations that previously have been associated with cognitive impairment and microcephaly. Interpretation Repeated elevations of inflammation-related proteins during the first two postnatal weeks are associated with increased risk of CP. PMID:24646503

  10. Implications of Preterm Birth for Maternal Mental Health and Infant Development.

    PubMed

    Anderson, Cheryl; Cacola, Priscila

    Preterm birth remains a major contributor to infant mortality and morbidity including neurodevelopmental delay and childhood disability. Mothers experiencing a preterm birth are at risk for maternal mental health issues, inclusive of depression and posttraumatic stress disorder (PTSD), which may affect mother-infant attachment and infant development. Depression and PTSD, frequently comorbid, following preterm birth and relationships between these symptoms, maternal-infant attachment, and infant development are reviewed. Assessments and interventions potentially capable of benefitting mother and infant are noted. The need for healthcare professionals to intervene prenatally and at postpartum is significant as maternal distress remains one of the most consistent factors related to infant development. Although depression has received much attention in the literature as a risk factor for preterm birth, impaired attachment, and delayed infant development, some of the consequences of PTSD have only recently gained research attention. A few studies support the role of PTSD in impaired maternal-infant attachment; yet, it is unclear whether preterm infants of mothers experiencing symptoms of PTSD following birth are at a higher risk for motor development problems. Because early mother-infant interactions are influenced by prematurity as well as maternal mental health, consideration for home interventions that stimulate infant development and encourage mother-infant relationships concurrently are important. Directed interventions may be beneficial for infant development and aid in strengthening the mother-infant relationship, potentially reducing depression and PTSD symptoms in the mother.

  11. The effects of mothers' singing on full-term and preterm infants and maternal emotional responses.

    PubMed

    Cevasco, Andrea M

    2008-01-01

    The purpose of this research was to determine the effects of mothers' singing on their adjustment to and bonding with their new infants as well as use of music in the home environment in the first 2 weeks after their infants' birth. Preterm mothers were assessed for coping with their infants' NICU stay, and premature infants' length of hospitalization was evaluated. Fifty-four full-term infants and mothers and 20 premature infants and 16 mothers were randomly assigned to experimental or control conditions. Mothers in both experimental groups were recorded singing songs of their choice for use at home. Recordings of each preterm mother's voice were played 20 minutes per day, 3 to 5 times per week, at a time when she was not able to visit her infant in the NICU. All full-term and preterm mothers in experimental and control groups completed a posttest survey 2 weeks after infants were discharged. Comparisons revealed that experimental preterm and full-term mothers indicated less adjustment to their baby and lifestyle changes and less bonding compared to control mothers, though this difference was not significant. Preterm and full-term experimental mothers reported the greatest number of postpartum medical complications, which might explain their poor adjustment and bonding scores. There was a significant difference between mothers' value of music, with preterm experimental valuing music more. Preterm and full-term experimental mothers used music with and sang to infants more compared to preterm and full-term control mothers, but not to a significant degree. Preterm mothers reported a mean score of 4.75 (with a 5 indicating that they strongly agreed) for the following item: knowing my infant listened to my singing helped me to cope with my infant's stay in the NICU. Furthermore, preterm infants who listened to the CD recording of their mothers' singing left the hospital an average of 2 days sooner than those in the control group, though this difference was not

  12. Hyponatremia due to Severe Primary Hypothyroidism in an Infant.

    PubMed

    Agathis, Nickolas T; Libman, Ingrid M; Moritz, Michael L

    2015-01-01

    Hyponatremia has been reported in the elderly with hypothyroidism and myxedema, but this has not been a universal finding in clinical studies and there have been only a few reports in children. We report a case of an infant who developed hyponatremia due to severe primary hypothyroidism. A 4-month-old ex-preterm male, who had been euthyroid on the newborn screen, developed unexplained hospital-acquired hyponatremia (serum Na 124 mEq/L) while on full oral feeds. He was euvolemic, appeared well and was without myxedema. An evaluation of hyponatremia was negative with the exception of severe primary hypothyroidism (TSH 315.4 IU/mL, repeat 540 IU/mL). The hyponatremia resolved with thyroxine supplementation. This case demonstrates that severe hypothyroidism can result in hyponatremia in infants. It is critical to consider hypothyroidism in the evaluation of an infant with unexplained hyponatremia as untreated hypothyroidism can lead to profound developmental delays.

  13. Delivery room management of term and preterm newly born infants.

    PubMed

    Saugstad, Ola Didrik

    2015-01-01

    Delivery room management, especially in the first 'golden' minute, is of the utmost importance. An exact and universal definition of when a baby is born is needed to obtain agreement on what is meant by the first minute of life. Education of young girls is a basic requirement to optimize the health of the mother and baby. Interventions in pregnancy should as far as possible be evidence based. Antenatal care, the selection of birth mode and antenatal steroid therapy when indicated also contribute to obtaining the best outcome. Delayed cord clamping is recommended for both preterm and term infants. However, more data are needed regarding the most immature infants. Routine suctioning of the mouth and airways is not required. Thermal control is important - keep the temperature in the delivery room at 26°C and wrap infants <28 weeks of gestation in plastic. However, this procedure does not reduce mortality. Since delayed cord clamping increases mean birth weight by approximately 30 g/kg, the present birth weight charts based on early clamping need to be corrected. Preterm infants in need of ventilatory support should start with CPAP from the first breath. A T-piece device seems to have some advantages compared to self-inflating bags. Surfactant instillation is often not needed prophylactically provided the mother has received antenatal steroids. Less invasive methods for administering surfactant may be useful. If ventilatory support is needed, start with air in term and near-term infants. For babies of 29-33 weeks of gestation start with 21-30% oxygen and for infants <29 weeks start with 30% oxygen and adjust according to the response obtained. © 2015 S. Karger AG, Basel.

  14. Prenatal predictors of chronic lung disease in very preterm infants

    PubMed Central

    Henderson‐Smart, D J; Hutchinson, J L; Donoghue, D A; Evans, N J; Simpson, J M; Wright, I

    2006-01-01

    Objective To identify prenatal risk factors for chronic lung disease (CLD) at 36 weeks postmenstrual age in very preterm infants. Population Data were collected prospectively as part of the ongoing audit of the Australian and New Zealand Neonatal Network (ANZNN) of all infants born at less than 32 weeks gestation admitted to all tertiary neonatal intensive care units in Australia and New Zealand. Methods Prenatal factors up to 1 minute of age were examined in the subset of infants born at gestational ages 22–31 weeks during 1998–2001, and who survived to 36 weeks postmenstrual age (n = 11 453). Factors that were significantly associated with CLD at 36 weeks were entered into a multivariate logistic regression model. Results After adjustment, low gestational age was the dominant risk factor, with an approximate doubling of the odds with each week of decreasing gestational age from 31 to less than 25 weeks (trend p<0.0001). Birth weight for gestational age also had a dose‐response effect: the lower the birth weight for gestational age, the greater the risk, with infants below the third centile having 5.67 times greater odds of CLD than those between the 25th and 75th centile (trend p<0.0001). There was also a significantly increased risk for male infants (odds ratio 1.51 (95% confidence interval 1.36 to 1.68), p<0.0001). Conclusions These population based data show that the prenatal factors low gestational age, low birth weight for gestational age, and male sex significantly predict the development of chronic respiratory insufficiency in very preterm infants and may assist clinical decision about delivery. PMID:16131530

  15. Brain development in preterm infants assessed using advanced MRI techniques.

    PubMed

    Tusor, Nora; Arichi, Tomoki; Counsell, Serena J; Edwards, A David

    2014-03-01

    Infants who are born preterm have a high incidence of neurocognitive and neurobehavioral abnormalities, which may be associated with impaired brain development. Advanced magnetic resonance imaging (MRI) approaches, such as diffusion MRI (d-MRI) and functional MRI (fMRI), provide objective and reproducible measures of brain development. Indices derived from d-MRI can be used to provide quantitative measures of preterm brain injury. Although fMRI of the neonatal brain is currently a research tool, future studies combining d-MRI and fMRI have the potential to assess the structural and functional properties of the developing brain and its response to injury. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Preventive care at home for very preterm infants improves infant and caregiver outcomes at 2 years.

    PubMed

    Spittle, Alicia J; Anderson, Peter J; Lee, Katherine J; Ferretti, Carmel; Eeles, Abbey; Orton, Jane; Boyd, Roslyn N; Inder, Terrie; Doyle, Lex W

    2010-07-01

    The objective of this study was to determine the effects of preventive care at home on child development and primary caregiver mental health at 2 years of age. A total of 120 very preterm infants (<30 weeks) were assigned randomly to intervention (n = 61) or control (n = 59) groups. The intervention group received the preventive care program (9 home visits over the first year from a physiotherapist and a psychologist, focusing on the parent-infant relationship, the parents' mental health, and the infant's development); and the control group received standard care. At corrected age of 2 years, developmental outcomes were assessed, and primary caregivers completed the Infant-Toddler Social and Emotional Assessment. The mental health of the primary caregivers was assessed with the Hospital Anxiety and Depression Scale. At 2 years of age, 115 children (96%) were assessed with the Bayley Scales of Infant and Toddler Development III and 100 children (83%) with the Infant-Toddler Social and Emotional Assessment; and 91 (86%) of 106 caregivers completed the Hospital Anxiety and Depression Scale. There were no statistically significant differences in cognitive, language, or motor composite scores between the treatment groups. However, children in the intervention group were reported by their primary caregivers to exhibit less externalizing and dysregulation behaviors and increased competence, compared with control subjects. Primary caregivers in the intervention group reported less anxiety and depression. A preventive care program for very preterm infants and their families improved behavioral outcomes for infants and reduced anxiety and depression for primary caregivers.

  17. Nutrition, growth, and allergic diseases among very preterm infants after hospital discharge.

    PubMed

    Zachariassen, Gitte

    2013-02-01

    The aims of this PhD thesis were: 1. Primarily to investigate the effect, of adding human milk fortifier to mother's milk while breastfeeding very preterm infants after hospital discharge, on growth until 1 year corrected age (CA) 2. Secondarily to describe breastfeeding rate and factors associated with breastfeeding among very preterm infants at hospital discharge. 3. To describe possible feeding-problems during the intervention-period, and allergic diseases during the first year of life, among very preterm infants related to their nutrition after hospital discharge. 4. To describe the content of macronutrients in human milk from mothers delivering very preterm. This PhD thesis is based on a prospective, randomized, and controlled interventional birth cohort study. A total of 633 very preterm infants with a gestational age (GA) ≤ 32 + 0 weeks were recruited consecutively from July 2004 until August 2008 of whom 157 were excluded due to diseases or circumstances influencing nutrition. Further 156 refused participation in the interventional part of the study, but data on breastfeeding, weight, and some epidemiological data until discharge were available. Results on breastfeeding rate at discharge were therefore based on data from 478 infants, and parents of 320 infants accepted participation in the intervention study. Of these 320 infants, 207 were exclusively breastfed and they were shortly before hospital discharge randomized to either breastfeeding without (group A) or with fortification (group B) until 4 months CA. Infants (n = 113) who were bottle-fed at discharge (group C) were given a preterm formula (PF) until 4 months CA. Infants were examined at the outpatient clinics at term, and at 2, 4, 6, and 12 months CA, where parameters on growth, allergic diseases, possible feeding problems, blood-samples, and milk samples were obtained. Data on duration of exclusively breastfeeding and time of introduction to formula and/or complementary food were also recorded

  18. Fertility Treatment Is Associated with Stay in the Neonatal Intensive Care Unit and Respiratory Support in Late Preterm Infants.

    PubMed

    Wang, Erica T; Sundheimer, Lauren W; Spades, Carla; Quant, Cara; Simmons, Charles F; Pisarska, Margareta D

    2017-08-01

    Late preterm infants are at risk for short-term morbidities. We report that late preterm singletons conceived with fertility treatment have increased risk for admission to the neonatal intensive care unit and respiratory support compared with spontaneously conceived infants. Fertility treatment may be a risk factor to consider in managing late preterm infants. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Prediction of Participation and Sensory Modulation of Late Preterm Infants at 12 Months: A Prospective Study

    ERIC Educational Resources Information Center

    Bart, O.; Shayevits, S.; Gabis, L. V.; Morag, I.

    2011-01-01

    The aim of the study was to prospectively assess the differences in participation and sensory modulation between late preterm infants (LPI) and term babies, and to predict it by LPI characteristics. The study population includes 124 late preterm infants at gestational age between 34 and 35 6/7 weeks who were born at the same medical center. The…

  20. Contingency Learning and Reactivity in Preterm and Full-Term Infants at 3 Months

    ERIC Educational Resources Information Center

    Haley, David W.; Grunau, Ruth E.; Oberlander, Tim F.; Weinberg, Joanne

    2008-01-01

    Learning difficulties in preterm infants are thought to reflect impairment in arousal regulation. We examined relationships among gestational age, learning speed, and behavioral and physiological reactivity in 55 preterm and 49 full-term infants during baseline, contingency, and nonreinforcement phases of a conjugate mobile paradigm at 3 months…

  1. Prediction of Participation and Sensory Modulation of Late Preterm Infants at 12 Months: A Prospective Study

    ERIC Educational Resources Information Center

    Bart, O.; Shayevits, S.; Gabis, L. V.; Morag, I.

    2011-01-01

    The aim of the study was to prospectively assess the differences in participation and sensory modulation between late preterm infants (LPI) and term babies, and to predict it by LPI characteristics. The study population includes 124 late preterm infants at gestational age between 34 and 35 6/7 weeks who were born at the same medical center. The…

  2. [Lactobacillus Rhamnosus sepsis in a preterm infant associated with probiotic integrator use: a case report.

    PubMed

    Molinaro, Manuela; Aiazzi, Massimo; La Torre, Antonio; Cini, Elisabetta; Banfi, Roberto

    2016-09-01

    Preterm infants are at high risk of neonatal sepsis. We report a case of a preterm infant under prophylaxis with Lactobacillus Rhamnosus for necrotizing enterocolitis; the child develops neonatal sepsis by Lactobacillus Rhamnosus. The infection is improved after probiotic withdrawal and had complete remission after 20 days of specific antibiotic therapy.

  3. Intermanual Transfer of Shapes in Preterm Human Infants from 33 to 34 + 6 Weeks Postconceptional Age

    ERIC Educational Resources Information Center

    Lejeune, Fleur; Marcus, Leila; Berne-Audeoud, Frederique; Streri, Arlette; Debillon, Thierry; Gentaz, Edouard

    2012-01-01

    This study investigated the ability of preterm infants to learn an object shape with one hand and discriminate a new shape in the opposite hand (without visual control). Twenty-four preterm infants between 33 and 34 + 6 gestational weeks received a tactile habituation task with either their right or left hand followed by a tactile discrimination…

  4. Long-Term Cognitive Outcomes of Infants Born Moderately and Late Preterm

    ERIC Educational Resources Information Center

    Odd, David Edward; Emond, Alan; Whitelaw, Andrew

    2012-01-01

    Aim: To investigate whether infants born late preterm have poorer cognitive outcomes than term-born infants. Method: A cohort study based on the Avon Longitudinal Study of Parents and Children. Cognitive measures were assessed between the ages of 8 and 11 years. Exposure groups were defined as moderate/late preterm (32-36 weeks' gestation) or term…

  5. Contingency Learning and Reactivity in Preterm and Full-Term Infants at 3 Months

    ERIC Educational Resources Information Center

    Haley, David W.; Grunau, Ruth E.; Oberlander, Tim F.; Weinberg, Joanne

    2008-01-01

    Learning difficulties in preterm infants are thought to reflect impairment in arousal regulation. We examined relationships among gestational age, learning speed, and behavioral and physiological reactivity in 55 preterm and 49 full-term infants during baseline, contingency, and nonreinforcement phases of a conjugate mobile paradigm at 3 months…

  6. Intermanual Transfer of Shapes in Preterm Human Infants from 33 to 34 + 6 Weeks Postconceptional Age

    ERIC Educational Resources Information Center

    Lejeune, Fleur; Marcus, Leila; Berne-Audeoud, Frederique; Streri, Arlette; Debillon, Thierry; Gentaz, Edouard

    2012-01-01

    This study investigated the ability of preterm infants to learn an object shape with one hand and discriminate a new shape in the opposite hand (without visual control). Twenty-four preterm infants between 33 and 34 + 6 gestational weeks received a tactile habituation task with either their right or left hand followed by a tactile discrimination…

  7. Perinatal Risk Factors Altering Regional Brain Structure in the Preterm Infant

    ERIC Educational Resources Information Center

    Thompson, Deanne K.; Warfield, Simon K.; Carlin, John B.; Pavlovic, Masa; Wang, Hong X.; Bear, Merilyn; Kean, Michael J.; Doyle, Lex W.; Egan, Gary F.; Inder, Terrie E.

    2007-01-01

    Neuroanatomical structure appears to be altered in preterm infants, but there has been little insight into the major perinatal risk factors associated with regional cerebral structural alterations. MR images were taken to quantitatively compare regional brain tissue volumes between term and preterm infants and to investigate associations between…

  8. Long-Term Cognitive Outcomes of Infants Born Moderately and Late Preterm

    ERIC Educational Resources Information Center

    Odd, David Edward; Emond, Alan; Whitelaw, Andrew

    2012-01-01

    Aim: To investigate whether infants born late preterm have poorer cognitive outcomes than term-born infants. Method: A cohort study based on the Avon Longitudinal Study of Parents and Children. Cognitive measures were assessed between the ages of 8 and 11 years. Exposure groups were defined as moderate/late preterm (32-36 weeks' gestation) or term…

  9. Perinatal Risk Factors Altering Regional Brain Structure in the Preterm Infant

    ERIC Educational Resources Information Center

    Thompson, Deanne K.; Warfield, Simon K.; Carlin, John B.; Pavlovic, Masa; Wang, Hong X.; Bear, Merilyn; Kean, Michael J.; Doyle, Lex W.; Egan, Gary F.; Inder, Terrie E.

    2007-01-01

    Neuroanatomical structure appears to be altered in preterm infants, but there has been little insight into the major perinatal risk factors associated with regional cerebral structural alterations. MR images were taken to quantitatively compare regional brain tissue volumes between term and preterm infants and to investigate associations between…

  10. Early Development of Preterm and Full-Term Infants: Exploratory Behavior in Eight-Month-Olds

    ERIC Educational Resources Information Center

    Sigman, Marian

    1976-01-01

    Preference for novelty, as measured with an exploratory behavior paradigm, was compared in 8-month-old full-term and preterm infants of matched conceptional age. Subjects were 64 infants, 32 full term and 32 preterm, with 16 males and 16 females in each group. (Author/JH)

  11. Model of Independency Mother in Caring for Preterm Infant Based on Experiential Learning Care (ELC)

    ERIC Educational Resources Information Center

    Saudah, Noer; Nursalam; Meriana; Sulistyono, Agus

    2015-01-01

    The role of parents has done less during the preterm infant care in hospitals caused dependence in caring for the baby. The objective of the research was to development a model of independence of the mother in the care of preterm infants with experiential learning approach based theory of goal attainment. Research's design used analytic…

  12. Factors Associated with Feeding Progression in Extremely Preterm Infants

    PubMed Central

    Park, Jinhee; Knafl, George; Thoyre, Suzanne; Brandon, Debra

    2015-01-01

    Background Among infants born prematurely, competence at oral feeding is necessary for growth and hospital discharge. Extremely preterm infants (EP, ≤ 28 weeks gestational age [GA]) are at risk for a variety of medical complications, which can limit the infant’s capacity to develop oral feeding competence. Objective This study examined feeding progression by assessing timing of acquisition of five early feeding milestones among EP infants, and the impact of immaturity and medical complications. Design A chart review was conducted for 94 EP infants who participated in a larger longitudinal randomized study. Feeding progression was defined as infants’ postmenstrual age (PMA) at five milestones: first enteral feeding, full enteral feeding, first oral feeding, half oral feeding, and full oral feeding. GA at birth and five medical complications (neurological risk, bronchopulmonary dysplasia [BPD], necrotizing entercolitis [NEC], patent ductus arteriosus [PDA], and gastroesophageal reflux disease [GERD]) were used as potential factors influencing the feeding progression. Linear mixed models were used to examine feeding progression across the milestones and contributions of GA at birth, and five medical complications on the progression, after controlling for milk type as a covariate. Result EP infants gradually achieved feeding milestones; however, the attainment of the feeding milestones slowed significantly for infants with younger GA at birth and the presence of medical complications, including neurological risk, BPD, NEC, and PDA, but not GERD. Milk type was a significant covariate for all analyses, suggesting infants fed with breast milk achieved each of five milestones earlier than formula-fed infants. Discussion Improved understanding of the timing of essential feeding milestones among EP infants, and the contribution of specific medical conditions to the acquisition of these milestones may allow for more targeted care to support feeding skill development

  13. Different pre-term formulas for different pre-term infants.

    PubMed

    Fanaro, Silvia; Ballardini, Elisa; Vigi, Vittorio

    2010-07-01

    Optimal nutrition is one of the most important aspects in the care of pre-term infants, especially for the gestationally youngest ones. These infants should receive a supply of nutrients that can sustain growth similar to that of a third trimester normal foetus. Traditional pre-term formulas do not ensure an optimal protein supply except when fed at high volumes, with an excess of fat and carbohydrates. Formulas with a protein content of 2-2.5 g 100ml(-1) and a protein/energy (P:E) ratio of less than 3g 100 kcal(-1) are not the best choice for the very low birth weight (VLBW) infants. We have tested a new formulation designed for the nutrition of the VLBW infants that is characterised by a protein content of 2.9 g 100ml(-1) and a P:E ratio of 3.5 g 100 kcal(-1). The milk formula was well tolerated and associated with better weight gain compared with fortified breast milk (18.1 vs. 15.2 g kg(-1)day(-1); p=0.0015). These results were obtained with a noticeably lower fluid supply (157 vs. 177 ml kg day(-1); p<0.0001) and lower energy intake (130 vs. 151 kcal kg(-1)day(-1); p<0.0001). Infant length and head circumference did not differ significantly between groups. Currently, the use of a formula with a P:E ratio of 3.5 g 100 kcal(-1) appears to be safe and to represent the best choice available for the gestationally youngest infants. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

  14. Parents' experiences of caring for preterm infants after discharge with grandmothers as their main support.

    PubMed

    Adama, Esther Abena; Bayes, Sara; Sundin, Deborah

    2017-05-05

    To explore parents of preterm infants' experiences of caring for their preterm infants with the grandmother as their primary support after discharge. Preterm delivery is the major cause of high neonatal mortality in sub-Saharan Africa. There is poor neonatal health outcome in the Ghanaian community with some illnesses culturally classified as not-for-hospital. In the community, grandmothers or older women provide support for new parents and decide treatment options for sick infants. However, there is paucity of research on how parents of preterm infants experience this support in the Ghanaian community. Qualitative narrative inquiry methodology was used. Face-to-face interviews using semi-structured interview guide were used to collect data from 21 mothers and nine fathers. Participant observation and field notes were used to complement interview data. Thematic content analysis of data within the three-dimensional narrative space was employed. Analysis focussed on the relationship of time, place, person and cultural practices affecting the care of preterm infants in the community. Three themes emerged from the data, namely (i) Grandmother's prescriptions, (ii) Fighting for the well-being of the infant and (iii) Being in a confused state. Cultural practices mainly initiated by grandmothers resulted in adverse health problems for preterm infants and disruption in parents' mental health. As grandmothers perform their traditional role of supporting new parents to care for preterm infants after discharge, they give both positive and negative advice which can adversely affect the health of vulnerable preterm infants in the community. Grandmothers are the main support providers of parents of preterm infants after neonatal unit discharge. Nurses should identify and include grandmothers in predischarge education in order to equip them to render appropriate support to parents and preterm infants. © 2017 John Wiley & Sons Ltd.

  15. Chest physiotherapy in preterm infants with lung diseases.

    PubMed

    Giannantonio, Carmen; Papacci, Patrizia; Ciarniello, Roberta; Tesfagabir, Mikael Ghennet; Purcaro, Velia; Cota, Francesco; Semeraro, Carla Maria; Romagnoli, Costantino

    2010-09-26

    In neonatology the role of chest physiotherapy is still uncertain because of the controversial outcomes. The aim of this study was to test the applicability in preterm infants of 'reflex rolling', from the Vojta method, in preterm neonates with lung pathology, with particular attention to the effects on blood gases and oxygen saturation, on the spontaneous breathing, on the onset of stress or pain. The study included 34 preterm newborns with mean gestational age of 30.5 (1.6) weeks - mean (DS) - and birth weight of 1430 (423) g - mean (DS) -, who suffered from hyaline membrane disease, under treatment with nasal CPAP (continuous positive airways pressure), or from pneumonia, under treatment with oxygen-therapy. The neonates underwent phase 1 of 'reflex rolling' according to Vojta method three times daily. Respiratory rate, SatO2, transcutaneous PtcCO2 e PtcO2 were monitored; in order to evaluate the onset of stress or pain following the stimulations, the NIPS score and the PIPP score were recorded; cerebral ultrasound scans were performed on postnatal days 1-3-5-7, and then weekly. In this population the first phase of Vojta's 'reflex rolling' caused an increase of PtcO2 and SatO2 values. No negative effects on PtcCO2 and respiratory rate were observed, NIPS and PIPP stress scores remained unmodified during the treatment; in no patient the intraventricular haemorrhage worsened in time and none of the infants developed periventricular leucomalacia. Our experience, using the Vojta method, allows to affirm that this method is safe for preterm neonates, but further investigations are necessary to confirm its positive effects and to evaluate long-term respiratory outcomes.

  16. Chest physiotherapy in preterm infants with lung diseases

    PubMed Central

    2010-01-01

    Background In neonatology the role of chest physiotherapy is still uncertain because of the controversial outcomes. Methods The aim of this study was to test the applicability in preterm infants of 'reflex rolling', from the Vojta method, in preterm neonates with lung pathology, with particular attention to the effects on blood gases and oxygen saturation, on the spontaneous breathing, on the onset of stress or pain. The study included 34 preterm newborns with mean gestational age of 30.5 (1.6) weeks - mean (DS) - and birth weight of 1430 (423) g - mean (DS) -, who suffered from hyaline membrane disease, under treatment with nasal CPAP (continuous positive airways pressure), or from pneumonia, under treatment with oxygen-therapy. The neonates underwent phase 1 of 'reflex rolling' according to Vojta method three times daily. Respiratory rate, SatO2, transcutaneous PtcCO2 e PtcO2 were monitored; in order to evaluate the onset of stress or pain following the stimulations, the NIPS score and the PIPP score were recorded; cerebral ultrasound scans were performed on postnatal days 1-3-5-7, and then weekly. Results In this population the first phase of Vojta's 'reflex rolling' caused an increase of PtcO2 and SatO2 values. No negative effects on PtcCO2 and respiratory rate were observed, NIPS and PIPP stress scores remained unmodified during the treatment; in no patient the intraventricular haemorrhage worsened in time and none of the infants developed periventricular leucomalacia. Conclusions Our experience, using the Vojta method, allows to affirm that this method is safe for preterm neonates, but further investigations are necessary to confirm its positive effects and to evaluate long-term respiratory outcomes. PMID:20868518

  17. Automated analysis of multi-channel EEG in preterm infants.

    PubMed

    Murphy, Keelin; Stevenson, Nathan J; Goulding, Robert M; Lloyd, Rhodri O; Korotchikova, Irina; Livingstone, Vicki; Boylan, Geraldine B

    2015-09-01

    To develop and validate two automatic methods for the detection of burst and interburst periods in preterm eight-channel electroencephalographs (EEG). To perform a detailed analysis of interobserver agreement on burst and interburst periods and use this as a benchmark for the performance of the automatic methods. To examine mathematical features of the EEG signal and their potential correlation with gestational age. Multi-channel EEG from 36 infants, born at less than 30 weeks gestation was utilised, with a 10 min artifact-free epoch selected for each subject. Three independent expert observers annotated all EEG activity bursts in the dataset. Two automatic algorithms for burst/interburst detection were applied to the EEG data and their performances were analysed and compared with interobserver agreement. A total of 12 mathematical features of the EEG signal were calculated and correlated with gestational age. The mean interobserver agreement was found to be 77% while mean algorithm/observer agreement was 81%. Six of the mathematical features calculated (spectral entropy, Higuchi fractal dimension, spectral edge frequency, variance, extrema median and Hilberts transform amplitude) were found to have significant correlation with gestational age. Automatic detection of burst/interburst periods has been performed in multi-channel EEG of 36 preterm infants. The algorithm agreement with expert observers is found to be on a par with interobserver agreement. Mathematical features of EEG have been calculated which show significant correlation with gestational age. Automatic analysis of preterm multi-channel EEG is possible. The methods described here have the potential to be incorporated into a fully automatic system to quantitatively assess brain maturity from preterm EEG. Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  18. Antibiotic perturbation of the preterm infant gut microbiome and resistome.

    PubMed

    Gasparrini, Andrew J; Crofts, Terence S; Gibson, Molly K; Tarr, Phillip I; Warner, Barbara B; Dantas, Gautam

    2016-09-02

    The gut microbiota plays important roles in nutrient absorption, immune system development, and pathogen colonization resistance. Perturbations early in life may be detrimental to host health in the short and the long-term. Antibiotics are among the many factors that influence the development of the microbiota. Because antibiotics are heavily administered during the first critical years of gut microbiota development, it is important to understand the effects of these interventions. Infants, particularly those born prematurely, represent an interesting population because they receive early and often extensive antibiotic therapy in the first months after birth. Gibson et al. recently demonstrated that antibiotic therapy in preterm infants can dramatically affect the gut microbiome. While meropenem, ticarcillin-clavulanate, and cefotaxime treatments were associated with decreased species richness, gentamicin and vancomycin had variable effects on species richness. Interestingly, the direction of species richness response could be predicted based on the abundance of 2 species and 2 genes in the microbiome prior to gentamicin or vancomycin treatment. Nonetheless, all antibiotic treatments enriched the presence of resistance genes and multidrug resistant organisms. Treatment with different antibiotics further resulted in unique population shifts of abundant organisms and selection for different sets of resistance genes. In this addendum, we provide an extended discussion of these recent findings, and outline important future directions for elucidating the interplay between antibiotics and preterm infant gut microbiota development.

  19. Benefits of donor human milk for preterm infants: current evidence.

    PubMed

    Bertino, Enrico; Giuliani, Francesca; Occhi, Luciana; Coscia, Alessandra; Tonetto, Paola; Marchino, Federica; Fabris, Claudio

    2009-10-01

    It's undoubted that optimum nutrition for term infants is breastfeeding, exclusive for the first six months, then followed by a complementary diet and carried on, if possible, for the first year of life or even more. During the last decades several data confirmed the great advantages of fresh mother's milk use also for feeding very low and extremely low birthweight preterm infants. When mother's milk is unavailable or in short supply, pasteurized donor breast milk is widely used in neonatal intensive care units. Pasteurization partially affects nutritional and immunological properties of breast milk, however it is known that pasteurized milk maintains some biological properties and clinical benefits. The substantial benefits of mother's own milk feeding of preterm infants are supported by strong evidence. However, there is increasing evidence also on specific benefits of donor breast milk. Future research is needed to compare formula vs. nutrient fortified donor breast milk, to compare formula and DM as supplements to maternal milk rather than as sole diet and to compare effects of different methods of heat treatments on donor human milk quality.

  20. [Advantages of individualized fortification of human milk for preterm infants].

    PubMed

    de Halleux, V; Close, A; Stalport, S; Studzinski, F; Habibi, F; Rigo, J

    2007-09-01

    Despite the benefits of human milk fortification, nutrients of human milk are not sufficient to cover the greater needs of very low birth weight and to ensure a growth similar to that of premature infants fed with preterm formula. These differences could be related to the variation in the macronutrient composition of expressed breast milk with lower protein and energy content. Unfortunately there is unusually no information on macronutrients composition prior human milk fortification. With such data, it would be possible to individualize the fortification. In order to use adjustable fortification of human milk, we have assessed a rapid and simple method using full spectrum infrared laser technology (Milkoscan) to analyze human milk composition. We describe the variation in concentration of protein, lipid and energy in the human milk received in our neonatal unit. Then we evaluate the benefit of adjustable fortification of human milk compared with standard fortification. After standard fortification the variability of protein and lipid remains with a risk of protein deficiency or excess and a risk of energy deficiency. After adjustable human milk fortification based on human milk analysis using Milkoscan, we observe a more stable protein content and a lower amount of added fortifier decreasing the risk of hyperosmolarity. Furthermore, the energy content is higher following of the fat human milk adjusted content. Up to now, our preliminary results suggest that individualized fortification of human milk improves growth rate in preterm infants (21 g/kg/d) to a level close to formula fed infants.

  1. Dietary transition difficulties in preterm infants: critical literature review.

    PubMed

    Pagliaro, Carla Lucchi; Bühler, Karina Elena Bernardis; Ibidi, Silvia Maria; Limongi, Suelly Cecília Olivan

    2016-01-01

    To analyze the scientific literature on dietary changes in preterm children during the first years of life. The PubMed database was used for article selection. The texts were analyzed according to their objectives, research design, and research group characteristics. The following were selected to comprise the criteria: (1) publications in the period from 1996 to 2014; (2) participation of infants and children from birth to 10 years of age; (3) development of oral motor skills necessary for feeding; (4) development of the feeding process; and (5) feeding difficulties during childhood. There were 282 studies identified, of which 17 were used in the review, and five more articles were identified through the reference list of selected articles, totaling 22 references. Very low birth weight preterm newborns are more likely to have feeding problems in early postnatal stages and during childhood when compared with full-term infants. Monitoring the feeding of these infants after hospital discharge is strictly recommended in an early intervention program aiming at better development of feeding skills. Copyright © 2015 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  2. Incidence and treatment of infantile haemangioma in preterm infants.

    PubMed

    Goelz, Rangmar; Poets, Christian F

    2015-01-01

    Infantile haemangioma (IH) are vascular tumours with a unique growth dynamic, mostly absent at birth, growth in the first months followed by involution over several years, often resulting in residual skin changes. Immune-histologically, IH cells are exclusively glucose transporter protein-1 positive.The incidence of IH is increasing with decreasing gestational age, from 1-4% in term infants to 23% in those of <1000 g birth weight, with a female and Caucasian predominance. Discovery of systemic and topical beta blockers as an effective treatment option resulted in a rapid shift away from systemic steroids towards these drugs. For preterm infants, however, data on efficacy, pharmacokinetics and long-term safety are sparse or absent. Topical treatment without systemic side effects like cryotherapy may thus be an attractive alternative at an early growth stage (<10 mm). Indications for treatment with beta blockers, mostly propranolol systemically and timolol maleat 0.5% topically, are currently extrapolated from studies in older infants. Both seem effective, but adverse effects on sleep, circulation and metabolism are well described for propranolol. Long-term outcome data for either drug are missing. In conclusion, evidence on optimal IH treatment in preterms is lacking despite their high incidence; pharmacokinetic and clinical studies are warranted.

  3. Longchain polyunsaturated fatty acid supplementation in preterm infants.

    PubMed

    Moon, Kwi; Rao, Shripada C; Schulzke, Sven M; Patole, Sanjay K; Simmer, Karen

    2016-12-20

    Controversy exists over whether longchain polyunsaturated fatty acids (LCPUFA) are essential nutrients for preterm infants because they may not be able to synthesise sufficient amounts of LCPUFA to meet the needs of the developing brain and retina. To assess whether supplementation of formula milk with LCPUFA is safe and of benefit to preterm infants. The main areas of interest were the effects of supplementation on the visual function, development and growth of preterm infants. Trials were identified by searching the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 2) in the Cochrane Library (searched 28 February 2016), MEDLINE Ovid (1966 to 28 February 2016), Embase Ovid (1980 to 28 February 2016), CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature; 1980 to 28 February 2016), MEDLINE In Process & Other Non-indexed Citations (1966 to 28 February 2016) and by checking reference lists of articles and conference proceedings. We also searched ClinicalTrials.gov (13 April 2016). No language restrictions were applied. All randomised trials evaluating the effect of LCPUFA-supplemented formula in enterally-fed preterm infants (compared with standard formula) on visual development, neurodevelopment and physical growth. Trials reporting only biochemical outcomes were not included. All authors assessed eligibility and trial quality, two authors extracted data separately. Study authors were contacted for additional information. Seventeen trials involving 2260 preterm infants were included in the review. The risk of bias varied across the included trials with 10 studies having low risk of bias in a majority of the domains. The median gestational age (GA) in the included trials was 30 weeks and median birth weight (BW) was 1300 g. The median concentration of docosahexaenoic acid (DHA) was 0.33% (range: 0.15% to 1%) and arachidonic acid (AA) 0.37% (range: 0.02% to 0.84%). Visual acuity Visual acuity over the first year was measured by

  4. Respiratory support with heated humidified high flow nasal cannula in preterm infants.

    PubMed

    Jeon, Ga Won

    2016-10-01

    The incidence of bronchopulmonary dysplasia (BPD) has not decreased over the last decade. The most important way to decrease BPD is by weaning the patient from the ventilator as soon as possible in order to reduce ventilator-induced lung injury that underlies BPD, and by using a noninvasive ventilator (NIV). Use of a heated, humidified, high flow nasal cannula (HHHFNC), which is the most recently introduced NIV mode for respiratory support in preterm infants, is rapidly increasing in many neonatal intensive care units due to the technical ease of use without sealing, and the attending physician's preference compared to other NIV modes. A number of studies have shown that nasal breakdown and neonatal complications were lower when using a HHHFNC than when using nasal continuous positive airway pressure (nCPAP), or nasal intermittent positive pressure ventilation. The rates of extubation failure during respiratory support were not different between patients who used HHHFNC and nCPAP. However, data from the use of HHHFNC as the initial respiratory support "after birth", particularly in extremely preterm infants, are lacking. Although the HHHFNC is efficacious and safe, large randomized controlled trials are needed before the HHHFNC can be considered an NIV standard, particularly for extremely preterm infants.

  5. Lung recruitment and endotracheal suction in ventilated preterm infants measured with electrical impedance tomography.

    PubMed

    Hough, Judith L; Shearman, Andrew D; Liley, Helen; Grant, Caroline A; Schibler, Andreas

    2014-11-01

    Although suctioning is a standard airway maintenance procedure, there are significant associated risks, such as loss of lung volume due to high negative suction pressures. This study aims to assess the extent and duration of change in end-expiratory level (EEL) resulting from endotracheal tube (ETT) suction and to examine the relationship between EEL and regional lung ventilation in ventilated preterm infants with respiratory distress syndrome. A prospective observational clinical study of the effect of ETT suction on 20 non-muscle-relaxed preterm infants with respiratory distress syndrome (RDS) on conventional mechanical ventilation was conducted in a neonatal intensive care unit. Ventilation distribution was measured with regional impedance amplitudes and EEL using electrical impedance tomography. ETT suction resulted in a significant increase in EEL post-suction (P < 0.01). Regionally, anterior EEL decreased and posterior EEL increased post-suction, suggesting heterogeneity. Tidal volume was significantly lower in volume-guarantee ventilation compared with pressure-controlled ventilation (P = 0.04). ETT suction in non-muscle-relaxed and ventilated preterm infants with RDS results in significant lung volume increase that is maintained for at least 90 min. Regional differences in distribution of ventilation with ETT suction suggest that the behaviour of the lung is heterogeneous in nature. © 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  6. Malaysian nurses' skin care practices of preterm infants: experience vs. knowledge.

    PubMed

    Mohamed, Zainah; Newton, Jennifer Margaret; Lau, Rosalind

    2014-04-01

    This study sought to explore the impact of Malaysian nurses' perceptions, knowledge and experiences in preterm infant skin care practices using a descriptive approach. Questionnaires were distributed to Neonatal Intensive Care Unit (NICU) nurses in one teaching hospital in Malaysia. A knowledge gap was revealed among nurses in both theoretical and practical knowledge of preterm infant skin. Nurses working for more than 5 years in NICU or having a Neonatal Nursing Certificate (NNC) were not predictors of having adequate knowledge of preterm infants' skin care. The results highlight the complex issue of providing effective skin care to preterm infants. However, a specific finding related to nurses' confidence provides some direction for future practice and research initiatives. Clear clinical evidence-based guidelines and Continuing Nursing Education on relevant topics of preterm infants' care may provide the required knowledge for the nurses.

  7. Comparison of Neonatal Abstinence Syndrome Manifestations in Preterm Versus Term Opioid-Exposed Infants.

    PubMed

    Allocco, Elizabeth; Melker, Marjorie; Rojas-Miguez, Florencia; Bradley, Caitlin; Hahn, Kristen A; Wachman, Elisha M

    2016-10-01

    Twenty percent to 40% of infants exposed to in utero opioid were delivered preterm. There is currently no neonatal abstinence syndrome (NAS) scoring tool known to accurately evaluate preterm opioid-exposed infants. This can lead to difficulties in titrating pharmacotherapy in this population. To describe NAS symptoms in preterm opioid-exposed infants in comparison with matched full-term controls. This was a retrospective cohort study from a single tertiary care center of methadone-exposed infants born between 2006 and 2010. Using modified Finnegan scale scores recorded every 3 to 4 hours beginning at 6 hours of life until 24 to 48 hours after medication discontinuation, NAS symptoms was compared between 45 preterm infants and 49 full-term matched controls. Concurrent neonatal medical diagnoses were also compared. The median gestational age in the preterm group was 35 weeks (interquartile range [IQR] = 33-36) versus 39 weeks (IQR = 38-40) in the term group. Preterm infants scored less frequently for many items including sleep disturbance (24.4% vs 46.2%), tremors (77.9% vs 89.7%), muscle tone (87.9% vs 97.4%), sweating (2.1% vs 9.4%), nasal stuffiness (11.9% vs 20.5%), and loose stools (7.0% vs 14.3%) than full-term controls. Preterm infants scored more frequently for hyperactive moro reflex (26.4% vs 5.5%), tachypnea (19.3% vs 16.1%), and poor feeding (24.6% vs 11.8%). Provider awareness of differences in manifestations of preterm and term infants with NAS, as well as concurrent prematurity diagnoses that can influence NAS scoring, is needed. These findings mandate the development of a modified NAS scoring tool for the preterm NAS population. A preterm NAS scoring tool needs to be developed and validated to more accurately evaluate and treat preterm opioid-exposed infants.

  8. Body fluid osmolality and tonicity in preterm infants.

    PubMed

    Semama, D S; Bouziane, M; Allaert, F A; Gouyon, J B

    2001-11-01

    In adult patients, a recent physiological approach for the osmoregulatory system based on body fluid tonicity (the so-called effective osmolality) seems to provide better information on water movements than does the classical body fluid osmolality. To evaluate whether plasma or urinary tonicities could give a better assessment of osmoregulation than plasma and urine osmolalities in sick preterm infants cared for in a NICU. A prospective study was conducted in 30 preterm infants (BW=1284+/-377 g; GA=28.8+/-1.7 weeks). Fifteen consecutive 8-h urine collections were performed for each infant from the 8th h of life (450 periods). A plasma sample was obtained at the end of each urine collection. Sodium, potassium, creatinine, osmolality and tonicity were measured or calculated in urine and blood samples as often as possible. Hypernatremia (PNa=146-149 mmol/l) was observed in seven infants (23.3%) and in 5.9% of the periods. Fifty-three percent of the infants and 20.4% of the periods presented with plasma hyperosmolality (>300 mosmol/kg H2O). The relationship between Posm and PNa was significant, but the clinical relevance was weak (r(2)=0.411; P<0.001). Plasma osmolality (Posm) positively correlated with urine osmolality (Uosm), but did not correlate significantly with CH2O/100 ml GFR. Plasma tonicity (2x(PNa+PK)) positively correlated with both urine tonicity (2x(UNa+UK)) and effective water clearance (EWC/100 ml GFR). On an individual basis, the linear relationship between urine and plasma osmolalities was significantly weaker than the relationship between urine and plasma tonicities. This study suggests that the calculation of plasma and urine tonicities allows a better assessment of water movements in body fluid compartments than plasma and urine osmolalities.

  9. Microstructure of the Default Mode Network in the Preterm Infants

    PubMed Central

    Cui, Jiaolong; Tymofiyeva, Olga; Desikan, Rahul; Flynn, Trevor; Kim, Hosung; Gano, Dawn; Hess, Christopher P; Ferriero, Donna M; Barkovich, A James; Xu, Duan

    2016-01-01

    Background and Prupose This study aims to evaluate the microstructure of the white matter tracts underlying the default mode network (DMN) in premature newborns using resting-state functional MRI (rsfMRI) in conjunction with diffusion tensor imaging (DTI)-based tractography. Material and Methods A cohort of 44 preterm infants underwent structural T1-weighted imaging, rsfMRI and DTI at 3T, including 21 infants with brain injuries and 23 infants with normal appearing structural imaging as controls. Neurodevelopment was evaluated using Bayley Scales of Infant Development (BSID) at 12 months adjusted age. Probabilistic independent components analysis was applied to rsfMRI data to explore resting state networks. The localized clusters of the DMN were used as seeding for probabilistic tractography. The DTI metrics (fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD)) of the reconstructed primary tracts within the DMN - cingula were measured. Results Results revealed decreased FA (0.20±0.03) and elevated RD values (1.24±0.16) of the cingula in the preterm infants with brain injuries compared with controls (FA: 0.25±0.03, p<0.001; RD: 1.06±0.16, p=0.001). BSID cognitive scores were significantly associated with cingulate FA (p=0.004) and RD (p=0.021), which suggest that the microstructural properties of interconnecting axonal pathways within the DMN are of critical importance in the infants’ early neurocognitive development. Conclusion This study of combined rsfMRI and DTI at rest suggests that such studies may allow for the investigation of key functional brain circuits in premature newborns, which could function not only as diagnostic tools, but also as biomarkers for long-term neurodevelopmental outcomes. PMID:28059709

  10. Duration of breastfeeding in preterm infants followed at a secondary referral service

    PubMed Central

    de Freitas, Brunnella Alcantara Chagas; Lima, Luciana Moreira; Carlos, Carla Fernanda Lisboa Valente; Priore, Silvia Eloiza; Franceschini, Sylvia do Carmo Castro

    2016-01-01

    Abstract Objective: Identify and analyze variables associated with shorter duration of breastfeeding in preterm infants. Methods: Retrospective cohort of premature infants followed up at secondary referral service in the period of 2010-2015. Inclusion: first appointment in the first month of corrected age and have undergone three or more consultations. Exclusion: diseases that impaired oral feeding. Outcome: duration of breastfeeding. A total of 103 preterm infants were evaluated, accounting for 28.8% of the preterm infants born in the municipality in that period, with a power of study of 80%. Descriptive analysis, t-test, chi-square test, Kaplan-Meier curves and Cox regression were used. p-values <0.05 were considered significant. Results: The median duration of breastfeeding among preterm infants was 5.0 months. The risk of breastfeeding discontinuation among preterm infants with gestational age <32 weeks was 2.6-fold higher than for those born at 32 weeks or more and the risk of breastfeeding interruption in preterm infants who were receiving breastfeeding supplementation in the first outpatient visit was 3-fold higher when compared to those who were exclusively breastfed in the first consultation. Conclusions: The median duration of breastfeeding in preterm infants was below the recommended one and discontinuation was associated with gestational <32 weeks and the fact that the infant was no longer receiving exclusive breastfeeding in the first outpatient visit. When these two variables were associated, their negative effect on the median duration of breastfeeding was potentiated. PMID:26614258

  11. Implications of kangaroo care for growth and development in preterm infants.

    PubMed

    Dodd, Virginia L

    2005-01-01

    To review research on kangaroo care with implications for growth and development in preterm infants. Nursing, medical, and child development research literature was searched through PubMed through 2003 using the search terms kangaroo Care, skin-to-skin, growth/development, and premature infants. Randomized controlled trials, pretest-posttest designs, and other comparative studies of kangaroo care were reviewed. Reports exploring parent perspectives were examined for attachment and parent-infant interaction findings. Theory and research regarding growth in preterm infants were explored. Research on topics of kangaroo care, skin-to-skin contact, preterm infant growth, preterm infant weight gain, and failure to thrive was evaluated. Research on kangaroo care reports physiologic safety for preterm infants and increased attachment for parents. Attachment promotes nurturing behaviors that support growth and development. Weight gain as a benefit of kangaroo care remains in question. Kangaroo care is safe for preterm infants and may have important benefits for growth and development. Suggestions are made for future research on effects of KC on preterm infants.

  12. Contingency Learning and Reactivity in Preterm and Full-Term Infants at 3 Months

    PubMed Central

    Haley, David W.; Grunau, Ruth E.; Oberlander, Tim F.; Weinberg, Joanne

    2010-01-01

    Learning difficulties in preterm infants are thought to reflect impairment in arousal regulation. We examined relationships among gestational age, learning speed, and behavioral and physiological reactivity in 55 preterm and 49 full-term infants during baseline, contingency, and nonreinforcement phases of a conjugate mobile paradigm at 3 months corrected age. For all infants, negative affect, looking duration, and heart rate levels increased during contingency and nonreinforcement phases, whereas respiratory sinus arrhythmia (RSA, an index of parasympathetic activity) decreased and cortisol did not change. Learners showed greater RSA suppression and less negative affect than nonlearners. This pattern was particularly evident in the preterm group. Overall, preterm infants showed less learning, spent less time looking at the mobile, and had lower cortisol levels than full-term infants. Preterm infants also showed greater heart rate responses to contingency and dampened heart rate responses to nonreinforcement compared to full-term infants. Findings underscore differences in basal and reactivity measures in preterm compared to full-term infants and suggest that the capacity to regulate parasympathetic activity during a challenge enhances learning in preterm infants. PMID:20717491

  13. Docosahexaenoic acid and visual functioning in preterm infants: a review.

    PubMed

    Molloy, Carly; Doyle, Lex W; Makrides, Maria; Anderson, Peter J

    2012-12-01

    Preterm children are at risk for a number of visual impairments which can be important for a range of other more complex visuocognitive tasks reliant on visual information. Despite the relatively high incidence of visual impairments in this group there are no good predictors that would allow early identification of those at risk for adverse outcomes. Several lines of evidence suggest that docosahexaenoic acid (DHA) supplementation for preterm infants may improve outcomes in this area. For example, diets deficient in the long-chain polyunsaturated fatty acid DHA have been shown to reduce its concentration in the cerebral cortex and retina, which interferes with physiological processes important for cognition and visual functioning. Further, various studies with pregnant and lactating women, as well as formula-fed infants, have demonstrated a general trend that supplementation with dietary DHA is associated with better childhood outcomes on tests of visual and cognitive development over the first year of life. However, research to date has several methodological limitations, including concentrations of DHA supplementation that have been too low to emulate the in utero accretion of DHA, using single measures of visual acuity to make generalised assumptions about the entire visual system, and little attempt to match what we know about inadequate DHA and structural ramifications with how specific functions may be affected. The objective of this review is to consider the role of DHA in the context of visual processing with a specific emphasis on preterm infants and to illustrate how future research may benefit from marrying what we know about structural consequences to inadequate DHA with functional outcomes that likely have far-reaching ramifications. Factors worth considering for clinical neuropsychological evaluation are also discussed.

  14. Zinc for preterm infants: Who needs it and how much is needed?

    USDA-ARS?s Scientific Manuscript database

    The establishment of micronutrient requirements for infants remains a challenge. For healthy full-term infants, breast milk is an appropriate standard for virtually all nutrients. In contrast, guidelines for infants who are not healthy, and infants who are born preterm, are much more tenuous....

  15. The Role of Chronic Hypoxia in the Development of Neurocognitive Abnormalities in Preterm Infants with Bronchopulmonary Dysplasia

    ERIC Educational Resources Information Center

    Raman, Lakshmi; Georgieff, Michael K.; Rao, Raghavendra

    2006-01-01

    Bronchopulmonary dysplasia is the most common pulmonary morbidity in preterm infants and is associated with chronic hypoxia. Animal studies have demonstrated structural, neurochemical and functional alterations due to chronic hypoxia in the developing brain. Long-term impairments in visual-motor, gross and fine motor, articulation, reading,…

  16. The Role of Chronic Hypoxia in the Development of Neurocognitive Abnormalities in Preterm Infants with Bronchopulmonary Dysplasia

    ERIC Educational Resources Information Center

    Raman, Lakshmi; Georgieff, Michael K.; Rao, Raghavendra

    2006-01-01

    Bronchopulmonary dysplasia is the most common pulmonary morbidity in preterm infants and is associated with chronic hypoxia. Animal studies have demonstrated structural, neurochemical and functional alterations due to chronic hypoxia in the developing brain. Long-term impairments in visual-motor, gross and fine motor, articulation, reading,…

  17. Exploratory study of EEG burst characteristics in preterm infants.

    PubMed

    Simayijiang, Zhayida; Backman, Sofia; Ulén, Johannes; Wikström, Sverre; Åstrom, Kalle

    2013-01-01

    In this paper, we study machine learning techniques and features of electroencephalography activity bursts for predicting outcome in extremely preterm infants. It was previously shown that the distribution of interburst interval durations predicts clinical outcome, but in previous work the information within the bursts has been neglected. In this paper, we perform exploratory analysis of feature extraction of burst characteristics and use machine learning techniques to show that such features could be used for outcome prediction. The results are promising, but further verification in larger datasets is needed to obtain conclusive results.

  18. Review of trace mineral requirements for preterm infants: what are the current recommendations for clinical practice?

    PubMed

    Finch, Carolyn Weiglein

    2015-02-01

    Inadequate nutrient stores at birth are an inevitable consequence of being born prematurely. Preterm infants also have high nutrient requirements, which increase with earlier gestational ages. As a result, early nutrition intervention is required to prevent further deficits that, if not corrected, can affect growth and long-term outcomes. Preterm infants often require several weeks of parenteral nutrition (PN) support, which includes trace mineral supplementation. Trace minerals are considered essential nutrients, unable to be synthesized in the human body. Deficiencies of trace minerals have been reported, yet evidence-based guidelines for assessment and supplementation have not been clearly defined. Food and Drug Administration-approved parenteral trace mineral intake guidelines are more than 30 years old. In an effort to more clearly define trace mineral supplementation and monitoring guidelines for preterm infants, a review of literature was performed with the purpose to (1) summarize trace mineral roles in preterm infants, (2) describe clinical signs of deficiency and toxicity, and (3) present intake recommendations and considerations for preterm infants based on current available literature. Review of literature was completed using PubMed and Cochrane databases to find relevant studies specific to trace mineral requirements for preterm infants, trace mineral supplementation of PN, human milk fortifiers, and preterm infant formulas. Review of literature supports that trace mineral depletion can lead to clinical compromise in preterm infants; therefore, suggesting that every effort be made to ensure adequate provision of trace minerals is given to preterm infants. Practical considerations for the clinical nutrition management of preterm infants were also identified in this review. © 2014 American Society for Parenteral and Enteral Nutrition.

  19. Developmental Outcomes of Extremely Preterm Infants Born to Adolescent Mothers

    PubMed Central

    Bann, Carla; Higgins, Rosemary; Vohr, Betty

    2015-01-01

    BACKGROUND AND OBJECTIVES: Extremely preterm infants and infants born to adolescent mothers are at risk for adverse developmental. The objectives were to evaluate development and behavior outcomes of extremely low birth weight (ELBW) infants born to adolescent mothers <20 compared with adult mothers ≥20 years and to identify socioeconomic risk factors that affect outcomes. METHODS: Retrospective cohort analysis of 211 infants >27 weeks of adolescent mothers and 1723 infants of adult mothers at Neonatal Research Network centers from 2008 to 2011. Groups were compared and regression models were run to predict 18- to 22-month adverse outcomes. Primary outcomes were Bayley-III scores, neurodevelopmental impairment, and Brief Infant Toddler Social Emotional Assessment problem scores (BITSEA/P) ≥75th percentile. RESULTS: Adolescent mothers were more often single, Hispanic, less educated, and had public insurance. By 18 to 22 months, their children had significantly increased rates of having lived ≥3 places (21% vs 9%), state supervision (7% vs 3%), rehospitalization (56% vs 46%), and BITSEA/P ≥75th percentile (50% vs 32%) and nonsignificant Bayley-III language scores <85 (56% vs 49%, P = .07). In regression analysis, children of adolescent mothers were more likely to have BITSEA/P ≥75th percentile (relative risk 1.50, 95% confidence interval 1.08–2.07). Living ≥3 places and nonwhite race were predictors of adverse behavior. State supervision was an independent predictor of each Bayley-III composite <70 and neurodevelopmental impairment. CONCLUSIONS: ELBW infants of adolescent mothers experience high social and environmental risks that are associated with adverse behavior outcomes. These findings inform the need for comprehensive follow-up, coordinated care services, and behavior interventions for ELBW infants of adolescent mothers. PMID:25963007

  20. Developmental outcomes of extremely preterm infants born to adolescent mothers.

    PubMed

    Hoffman, Laurie; Bann, Carla; Higgins, Rosemary; Vohr, Betty

    2015-06-01

    Extremely preterm infants and infants born to adolescent mothers are at risk for adverse developmental. The objectives were to evaluate development and behavior outcomes of extremely low birth weight (ELBW) infants born to adolescent mothers <20 compared with adult mothers ≥20 years and to identify socioeconomic risk factors that affect outcomes. Retrospective cohort analysis of 211 infants >27 weeks of adolescent mothers and 1723 infants of adult mothers at Neonatal Research Network centers from 2008 to 2011. Groups were compared and regression models were run to predict 18- to 22-month adverse outcomes. Primary outcomes were Bayley-III scores, neurodevelopmental impairment, and Brief Infant Toddler Social Emotional Assessment problem scores (BITSEA/P) ≥75th percentile. Adolescent mothers were more often single, Hispanic, less educated, and had public insurance. By 18 to 22 months, their children had significantly increased rates of having lived ≥3 places (21% vs 9%), state supervision (7% vs 3%), rehospitalization (56% vs 46%), and BITSEA/P ≥75th percentile (50% vs 32%) and nonsignificant Bayley-III language scores <85 (56% vs 49%, P = .07). In regression analysis, children of adolescent mothers were more likely to have BITSEA/P ≥75th percentile (relative risk 1.50, 95% confidence interval 1.08-2.07). Living ≥3 places and nonwhite race were predictors of adverse behavior. State supervision was an independent predictor of each Bayley-III composite <70 and neurodevelopmental impairment. ELBW infants of adolescent mothers experience high social and environmental risks that are associated with adverse behavior outcomes. These findings inform the need for comprehensive follow-up, coordinated care services, and behavior interventions for ELBW infants of adolescent mothers. Copyright © 2015 by the American Academy of Pediatrics.

  1. The effect of kangaroo care on neurodevelopmental outcomes in preterm infants.

    PubMed

    Head, Lauren M

    2014-01-01

    Preterm birth is associated with long-term deficits in executive functioning and cognitive performance. As advances in neonatal care enable more preterm infants to survive, development of strategies to address high rates of neurodevelopmental disabilities and poor academic achievement in preterm infants are crucial. Evidence suggests that infants' brains are plastic in nature and, therefore, can be shaped by the environment. Kangaroo care has become popularized as a means of modifying the stress of the NICU environment. However, few studies have examined whether kangaroo care affects neurodevelopmental outcomes in preterm infants. This review examined available literature that investigated the effect of kangaroo care on cognition in preterm infants. Current evidence suggests that short-term benefits of kangaroo care are associated with improved neurodevelopment. However, few studies have examined the long-term impact of kangaroo care on cognitive outcomes in preterm infants. To address neurological disparities in children born preterm, research using kangaroo care as a strategy to improve neurodevelopment in preterm infants is warranted.

  2. Music as a nursing intervention for preterm infants in the NICU.

    PubMed

    Neal, Diana O; Lindeke, Linda L

    2008-01-01

    Although there is general agreement that noise in the neonatal intensive care unit should be reduced, there is controversy about the use of music as a developmental care strategy with prererm infants. Much literature supports using music with preterm infants, indicating that it enhances physiologic and neurobehavioral functioning, but some experts worry that music is overstimulating. This article presents evidence supporting the use of music with preterm infants as well as criticism of same. Recommendations for music interventions with preterm infants are discussed, although fUrther research is needed before specific guidelines can he established.

  3. Disparities in mortality rates among US infants born late preterm or early term, 2003-2005.

    PubMed

    King, Jennifer P; Gazmararian, Julie A; Shapiro-Mendoza, Carrie K

    2014-01-01

    The purpose of this study was to identify disparities in neonatal, post-neonatal, and overall infant mortality rates among infants born late preterm (34-36 weeks gestation) and early term (37-38 weeks gestation) by race/ethnicity, maternal age, and plurality. In analyses of 2003-2005 data from US period linked birth/infant death datasets, we compared infant mortality rates by race/ethnicity, maternal age, and plurality among infants born late preterm or early term and also determined the leading causes of death among these infants. Among infants born late preterm, infants born to American Indian/Alaskan Native, non-Hispanic black, or teenage mothers had the highest infant mortality rates per 1,000 live births (14.85, 9.90, and 11.88 respectively). Among infants born early term, corresponding mortality rates were 5.69, 4.49, and 4.82, respectively. Among infants born late preterm, singletons had a higher infant mortality rate than twins (8.59 vs. 5.62), whereas among infants born early term, the rate was higher among twins (3.67 vs. 3.15). Congenital malformations and sudden infant death syndrome were the leading causes of death among both late preterm and early term infants. Infant mortality rates among infants born late preterm or early term varied substantially by maternal race/ethnicity, maternal age, and plurality. Information about these disparities may help in the development of clinical practice and prevention strategies targeting infants at highest risk.

  4. Disparities in Mortality Rates Among US Infants Born Late Preterm or Early Term, 2003–2005

    PubMed Central

    Gazmararian, Julie A.; Shapiro-Mendoza, Carrie K.

    2015-01-01

    The purpose of this study was to identify disparities in neonatal, post-neonatal, and overall infant mortality rates among infants born late preterm (34–36 weeks gestation) and early term (37–38 weeks gestation) by race/ethnicity, maternal age, and plurality. In analyses of 2003–2005 data from US period linked birth/infant death datasets, we compared infant mortality rates by race/ethnicity, maternal age, and plurality among infants born late preterm or early term and also determined the leading causes of death among these infants. Among infants born late preterm, infants born to American Indian/Alaskan Native, non-Hispanic black, or teenage mothers had the highest infant mortality rates per 1,000 live births (14.85,9.90, and 11.88 respectively). Among infants born early term, corresponding mortality rates were 5.69, 4.49, and 4.82, respectively. Among infants born late preterm, singletons had a higher infant mortality rate than twins (8.59 vs. 5.62), whereas among infants born early term, the rate was higher among twins (3.67 vs. 3.15). Congenital malformations and sudden infant death syndrome were the leading causes of death among both late preterm and early term infants. Infant mortality rates among infants born late preterm or early term varied substantially by maternal race/ ethnicity, maternal age, and plurality. Information about these disparities may help in the development of clinical practice and prevention strategies targeting infants at highest risk. PMID:23519825

  5. High versus standard volume enteral feeds to promote growth in preterm or low birth weight infants.

    PubMed

    Abiramalatha, Thangaraj; Thomas, Niranjan; Gupta, Vijay; Viswanathan, Anand; McGuire, William

    2017-09-12

    registries. Randomised and quasi-randomised controlled trials that compared high-volume versus standard-volume enteral feeds for preterm or low birth weight infants. Two review authors assessed trial eligibility and risk of bias and independently extracted data. We analysed treatment effects in individual trials and reported the risk ratio and risk difference for dichotomous data, and the mean difference for continuous data, with respective 95% confidence intervals. . We assessed the quality of evidence at the outcome level via the GRADE approach. We found one eligible trial that included 64 infants. This trial was not blinded. Analysis showed a higher rate of weight gain in the high-volume feeds group: mean difference 6.20 g/kg/d (95% confidence interval 2.71 to 9.69). There was no increase in the risk of feed intolerance or necrotising enterocolitis with high-volume feeds, but 95% confidence intervals around these estimates were wide. We assessed the quality of evidence for these outcomes as 'low' or 'very low' because of imprecision of the estimates of effect and concern about risk of bias due to lack of blinding in the included trial. Trial authors provided no data on other outcomes, including gastro-oesophageal reflux, aspiration pneumonia, necrotising enterocolitis, patent ductus arteriosus, bronchopulmonary dysplasia, or long-term growth and neurodevelopment. We found only very limited data from one small unblinded trial on the effects of high-volume feeds on important outcomes for preterm or low birth weight infants. The quality of evidence is low to very low. Hence, available evidence is insufficient to support or refute high-volume enteral feeds in preterm or low birth weight infants. A large, pragmatic randomised controlled trial is needed to provide data of sufficient quality and precision to inform policy and practice.

  6. Regional (spinal, epidural, caudal) versus general anaesthesia in preterm infants undergoing inguinal herniorrhaphy in early infancy.

    PubMed

    Jones, Lisa J; Craven, Paul D; Lakkundi, Anil; Foster, Jann P; Badawi, Nadia

    2015-06-09

    combined regional and general anaesthesia, in former preterm infants undergoing inguinal herniorrhaphy in early infancy. At least two of three review authors (LJ, JF, AL) independently extracted data and performed analyses. Authors were contacted to obtain missing data. The methodological quality of each study was assessed according to the criteria of the Cochrane Neonatal Review Group. Data were analysed using Review Manager 5. Meta-analyses were performed with calculation of risk ratios (RR) and risk difference (RD), along with their 95% confidence intervals (CI) where appropriate. Seven small trials comparing spinal with general anaesthesia in the repair of inguinal hernia were identified. Two trial reports are listed as 'Studies awaiting classification' due to insufficient information on which to base an eligibility assessment. There was no statistically significant difference in the risk of postoperative apnoea/bradycardia (typical RR 0.72, 95% CI 0.48 to 1.06; 4 studies, 138 infants), postoperative oxygen desaturation (typical RR 0.82, 95% CI 0.61 to 1.11; 2 studies, 48 infants), the use of postoperative analgesics (RR 0.42, 95% CI 0.15 to 1.18; 1 study, 44 infants), or postoperative respiratory support (typical RR 0.09, 95% CI 0.01 to1.64; 3 studies, 98 infants) between infants receiving spinal or general anaesthesia. When infants who had received preoperative sedatives were excluded, the meta-analysis supported a reduction in the risk of postoperative apnoea in the spinal anaesthesia group (typical RR 0.53, 95% CI 0.34 to 0.82; 4 studies, 129 infants). Infants with no history of apnoea in the preoperative period and receiving spinal anaesthesia (including a subset of infants who had received sedatives) had a reduced risk of postoperative apnoea and this reached statistical significance (typical RR 0.34, 95% CI 0.14 to 0.81; 4 studies, 134 infants). Infants receiving spinal rather than general anaesthesia had a statistically significant increased risk of anaesthetic

  7. Accurate automated apnea analysis in preterm infants.

    PubMed

    Vergales, Brooke D; Paget-Brown, Alix O; Lee, Hoshik; Guin, Lauren E; Smoot, Terri J; Rusin, Craig G; Clark, Matthew T; Delos, John B; Fairchild, Karen D; Lake, Douglas E; Moorman, Randall; Kattwinkel, John

    2014-02-01

    In 2006 the apnea of prematurity (AOP) consensus group identified inaccurate counting of apnea episodes as a major barrier to progress in AOP research. We compare nursing records of AOP to events detected by a clinically validated computer algorithm that detects apnea from standard bedside monitors. Waveform, vital sign, and alarm data were collected continuously from all very low-birth-weight infants admitted over a 25-month period, analyzed for central apnea, bradycardia, and desaturation (ABD) events, and compared with nursing documentation collected from charts. Our algorithm defined apnea as > 10 seconds if accompanied by bradycardia and desaturation. Of the 3,019 nurse-recorded events, only 68% had any algorithm-detected ABD event. Of the 5,275 algorithm-detected prolonged apnea events > 30 seconds, only 26% had nurse-recorded documentation within 1 hour. Monitor alarms sounded in only 74% of events of algorithm-detected prolonged apnea events > 10 seconds. There were 8,190,418 monitor alarms of any description throughout the neonatal intensive care unit during the 747 days analyzed, or one alarm every 2 to 3 minutes per nurse. An automated computer algorithm for continuous ABD quantitation is a far more reliable tool than the medical record to address the important research questions identified by the 2006 AOP consensus group. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  8. Accurate Automated Apnea Analysis in Preterm Infants

    PubMed Central

    Vergales, Brooke D.; Paget-Brown, Alix O.; Lee, Hoshik; Guin, Lauren E.; Smoot, Terri J.; Rusin, Craig G.; Clark, Matthew T.; Delos, John B.; Fairchild, Karen D.; Lake, Douglas E.; Moorman, Randall; Kattwinkel, John

    2017-01-01

    Objective In 2006 the apnea of prematurity (AOP) consensus group identified inaccurate counting of apnea episodes as a major barrier to progress in AOP research. We compare nursing records of AOP to events detected by a clinically validated computer algorithm that detects apnea from standard bedside monitors. Study Design Waveform, vital sign, and alarm data were collected continuously from all very low-birth-weight infants admitted over a 25-month period, analyzed for central apnea, bradycardia, and desaturation (ABD) events, and compared with nursing documentation collected from charts. Our algorithm defined apnea as > 10 seconds if accompanied by bradycardia and desaturation. Results Of the 3,019 nurse-recorded events, only 68% had any algorithm-detected ABD event. Of the 5,275 algorithm-detected prolonged apnea events > 30 seconds, only 26% had nurse-recorded documentation within 1 hour. Monitor alarms sounded in only 74% of events of algorithm-detected prolonged apnea events > 10 seconds. There were 8,190,418 monitor alarms of any description throughout the neonatal intensive care unit during the 747 days analyzed, or one alarm every 2 to 3 minutes per nurse. Conclusion An automated computer algorithm for continuous ABD quantitation is a far more reliable tool than the medical record to address the important research questions identified by the 2006 AOP consensus group. PMID:23592319

  9. Deformation of the palate in preterm infants

    PubMed Central

    Procter, A.; Lether, D.; Oliver, R.; Cartlidge, P. H.

    1998-01-01

    AIM—To investigate the effect of gestation, postmenstrual age, and orotracheal intubation on palate morphology.
METHODS—A prospective study was made of 76 newborn infants of 25 to 41 weeks' gestation. Palate dimensions were measured on plaster models produced from serial palatal impressions. Palate size relative to that of the mouth was assessed using a ratio of palate depth to palate width (Palatal Index).
RESULTS—Palate depth and width were related to postmenstrual age and gestation. Palatal Index ranged from 0.15 to 0.57, indicating a wide variation in palate shape, but gestation and postmenstrual age had no effect. Prolonged intubation had a small effect, equivalent to an increase in palatal depth of less than 2 mm at 32 weeks' postmenstrual age. The effect was transient.
CONCLUSION—Prolonged orotracheal intubation (>10 days) leads to a small and temporary increase in palatal depth. However, this is unlikely to account for palatal grooving, which is probably caused by an overgrowth of the lateral palatine ridges.

 PMID:9536837

  10. Developmental study of early posture control in preterm and fullterm infants.

    PubMed

    Gaetan, Eliane Mewes; Moura-Ribeiro, Maria Valeriana L

    2002-12-01

    In a prospective study, 10 infants born between 32 to 36 weeks of gestation and 10 infants born at fullterm were observed on day 15, and in months 1, 2 and 3. The investigation showed that the development of early postural control takes place in a sequential way in preterm infants, similar to that of in fullterm infants. However, some movement components for the acquisition of motor abilities showed a different trend in the development of preterm infants when compared to fullterm infants: the onset for the acquisition of the extensor and flexor patterns was slower and the distribution of the load bearing was less mature.

  11. Stem-Like Cell Characteristics from Breast Milk of Mothers with Preterm Infants as Compared to Mothers with Term Infants.

    PubMed

    Briere, Carrie-Ellen; Jensen, Todd; McGrath, Jacqueline M; Young, Erin E; Finck, Christine

    2017-04-01

    Breast milk stem cells are hypothesized to be involved in infant health and development. Our research team is the first known team to enroll mothers of hospitalized preterm infants during the first few weeks of lactation and compare stem cell phenotypes and gene expression to mothers of healthy full-term infants. Participants were recruited from a Level IV Neonatal Intensive Care Unit (preterm dyads) and the community (full-term dyads) in the northeastern United States. Mothers of hospitalized preterm infants (<37 weeks gestational age at birth) and mothers of healthy full-term infants (>39 weeks gestational age at birth). Breast milk stem-like cell populations were identified in both preterm and full-term breast milk samples. The data suggest variability in the proportion of stem cell phenotypes present, as well as statistically significant differential expression (both over- and underexpression) of stem cell-specific genetic markers when comparing mothers' milk for preterm and full-term births. Our findings indicate that (1) stem cells are present in preterm breast milk; (2) differential expression of stem cell-specific markers can be detected in preterm and full-term breast milk samples; and (3) the percentage of cells expressing the various stem cell-specific markers differs when preterm and full-term breast milk samples are compared.

  12. [Clinical features and magnetic resonance imaging evaluation of encephalopathy in high-risk late preterm infants].

    PubMed

    Zhu, Yan; Zhang, Ke; Hu, Lan; Xiao, Mi-Li; Li, Zhi-Hua; Chen, Chao

    2017-05-01

    To investigate the risk factors, clinical features, and magnetic resonance imaging (MRI) changes of encephalopathy in high-risk late preterm infants. Head MRI scan was performed for late preterm infants with high-risk factors for brain injury who were hospitalized between January 2009 and December 2014. The risk factors, clinical features, and head MRI features of encephalopathy in late preterm infants were analyzed. A total of 1 007 late preterm infants underwent MRI scan, among whom 313 (31.1%) had imaging features in accordance with the features of encephalopathy of prematurity. Of all infants, 76.7% had white matter damage. There was no association between the development of encephalopathy and gestational age in late preterm infants, but the detection rate of encephalopathy gradually increased with the increasing birth weight (P<0.05). The logistic regression analysis showed that a history of resuscitation was an independent risk factor for encephalopathy of prematurity (P<0.01). Encephalopathy of prematurity is commonly seen in high-risk late preterm infants, especially white matter damage. A history of resuscitation is an independent risk factor for encephalopathy in late preterm infants.

  13. Maturity of the adrenal cortex in very preterm infants is related to gestational age.

    PubMed

    Bolt, Roel J; Van Weissenbruch, Mirjam M; Popp-Snijders, Corrie; Sweep, Fred G J; Lafeber, Harry N; Delemarre-van de Waal, Henriette A

    2002-09-01

    To study the maturity of the adrenal cortex in preterms born before 33 wk of gestation, basal levels of cortisol and cortisone and the cortisol and 17-hydroxyprogesterone (17-OHP) response to 1 microg/kg adrenocorticotropic hormone stimulation were measured in 24 appropriate-for-gestational age preterm infants (26-33 wk; 690-1985 g). Gestational age influenced the response of cortisol, 17-OHP, and the ratio between cortisol/17-OHP in the studied infants. In preterms born <30 wk of gestation, levels of cortisol, and the ratio between cortisol/17-OHP were lower compared with preterms born between 30 and 33 wk. Levels of cortisone were higher in preterms born <30 wk, suggesting a lower activity of 11 beta-hydroxysteroid dehydrogenase that may be related to maturity as well. These findings indicate that the adrenal cortex function in preterm infants is closely related to the duration of gestation and may be important in neonatal morbidity.

  14. Bilingualism as a potential strategy to improve executive function in preterm infants: a review.

    PubMed

    Head, Lauren M; Baralt, Melissa; Darcy Mahoney, Ashley E

    2015-01-01

    Preterm birth is associated with long-term deficits in executive functioning and cognitive performance. Using the model of brain plasticity as a theoretical framework, it is possible that preterm infants' neurodevelopmental sequelae can be altered. Evidence suggests that bilingualism confers cognitive advantages on executive functioning, so it is possible that bilingualism may improve preterm infants' neurodevelopment. However, bilingualism has only been studied in term children. This review examined literature that compared the performance of preterm-born children to term children and bilingual children to monolingual children on executive function tasks. To address cognitive disparities in preterm-born children, studies investigating the effect of bilingualism on preterm infants' executive functioning is warranted.

  15. The Effect of the Infant Behavioral Assessment and Intervention Program on Mother-Infant Interaction after Very Preterm Birth

    ERIC Educational Resources Information Center

    Meijssen, Dominique; Wolf, Marie-Jeanne; Koldewijn, Karen; Houtzager, Bregje A.; Van Wassenaer, Aleid; Tronick, Ed; Kok, Joke; Van Baar, Anneloes

    2010-01-01

    Background: Prematurity and perinatal insults lead to increased developmental vulnerability. The home-based Infant Behavioral Assessment and Intervention Program (IBAIP) was designed to improve development of preterm infants. In a multicenter randomized controlled trial the effect of IBAIP on mother-infant interaction was studied as a secondary…

  16. The Effect of the Infant Behavioral Assessment and Intervention Program on Mother-Infant Interaction after Very Preterm Birth

    ERIC Educational Resources Information Center

    Meijssen, Dominique; Wolf, Marie-Jeanne; Koldewijn, Karen; Houtzager, Bregje A.; Van Wassenaer, Aleid; Tronick, Ed; Kok, Joke; Van Baar, Anneloes

    2010-01-01

    Background: Prematurity and perinatal insults lead to increased developmental vulnerability. The home-based Infant Behavioral Assessment and Intervention Program (IBAIP) was designed to improve development of preterm infants. In a multicenter randomized controlled trial the effect of IBAIP on mother-infant interaction was studied as a secondary…

  17. Not ready for prime time: transitional events in the extremely preterm infant.

    PubMed

    Armentrout, Debra

    2014-01-01

    Successful transition from intrauterine to extrauterine life involves significant physiologic changes. The majority of these changes occur relatively quickly during those first moments following delivery; however, transition for the extremely preterm infant occurs over a longer period of time. Careful assessment and perceptive interventions on the part of neonatal care providers is essential as the extremely preterm infant adjusts to life outside the womb. This article will focus on respiratory, cardiovascular, gastrointestinal, and neurologic transitional events experienced by the extremely premature infant.

  18. Sequela of preterm versus term infants born to mothers on a methadone maintenance program: differential course of neonatal abstinence syndrome.

    PubMed

    Dysart, Kevin; Hsieh, Hui-Chen; Kaltenbach, Karol; Greenspan, Jay S

    2007-01-01

    We determined the effect of preterm delivery on the course of neonatal abstinence syndrome (NAS) in infants born to mothers participating in a methadone maintenance program. A retrospective cohort study was conducted in which infant and maternal data were collected from the medical records of 53 preterm and 66 term infants. Infants were selected from all infants admitted to Thomas Jefferson University hospital born between 1998 and 2002 whose mothers were enrolled in the methadone maintenance program. All infants were managed by a standard protocol utilizing the Neonatal Abstinence Scoring System (NASS) and neonatal opiate solution (NOS). Preterm and term infants were compared. Preterm infants had shorter lengths of stay, treatment courses and required less medication than did term infants during the same time period. These data indicate that following exposure to maternal methadone, preterm infants have a different neonatal course than do infants born at term.

  19. Challenges in Treating Low Blood Pressure in Preterm Infants

    PubMed Central

    Dempsey, Eugene M.

    2015-01-01

    Whilst the prevalence of low blood pressure in preterm infants seems to have fallen over the last number of years, the problem is still frequently encountered in the neonatal intensive care unit and many babies continue to receive intervention. Great variability in practice persists, with a significant number of extremely low gestational age newborns in some institutions receiving some form of intervention, and in other units substantially less. A great degree of this variability relates to the actual criteria used to define hypotension, with some using blood pressure values alone to direct therapy and others using a combination of clinical, biochemical and echocardiography findings. The choice of intervention remains unresolved with the majority of centres continuing to administer volume followed by dopamine as a first line inotrope/vasopressor agent. Despite over 40 years of use there is little evidence that dopamine is of benefit both in the short term and long-term. Long-term follow up is available in only two randomised trials, which included a total of 99 babies. An under recognized problem relates to the administration of inotrope infusions in very preterm infants. There are no pediatric specific inotrope formulations available and so risks of errors in preparation and administration remain. This manuscript outlines these challenges and proposes some potential solutions. PMID:27417363

  20. Alberta Infant Motor Scale (AIMS) Performance of Greek Preterm Infants: Comparisons With Full-Term Infants of the Same Nationality and Impact of Prematurity-Related Morbidity Factors.

    PubMed

    Syrengelas, Dimitrios; Kalampoki, Vassiliki; Kleisiouni, Paraskevi; Manta, Vassiliki; Mellos, Stavros; Pons, Roser; Chrousos, George P; Siahanidou, Tania

    2016-07-01

    Only a few studies have been conducted with the objective of creating norms of the Alberta Infant Motor Scale (AIMS) for the assessment of gross motor development of preterm infants. The AIMS performance of preterm infants has been compared with that of the Canadian norms of full-term infants, but not with that of full-term infants of the same nationality. Moreover, the possible impact of prematurity-related morbidity factors on AIMS performance is unknown. The aims of this study were: (1) to evaluate AIMS trajectory in a large population of Greek preterm infants and create norms, (2) to compare it with the AIMS trajectory of Greek full-term infants, and (3) to examine the possible influence of neonatal morbidity on AIMS scores in the preterm sample. This was a cross-sectional study. Mean AIMS scores were compared, per month (1-19), between 403 preterm infants (≤32 weeks of age, corrected for prematurity) and 1,038 full-term infants. In preterm infants, the association of AIMS scores with respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH) of grade ≤III, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and sepsis was assessed by hierarchical regression analysis. Alberta Infant Motor Scale scores were significantly lower in preterm infants than in full-term infants. Mean AIMS scores in preterm infants were significantly associated with RDS (b=-1.93; 95% CI=-2.70, -1.16), IVH (b=-0.97; 95% CI=-1.69, -0.25), and ROP (b=-1.12; 95% CI=-1.99, -0.24) but not with BPD or sepsis in hierarchical regression analysis. Alberta Infant Motor Scale norms were created for Greek preterm infants. This study confirms that AIMS trajectories of preterm infants are below those of full-term infants of the same nationality. The influence of morbidity factors, including RDS, IVH, and ROP, should be taken into account when administering the AIMS in preterm infants. © 2016 American Physical Therapy Association.

  1. Metabolic bone disease in the preterm infant: Current state and future directions

    PubMed Central

    Rehman, Moghis Ur; Narchi, Hassib

    2015-01-01

    Neonatal osteopenia is an important area of interest for neonatologists due to continuing increased survival of preterm infants. It can occur in high-risk infants such as preterm infants, infants on long-term diuretics or corticosteroids, and those with neuromuscular disorders. Complications such as rickets, pathological fractures, impaired respiratory function and poor growth in childhood can develop and may be the first clinical evidence of the condition. It is important for neonatologists managing such high-risk patients to regularly monitor biochemical markers for evidence of abnormal bone turnover and inadequate mineral intake in order to detect the early phases of impaired bone mineralization. Dual-energy X-ray absorptiometry has become an increasingly used research tool for assessing bone mineral density in children and neonates, but more studies are still needed before it can be used as a useful clinical tool. Prevention and early detection of osteopenia are key to the successful management of this condition and oral phosphate supplements should be started as soon as is feasible. PMID:26413483

  2. Cell-Associated Interleukin-8 in Cord Blood of Term and Preterm Infants

    PubMed Central

    Dembinski, J.; Behrendt, D.; Heep, A.; Dorn, C.; Reinsberg, J.; Bartmann, P.

    2002-01-01

    To assess the effect of gestational age and labor on the interleukin-8 (IL-8) concentration in whole cord blood and serum, IL-8 levels were determined simultaneously in cord blood serum and lysate in 134 infants. Following the elimination of some of the samples due to exclusion criteria, the data for 99 uninfected infants (71 term and 28 preterm) and 9 infants with neonatal bacterial infection delivered either vaginally or by elective or emergency cesarean section were analyzed. The effects of labor and gestational age were tested by analysis of variance. IL-8 was not detectable in the serum of 25 infants, whereas IL-8 levels in whole blood were measurable in all of the samples. The median IL-8 conncentrations in whole cord blood lysate were 106 pg/ml (range, 20 to 415 pg/ml) in preterm infants and 176 pg/ml (range, 34 to 1,667 pg/ml) in term infants. In contrast to the IL-8 levels in serum, IL-8 levels in whole blood were reduced after ECS. Gestational age had no independent effect on the IL-8 concentrations in either serum or whole blood; these concentrations increased in infected infants after labor. We conclude that the neonatal proinflammatory response to labor stress was more evident in the concentrations of IL-8 in whole blood than in serum. The levels of IL-8 in whole-blood lysate reflect proinflammatory stimulation in neonates and may be a useful diagnostic tool for the early diagnosis of neonatal infection. PMID:11874870

  3. Severe bronchiolitis in infants born very preterm and neurodevelopmental outcome at 2 years.

    PubMed

    Gouin, Marion; Nguyen, Sylvie; Savagner, Christophe; Troussier, Francoise; Gascouin, Géraldine; Rozé, Jean-Christophe; Flamant, Cyril

    2013-05-01

    Preterm infants are at greater risk of bronchopulmonary dysplasia, which is associated with neurodevelopmental impairment. These infants are also more likely to develop severe bronchiolitis, which can contribute to neurodevelopmental impairment. The aim of this study was to determine whether severe bronchiolitis in very preterm infants (born before 33 weeks of gestation) was associated with an increased risk of neurodevelopmental impairment at 2 years of age. We analyzed a population-based cohort of infants (the Loire Infant Follow-up Team cohort) born between 1 January 2003 and 31 December 2009. Severe bronchiolitis was defined as hospitalization due to bronchiolitis during the first year of life. Neurodevelopmental outcome was assessed at 2 years of corrected age. A total of 2,405 infants were included in this analysis and categorized based on neonatal respiratory status: 1,308 (54.4 %) received no respiratory assistance, 864(35.9 %) received oxygen for <28 days, and 167 (6.9 %) had mild and 66 (2.7) moderate or severe bronchopulmonary dysplasia. At 2 years, 502 children displayed non-optimal neurodevelopmental outcome (20.9 %). Moderate or severe bronchopulmonary dysplasia was significantly associated with non-optimal neurodevelopmental outcome at 2 years (adjusted odds ratios (OR) = 2.3 [95 % confidence interval (CI): 1.3-3.9], p = 0.003). In the first year, 318 infants acquired severe bronchiolitis (13.2 %), which was not associated with non-optimal neurodevelopmental outcome (adjusted OR = 1.0 [95 % CI: 0.8-1.4]; p = 0.88). In conclusion, respiratory status in the neonatal period was significantly associated with non-optimal neurodevelopmental outcome at 2 years, while severe bronchiolitis was not.

  4. Postural Complexity Differs Between Infant Born Full Term and Preterm During the Development of Early Behaviors

    PubMed Central

    Dusing, Stacey C; Izzo, Theresa A.; Thacker, Leroy R.; Galloway, James C

    2014-01-01

    Background and Aims Postural control differs between infants born preterm and full term at 1–3 weeks of age. It is unclear if differences persist or alter the development of early behaviors. The aim of this longitudinal study was to compare changes in postural control variability during development of head control and reaching in infants born preterm and full term. Methods Eighteen infants born preterm (mean gestational age 28.3±3.1 weeks) were included in this study and compared to existing data from 22 infants born full term. Postural variability was assessed longitudinally using root mean squared displacement and approximate entropy of the center of pressure displacement from birth to 6 months as measures of the magnitude of the variability and complexity of postural control. Behavioral coding was used to quantify development of head control and reaching. Results Group differences were identified in postural complexity during the development of head control and reaching. Infants born preterm used more repetitive and less adaptive postural control strategies than infants born full term. Both groups changed their postural complexity utilized during the development of head control and reaching. Discussion Early postural complexity was decreased in infants born preterm, compared to infants born full term. Commonly used clinical assessments did not identify these early differences in postural control. Altered postural control in infants born preterm influenced ongoing skill development in the first six months of life. PMID:24485170

  5. Lumbar cisternography in evaluation of hydrocephalus in the preterm infant

    SciTech Connect

    Donn, S.M.; Roloff, D.W.; Keyes, J.W. Jr.

    1983-10-01

    Radionuclide lumbar cisternography using indium 111-diethylenetriamine pentaacetic acid (111In-DTPA) and a mobile gamma-camera with a converging collimator was utilized as a bedside procedure to evaluate CSF dynamics and the patency of the cerebral ventricular system in 30 preterm infants with hydrocephalus. Serial images of the brain were obtained at 0, 1, 2, 6, 24, and 48 hours after instillation of the isotope in the lumbar subarachnoid space. Three distinct patterns were seen. Infants with posthemorrhagic hydrocephalus displayed prompt ventricular filling but markedly delayed emptying with minimal flow over the cerebral convexities. Infants with ventriculomegaly secondary to suspected brain atrophy or periventricular leukomalacia demonstrated a pattern of prompt ventricular filling, delayed emptying, but with flow present over the convexities. An infant with noncommunicating hydrocephalus secondary to an Arnold-Chiari malformation showed a pattern of complete obstruction with no ventricular filling. Radionuclide lumbar cisternography appears to be a safe, well-tolerated procedure which produces images of sufficient resolution to provide valuable information about CSF dynamics, delineating basal cisternae, ventricles, and subarachnoid flow paths.

  6. Light reduction and the electroretinogram of preterm infants

    PubMed Central

    Kennedy, K.; Ipson, M.; Birch, D.; Tyson, J.; Anderson, J.; Nusinowitz, S.; West, L.; Spencer, R.; Birch, E.

    1997-01-01

    AIMS—To examine the effects of light on retinal development and function in preterm infants as measured by the electroretinogram (ERG). Secondary outcomes included visual acuity testing, the incidence of retinopathy of prematurity, and general wellbeing, reflected in feeding tolerance, rate of weight gain, and length of hospital stay.
METHODS—Eligibility criteria for enrolment were birthweight ⩽ 1250 g and gestational age ⩽ 31 weeks. Sixty one infants were randomly allocated by 6 hours after birth to a control or treatment group which wore 97% light filtering goggles for a minimum of four weeks or until the infant reached 31 weeks postmenstrual age.
RESULTS—There were no significant differences between the two groups in the numbers of electroretinograms performed at 36 weeks of postmenstrual age. Although the sample size was not large enough to exclude clinically important differences in secondary outcomes, no significant differences were observed between the groups in visual acuity testing at 4-6 months corrected age, incidence of retinopathy of prematurity, weight gain, or length of stay.
CONCLUSION—These data support the safety and feasibility of this intervention. A much larger study will be needed to determine whether light reduction to the eyes of very low birthweight infants will reduce the incidence of retinopathy of prematurity or enhance general wellbeing.

 Keywords: light exposure; retinal development; electroretinogram PMID:9175946

  7. Home Visiting and the Health of Preterm Infants.

    PubMed

    Casey, Patrick H; Irby, Carmen; Withers, Sandra; Dorsey, Susan; Li, Jingyun; Rettiganti, Malik

    2017-08-01

    The results of home visiting programs which target medically fragile low-birth-weight preterm infants (LBWPT) have been inconsistent. We provided nurse/social worker home visits to families of LBWPT infants on a regular schedule. Teams were trained in approaches to improve the health and development of the infants. The completion of immunization series was sigmificantly higher and the infant mortality rates of the home visits childen were significanly lower compared to national and state rates. We used state Medicaid data and examined frequency of hospitalization, emergency department visits, routine and nonscheduled visits to primary care physician, and pharmacy use of the home-visited subjects compared with a propensity-matched group. The home-visited group had more routine and nonscheduled visits but no more hospitalizations or E.D. visits. Home visiting teams improved important markers of child health, including completed immunizations and mortality rate, perhaps by the careful monitoring of health status and assuring health care when needed.

  8. [Breast feeding rates and factors influencing breast feeding practice in late preterm infants: comparison with preterm born at less than 34 weeks of gestational age].

    PubMed

    Jang, Gun Ja; Lee, Sang Lak; Kim, Hyeon Mi

    2012-04-01

    This study was done to compare breast feeding rates and factors influencing feeding practice between late preterm (34 ≤ GA < 37) and preterm infants (GA<34). A survey was done of 207 late preterm and 117 preterm infants in neonatal intensive care units (NICU) of 4 university hospitals in D city. Data were collected from July 2009 to June 2010 from 324 medical records in the NICU. Breast-feeding at home was checked either by telephone survey or questioning during hospital visits. Rate of breast feeding for late preterm infants was significantly lower than for preterm infants. There was no significant difference in breast-feeding at home. We found differences in factors influencing breast feeding between the two groups. Factors influencing feeding for late preterm infants were type of delivery, mothers' occupation, feeding type during hospitalization, time elapse from hospital discharge, total admission days, infant's body weight at first feeding and length of NPO (nothing by mouth). Factors influencing feeding for preterm infants were birth order, maternal disease and obstetric complications, and one-minute Apgar score. Results of the study show low rates of breast-feeding for late preterm infants indicating a need for breast-feeding education for mothers of these infants.

  9. Early Vocalization of Preterm Infants with Extremely Low Birth Weight (ELBW), Part I: From Birth to Expansion Stage

    ERIC Educational Resources Information Center

    Torola, Helena; Lehtihalmes, Matti; Heikkinen, Hanna; Olsen, Paivi; Yliherva, Anneli

    2012-01-01

    The vocalization of preterm infants with extremely low birth weight (ELBW) up to the expansion stage was systematically described and compared with those of healthy full-term infants. The sample consisted of 18 preterm ELBW infants and the control group of 11 full-term infants. The follow-up was performed intensively using video-recordings. The…

  10. Early Vocalization of Preterm Infants with Extremely Low Birth Weight (ELBW), Part I: From Birth to Expansion Stage

    ERIC Educational Resources Information Center

    Torola, Helena; Lehtihalmes, Matti; Heikkinen, Hanna; Olsen, Paivi; Yliherva, Anneli

    2012-01-01

    The vocalization of preterm infants with extremely low birth weight (ELBW) up to the expansion stage was systematically described and compared with those of healthy full-term infants. The sample consisted of 18 preterm ELBW infants and the control group of 11 full-term infants. The follow-up was performed intensively using video-recordings. The…

  11. Short-term respiratory outcomes in late preterm infants.

    PubMed

    Natile, Miria; Ventura, Maria Luisa; Colombo, Marco; Bernasconi, Davide; Locatelli, Anna; Plevani, Cristina; Valsecchi, Maria Grazia; Tagliabue, Paolo

    2014-06-03

    To evaluate short-term respiratory outcomes in late preterm infants (LPI) compared with those of term infants (TI). A retrospective study conducted in a single third level Italian centre (2005-2009) to analyse the incidence and risk factors of composite respiratory morbidity (CRM), the need for adjunctive therapies (surfactant therapy, inhaled nitric oxide, pleural drainage), the highest level of respiratory support (mechanical ventilation - MV, nasal continuous positive airway pressure--N-CPAP, nasal oxygen) and the duration of pressure support (hours in N-CPAP and/or MV). During the study period 14,515 infants were delivered. There were 856 (5.9%) LPI and 12,948 (89.2%) TI. CRM affected 105 LPI (12.4%), and 121 TI (0.9%), with an overall rate of 1.6%. Eighty-four LPI (9.8%) and 73 TI (0.56%) received respiratory support, of which 13 LPI (1.5%) and 16 TI (0.12%) were ventilated. The adjusted OR for developing CRM significantly increased from 3.3 (95% CI 2.0-5.5) at 37 weeks to 40.8 (95% CI 19.7-84.9%) at 34 weeks. The adjusted OR for the need of MV significantly increased from 3.4 (95% CI 1.2-10) at 37 weeks to 34.4 (95% CI 6.7-180.6%) at 34 weeks. Median duration of pressure support was significantly higher at 37 weeks (66.6 h vs 40.5 h). Twin pregnancies were related to a higher risk of CRM (OR 4.3, 95% CI 2.6-7.3), but not independent of gestational age (GA). Cesarean section (CS) was associated with higher risk of CRM independently of GA, but the OR was lower in CS with labour (2.2, 95% CI 1.4-3.4 vs 3.0, 95% CI 2.1-4.2). In this single third level care study late preterm births, pulmonary diseases and supportive respiratory interventions were lower than previously documented. LPI are at a higher risk of developing pulmonary disease than TI. Infants born from elective cesarean sections, late preterm twins in particular and 37 weekers too might benefit from preventive intervention.

  12. Infants Born Preterm Demonstrate Impaired Object Exploration Behaviors Throughout Infancy and Toddlerhood

    PubMed Central

    Kokkoni, Elena; Cunha, Andrea Baraldi; Galloway, James Cole

    2015-01-01

    Background Object exploration behaviors form the foundation for future global development, but little is known about how these behaviors are exhibited by infants born preterm. Objective The study objective was to longitudinally compare a comprehensive set of object exploration behaviors in infants born preterm and infants born full-term from infancy into toddlerhood. Design Twenty-two infants born full-term and 28 infants born preterm were monitored as they interacted with objects throughout their first 2 years. Methods Infants were provided up to 30 seconds to interact with each of 7 objects across 9 visits. Experimenters coded videos of infants' behaviors. Growth modeling and t tests were used to compare how much infants exhibited behaviors and how well they matched their behaviors to the properties of objects. Results Infants born preterm explored objects less in the first 6 months, exhibited less visual-haptic multimodal exploration, displayed reduced variability of exploratory behavior in a manner that reflected severity of risk, and were less able to match their behaviors to the properties of objects in a manner that reflected severity of risk. Infants born preterm with significant brain injury also had impaired bimanual abilities. Limitations There was a limited sample of infants born preterm with significant brain injury. Conclusions Infants born preterm have impaired abilities to interact with objects even in the first months of life. This impairment likely limits the knowledge they acquire about objects and about how they can act on them; this limited knowledge may, in turn, impair their early learning abilities. These results highlight the need for assessment and intervention tools specific for object exploration in young infants. PMID:25169919

  13. Postnatal Changes in Tibial Bone Speed of Sound of Preterm and Term Infants during Infancy.

    PubMed

    Chen, Hsiu-Lin; Lee, Wei-Te; Lee, Pei-Lun; Liu, Po-Len; Yang, Rei-Cheng

    2016-01-01

    This study aimed to evaluate changes in tibial bone speed of sound (SOS) over time, in preterm and term infants during infancy, in addition to identifying factors influencing the development of tibial SOS during infancy. Preterm (n = 155) and term (n = 65) infants were enrolled in this study. Tibial bone SOS was measured using quantitative ultrasonography (QUS) on the left tibia of newborn infants after birth (within 7 days), at 1 month old, and then every 2 months until subjects were approximately 12-15 months old. Follow-up checks included anthropometric measurements and tibial bone SOS. Mean tibial bone SOS at birth was significantly higher in term infants (mean ± SD, 2968.5 ± 99.7 m/s) than in preterm infants (2912.2 ± 122.6 m/s). Values of follow-up tibial bone SOS declined for the first 4 months, and then increased gradually until 12-15 months old. This increasing trend was greater in preterm infants after 2 months of corrected age than in term infants. There were no significant differences by 12-15 months of age between preterm and term infants. A longitudinal mixed-effect model controlling for internal correlations and other covariates in the two groups showed that age and the SOS value at birth were important factors affecting the tibial bone SOS in both preterm and term newborn infants during infancy. There are significant differences in the pattern of change in tibial bone SOS values between preterm and term infants during the first 12-15 months of life. Age and SOS value at birth were important factors affecting the pattern of tibial bone SOS change in both preterm and term newborn infants during infancy.

  14. Assessment of cardiorespiratory stability using the infant car seat challenge before discharge in preterm infants (<37 weeks’ gestational age)

    PubMed Central

    Narvey, Michael R

    2016-01-01

    Preterm infants younger than 37 weeks corrected gestational age are at increased risk for abnormal control of respiration. The infant car seat challenge has been used as a screening tool to ensure cardiorespiratory stability before discharging preterm infants from many hospitals in Canada. While it is clear that infants placed in a car seat are more likely to experience oxygen desaturation and/or bradycardia than when they are supine, neither positioning predicts an adverse neurodevelopmental outcome or mortality post-discharge. A review of the literature yielded insufficient evidence to recommend routine use of the infant car seat challenge as part of discharge planning for preterm infants. This finding has prompted a change in recommendation from a previous Canadian Paediatric Society position statement published in 2000. PMID:27398056

  15. Infant Physiological Regulation and Maternal Risks as Predictors of Dyadic Interaction Trajectories in Families with a Preterm Infant

    ERIC Educational Resources Information Center

    Poehlmann, Julie; Schwichtenberg, A. J. Miller; Bolt, Daniel M.; Hane, Amanda; Burnson, Cynthia; Winters, Jill

    2011-01-01

    This longitudinal study examined predictors of rates of growth in dyadic interaction quality in children born preterm who did not experience significant neurological findings during neonatal intensive care unit (NICU) hospitalization. Multiple methods were used to collect data from 120 preterm infants (48% girls, 52% boys) and their mothers.…

  16. Infant Physiological Regulation and Maternal Risks as Predictors of Dyadic Interaction Trajectories in Families with a Preterm Infant

    ERIC Educational Resources Information Center

    Poehlmann, Julie; Schwichtenberg, A. J. Miller; Bolt, Daniel M.; Hane, Amanda; Burnson, Cynthia; Winters, Jill

    2011-01-01

    This longitudinal study examined predictors of rates of growth in dyadic interaction quality in children born preterm who did not experience significant neurological findings during neonatal intensive care unit (NICU) hospitalization. Multiple methods were used to collect data from 120 preterm infants (48% girls, 52% boys) and their mothers.…

  17. Congenital methemoglobinaemia due to Hb F-M-Fort Ripley in a preterm newborn.

    PubMed

    Ghotra, Satvinder; Jangaard, Krista; Pambrun, Chantale; Fernandez, Conrad Vincent

    2016-03-11

    Methemoglobinaemia is a rare cause of cyanosis in newborns. Congenital methemoglobinaemias due to M haemoglobin or deficiency of cytochrome b5 reductase are even rarer. We present a case of congenital methemoglobinaemia presenting at birth in a preterm infant. A baby boy born at 29 weeks and 3 days of gestation had persistent central cyanosis immediately after delivery, not attributable to a respiratory or cardiac pathology. Laboratory methemoglobin levels were not diagnostic. Cytochrome b5 reductase levels were normal and a newborn screen was unable to pick up any abnormal variants of fetal haemoglobin. Genetic testing showed a γ globin gene mutation resulting in the M haemoglobin, called Hb F-M-Fort Ripley. The baby had no apparent cyanosis at a corrected gestational age of 42 weeks. Although rare, congenital methaemoglobin aemia should be considered in the differential in a preterm with central cyanosis and investigated with genetic testing for γ globin chain mutations if other laboratory tests are non-conclusive.

  18. Preterm Infants Show Reduced Stress Behaviors and Activity after 5 days of Massage Therapy

    PubMed Central

    Hernandez-Reif, Maria; Diego, Miguel; Field, Tiffany

    2007-01-01

    Preterm infants residing in an NICU were randomly assigned to a massage therapy or to a control group. The preterm infants in the massage therapy group received three 15 minute massages each day for 5 consecutive days, with the massages consisting of moderate pressure stroking to the head, shoulders, back, arms and legs and kinesthetic exercises consisting of flexion and extension of the limbs. Infant stress behaviors and activity were recorded on the first and last day of the study. Preterm infants receiving massage therapy showed fewer stress behaviors and less activity from the first to the last day of the study. The findings suggest that massage has pacifying or stress reducing effects on preterm infants, which is noteworthy given that they experience numerous stressors during their hospitalization. PMID:17548111

  19. [Cerebral brain injury in preterm infants and the role of neuroimaging in predicting neurodevelopmental outcomes].

    PubMed

    Schneider, J; Vasung, L; Truttmann, A C; Huppi, P S

    2014-02-19

    Due to advances in neonatal intensive care over the last decades, the pattern of brain injury seen in very preterm infants has evolved in more subtle lesions that are still essential to diagnose in regard to neurodevelopmental outcome. While cranial ultrasound is still used at the bedside, magnetic resonance imaging (MRI) is becoming increasingly used in this population for the assessment of brain maturation and white and grey matter lesions. Therefore, MRI provides a better prognostic value for the neurodevelopmental outcome of these preterms. Furthermore, the development of new MRI techniques, such as diffusion tensor imaging, resting state functional connectivity and magnetic resonance spectroscopy, may further increase the prognostic value, helping to counsel parents and allocate early intervention services.

  20. Factors Associated with Infant Feeding Difficulties in the Very Preterm Infant

    PubMed Central

    Crapnell, TL; Rogers, CE; Neil, JJ; Inder, TE; Woodward, LJ; Pineda, RG

    2013-01-01

    Aim To investigate early medical and family factors associated with later feeding risk in preterm infants. Methods For this longitudinal study, we enrolled 136 infants born ≤30 weeks gestation. Medical and social background factors were assessed at term equivalent age. Infants underwent magnetic resonance imaging, neurobehavioral evaluation, and feeding assessment. Parent involvement in the neonatal intensive care unit was tracked, and maternal mental health was assessed at discharge. At age two years, feeding outcome was assessed using the Eating Subscale of the Infant-Toddler Social Emotional Assessment (n=80). Associations between feeding problems at age two and 1) early medical factors, 2) neurobehavioral functioning and feeding at term equivalent age, 3) cerebral structure, and 4) maternal mental health were investigated using regression. Results Eighteen (23%) children had feeding problems at age two years. Feeding problems were associated with early hypotonia (p=0.03; β=0.29) and lower socioeconomic status (p=0.046; β=−0.22). No associations were observed between early medical factors, early feeding performance, cerebral structure alterations or maternal well-being and feeding outcome. Conclusion Early hypotonia may disrupt the development of oral-motor skills. Hypotonia and poor feeding also may share a common etiology. Associations with lower socioeconomic status highlight the influence of family background factors in feeding problems in the preterm infant. PMID:23952198

  1. Impact of the NICU environment on language deprivation in preterm infants.

    PubMed

    Rand, Katherine; Lahav, Amir

    2014-03-01

    It is unclear whether the atypical language development commonly seen in preterm infants is a consequence of language deficiency experienced during their prolonged NICU stay. This review provides a novel viewpoint, which highlights the potential impact of the NICU design on the developmental origin of language disabilities in preterm infants. Further research is needed to identify evidence-based design solutions for providing preterm infants with a healthier linguistic hospital environment that aids growth and development. ©2013 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  2. Hypertrophic Cardiomyopathy After a Single Dose of Dexamethasone in a Preterm Infant.

    PubMed

    Kale, Yusuf; Aydemir, Ozge; Ceylan, Ozben; Bas, Ahmet Yagmur; Demirel, Nihal

    2015-08-01

    Dexamethasone is widely used in preterm infants with severe pulmonary disease. Hypertrophic cardiomyopathy (HCM) is a transient side effect observed after multiple doses of dexamethasone. We report a preterm infant with myocardial hypertrophy after a single dose of dexamethasone (0.5 mg/kg) used to treat laryngeal edema secondary to prolonged intubation. A benign course was observed without left ventricular outflow tract obstruction and with recovery within 4 weeks. Myocardial effects of dexamethasone may be independent of dose and duration of treatment. The risk/benefit ratio must be carefully considered before using even a single dose of dexamethasone in preterm infants.

  3. Neonatal pain control and neurologic effects of anesthetics and sedatives in preterm infants.

    PubMed

    McPherson, Christopher; Grunau, Ruth E

    2014-03-01

    Preclinical and clinical studies have demonstrated the adverse consequences of untreated pain and stress on brain development in the preterm infant. Sucrose has widely been implemented as standard therapy for minor procedural pain. Anesthetics are commonly utilized in preterm infants during major surgery. Pharmacologic agents (benzodiazepines and opioids) have been examined in clinical trials of preterm infants requiring invasive mechanical ventilation. Controversy exists regarding the safety and long-term impact of these interventions. Ongoing multidisciplinary research will help define the impact of these agents and identify potential alternative therapies.

  4. Maternal Resolution of Grief After Preterm Birth: Implications for Infant Attachment Security

    PubMed Central

    Clements, Melissa; Poehlmann, Julie

    2011-01-01

    OBJECTIVE: This study explored the association between mothers' unresolved grief regarding their infant's preterm birth and infant-mother attachment security. We hypothesized that mothers with unresolved grief would be more likely to have insecurely attached infants at 16 months and that this association would be partially mediated by maternal interaction quality. METHODS: This longitudinal study focused on 74 preterm infants (age of <36 weeks) and their mothers who were part of a larger study of high-risk infants. The present analysis included assessment of neonatal and socioeconomic risks at NICU discharge; maternal depression, Reaction to Preterm Birth Interview findings, and quality of parenting at a postterm age of 9 months; and infant-mother attachment at postterm age of 16 months. Associations among findings of grief resolution with the Reaction to Preterm Birth Interview, quality of parenting interactions, and attachment security were explored by using relative risk ratios and logistic and multivariate regression models. RESULTS: The relative risk of developing insecure attachment when mothers had unresolved grief was 1.59 (95% confidence interval: 1.03–2.44). Controlling for covariates (adjusted odds ratio: 2.94), maternal feelings of resolved grief regarding the preterm birth experience were associated with secure infant-mother attachment at 16 months. Maternal grief resolution and interaction quality were independent predictors of attachment security. CONCLUSION: Maternal grief resolution regarding the experience of preterm birth and the quality of maternal interactions have important implications for emerging attachment security for infants born prematurely. PMID:21242223

  5. Relationship of Maternal Psychological Distress Classes to Later Mother-Infant Interaction, Home Environment, and Infant Development in Preterm Infants.

    PubMed

    Santos, Hudson; Yang, Qing; Docherty, Sharron L; White-Traut, Rosemary; Holditch-Davis, Diane

    2016-06-01

    Latent class analyses can be used early in the postpartum period to identify mothers of preterm infants experiencing similar patterns of psychological distress symptoms, but whether these classes of mothers also differ in parental responses to their infants or in their infants' development is largely unknown. In this longitudinal multisite-repeated measures study, we evaluated the usefulness of three psychological distress classes (low distress, high depressive and anxiety symptoms, and extreme distress) in predicting mother-infant interactions, quality of home environment, and infant development in 229 mother-preterm infant pairs. Mothers completed psychological distress questionnaires at study entry; parent-infant interaction was recorded at 2 and 6 months of age corrected for prematurity; and infant developmental data were collected 12 months corrected age. Mothers in the extreme distress class engaged in more developmental stimulation at 2 months (β = .99, p < 0.01) and at 6 months (β = 1.38, p < .01) than mothers in the other classes and had better quality of home environment at 2 months (β = 2.52, p = .03). When not controlling for neurological insult, infants of mothers in the extreme distress class had poorer cognitive (β = -10.28, p = .01) and motor (β = -15.12, p < .01) development scores at 12 months corrected age than infants of mothers in the other distress classes, but after controlling for infant neurological insult, there were no differences in cognitive, motor, and language development based on maternal psychological distress class. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  6. Focused Attention, Heart Rate Deceleration, and Cognitive Development in Preterm and Full-Term Infants

    PubMed Central

    Petrie Thomas, Julianne H.; Whitfield, Michael F.; Oberlander, Tim F.; Synnes, Anne R.; Grunau, Ruth E.

    2012-01-01

    The majority of children who are born very preterm escape major impairment, yet more subtle cognitive and attention problems are very common in this population. Previous research has linked infant focused attention during exploratory play to later cognition in children born full-term and preterm. Infant focused attention can be indexed by sustained decreases in heart rate (HR). However there are no preterm studies that have jointly examined infant behavioral attention and concurrent HR response during exploratory play in relation to developing cognition. We recruited preterm infants free from neonatal conditions associated with major adverse outcomes, and further excluded infants with developmental delay (Bayley Mental Development Index [MDI < 70]) at 8 months corrected age (CA). During infant exploratory play at 8 months CA, focused attention and concurrent HR response were compared in 83 preterm infants (born 23–32 weeks gestational age [GA]) who escaped major impairment to 46 full-term infants. Focused attention and HR response were then examined in relation to Bayley MDI, after adjusting for neonatal risk. MDI did not differ by group, yet full-term infants displayed higher global focused attention ratings. Among the extremely preterm infants born <29 weeks, fewer days on mechanical ventilation, mean longest focus, and greater HR deceleration during focused attention episodes, accounted for 49% of adjusted variance in predicting concurrent MDI. There were no significant associations for later-born gestational age (29–32 weeks) or full-term infants. Among extremely preterm infants who escape major impairment, our findings suggest unique relationships between focused attention, HR deceleration, and developing cognition. PMID:22487941

  7. Effects of early parenteral iron combined erythropoietin in preterm infants

    PubMed Central

    Qiao, Linxia; Tang, Qingya; Zhu, Wenying; Zhang, Haiyan; Zhu, Yuefang; Wang, Hua

    2017-01-01

    Abstract Backgroud: The aim of the study was to evaluate the effect of early parenteral iron supplementation combined erythropoietin for prevention of anemia in preterm infants. Methods: In total, 96 preterm infants were randomly assigned to 3 groups: a control group receiving standard parenteral nutrition (group 1: n = 31), an iron-supplemented group (group 2: IS, n = 33), and an iron-supplemented combined erythropoietin group (group 3: IS+EPO, n = 32). The primary objective was to assess hemoglobin (Hb) levels. The secondary objectives included assessment of red blood cell counts (RBC), mean cell volume (MCV), serum iron, ferritin, percentages of reticulocyte (RET), total iron binding capacity (TIBC) and oxidative stress, which was assessed by measuring plasma levels of malondialdehyde and superoxide dismutase at baseline and at 2 weeks. The blood routine indices including Hb, RBC, MCV, and percentages of RET were measured at corrected age of 1 and 3 months. Results: At 2 weeks of life, the percentages of reticulocyte in group 2 and group 3 were significantly higher than those in group 1 (2.1±0.4, 2.5±0.3, and 1.7±0.3, respectively, P < 0.001, P<0.001), whereas TIBC were significantly lower than those in group 1 (36.7±4.6, 36.0±4.7, and 41.6 ± 5.2 respectively, P = 0.011, P = 0.006). There were no significant differences in RBC counts, the levels of hemoglobin, ferritin, malondialdehyde, and superoxide dismutase among the 3 groups at 2weeks of life. RBC, Hb, MCV, body weight, body length, and head circumference at a corrected age of 1 month did not differ among 3 groups. At corrected age of 3months, more infants in the control group had abnormal Hb and MCV levels (Hb levels: 114.3 ± 21.3, 123.7 ± 31.6, and 125.1 ± 21.2, P = 0.021, P = 0.034, respectively; MCV: 74.1 ± 3.5, 78.3 ± 4.7 and 79.1 ± 5.2, P = 0.017, P = 0.012, respectively), whereas cases of oral iron, cases of breastfeeding

  8. Probiotics, prebiotics infant formula use in preterm or low birth weight infants: a systematic review

    PubMed Central

    2012-01-01

    Background Previous reviews (2005 to 2009) on preterm infants given probiotics or prebiotics with breast milk or mixed feeds focused on prevention of Necrotizing Enterocolitis, sepsis and diarrhea. This review assessed if probiotics, prebiotics led to improved growth and clinical outcomes in formula fed preterm infants. Methods Cochrane methodology was followed using randomized controlled trials (RCTs) which compared preterm formula containing probiotic(s) or prebiotic(s) to conventional preterm formula in preterm infants. The mean difference (MD) and corresponding 95% confidence intervals (CI) were reported for continuous outcomes, risk ratio (RR) and corresponding 95% CI for dichotomous outcomes. Heterogeneity was assessed by visual inspection of forest plots and a chi2 test. An I2 test assessed inconsistencies across studies. I2> 50% represented substantial heterogeneity. Results Four probiotics studies (N=212), 4 prebiotics studies (N=126) were included. Probiotics: There were no significant differences in weight gain (MD 1.96, 95% CI: -2.64 to 6.56, 2 studies, n=34) or in maximal enteral feed (MD 35.20, 95% CI: -7.61 to 78.02, 2 studies, n=34), number of stools per day increased significantly in probiotic group (MD 1.60, 95% CI: 1.20 to 2.00, 1 study, n=20). Prebiotics: Galacto-oligosaccharide / Fructo-oligosaccharide (GOS/FOS) yielded no significant difference in weight gain (MD 0.04, 95% CI: -2.65 to 2.73, 2 studies, n=50), GOS/FOS yielded no significant differences in length gain (MD 0.01, 95% CI: -0.03 to 0.04, 2 studies, n=50). There were no significant differences in head growth (MD −0.01, 95% CI: -0.02 to 0.00, 2 studies, n=76) or age at full enteral feed (MD −0.79, 95% CI: -2.20 to 0.61, 2 studies, n=86). Stool frequency increased significantly in prebiotic group (MD 0.80, 95% CI: 0.48 to 1.1, 2 studies, n=86). GOS/FOS and FOS yielded higher bifidobacteria counts in prebiotics group (MD 2.10, 95% CI: 0.96 to 3.24, n=27) and (MD 0.48, 95% CI: 0

  9. Probiotics, prebiotics infant formula use in preterm or low birth weight infants: a systematic review.

    PubMed

    Mugambi, Mary N; Musekiwa, Alfred; Lombard, Martani; Young, Taryn; Blaauw, Reneé

    2012-08-28

    Previous reviews (2005 to 2009) on preterm infants given probiotics or prebiotics with breast milk or mixed feeds focused on prevention of Necrotizing Enterocolitis, sepsis and diarrhea. This review assessed if probiotics, prebiotics led to improved growth and clinical outcomes in formula fed preterm infants. Cochrane methodology was followed using randomized controlled trials (RCTs) which compared preterm formula containing probiotic(s) or prebiotic(s) to conventional preterm formula in preterm infants. The mean difference (MD) and corresponding 95% confidence intervals (CI) were reported for continuous outcomes, risk ratio (RR) and corresponding 95% CI for dichotomous outcomes. Heterogeneity was assessed by visual inspection of forest plots and a chi² test. An I² test assessed inconsistencies across studies. I²> 50% represented substantial heterogeneity. Four probiotics studies (N=212), 4 prebiotics studies (N=126) were included. Probiotics: There were no significant differences in weight gain (MD 1.96, 95% CI: -2.64 to 6.56, 2 studies, n=34) or in maximal enteral feed (MD 35.20, 95% CI: -7.61 to 78.02, 2 studies, n=34), number of stools per day increased significantly in probiotic group (MD 1.60, 95% CI: 1.20 to 2.00, 1 study, n=20). Prebiotics: Galacto-oligosaccharide/Fructo-oligosaccharide (GOS/FOS) yielded no significant difference in weight gain (MD 0.04, 95% CI: -2.65 to 2.73, 2 studies, n=50), GOS/FOS yielded no significant differences in length gain (MD 0.01, 95% CI: -0.03 to 0.04, 2 studies, n=50). There were no significant differences in head growth (MD -0.01, 95% CI: -0.02 to 0.00, 2 studies, n=76) or age at full enteral feed (MD -0.79, 95% CI: -2.20 to 0.61, 2 studies, n=86). Stool frequency increased significantly in prebiotic group (MD 0.80, 95% CI: 0.48 to 1.1, 2 studies, n=86). GOS/FOS and FOS yielded higher bifidobacteria counts in prebiotics group (MD 2.10, 95% CI: 0.96 to 3.24, n=27) and (MD 0.48, 95% CI: 0.28 to 0.68, n=56). There is not

  10. Stability of Early Risk Assessment for Autism Spectrum Disorder in Preterm Infants

    ERIC Educational Resources Information Center

    Yaari, Maya; Yitzhak, Neta; Harel, Ayelet; Friedlander, Edwa; Bar-Oz, Benjamin; Eventov-Friedman, Smadar; Mankuta, David; Gamliel, Ifat; Yirmiya, Nurit

    2016-01-01

    Stability and change in early autism spectrum disorder risk were examined in a cohort of 99 preterm infants (?34 weeks of gestation) using the Autism Observation Scale for Infants at 8 and 12 months and the Autism Diagnostic Observation Schedule--Toddler Module at 18 months. A total of 21 infants were identified at risk by the Autism Observation…

  11. Greater mortality and mordidity in extremely preterm infants fed a diet containing cow milk protein products

    USDA-ARS?s Scientific Manuscript database

    Provision of human milk has important implications for the health and outcomes of extremely preterm (EP) infants. This study evaluated the effects of an exclusive human milk diet on the health of EP infants during their stay in the neonatal intensive care unit. EP infants <1,250 g birth weight recei...

  12. Maternal Drug Use during Pregnancy: Are Preterm and Full-Term Infants Affected Differently?

    ERIC Educational Resources Information Center

    Brown, Josephine V.; Bakeman, Roger; Coles, Claire D.; Sexson, William R.; Demi, Alice S.

    1998-01-01

    Examined effects of prenatal drug exposure on infants born preterm and full-term to African American mothers. Found more extreme fetal growth deficits in later-born infants, and more extreme irritability increases in earlier-born infants. Gestation length did not moderate cardiorespiratory reactivity effects. Exposure effects occurred for…

  13. Stability of Early Risk Assessment for Autism Spectrum Disorder in Preterm Infants

    ERIC Educational Resources Information Center

    Yaari, Maya; Yitzhak, Neta; Harel, Ayelet; Friedlander, Edwa; Bar-Oz, Benjamin; Eventov-Friedman, Smadar; Mankuta, David; Gamliel, Ifat; Yirmiya, Nurit

    2016-01-01

    Stability and change in early autism spectrum disorder risk were examined in a cohort of 99 preterm infants (?34 weeks of gestation) using the Autism Observation Scale for Infants at 8 and 12 months and the Autism Diagnostic Observation Schedule--Toddler Module at 18 months. A total of 21 infants were identified at risk by the Autism Observation…

  14. Parenteral nutrition as an unexpected and preventable source of mercury exposure in preterm infants

    PubMed Central

    Jering, Karola; Aschner, Michael; Beller, Amy; Hamm, Ellyn L.; Langdon, Margaret; Maitre, Nathalie L.

    2015-01-01

    Perinatal mercury exposure has neurodevelopmental consequences, which may be worse in preterm infants. In our cohort (N=60), maternal and infant prenatal exposures were low, but infant levels increased during hospitalization and correlated only with duration of parenteral nutrition. A non-negligible exposure resulted from the nutrition preparation on equipment shared with adult preparations. PMID:25812777

  15. Surfactant for bacterial pneumonia in late preterm and term infants.

    PubMed

    Tan, Kenneth; Lai, Nai Ming; Sharma, Ajay

    2012-02-15

    Pulmonary surfactant is an important part of the host defence against respiratory infections. Bacterial pneumonia in late preterm or term newborn infants often leads to surfactant deficiency or dysfunction, as surfactant is either inactivated or peroxidated. Studies of animal models of pneumonia and clinical case reports suggest that exogenous surfactant might be beneficial to infants with bacterial pneumonia. To assess the effect of exogenous surfactant treatment on mortality and pulmonary complications in infants with bacterial pneumonia. We used standard Cochrane Collaboration methodology to conduct our search of databases. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 6); MEDLINE (accessed via Ovid SP June 2011); EMBASE (via Ovid SP 1980 to June 2011); and CINAHL Plus (accessed via EBSCOHost June 2011). We limited our search to randomised and quasi-randomised trials of surfactant replacement therapy in infants > 35 weeks gestation with bacterial pneumonia in the first 28 days of life. The primary outcome measures were death, time to resolution of pneumonia, incidence of chronic lung disease, pneumothoraces and pulmonary haemorrhage. We assessed all studies with predefined criteria as to whether they were eligible for inclusion. We extracted data using RevMan 5 (RevMan 2011). We used the standard Cochrane Collaboration methodology for data collection and analysis to assess risk of bias, heterogeneity, treatment effect, missing data and reporting bias where appropriate. We did not identify any studies that met our inclusion criteria. There is no evidence from randomised controlled trials (RCTs) to support or refute the efficacy of surfactant in near-term and term infants with proven or suspected bacterial pneumonia. RCTs are still required to answer this question.

  16. Preschool Assessment of Preterm Infants Treated With Darbepoetin and Erythropoietin

    PubMed Central

    Cannon, Daniel C.; Phillips, John; Caprihan, Arvind; Patel, Shrena; Winter, Sarah; Steffen, Michael; Yeo, Ronald A.; Campbell, Richard; Wiedmeier, Susan; Baker, Shawna; Gonzales, Sean; Lowe, Jean

    2016-01-01

    BACKGROUND: We previously reported improved neurodevelopmental outcomes at 2 years among infants treated with the erythropoiesis-stimulating agents (ESAs) darbepoetin alfa (darbepoetin) or erythropoietin. Here we characterize 4-year outcomes. METHODS: Former preterm infants randomly assigned to receive darbepoetin (10 μg/kg, once per week), erythropoietin (400 U/kg, 3 times/week), or placebo through 35 weeks’ postconceptual age were evaluated at 3.5 to 4 years of age. For comparison, healthy children formerly delivered full term (term controls [TCs]) were also recruited. All participants were assessed by using measures of full-scale IQ (FSIQ) and general language from the Wechsler Preschool and Primary Scale of Intelligence, Third Edition, and an overall measure of executive function, on the basis of tests evaluating inhibitory control and spatial working memory. Rates of neurodevelopmental impairment were compared across groups. RESULTS: Multivariate analysis of variance compared children randomly assigned to ESAs (n = 39), placebo (n =14), and TCs (n = 24). FSIQ and performance IQ were significantly higher in the ESA group than in the placebo group (FSIQ: 91.1 ± 17.5 vs 79.2 ± 18.5, P = .036; performance IQ: 93.0 ± 17.0 vs 79.5 ± 19.5, P = .018). Follow-up analyses revealed that the children receiving ESAs performed better than those who received placebo on executive function tasks. The ESA group’s performance was below that of TCs, but the results did not reach significance on executive function. The incidence of neurodevelopmental impairment was greater in the placebo group than in the ESA group. CONCLUSIONS: ESA-treated infants had better cognitive outcomes and less developmental impairment at 3.5 to 4 years of age compared with placebo-treated infants. ESAs show promise in improving long-term cognitive outcomes of infants born prematurely. PMID:26908704

  17. Academic, social, and behavioral outcomes at age 12 of infants born preterm.

    PubMed

    Winchester, Suzy Barcelos; Sullivan, Mary C; Marks, Amy Kerivan; Doyle, Thomas; DePalma, Jennifer; McGrath, Margaret M

    2009-11-01

    The effects of gradient levels of perinatal morbidity on school outcomes have been investigated at age 12 in four preterm groups, classified as healthy (no medical or neurological illness), medical morbidity, neurological morbidity, and small-for-gestational-age (SGA), and a full-term comparison group. Teachers report on academic competence, social skills, and problem behaviors. Data on school type, classroom setting, and school service use are gathered from school records. Preterm groups are found to be equivalent to full-term peers in social skills and problem behavior. Preterm groups with neurological and SGA morbidity have the lowest academic competence scores. Unexpectedly, preterm infants with medical morbidity have higher academic competence scores compared with the other preterm groups. School service use increases with greater perinatal morbidity and is contingent on multiple rather than single indicators of perinatal morbidity. Continued monitoring of preterm infants through early adolescence will ensure that appropriate school services and resources are available to maximize their school success.

  18. Effects of employment and education on preterm and full-term infant mortality in Korea.

    PubMed

    Ko, Y-J; Shin, S-H; Park, S M; Kim, H-S; Lee, J-Y; Kim, K H; Cho, B

    2014-03-01

    The infant mortality rate is a sensitive and commonly used indicator of the socio-economic status of a population. Generally, studies investigating the relationship between infant mortality and socio-economic status have focused on full-term infants in Western populations. This study examined the effects of education level and employment status on full-term and preterm infant mortality in Korea. Data were collected from the National Birth Registration Database and merged with data from the National Death Certification Database. Prospective cohort study. In total, 1,316,184 singleton births registered in Korea's National Birth Registration Database between January 2004 and December 2006 were included in the study. Multivariate logistic regression analysis was performed. Paternal and maternal education levels were inversely related to infant mortality in preterm and full-term infants following multivariate adjusted logistic models. Parental employment status was not associated with infant mortality in full-term infants, but was associated with infant mortality in preterm infants, after adjusting for place of birth, gender, marital status, paternal age, maternal age and parity. Low paternal and maternal education levels were found to be associated with infant mortality in both full-term and preterm infants. Low parental employment status was found to be associated with infant mortality in preterm infants but not in full-term infants. In order to reduce inequalities in infant mortality, public health interventions should focus on providing equal access to education. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  19. Going home: Facilitating discharge of the preterm infant

    PubMed Central

    Jefferies, Ann L

    2014-01-01

    At the time of discharge home, parents of preterm infants in the neonatal intensive care unit often feel apprehensive and may question their ability to care for their baby. The well-planned, comprehensive discharge of a medically stable infant helps to ensure a positive transition to home and safe, effective care after discharge. This statement provides guidance in planning discharge of infants born before 34 weeks’ gestational age from tertiary and community settings. Discharge readiness is usually determined by demonstration of functional maturation, including the physiological competencies of thermoregulation, control of breathing, respiratory stability, and feeding skills and weight gain. Supporting family involvement and providing education from the time of admission improve parental confidence and decrease anxiety. Assessing the physical and psychosocial discharge environment is an important part of the discharge process. The clinical team is responsible for ensuring that appropriate investigations and screening tests have been completed, that medical concerns have been resolved and that a follow-up plan is in place at the time of discharge home. PMID:24627654

  20. The Development of Extremely Preterm Infants Born to Women Who Had Genitourinary Infections During Pregnancy

    PubMed Central

    Leviton, Alan; Allred, Elizabeth N.; Kuban, Karl C. K.; O'Shea, T. Michael; Paneth, Nigel; Onderdonk, Andrew B.; Fichorova, Raina N.; Dammann, Olaf

    2016-01-01

    Gestational genitourinary infections, which have been associated with neurodevelopmental impairments among infants born near term, have not been studied among very preterm infants. The mothers of 989 infants born before 28 weeks of gestation were interviewed about urine, bladder, or kidney infections (UTIs) and cervical or vaginal infections (CVIs) during pregnancy, as well as other exposures and characteristics, and their charts were reviewed for the Extremely Low Gestational Age Newborns (ELGAN) Study (2002–2004). At 2 years of age, these infants underwent a neurodevelopmental assessment. Generalized estimating equation logistic regression models of developmental adversities were used to adjust for potential confounders. Infants born to women who reported a UTI were less likely than were others to have a very low Mental Development Index (adjusted odds ratio = 0.5; 95% confidence interval: 0.3, 0.8), whereas infants born to women who reported a CVI were more likely than others to have a low Psychomotor Development Index (adjusted odds ratio = 1.7; 95% confidence interval: 1.04, 2.7). In this high-risk sample, maternal gestational CVI, but not UTI, was associated with a higher risk of impaired motor development at 2 years of age. The apparent protective effect of UTI might be spurious, reflect confounding due to untreated asymptomatic bacteriuria among women who were not given a diagnosis of UTI, or reflect preconditioning. PMID:26667255

  1. Postnatal growth and development in the preterm and small for gestational age infant.

    PubMed

    Cooke, Richard J

    2010-01-01

    A clear relationship exists between undernutrition, poorer growth and poor development in term and preterm infants. However, preterm infants are at greater risk than term infants. Undernutrition is more common and 'programmed' growth rates are almost six times faster. Thus, even short periods of nutritional deprivation may have significant effects. Recent advances have led to an improvement in early growth but very low birthweight infants remain small for gestational age at hospital discharge. Studies suggest that a 'window of opportunity' exists after hospital discharge, in that better growth between discharge and 2-3 months corrected age is paralleled by better development, and poorer growth is associated with poorer development. However, interventions aimed at improving growth and development have yielded varying results. This may partly be related to differences in study design as well as the composition of the nutrient-enriched formulas. Irrespective, one point is concerning, i.e. infant boys appear to be at a developmental disadvantage when fed a term infant formula after discharge. A single study has also suggested that dietary intervention can improve brain growth in term and preterm infants with perinatal brain injury. However, concern has been expressed about rapid 'catch-up' growth in preterm infants and the development of insulin resistance and visceral adiposity. Data from our group do not support the idea of increased or altered adiposity in preterm infants fed a nutrient-enriched formula after hospital discharge.

  2. Vaccination timeliness in preterm infants: An integrative review of the literature.

    PubMed

    Sisson, Helen; Gardiner, Eric; Watson, Roger

    2017-06-15

    To take a systematic approach to reviewing the scientific literature examining the timeliness of vaccination in preterm infants and to identify any factors associated with timeliness. Preterm infants are vulnerable to infection and guidance advocates they are vaccinated in accordance with their full-term peers. Vaccination is well tolerated and protective immune responses are observed, yet some early enquiries suggest that preterm infants experience unwarranted delays. The recent surge in pertussis cases and the increase in vaccinations administered make this a topic requiring further exploration. An integrative review of the empirical literature. Studies were identified following a search of Medline, Academic Search Premier, Cochrane Database of Systematic Reviews and the Cumulative Index to Nursing and Allied Health Literature. The review methods used were influenced by a narrative synthesis approach. The retrieval of papers adhered to recognised reporting standards. Fourteen studies were identified, which indicated that infants with the lowest gestational ages and birthweights experience the greatest delays. Vaccination timeliness is influenced by hospitalisation and increased postdischarge follow-up. There was a lack of consensus to indicate that parental socio-economic status and level of education were indicators for a delay. The studies propose that many delays are unjustified and not according to genuine contraindications. This review indicates that preterm infants are not vaccinated in a timely manner. Those involved in vaccinating preterm infants must be informed of the genuine contraindications to avoid unnecessary delays putting preterm infants at an increased risk of infection. Care providers should acknowledge the risk of a delay in preterm infants and actively promote vaccination in this population. Regular training should help to negate the occurrence of inappropriate delays, and careful discharge planning is needed to ensure that preterm infants

  3. Breastfeeding the late preterm infant: experiences of mothers and perceptions of public health nurses.

    PubMed

    Dosani, Aliyah; Hemraj, Jena; Premji, Shahirose S; Currie, Genevieve; Reilly, Sandra M; Lodha, Abhay K; Young, Marilyn; Hall, Marc

    2016-01-01

    The promotion and maintenance of breastfeeding with late preterm infants (LPIs) remain under examined topics of study. This dearth of research knowledge, especially for this population at-risk for various health complications, requires scientific investigation. In this study, we explore the experiences of mothers and the perceptions of public health nurses (PHNs) about breastfeeding late preterm infants in Calgary, Alberta, Canada. We used an exploratory mixed methods design with a convenience sample of 122 mothers to gather quantitative data about breastfeeding. We collected qualitative data by means of individual face-to-face interviews with 11 mothers and 10 public health nurses. Data were collected from April 2013 to June 2014. We then employed an interpretive thematic analysis to identify central themes and relationships across narratives. We collected 74 complete data sets about breastfeeding. During the first 6-8 weeks postpartum, 61 mothers breastfed their infants. Of these, 51 partially breastfed and 10 exclusively breastfed. For qualitative purposes, the researchers interviewed 11 mothers with late preterm babies and three themes emerged: significant difficulty with breastfeeding, failing to recognize the infant's feeding distress and disorganized behavior, and the parental stress caused by the multiple feeding issues. The public health nurses' comments reinforced and expanded on what the mothers reported. The themes for the nurses included: challenges with initiating breastfeeding, challenges during breastfeeding, and the need for stimulation during breastfeeding. Mothers face challenges when breastfeeding their late preterm infants and public health nurses can guide them through this experience. Families with a late preterm infant need to be informed about the challenges associated with breastfeeding a late preterm infant. It is necessary for all health care professionals to receive proper training on safe and effective breastfeeding of late preterm

  4. A qualitative study: Mothers of late preterm infants relate their experiences of community-based care.

    PubMed

    Premji, Shahirose S; Currie, Genevieve; Reilly, Sandra; Dosani, Aliyah; Oliver, Lynnette May; Lodha, Abhay K; Young, Marilyn

    2017-01-01

    In Alberta, the high occurrence of late preterm infants and early hospital discharge of mother-infant dyads has implications for postpartum care in the community. Shortened hospital stay and complexities surrounding the care of biologically and developmentally immature late preterm infants heighten anxiety and fears. Our descriptive phenomenological study explores mothers' experience of caring for their late preterm infants in the community. Eleven mothers were interviewed using a semi-structured interview guide. Interview transcripts were analysed using an interpretive thematic approach. The mothers' hospital experience informed their perspective that being a late preterm infant was not a "big deal," and they tended to treat their infant as normal. "Feeding was really problem," especially the variability in feeding effectiveness, which was not anticipated. Failing to recognize late preterm infants' feeding distress exemplified lack of knowledge of feeding cues and tendencies to either rationalize or minimize feeding concerns. Public health nurses represent a source of informational support for managing neonatal morbidities associated with being late preterm; however, maternal experiences with public health nurses varied. Some nurses used a directive style that overwhelmed certain mothers. Seeing multiple public health nurses and care providers was not always effective, given inconsistent and contradictory guidance to care. These new and changing situations increased maternal anxiety and stress and influenced maternal confidence in care. Fathers, family, and friends were important sources of emotional support. After discharge, mothers report their lack of preparation to meet the special needs of their late preterm infants. Current approaches to community-based care can threaten maternal confidence in care. New models and pathways of care for late preterm infants and their families need to be responsive to the spectrum of feeding issues encountered, limit

  5. [Correlation between growth rate of corpus callosum and neuromotor development in preterm infants].

    PubMed

    Liu, Rui-Ke; Sun, Jie; Hu, Li-Yan; Liu, Fang

    2015-08-01

    To investigate the growth rate of corpus callosum by cranial ultrasound in very low birth weight preterm infants and to provide a reference for early evaluation and improvement of brain development. A total of 120 preterm infants under 33 weeks' gestation were recruited and divided into 26-29(+6) weeks group (n=64) and 30-32(+6) weeks group (n=56) according to the gestational age. The growth rate of corpus callosum was compared between the two groups. The correlation between the corpus callosum length and the cerebellar vermis length and the relationship of the growth rate of corpus callosum with clinical factors and the neuromotor development were analyzed. The growth rate of corpus callosum in preterm infants declined since 2 weeks after birth. Compared with the 30-32(+6) weeks group, the 26-29(+6) weeks group had a significantly lower growth rate of corpus callosum at 3-4 weeks after birth, at 5-6 weeks after birth, and from 7 weeks after birth to 40 weeks of corrected gestational age. There was a positive linear correlation between the corpus callosum length and the cerebellar vermis length. Small-for-gestational age infants had a low growth rate of corpus callosum at 2 weeks after birth. The 12 preterm infants with severe abnormal intellectual development had a lower growth rate of corpus callosum compared with the 108 preterm infants with non-severe abnormal intellectual development at 3-6 weeks after birth. The 5 preterm infants with severe abnormal motor development had a significantly lower growth rate of corpus callosum compared with the 115 preterm infants with non-severe abnormal motor development at 3-6 weeks after birth. The decline of growth rate of corpus callosum in preterm infants at 2-6 weeks after birth can increase the risk of severe abnormal neuromotor development.

  6. Maternal Smoking during Pregnancy and Necrotizing Enterocolitis-associated Infant Mortality in Preterm Babies.

    PubMed

    Ding, Guodong; Yu, Jing; Chen, Yan; Vinturache, Angela; Pang, Yu; Zhang, Jun

    2017-03-31

    Few studies have examined the possible pregnancy-related risk factors for necrotizing enterocolitis (NEC)-associated deaths during infancy. Infant death due to NEC in preterm babies was identified from the US Linked Livebirth and Infant Death records between 2000 and 2004. The average number of cigarettes per day reported by the mothers who were smoking during pregnancy was classified in three categories: non-smoking, light smoking (<10 cigarettes/day) and heavy smoking (≥10 cigarettes/day). Logistic regression analyses examined the association between prenatal smoking and NEC-associated infant mortality rates with adjustment for potential confounders. Compared with non-smoking mothers, light and heavy smoking mothers have a higher risk of NEC-associated infant mortality [light smoking: adjusted odds ratio (aOR) = 1.21, 95% confidence interval (CI), 1.03-1.43; heavy smoking: aOR = 1.30, 95% CI, 1.12-1.52], respectively. Moreover, the association was stronger among white race (light smoking: aOR = 1.69, 95% CI, 1.34-2.13; heavy smoking: aOR = 1.44, 95% CI, 1.18-1.75) and female babies (light smoking: aOR = 1.31, 95% CI, 1.02-1.69; heavy smoking: aOR = 1.62, 95% CI, 1.29-2.02). Maternal smoking during pregnancy is associated with increased risks of infant mortality due to NEC in preterm babies, especially in white race and female babies.

  7. Maternal Smoking during Pregnancy and Necrotizing Enterocolitis-associated Infant Mortality in Preterm Babies

    PubMed Central

    Ding, Guodong; Yu, Jing; Chen, Yan; Vinturache, Angela; Pang, Yu; Zhang, Jun

    2017-01-01

    Few studies have examined the possible pregnancy-related risk factors for necrotizing enterocolitis (NEC)-associated deaths during infancy. Infant death due to NEC in preterm babies was identified from the US Linked Livebirth and Infant Death records between 2000 and 2004. The average number of cigarettes per day reported by the mothers who were smoking during pregnancy was classified in three categories: non-smoking, light smoking (<10 cigarettes/day) and heavy smoking (≥10 cigarettes/day). Logistic regression analyses examined the association between prenatal smoking and NEC-associated infant mortality rates with adjustment for potential confounders. Compared with non-smoking mothers, light and heavy smoking mothers have a higher risk of NEC-associated infant mortality [light smoking: adjusted odds ratio (aOR) = 1.21, 95% confidence interval (CI), 1.03–1.43; heavy smoking: aOR = 1.30, 95% CI, 1.12–1.52], respectively. Moreover, the association was stronger among white race (light smoking: aOR = 1.69, 95% CI, 1.34–2.13; heavy smoking: aOR = 1.44, 95% CI, 1.18–1.75) and female babies (light smoking: aOR = 1.31, 95% CI, 1.02–1.69; heavy smoking: aOR = 1.62, 95% CI, 1.29–2.02). Maternal smoking during pregnancy is associated with increased risks of infant mortality due to NEC in preterm babies, especially in white race and female babies. PMID:28361963

  8. Metabolic products in urine of preterm infants characterized via gas chromatography-mass spectrometry

    PubMed Central

    Hao, Hu; Li, Sitao; Zhou, Wei; Wang, Hong; Liu, Mengxian; Shi, Congcong; Chen, Jing; Xiao, Xin

    2015-01-01

    Objective: To characterize the metabolic products of urine associated with preterm birth, thus providing clinical guidelines for intestinal and parenteral nutrition in preterm infants. Methods: Urine samples of 47 preterm infants and 45 full-term infants were collected and prepared for trimethylsilylation by treatment with urease. The levels of lysine, phenylalanine, histidine, ornithine, fumaric acid, malic acid, succinic acid, lactose, stearic acid, and 4-hydroxyphenylacetic acid were detected by gas chromatography-mass spectrometry (GC/MS), and statistically analyzed. Results: The normalized concentrations of the following metabolites in preterm infant urine samples were significantly lower than that of full-term infant urine samples: lysine (P = 0.003), phenylalanine (P = 0.001), histidine (P = 0.006), ornithine (P = 0.000), fumaric acid (P = 0.002), malic acid (P = 0.006), succinic acid (P = 0.000), lactose (P = 0.000), stearic acid (P = 0.000) and 4-hydroxyphenylacetic acid (P = 0.000). Conclusions: The results of the GC/MS analysis indicated that amino acid, carbohydrate, and fatty acid metabolism defects exist in preterm infants. The use of GC/MS to determine metabolic products in urine samples could be helpful for prospectively evaluating the nutritional status of preterm infants, and therefore providing clinical guidelines on reasonable nutritional support. PMID:26629171

  9. Human milk for preterm infants: why, what, when and how?

    PubMed

    Menon, Gopi; Williams, Thomas C

    2013-11-01

    A mother's expressed breast milk (MEBM) is overall the best feed for her preterm baby during the neonatal period, and is associated with improved short-term and long-term outcomes. Neonatal services should commit the resources needed to optimise its use. The place of banked donor expressed breast milk (DEBM) is less clear, but it probably has a role in reducing the risk of necrotising enterocolitis and sepsis in preterm infants at particularly high risk. There is considerable variation in the composition of human milk and nutrient fortification is often needed to achieve intrauterine growth rates. Human milk can transmit potentially harmful micro-organisms, and pasteurisation, which denatures some of the bioactive factors, is the only known way of preventing this. This is carried out for DEBM but not MEBM in the UK. Future research on human milk should focus on (a) critical exposure periods, (b) understanding better its bioactive properties, (c) the role of DEBM and (d) nutritional quality assurance.

  10. [Antenatal corticosteroid use and clinical evolution of preterm newborn infants].

    PubMed

    2004-01-01

    To describe the use of antenatal corticosteroid and clinical evolution of preterm babies. An observational prospective cohort study was carried out. All 463 pregnant women and their 514 newborn babies with gestational age ranging from 23 to 34 weeks, born at the Brazilian Neonatal Research Network units, were evaluated from August 1 to December 31, 2001. The data were obtained through maternal interview, analysis of medical records, and follow-up of the newborn infants. Data analysis was performed with the use of chi-square, t Student, Mann-Whitney, and ANOVA tests and multiple logistic regression, with level of significance set at 5%. Treatment was directly associated with the number of prenatal visits, with maternal hypertension and with the antenatal use of tocolytic agents. Babies from treated pregnant women presented better Apgar scores at the 1st and 5th minute, reduced need for intervention in the delivery room and lower SNAPPE II. They were born with higher birth weight, longer gestational age and needed less surfactant use, ventilation, and oxygenation time. After multiple logistic regression, the use of antenatal corticosteroid independently improved birth conditions, decreased ventilation time, being related to increased occurrence of neonatal sepsis. The use of corticosteroid was associated with better prenatal care and birth conditions, better preterm evolution but higher risk of infection.

  11. Antenatal Magnesium and Cerebral Palsy in Preterm Infants

    PubMed Central

    Hirtz, Deborah G.; Weiner, Steven J.; Bulas, Dorothy; DiPietro, Michael; Seibert, Joanna; Rouse, Dwight J.; Mercer, Brian M.; Varner, Michael W.; Reddy, Uma M.; Iams, Jay D.; Wapner, Ronald J.; Sorokin, Yoram; Thorp, John M.; Ramin, Susan M.; Malone, Fergal D.; Carpenter, Marshall W.; O’Sullivan, Mary J.; Peaceman, Alan M.; Hankins, Gary D. V.; Dudley, Donald; Caritis, Steve N.

    2015-01-01

    Objective To evaluate the relationship of maternal antenatal magnesium sulfate (MgSO4) with neonatal cranial ultrasound abnormalities and cerebral palsy (CP). Study design In a randomized trial of MgSO4 or placebo in women at high risk of preterm delivery, up to three cranial ultrasound were obtained in the neonatal period. Images were reviewed by at least two pediatric radiologists masked to treatment and other clinical conditions. Diagnoses were predefined for intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), intracerebral echolucency or echodensity, and ventriculomegaly. CP was diagnosed at two years by standardized neurological examination. Results Intraventricular hemorrhage, PVL, intracerebral echolucency or echodensity, and ventriculomegaly were all strongly associated with an increased risk of CP. MgSO4 administration did not affect the risk of cranial ultrasound abnormality observed at 35 weeks post-menstrual age or later. However, for the 82% of infants born at <32 weeks gestation, MgSO4 was associated with a reduction in risk of echolucency or echodensity. The reduction in risk for echolucency explained 21% of the effect of MgSO4 on CP (p=0.04), and for echodensity explained 20% of the effect (p=0.02). Conclusions MgSO4 given prior to preterm delivery was associated with decreased risk of developing echodensities and echolucencies at <32 weeks gestation. However, this effect can only partially explain the effect of MgSO4 on CP at two years of age. PMID:26254839

  12. Liquid human milk fortifier significantly improves docosahexaenoic and arachidonic acid status in preterm infants.

    PubMed

    Berseth, C L; Harris, C L; Wampler, J L; Hoffman, D R; Diersen-Schade, D A

    2014-09-01

    We report the fatty acid composition of mother׳s own human milk from one of the largest US cohorts of lactating mothers of preterm infants. Milk fatty acid data were used as a proxy for intake at enrollment in infants (n=150) who received human milk with a powder human milk fortifier (HMF; Control) or liquid HMF [LHMF; provided additional 12mg docosahexaenoic acid (DHA), 20mg arachidonic acid (ARA)/100mL human milk]. Mothers provided milk samples (n=129) and reported maternal DHA consumption (n=128). Infant blood samples were drawn at study completion (Study Day 28). Human milk and infant PPL fatty acids were analyzed using capillary column gas chromatography. DHA and ARA were within ranges previously published for US term and preterm human milk. Compared to Control HMF (providing no DHA or ARA), human milk fortified with LHMF significantly increased infant PPL DHA and ARA and improved preterm infant DHA and ARA status.

  13. Responses to a modified visual cliff by pre-walking infants born preterm and at term.

    PubMed

    Lin, Yuan-Shan; Reilly, Marie; Mercer, Vicki S

    2010-02-01

    The purpose of this study was to examine, using a modified visual cliff apparatus, possible perceptual differences at crawling age between infants born preterm and infants born at term without documented visual or motor impairments. Sixteen infants born at term and 16 born preterm were encouraged to crawl to their caregivers on a modified visual cliff. Successful trials, crossing time, duration of visual attention, duration of tactile exploration, motor strategies, and avoidance behaviors were analyzed. A significant surface effect was found, with longer crossing times and longer durations of visual attention and tactile exploration in the condition with the visual appearance of a deep cliff. Although the two groups of infants did not differ on any of the timed measures, infants born at term demonstrated a larger number of motor strategies and avoidance behaviors by simple tally. This study indicates that infants born at term and those born preterm can perceive a visual cliff and adapt their responses accordingly.

  14. The efficacy of massage on short and long term outcomes in preterm infants.

    PubMed

    Abdallah, Bahia; Badr, Lina Kurdahi; Hawwari, Mirvat

    2013-12-01

    Premature infants lack the tactile stimulation they would have otherwise experienced in the womb. Infant massage is a developmentally supportive intervention that has been documented for several decades to have a positive effect on both full term and preterm infants. The purpose of this study was to assess the short and long term benefits of massage on stable preterm infants. A quasi experimental design was used, 66 infants were recruited from two university hospitals with tertiary level NICUs; 32 infants received the massage therapy by their mothers. Data collection by a researcher blind to the infants' group assignments included weight at discharge, pain responses on the PIPP scale at discharge, length of stay in hospital, neuro-developmental outcome (Bayley scores) and breastfeeding duration at 12 months corrected age. Infants who were massaged had significantly lower scores on the PIPP after a heel-stick compared to before the massage and had lower PIPP scores at discharge compared to the control group. Massaged infants had higher cognitive scores at 12 months corrected age. Weight gain, length of stay, breastfeeding duration and motor scores did not differ between groups. Stable preterm infants benefit from massage therapy given by their mothers and may be a culturally acceptable form of intervention to improve the outcomes of preterm infants. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Factors Associated with Retinopathy of Prematurity in Hospitalized Preterm Infants in Sanandaj, Iran

    PubMed Central

    Mansouri, Majid; Hemmatpour, Sirous; Sedighiani, Fouzieh; Ghamari, Mojgan; Chavoshi, Delnia

    2016-01-01

    Introduction In the near future, retinopathy of prematurity (ROP) will be the most significant cause of blindness in upper and middle-income countries. Due to the increasing survival chances for premature and low birth weight infants and the importance of the diagnosis and treatment of ROP, this study was aimed at determining the prevalence of ROP and its related factors in Sanandaj, Iran, in 2014. Methods This cross-sectional study was performed on 47 preterm infants, weighing less than 2000 g or with a gestational age of less than of 34 weeks. The sampling method was census. From the first examination to 1 to 4 weeks later, until retinal vascularization completion, examinations were performed by the same ophthalmologist. Data were analyzed using SPSS version 20 and frequency, mean, SD and Chi-square tests. Results The prevalence of ROP in the infants was 10.6%. Prevalence among girls was 16% and among boys it was 4.5%. The results showed that 23.5% of infants with ROP needed mechanical ventilation. The difference between the two groups was statistically significant (p = 0.031). Conclusion In this study, the prevalence of ROP in the NICU and neonatal ward of Besat Hospital in Sanandaj was low. However, due to serious consequences of the disease in premature infants, timely screening, determination, and control of risk factors provided necessary support to manage the disease. PMID:27790346

  16. Long-term outcome of preterm infants and the role of neuroimaging.

    PubMed

    Myers, Eliza; Ment, Laura R

    2009-12-01

    Preterm birth has been defined as one of the major public health problems of this decade, preterm neonates being at high risk for neurodevelopmental disabilities. As preterm survival rates increase, the next great imperative for perinatal medicine is to understand and prevent the serious adverse neurodevelopmental outcomes of preterm birth. The challenge for neonatologists and neurologists alike is identifying early markers of outcome in the prematurely born. This article reviews current trends in prevalence, mortality, and morbidity, and the present status of outcome data for cognitive and neurosensory neurodevelopmental dysfunctions in preterm infants. New neuroimaging modalities and analysis tools are contributing to the understanding of neurologic sequelae of preterm birth by providing microstructural evidence of injury sustained by the preterm brain.

  17. Using Functional Magnetic Resonance Imaging to Detect Preserved Function in a Preterm Infant with Brain Injury.

    PubMed

    Herzmann, Charlotte; Zubiaurre-Elorza, Leire; Wild, Conor J; Linke, Annika C; Han, Victor K; Lee, David S C; Cusack, Rhodri

    2017-10-01

    We studied developmental plasticity using functional magnetic resonance imaging (fMRI) in a preterm infant with brain injury on structural MRI. fMRI showed preserved brain function and subsequent neurodevelopment was within the normal range. Multimodal neuroimaging including fMRI can improve understanding of neural plasticity after preterm birth and brain injury. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Gaze aversion during social interaction in preterm infants: a function of attention skills?

    PubMed

    De Schuymer, Leentje; De Groote, Isabel; Desoete, Annemie; Roeyers, Herbert

    2012-02-01

    Preterm infants avert their gaze more often and for longer periods in early social interactions compared to full term infants. In previous studies this finding is interpreted as being a function of the higher degree of parental stimulation that is often found in parents of preterm children. The current study explores an additional hypothesis. Since the development of general visual attention abilities is found to be less optimal in preterm children, it is possible that less optimal maturation of attention abilities partially explains the elevated gaze aversion in a social context. Therefore, the current study investigated the association between gaze aversion in a social context and the ability to disengage and shift visual attention in a non-social context in 20 preterm and 42 full term infants aged 4 and 6 months. Results confirm that preterm infants are slower to shift their attention in a non-social context and that they avert their gaze more often in a social context compared to full term children. Furthermore, more frequent gaze aversion during social interaction at 6 months was related to longer disengagement and the shifting of attention at 4 and 6 months, but only within the preterm group. The results suggest that attention maturation is less optimal in preterm children; this can be observed in a non-social as well as a social context. Less attention maturation in preterm children can negatively influence the amount of time they can stay actively involved in social interaction.

  19. Reservoirs of coagulase negative staphylococci in preterm infants.

    PubMed Central

    Eastick, K.; Leeming, J. P.; Bennett, D.; Millar, M. R.

    1996-01-01

    This investigation was undertaken to determine the magnitude of, and interrelations between, reservoirs of coagulase negative staphylococci on infants' skin at various sites (including sites used for insertion of intravascular catheters) and in faeces during the first six months of life. Sites with large numbers of coagulase negative staphylococci were identified by sampling 16 skin sites and stools from 20 preterm neonates at 8-30 days of life. A more detailed survey of numbers and types of coagulase negative staphylococci in stool and at six skin sites of 10 preterm infants was then performed over the first six months of life. Isolates of coagulase negative staphylococci were collected and characterised by speciation, antibiotic susceptibility profiling, and plasmid restriction fragment length polymorphism analysis. Large, relatively stable reservoirs were identified in the faeces, around the ear, and in the axilla and nares. Skin on the forearm and leg, sites at which peripheral catheters are frequently sited, carried small unstable numbers of coagulase negative staphylococci, which were usually indistinguishable from coagulase negative staphylococci isolated from other body sites on the same baby. Contamination of catheter insertion sites with coagulase negative staphylococci from reservoir sites on the same baby could explain these observations. These data suggest that interventions reducing cross-contamination between sites on the same baby might be as important in preventing coagulase negative staphylococcal bacteraemias as measures taken to prevent cross infection between babies. Procedures which are likely to result in heavy coagulase negative staphylococcal contamination of the hands of healthcare staff, such as changing soiled nappies, should receive particular attention. PMID:8777675

  20. The Relationship between Planned and Reported Home Infant Sleep Locations among Mothers of Late Preterm and Term Infants

    PubMed Central

    Tully, Kristin P.; Holditch-Davis, Diane; Brandon, Debra

    2015-01-01

    Objective To compare maternal report of planned and practiced home sleep locations of infants born late preterm (34 0/7 to 36 6/7 gestational weeks) with those infants born term (≥ 37 0/7 gestational weeks) over the first postpartum month. Methods Open-ended semi-structured maternal interviews were conducted in a U.S. hospital following birth and by phone at one month postpartum during 2010–2012. Participants were 56 mother-infant dyads: 26 late preterm and 30 term. Results Most women planned to room share at home with their infants and reported doing so for some or all of the first postpartum month. More women reported bed sharing during the first postpartum month than had planned to do so in both the late preterm and term groups. The primary reason for unplanned bed sharing was to soothe nighttime infant fussiness. Those participants who avoided bed sharing at home commonly discussed their fear for infant safety. A few parents reported their infants were sleeping propped on pillows and co-sleeping on a recliner. Some women in both the late preterm and term groups reported lack of opportunity to obtain a bassinet prior to childbirth. Conclusions The discrepancy between plans for infant sleep location at home and maternally reported practices were similar in late preterm and term groups. Close maternal proximity to their infants at night was derived from the need to assess infant well-being, caring for infants, and women’s preferences. Bed sharing concerns related to infant safety and the establishment of an undesirable habit, and alternative arrangements included shared recliner sleep. PMID:25626714

  1. The relationship between planned and reported home infant sleep locations among mothers of late preterm and term infants.

    PubMed

    Tully, Kristin P; Holditch-Davis, Diane; Brandon, Debra

    2015-07-01

    To compare maternal report of planned and practiced home sleep locations of infants born late preterm (34 0/7 to 36 6/7 gestational weeks) with those infants born term (≥37 0/7 gestational weeks) over the first postpartum month. Open-ended semi-structured maternal interviews were conducted in a US hospital following birth and by phone at 1 month postpartum during 2010-2012. Participants were 56 mother-infant dyads: 26 late preterm and 30 term. Most women planned to room share at home with their infants and reported doing so for some or all of the first postpartum month. More women reported bed sharing during the first postpartum month than had planned to do so in both the late preterm and term groups. The primary reason for unplanned bed sharing was to soothe nighttime infant fussiness. Those participants who avoided bed sharing at home commonly discussed their fear for infant safety. A few parents reported their infants were sleeping propped on pillows and co-sleeping on a recliner. Some women in both the late preterm and term groups reported lack of opportunity to obtain a bassinet prior to childbirth. The discrepancy between plans for infant sleep location at home and maternally reported practices were similar in late preterm and term groups. Close maternal proximity to their infants at night was derived from the need to assess infant well-being, caring for infants, and women's preferences. Bed sharing concerns related to infant safety and the establishment of an undesirable habit, and alternative arrangements included shared recliner sleep.

  2. Oxygen Supplementation to Stabilize Preterm Infants in the Fetal to Neonatal Transition: No Satisfactory Answer

    PubMed Central

    Torres-Cuevas, Isabel; Cernada, Maria; Nuñez, Antonio; Escobar, Javier; Kuligowski, Julia; Chafer-Pericas, Consuelo; Vento, Maximo

    2016-01-01

    Fetal life elapses in a relatively low oxygen environment. Immediately after birth with the initiation of breathing, the lung expands and oxygen availability to tissue rises by twofold, generating a physiologic oxidative stress. However, both lung anatomy and function and the antioxidant defense system do not mature until late in gestation, and therefore, very preterm infants often need respiratory support and oxygen supplementation in the delivery room to achieve postnatal stabilization. Notably, interventions in the first minutes of life can have long-lasting consequences. Recent trials have aimed to assess what initial inspiratory fraction of oxygen and what oxygen targets during this transitional period are best for extremely preterm infants based on the available nomogram. However, oxygen saturation nomogram informs only of term and late preterm infants but not on extremely preterm infants. Therefore, the solution to this conundrum may still have to wait before a satisfactory answer is available. PMID:27148504

  3. [Quality analyses of the development of preterm infants: results of the Lower-Saxonian preterm infant follow-up project and a comparison group of term infants].

    PubMed

    Damm, Gabriele; Macha, Thorsten; Petermann, Franz; Voss, Wolfgang; Sens, Brigitte

    2015-01-01

    Based on perinatal and neonatal quality assurance programmes, a follow-up project for the high-risk group of extremely preterm infants, unparalleled in Germany, was initiated in the federal state of Lower Saxony in 2004. Here we describe the new approach of examining a comparison group of term infants, which, for the first time, allows a valid interpretation of the collection of area-wide long-term outcome data on preterm children. The prospective long-term outcome project investigates the medical care situation for children born at less than 28 weeks of gestation up to school age. Based on the information obtained about the children's development the quality of health care will be optimised. A standardised examining concept with established development tests at defined follow-up intervals (at the age of 6 months, 2, 5 and 10 years) is used. At the age of five years 75 % of the examined premature children exhibited impairments. In order to better assess remarkable results, a comparison group of term infants (n=305) selected by a matched-pairs method was examined at the age of five using an analogous concept in kindergartens in Lower Saxony. The results were compared with the first two age cohorts of the follow-up-project (n=226) and quality analyses performed. As expected, significant differences have been found in the children's motor, cognitive and linguistic development between the preterm and term infants examined. This fact draws attention to the importance of early support for the majority of extremely premature infants. Feedback on the results given to the medical staff involved allows for the implementation of best practices and quality improvements. Identifying potential for improvement in everyday health care will help to develop specific optimisation measures. Copyright © 2015. Published by Elsevier GmbH.

  4. Maternal weight status and responsiveness to preterm infant behavioral cues during feeding.

    PubMed

    Arianas, Evanthia A; Rankin, Kristin M; Norr, Kathleen F; White-Traut, Rosemary C

    2017-04-11

    Parental obesity is highly predictive of child obesity, and preterm infants are at greater risk of obesity, but little is known about obese and non-obese mothers' responsiveness to preterm infant cues during feeding. The relationship between maternal weight status and response to preterm infant behavioral cues during feeding at 6-weeks corrected age was examined. This secondary analysis used data from a randomized clinical trial. Maternal weight was coded during a play session. Mother-infant interaction during feeding was coded using the Nursing Child Assessment Satellite Training Feeding Scale (NCAST). We used multivariate linear regressions to examine NCAST scores and multivariate logistic regressions for the two individual items, satiation cues and termination of feeding. Of the 139 mothers, 56 (40.3%) were obese, two underweight women were excluded. Obese mothers did not differ from overweight/normal weight mothers for overall NCAST scores, but they had higher scores on response to infant's distress subscale (mean = 10.2 vs. 9.6, p = 0.01). The proportion of infants who exhibited satiation cues did not differ by maternal weight. Obese mothers were more likely than overweight/normal weight mothers to terminate the feeding when the infant showed satiation cues (82.1% vs. 66.3%, p = 0.04, adjusted OR = 2.31, 95% CI = 0.97, 5.48). Limitations include lack of BMI measures and small sample size. Additional research is needed about maternal weight status and whether it influences responsiveness to preterm infant satiation cues. Results highlight the need for educating all mothers of preterm infants regarding preterm infant cues. NCT02041923 . Feeding and Transition to Home for Preterms at Social Risk (H-HOPE). Registered 15 January 2014.

  5. Incubator weaning in preterm infants and associated practice variation.

    PubMed

    Schneiderman, R; Kirkby, S; Turenne, W; Greenspan, J

    2009-08-01

    To evaluate the relationship of weight of preterm infants when first placed into an open crib with days to full oral feedings, growth velocity and length of stay (LOS), and to identify unwarranted variation in incubator weaning after adjusting for severity indices. A retrospective study using the ParadigmHealth neonatal database from 2003 to 2006 reviewed incubator weaning to an open crib in appropriate-for-gestational-age (AGA) infants from 22 to weeks gestation. Primary outcome measurements included days to full oral (PO) feeding, weight gain from open crib to discharge and length of stay. Models were severity adjusted. To understand hospital practice variation, we also used a regression model to estimate the weight at open crib for the top 10 volume hospitals. In all 2908 infants met the inclusion criteria for the study. Their mean weight at open crib was 1850 g. On average every additional 100 g an infant weighed at the open crib was associated with increased time to full PO feeding by 0.8 days, decreased weight gained per day by 1 gram and increased LOS by 0.9 days. For the top 10 volume hospitals, severity variables alone accounted for 9% of the variation in weight at open crib, whereas the hospital in which the baby was treated accounted for an additional 19% of the variation. Even after controlling for severity, significant practice variation exists in weaning to an open crib, leading to potential delays in achieving full-volume oral feeds, decreased growth velocity and prolonged LOS.

  6. A qualitative study: Mothers of late preterm infants relate their experiences of community-based care

    PubMed Central

    Dosani, Aliyah; Oliver, Lynnette May; Lodha, Abhay K; Young, Marilyn

    2017-01-01

    Purpose In Alberta, the high occurrence of late preterm infants and early hospital discharge of mother-infant dyads has implications for postpartum care in the community. Shortened hospital stay and complexities surrounding the care of biologically and developmentally immature late preterm infants heighten anxiety and fears. Our descriptive phenomenological study explores mothers’ experience of caring for their late preterm infants in the community. Methods Eleven mothers were interviewed using a semi-structured interview guide. Interview transcripts were analysed using an interpretive thematic approach. Findings The mothers’ hospital experience informed their perspective that being a late preterm infant was not a “big deal,” and they tended to treat their infant as normal. “Feeding was really problem,” especially the variability in feeding effectiveness, which was not anticipated. Failing to recognize late preterm infants’ feeding distress exemplified lack of knowledge of feeding cues and tendencies to either rationalize or minimize feeding concerns. Public health nurses represent a source of informational support for managing neonatal morbidities associated with being late preterm; however, maternal experiences with public health nurses varied. Some nurses used a directive style that overwhelmed certain mothers. Seeing multiple public health nurses and care providers was not always effective, given inconsistent and contradictory guidance to care. These new and changing situations increased maternal anxiety and stress and influenced maternal confidence in care. Fathers, family, and friends were important sources of emotional support. Conclusion After discharge, mothers report their lack of preparation to meet the special needs of their late preterm infants. Current approaches to community-based care can threaten maternal confidence in care. New models and pathways of care for late preterm infants and their families need to be responsive to the

  7. Arterial hypotension and prerenal failure in an extremely preterm infant associated with oral sildenafil.

    PubMed

    Balasubramanian, H; Strunk, T; Kohan, R

    2015-06-01

    We report significant hypotension and prerenal failure in an extremely preterm infant following two doses of oral sildenafil that warranted discontinuation of the drug and treatment with inotropes. Blood pressure and urine output normalized after 24 h of withdrawal of the oral drug. Sildenafil should be used cautiously in extremely preterm infants early in the neonatal course, where there is limited data on its efficacy and safety.

  8. Implications of epigenetics and stress regulation on research and developmental care of preterm infants.

    PubMed

    Montirosso, Rosario; Provenzi, Livio

    2015-01-01

    Epigenetics refers to chemical modifications leading to changes in gene expression without any alteration of the DNA structure. We suggest ways through which epigenetic mechanisms might contribute to alter developmental trajectories in preterm infants. Although theoretical and methodological issues still need to be addressed, we discuss how epigenetics might be an emergent research field with potential innovative insights for researchers and clinicians involved in the neonatal care of preterm infants. © 2015 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  9. Patterns of metabolic adaptation for preterm and term infants in the first neonatal week.

    PubMed Central

    Hawdon, J M; Ward Platt, M P; Aynsley-Green, A

    1992-01-01

    There have been few comprehensive accounts of the relationships between glucose and other metabolic fuels during the first postnatal week, especially in the context of modern feeding practises. A cross sectional study was performed of 156 term infants and 62 preterm infants to establish the normal ranges and interrelationships of blood glucose and intermediary metabolites in the first postnatal week, and to compare these with those of 52 older children. Blood glucose concentrations varied more for preterm than for term infants (1.5-12.2 mmol/l v 1.5-6.2 mmol/l), and preterm infants had low ketone body concentrations, even at low blood glucose concentrations. Breast feeding of term infants and enteral feeding of preterm infants appeared to enhance ketogenic ability. Term infants had lower prefeed blood glucose concentrations than children but, like children, appeared to be capable of producing ketone bodies. This study demonstrates that neonatal blood glucose concentrations should be considered in the context of availability of other metabolic fuels, and that the preterm infant has a limited ability to mobilise alternative fuels. PMID:1586171

  10. Effect of palivizumab prophylaxis on subsequent recurrent wheezing in preterm infants.

    PubMed

    Yoshihara, Shigemi; Kusuda, Satoshi; Mochizuki, Hiroyuki; Okada, Kenji; Nishima, Sankei; Simões, Eric A F

    2013-11-01

    Palivizumab effectively prevents severe respiratory syncytial virus (RSV) disease in preterm infants. Our objective was to test whether palivizumab prophylaxis given to preterm infants during the first RSV season reduces the incidence of subsequent recurrent wheezing up to 3 years of life. We conducted an observational prospective multicenter (52 registered hospitals in Japan) case-control study in preterm infants with a gestational age between 33 and 35 weeks followed for 3 years. During the 2007-2008 RSV season, the decision to administer palivizumab was made based on standard medical practice. In April 2008, 52 hospitals were recruited. Study participants were prospectively followed to the age of 3 years. Parents of study subjects reported the infants' physician's assessment of recurrent wheezing, used a report card and a novel mobile phone-based reporting system by using the Internet. The primary end point was the incidence of physician-diagnosed recurrent wheezing. Of 444 preterm infants enrolled, 349 received palivizumab during the first 6 months of life and 95 infants did not. Physician-diagnosed recurrent wheezing was observed in 6.4% and 18.9% of infants in the treated and untreated groups, respectively (P < .001). This difference remained significant after adjustment for known risk factors of recurrent wheezing (P < .001). Palivizumab prophylaxis administered to preterm infants 33 to 35 weeks' gestational age is associated with a significantly lower incidence of recurrent wheezing during the first 3 years of life.

  11. Maternal singing during kangaroo care led to autonomic stability in preterm infants and reduced maternal anxiety.

    PubMed

    Arnon, Shmuel; Diamant, Chagit; Bauer, Sofia; Regev, Rivka; Sirota, Gisela; Litmanovitz, Ita

    2014-10-01

    Kangaroo care (KC) and maternal singing benefit preterm infants, and we investigated whether combining these benefitted infants and mothers. A prospective randomised, within-subject, crossover, repeated-measures study design was used, with participants acting as their own controls. We evaluated the heart rate variability (HRV) of stable preterm infants receiving KC, with and without maternal singing. This included low frequency (LF), high frequency (HF) and the LF/HF ratio during baseline (10 min), singing or quiet phases (20 min) and recovery (10 min). Physiological parameters, maternal anxiety and the infants' behavioural state were measured. We included 86 stable preterm infants, with a postmenstrual age of 32-36 weeks. A significant change in LF and HF, and lower LF/HF ratio, was observed during KC with maternal singing during the intervention and recovery phases, compared with just KC and baseline (all p-values <0.05). Maternal anxiety was lower during singing than just KC (p = 0.04). No differences in the infants' behavioural states or physiological parameters were found, with or without singing. Maternal singing during KC reduces maternal anxiety and leads to autonomic stability in stable preterm infants. This effect is not detected in behavioural state or physiological parameters commonly used to monitor preterm infants. ©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  12. Cerebral ultrasound abnormalities in preterm infants caused by late-onset sepsis

    PubMed Central

    van den Dungen, F. A. M.; Vermeulen, R. J.; van Weissenbruch, M. M.

    2017-01-01

    Introduction This study describes cerebral ultrasound abnormalities caused by late-onset sepsis (LOS) in very preterm infants with a gestational age of < 32 weeks and/or birthweight < 1500 grams. Methods The prospective study (“INFANT study”) included 117 preterm infants with suspected LOS. Proven LOS was defined as a positive blood culture after 72 hours of life. In case of coagulase-negative staphylococci an elevated C-reactive protein was additionally required to establish proven LOS. Patients were identified as proven LOS and patients with only clinical symptoms of LOS. Cerebral ultrasound images were obtained in the first week after birth, during/after LOS and before discharge. Cerebral findings were divided in no/minor and major abnormalities. Results Eighty-six preterm infants had proven LOS and 31 preterm infants had only clinical signs of LOS. Four infants were excluded because pre-existing major brain abnormalities. No significant differences (p = 0.624) for incidence of major brain abnormalities on cerebral ultrasound were found. Conclusion No differences were revealed in prevalence of major brain abnormalities between the groups with proven LOS and with clinical signs of LOS. Both infants with a gram negative sepsis developed major brain abnormalities, whereas only two of 66 preterm infants coagulase-negative staphylococci sepsis developed major brain abnormalities. PMID:28301503

  13. Mode of Birth Influences Preterm Infant Intestinal Colonization With Bacteroides Over the Early Neonatal Period.

    PubMed

    Gregory, Katherine E; LaPlante, Rose D; Shan, Gururaj; Kumar, Deepak Vijaya; Gregas, Matt

    2015-12-01

    Intestinal colonization during infancy is important to short- and long-term health outcomes. Bacteroides, an early member of the intestinal microbiome, is necessary for breaking down complex molecules within the intestine and function to assist the body's immune system in fighting against potentially harmful pathogens. Little is known about the colonization pattern of Bacteroides in preterm infants during the early neonatal period. This study measured Bacteroides colonization during the early neonatal period in a population of preterm infants, based on clinical factors including mode of birth, antibiotics, and nutrition. Bacterial DNA was isolated from 144 fecal samples from 29 preterm infants and analyzed using quantitative real-time polymerase chain reaction. Analyses included liner mixed models to determine which clinical factors affect Bacteroides colonization of the infant gut. We found that infants born via vaginal canal had a higher rate of increase in Bacteroides than infants born via cesarean section (P < .001). We did not find significant associations between antibiotic administration and differences in nutritional exposures with Bacteroides colonization. These findings highlight the significant influence of mode of birth on Bacteroides colonization. While mode of birth is not always modifiable, these study findings may help develop interventions for preterm infants born via cesarean section aimed at overcoming delayed Bacteroides colonization. Greater study of the intestinal microbiome and the clinical factors relevant to the preterm infant is needed so that interventions may be developed and tested, resulting in optimal microbial and immune health.

  14. Mode of Birth Influences Preterm Infant Intestinal Colonization with Bacteroides Over the Early Neonatal Period

    PubMed Central

    Gregory, Katherine E.; LaPlante, Rose D.; Shan, Gururaj; Kumar, Deepak Vijaya; Gregas, Matt

    2015-01-01

    Background Intestinal colonization during infancy is important to short and long term health outcomes. Bacteroides, an early member of the intestinal microbiome, are necessary for breaking down complex molecules within the intestine and function to assist the body’s immune system in fighting against potentially harmful pathogens. Little is known about the colonization pattern of Bacteroides in preterm infants during the early neonatal period. Purpose This study measured Bacteroides colonization during the early neonatal period in a population of preterm infants based on clinical factors including mode of birth, antibiotics, and nutrition. Methods Bacterial DNA was isolated from 144 fecal samples from 29 preterm infants and analyzed using quantitative real time polymerase chain reaction (PCR). Analyses included liner mixed models to determine which clinical factors affect Bacteroides colonization of the infant gut. Results We found that infants born via vaginal canal had a higher rate of increase in Bacteroides than infants born via Cesarean section (p<.001). We did not find significant associations between antibiotic administration and differences in nutritional exposures with Bacteroides colonization. Implications for Practice These findings highlight the significant influence of mode of birth on Bacteroides colonization. While mode of birth is not always modifiable, these study findings may help develop interventions for preterm infants born via Cesarean section aimed at overcoming delayed Bacteroides colonization. Implications for Research Greater study of the intestinal microbiome and the clinical factors relevant to the preterm infant is needed so that interventions may be developed and tested, resulting in optimal microbial and immune health. PMID:26551793

  15. Bioactive Proteins in Human Milk-Potential Benefits for Preterm Infants.

    PubMed

    Lönnerdal, Bo

    2017-03-01

    Human milk contains many bioactive proteins that are likely to be involved in the better outcomes of breast-fed infants compared with those fed infant formula. Bovine milk proteins or protein fractions may be able to provide some of these benefits and may, therefore, be used for preterm infants. Recombinant human milk proteins are likely to exert bioactivities similar to those of the native human milk proteins, but considerable research is needed before they can be used in routine care of preterm infants.

  16. Transmission of methicillin-resistant Staphylococcus aureus to preterm infants through breast milk.

    PubMed

    Behari, Priya; Englund, Janet; Alcasid, Grace; Garcia-Houchins, Sylvia; Weber, Stephen G

    2004-09-01

    To determine a potential source of MRSA colonization and infection among preterm infants in a neonatal intensive care unit (NICU) using molecular analysis of breast milk samples. Case report, outbreak investigation. Preterm triplets were delivered at 26 weeks' gestation via cesarean section when routine active surveillance for MRSA was performed for all infants in a NICU. Surveillance consisted of swabbing the throat, nose, and umbilicus (TNU) weekly. Although infants A and B initially had negative TNU swabs, repeat cultures were positive for MRSA on day of life (DOL) 10 and DOL 18, respectively. Surveillance and clinical cultures for infant C were negative. Infant A developed sepsis, and multiple blood cultures were positive for MRSA beginning on DOL 14. Infant B developed conjunctivitis and a conjunctival exudate culture was positive for MRSA on DOL 70. Both infants were fed breast milk via nasogastric tube. Cultures of breast milk samples for infants A and B dated prior to either infant's first positive surveillance culture were positive for MRSA. All MRSA isolates had identical results on antibiotic susceptibility testing. PFGE demonstrated identical banding patterns for the MRSA isolates from the blood culture of infant A, breast milk for infants A and B, and a surveillance swab from infant B. At no time did the mother develop evidence of mastitis or other local breast infection. MRSA can be passed from mother to preterm infant through contaminated breast milk, even in the absence of maternal infection. Colonization and clinical disease can result.

  17. Randomized trial of exclusive human milk versus preterm formula diets in extremely premature infants.

    PubMed

    Cristofalo, Elizabeth A; Schanler, Richard J; Blanco, Cynthia L; Sullivan, Sandra; Trawoeger, Rudolf; Kiechl-Kohlendorfer, Ursula; Dudell, Golde; Rechtman, David J; Lee, Martin L; Lucas, Alan; Abrams, Steven

    2013-12-01

    To compare the duration of parenteral nutrition, growth, and morbidity in extremely premature infants fed exclusive diets of either bovine milk-based preterm formula (BOV) or donor human milk and human milk-based human milk fortifier (HUM), in a randomized trial of formula vs human milk. Multicenter randomized controlled trial. The authors studied extremely preterm infants whose mothers did not provide their milk. Infants were fed either BOV or an exclusive human milk diet of pasteurized donor human milk and HUM. The major outcome was duration of parenteral nutrition. Secondary outcomes were growth, respiratory support, and necrotizing enterocolitis (NEC). Birth weight (983 vs 996 g) and gestational age (27.5 vs 27.7 wk), in BOV and HUM, respectively, were similar. There was a significant difference in median parenteral nutrition days: 36 vs 27, in BOV vs HUM, respectively (P = .04). The incidence of NEC in BOV was 21% (5 cases) vs 3% in HUM (1 case), P = .08; surgical NEC was significantly higher in BOV (4 cases) than HUM (0 cases), P = .04. In extremely preterm infants given exclusive diets of preterm formula vs human milk, there was a significantly greater duration of parenteral nutrition and higher rate of surgical NEC in infants receiving preterm formula. This trial supports the use of an exclusive human milk diet to nourish extremely preterm infants in the neonatal intensive care unit. Copyright © 2013 Mosby, Inc. All rights reserved.

  18. Neurological assessment of preterm infants at term conceptional age in comparison with normal full-term infants.

    PubMed

    Forslund, M; Bjerre, I

    1983-10-01

    In a long-term prospective study 46 unselected infants born before 35 weeks of gestational age were followed up, which included repeated neurological and psychological examination. 40 of them were neurologically evaluated at term conceptional age and compared with 26 full-term newborns, all the infants being considered healthy. There was no difference in mean weight or length between the two groups, but mean head circumference was greater in the preterm group. The preterm infants had lower muscle tone as judged by spontaneous posture of arms and legs, and poor resistance to passive movements and slow arm recoil. In the traction test they had more head lag. The withdrawal and Moro reflexes were weaker, while asymmetric tonic neck reflex (ATNR) was easier to elicit. Head control in the sitting position was better. All infants were evaluated with a prenatal and perinatal optimality score, which was not however significantly correlated with the neurological findings. The preterm infants with only slightly reduced optimality score (low risk group) had approximately the same birth weight and gestational age as the other preterms. They more resembled the full-term infants with good resistance to passive movements, fast arm recoil and good responses concerning the withdrawal and Moro reflexes. However, they had a semiflexed position in supine and thus in this respect were more like the other preterms.

  19. Preterm and Term Infants' Perception of Temporally Coordinated Syllable-Object Pairings: Implications for Lexical Development

    ERIC Educational Resources Information Center

    Gogate, Lakshmi; Maganti, Madhavilatha; Perenyi, Agnes

    2014-01-01

    Purpose: This experimental study examined term infants (n = 34) and low-risk near-term preterm infants (gestational age 32-36 weeks) at 2 months chronological age (n = 34) and corrected age (n = 16). The study investigated whether the preterm infants presented with a delay in their sensitivity to synchronous syllable-object pairings when compared…

  20. Preterm and Term Infants' Perception of Temporally Coordinated Syllable-Object Pairings: Implications for Lexical Development

    ERIC Educational Resources Information Center

    Gogate, Lakshmi; Maganti, Madhavilatha; Perenyi, Agnes

    2014-01-01

    Purpose: This experimental study examined term infants (n = 34) and low-risk near-term preterm infants (gestational age 32-36 weeks) at 2 months chronological age (n = 34) and corrected age (n = 16). The study investigated whether the preterm infants presented with a delay in their sensitivity to synchronous syllable-object pairings when compared…

  1. [Duration of breastfeeding in preterm infants followed at a secondary referral service].

    PubMed

    Freitas, Brunnella Alcantara Chagas de; Lima, Luciana Moreira; Carlos, Carla Fernanda Lisboa Valente; Priore, Silvia Eloiza; Franceschini, Sylvia do Carmo Castro

    2016-06-01

    Identify and analyze variables associated with shorter duration of breastfeeding in preterm infants. Retrospective cohort of premature infants followed up at secondary referral service in the period of 2010-2015. first appointment in the first month of corrected age and have undergone three or more consultations. Exclusion: diseases that impaired oral feeding. duration of breastfeeding. A total of 103 preterm infants were evaluated, accounting for 28.8% of the preterm infants born in the municipality in that period, with a power of study of 80%. Descriptive analysis, t-test, chi-square test, Kaplan-Meier curves and Cox regression were used. p-values<0.05 were considered significant. The median duration of breastfeeding among preterm infants was 5.0 months. The risk of breastfeeding discontinuation among preterm infants with gestational age <32 weeks was 2.6-fold higher than for those born at 32 weeks or more and the risk of breastfeeding interruption in preterm infants who were receiving breastfeeding supplementation in the first outpatient visit was 3-fold higher when compared to those who were exclusively breastfed in the first consultation. The median duration of breastfeeding in preterm infants was below the recommended one and discontinuation was associated with gestational <32 weeks and the fact that the infant was no longer receiving exclusive breastfeeding in the first outpatient visit. When these two variables were associated, their negative effect on the median duration of breastfeeding was potentiated. Copyright © 2015 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

  2. Lost without trace: oximetry signal dropout in preterm infants.

    PubMed

    Lim, Kathleen; Wheeler, Kevin I; Jackson, Hamish D; Sadeghi Fathabadi, Omid; Gale, Timothy J; Dargaville, Peter A

    2015-09-01

    Oxygen saturation (SpO2) signal dropout leaves caregivers without a reliable measure to guide oxygen therapy. We studied SpO2 dropout in preterm infants on continuous positive airway pressure, noting the SpO2 values at signal loss and recovery and thus the resultant change in SpO2, and the factors influencing this parameter. In 32 infants of median gestation 26 weeks, a total of 3932 SpO2 dropout episodes were identified (1.1 episodes/h). In the episodes overall, SpO2 decreased by 1.1%, with the SpO2 change influenced by starting SpO2 (negative correlation), but not dropout duration. For episodes starting in hypoxia (SpO2 <85%), SpO2 recovered at a median of 3.2% higher than at SpO2 dropout, with a downward trajectory in a quarter of cases. We conclude that after signal dropout SpO2 generally recovers in a relative normoxic range. Blind FiO2 adjustments are thus unlikely to be of benefit during most SpO2 dropout episodes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  3. Clinical pharmacology of fentanyl in preterm infants. A review.

    PubMed

    Pacifici, Gian Maria

    2015-06-01

    Fentanyl is a synthetic opioid that is very important in anesthetic practice because of its relatively short time to peak analgesic effect and the rapid termination of action after small bolus doses. The objective of this survey is to review the clinical pharmacology of fentanyl in preterm infants. The bibliographic search was performed using PubMed and EMBASE databases as search engines. In addition, the books Neofax: A manual of drugs used in neonatal care and Neonatal formulary were consulted. Fentanyl is N-dealkylated by CYP3A4 into the inactive norfentanyl. Fentanyl may be administered as bolus doses or as a continuous infusion. In neonates, there is a remarkable interindividual variability in the kinetic parameters. In neonates, fentanyl half-life ranges from 317 minutes to 1266 minutes and in adults it is 222 minutes. Respiratory depression occurs when fentanyl doses are >5 μg/kg. Chest wall rigidity may occur in neonates and occasionally is associated with laryngospasm. Tolerance to fentanyl may develop after prolonged use of this drug. Significant withdrawal symptoms have been reported in infants treated with continuous infusion for 5 days or longer. Fentanyl is an extremely potent analgesic and is the opioid analgesic most frequently used in the neonatal intensive care unit.

  4. Home care practices for preterm and term infants after hospital discharge in Massachusetts, 2007 to 2010.

    PubMed

    Hwang, S S; Lu, E; Cui, X; Diop, H; Barfield, W D; Manning, S E

    2015-10-01

    The objective of this study was to compare the prevalence of home care practices in very to moderately preterm (VPT), late preterm (LPT) and term infants born in Massachusetts. Using 2007 to 2010 Massachusetts Pregnancy Risk Assessment Monitoring System data, births were categorized by gestational age (VPT: 23 to 33 weeks; LPT: 34 to 36 weeks; term: 37 to 42 weeks). Home care practices included breastfeeding initiation and continuation, and infant sleep practices (supine sleep position, sleeping in a crib, cosleeping in an adult bed). We developed multivariate models to examine the association of infant sleep practices and breastfeeding with preterm status, controlling for maternal sociodemographic characteristics. Supine sleep position was more prevalent among term infants compared with VPT and LPT infants (77.1%, 71.5%, 64.4%; P=0.02). In the adjusted model, LPT infants were less likely to be placed in supine sleep position compared with term infants (adjusted prevalence ratio=0.86; 95% confidence interval: 0.75 to 0.97). Breastfeeding initiation and continuation did not differ among preterm and term groups. Nearly 16% of VPT and 18% of LPT and term infants were not sleeping in cribs and 14% of LPT and term infants were cosleeping on an adult bed. Compared with term infants, LPT infants were less likely to be placed in supine sleep position after hospital discharge. A significant percent of preterm and term infants were cosleeping on an adult bed. Hospitals may consider improving their safe sleep education, particularly to mothers of LPT infants.

  5. Does a parent-administrated early motor intervention influence general movements and movement character at 3months of age in infants born preterm?

    PubMed

    Fjørtoft, Toril; Ustad, Tordis; Follestad, Turid; Kaaresen, Per Ivar; Øberg, Gunn Kristin

    2017-09-01

    Studies of preterm and term-born infants have shown absent fidgety movements and an abnormal movement character to be related to brain lesions and unfavourable neurological outcomes. The present study examines what effect a parent-administered early intervention program applied to preterm infants in a randomised control trial (RCT) between 34 and 36weeks gestational age has on their fidgety movements and overall movement character at three months of age. The study was part of the RCT in an early intervention programme including preterm infants born between 2010 and 2014 at three Norwegian university hospitals. 130 preterm infants participated in the study, with 59 of them in the control group and 71 in the intervention group. Fidgety movements and overall movement character at three months corrected age. No difference was found between the intervention group and the control group in terms of fidgety movements or movement character. Approximately half of the infants in both groups showed an abnormal movement character. No evidence was found in this RCT to suggest that an intervention at 34 to 37weeks gestational age has a significant effect on the fidgety movements or overall movement character of preterm infants. This is in line with the assumption that absent fidgety movements and an abnormal movement character are due to permanent brain injury and are therefore good predictors for later neurological impairments. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Modelling the cost-effectiveness of human milk and breastfeeding in preterm infants in the United Kingdom.

    PubMed

    Mahon, James; Claxton, Lindsay; Wood, Hannah

    2016-12-01

    To estimate the cost savings and health benefits in the UK NHS that could be achieved if human milk usage in the NICU was increased. A systematic review established the disease areas with the strong sources of evidence of the short, medium and long-term benefits of human milk for preterm infants as opposed to the use of formula milk. The analysis assessed the economic impact of reducing rates of necrotising enterocolitis, sepsis, sudden infant death syndrome, leukaemia, otitis media, obesity and neurodevelopmental impairment. Based on the number of preterm babies born in 2013, if 100% of premature infants being fed mother's milk could be achieved in the NICU, the total lifetime cost savings to the NHS due to improved health outcomes is estimated to be £46.7 million (£30.1 million in the first year) with a total lifetime QALY gain of 10,594, There would be 238 fewer deaths due to neonatal infections and SIDS, resulting in a reduction of approximately £153.4 million in lifetime productivity. Sensitivity analyses indicated that results were robust to a wide range of inputs. This analysis established that increasing the use of human milk in NICUs in the UK would lead to cost savings to the NHS. More research is needed on the medium and long term health and economic outcomes associated with breastfeeding preterm infants, and the differences between mother's own and donor breast milk.

  7. A Pharmacoeconomic Analysis of In-Hospital Costs Resulting from Reintubation in Preterm Infants Treated with Lucinactant, Beractant, or Poractant Alfa

    PubMed Central

    Guardia, Carlos G.; Moya, Fernando R.; Sinha, Sunil; Simmons, Phillip D.; Segal, Robert; Greenspan, Jay S.

    2012-01-01

    OBJECTIVES Reintubation and subsequent mechanical ventilation (MV) in preterm infants after surfactant replacement therapy are associated with excess morbidity and mortality and likely increase in-hospital costs. Specific surfactant therapy selection for prevention of respiratory distress syndrome (RDS) in preterm infants receiving conventional MV may impact not only clinical outcomes but also pharmacoeconomic outcomes. METHODS We conducted a pharmacoeconomic analysis of the impact of surfactant selection and reintubation and subsequent MV of preterm infants on health care resource utilization. Rates of reintubation and duration of MV after reintubation were determined from 1546 preterm infants enrolled in two surfactant trials comparing lucinactant to beractant and poractant alfa. Hospital costs were obtained from a 2010 US database from 1564 preterm infants with RDS, with a direct cost of $2637 per day for MV in the neonatal intensive care unit. Cost of reintubation by study and treatment was estimated as the incidence of reintubation multiplied by days on MV therapy after reintubation multiplied by cost per day for direct MV costs, standardized per 100 surfactant-treated infants. RESULTS There were no differences between studies or treatment groups in the overall extubation rate. Average MV duration following reintubation was similar between groups in both trials; however, reintubation rates were significantly lower (p<0 05) for infants treated with lucinactant than for those receiving beractant or poractant alfa. The observed differences in reintubation rates resulted in a projected cost saving of $160,013 to $252,203 per 100 infants treated with lucinactant versus animal-derived surfactants. CONCLUSIONS In this analysis, higher reintubation rates following successful extubation in preterm infants receiving animal-derived surfactant preparations significantly increased estimated in-hospital costs, primarily due to excess costs associated with MV. This analysis

  8. Postnatal growth standards for preterm infants: the Preterm Postnatal Follow-up Study of the INTERGROWTH-21(st) Project.

    PubMed

    Villar, José; Giuliani, Francesca; Bhutta, Zulfiqar A; Bertino, Enrico; Ohuma, Eric O; Ismail, Leila Cheikh; Barros, Fernando C; Altman, Douglas G; Victora, Cesar; Noble, Julia A; Gravett, Michael G; Purwar, Manorama; Pang, Ruyan; Lambert, Ann; Papageorghiou, Aris T; Ochieng, Roseline; Jaffer, Yasmin A; Kennedy, Stephen H

    2015-11-01

    Charts of size at birth are used to assess the postnatal growth of preterm babies on the assumption that extrauterine growth should mimic that in the uterus. The INTERGROWTH-21(st) Project assessed fetal, newborn, and postnatal growth in eight geographically defined populations, in which maternal health care and nutritional needs were met. From these populations, the Fetal Growth Longitudinal Study selected low-risk women starting antenatal care before 14 weeks' gestation and monitored fetal growth by ultrasonography. All preterm births from this cohort were eligible for the Preterm Postnatal Follow-up Study, which included standardised anthropometric measurements, feeding practices based on breastfeeding, and data on morbidity, treatments, and development. To construct the preterm postnatal growth standards, we selected all live singletons born between 26 and before 37 weeks' gestation without congenital malformations, fetal growth restriction, or severe postnatal morbidity. We did analyses with second-degree fractional polynomial regression models in a multilevel framework accounting for repeated measures. Fetal and neonatal data were pooled from study sites and stratified by postmenstrual age. For neonates, boys and girls were assessed separately. From 4607 women enrolled in the study, there were 224 preterm singleton births, of which 201 (90%) were enrolled in the Preterm Postnatal Follow-up Study. Variance component analysis showed that only 0·2% and 4·0% of the total variability in postnatal length and head circumference, respectively, could be attributed to between-site differences, justifying pooling the data from all study sites. Preterm growth patterns differed from those for babies in the INTERGROWTH-21(st) Newborn Size Standards. They overlapped with the WHO Child Growth Standards for term babies by 64 weeks' postmenstrual age. Our data have yielded standards for postnatal growth in preterm infants. These standards should be used for the assessment of

  9. Does Human Milk Modulate Body Composition in Late Preterm Infants at Term-Corrected Age?

    PubMed

    Giannì, Maria Lorella; Consonni, Dario; Liotto, Nadia; Roggero, Paola; Morlacchi, Laura; Piemontese, Pasqua; Menis, Camilla; Mosca, Fabio

    2016-10-23

    (1) Background: Late preterm infants account for the majority of preterm births and are at risk of altered body composition. Because body composition modulates later health outcomes and human milk is recommended as the normal method for infant feeding, we sought to investigate whether human milk feeding in early life can modulate body composition development in late preterm infants; (2) Methods: Neonatal, anthropometric and feeding data of 284 late preterm infants were collected. Body composition was evaluated at term-corrected age by air displacement plethysmography. The effect of human milk feeding on fat-free mass and fat mass content was evaluated using multiple linear regression analysis; (3) Results: Human milk was fed to 68% of the infants. According to multiple regression analysis, being fed any human milk at discharge and at  term-corrected and being fed exclusively human milk at term-corrected age were positively associated with fat-free mass content(β = -47.9, 95% confidence interval (CI) = -95.7; -0.18; p = 0.049; β = -89.6, 95% CI = -131.5; -47.7; p < 0.0001; β = -104.1, 95% CI = -151.4; -56.7, p < 0.0001); (4) Conclusion: Human milk feeding appears to be associated with fat-free mass deposition in late preterm infants. Healthcare professionals should direct efforts toward promoting and supporting breastfeeding in these vulnerable infants.

  10. Live maternal speech and singing have beneficial effects on hospitalized preterm infants.

    PubMed

    Filippa, Manuela; Devouche, Emmanuel; Arioni, Cesare; Imberty, Michel; Gratier, Maya

    2013-10-01

    To study the effects of live maternal speaking and singing on physiological parameters of preterm infants in the NICU and to test the hypothesis that vocal stimulation can have differential effects on preterm infants at a behavioural level. Eighteen mothers spoke and sang to their medically stable preterm infants in their incubators over 6 days, between 1 and 2 pm. Heart rate (HR), oxygen saturation (OxSat), number of critical events (hypoxemia, bradycardia and apnoea) and change in behavioural state were measured. Comparisons of periods with and without maternal vocal stimulation revealed significantly greater oxygen saturation level and heart rate and significantly fewer negative critical events (p < 0.0001) when the mother was speaking and singing. Unexpected findings were the comparable effects of maternal talk and singing on infant physiological parameters and the differential ones on infant behavioural state. A renewed connection to the mother's voice can be an important and significant experience for preterm infants. Exposure to maternal speech and singing shows significant early beneficial effects on physiological state, such as oxygen saturation levels, number of critical events and prevalence of calm alert state. These findings have implications for NICU interventions, encouraging maternal interaction with their medically stable preterm infants. ©2013 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  11. Does Human Milk Modulate Body Composition in Late Preterm Infants at Term-Corrected Age?

    PubMed Central

    Giannì, Maria Lorella; Consonni, Dario; Liotto, Nadia; Roggero, Paola; Morlacchi, Laura; Piemontese, Pasqua; Menis, Camilla; Mosca, Fabio

    2016-01-01

    (1) Background: Late preterm infants account for the majority of preterm births and are at risk of altered body composition. Because body composition modulates later health outcomes and human milk is recommended as the normal method for infant feeding, we sought to investigate whether human milk feeding in early life can modulate body composition development in late preterm infants; (2) Methods: Neonatal, anthropometric and feeding data of 284 late preterm infants were collected. Body composition was evaluated at term-corrected age by air displacement plethysmography. The effect of human milk feeding on fat-free mass and fat mass content was evaluated using multiple linear regression analysis; (3) Results: Human milk was fed to 68% of the infants. According to multiple regression analysis, being fed any human milk at discharge and at  term-corrected and being fed exclusively human milk at term-corrected age were positively associated with fat-free mass content(β = −47.9, 95% confidence interval (CI) = −95.7; −0.18; p = 0.049; β = −89.6, 95% CI = −131.5; −47.7; p < 0.0001; β = −104.1, 95% CI = −151.4; −56.7, p < 0.0001); (4) Conclusion: Human milk feeding appears to be associated with fat-free mass deposition in late preterm infants. Healthcare professionals should direct efforts toward promoting and supporting breastfeeding in these vulnerable infants. PMID:27782098

  12. Neuroimaging and Neurodevelopmental Outcome in Extremely Preterm Infants

    PubMed Central

    Barnes, Patrick D.; Bulas, Dorothy; Slovis, Thomas L.; Finer, Neil N.; Wrage, Lisa A.; Das, Abhik; Tyson, Jon E.; Stevenson, David K.; Carlo, Waldemar A.; Walsh, Michele C.; Laptook, Abbot R.; Yoder, Bradley A.; Van Meurs, Krisa P.; Faix, Roger G.; Rich, Wade; Newman, Nancy S.; Cheng, Helen; Heyne, Roy J.; Vohr, Betty R.; Acarregui, Michael J.; Vaucher, Yvonne E.; Pappas, Athina; Peralta-Carcelen, Myriam; Wilson-Costello, Deanne E.; Evans, Patricia W.; Goldstein, Ricki F.; Myers, Gary J.; Poindexter, Brenda B.; McGowan, Elisabeth C.; Adams-Chapman, Ira; Fuller, Janell; Higgins, Rosemary D.

    2015-01-01

    BACKGROUND: Extremely preterm infants are at risk for neurodevelopmental impairment (NDI). Early cranial ultrasound (CUS) is usual practice, but near-term brain MRI has been reported to better predict outcomes. We prospectively evaluated MRI white matter abnormality (WMA) and cerebellar lesions, and serial CUS adverse findings as predictors of outcomes at 18 to 22 months’ corrected age. METHODS: Early and late CUS, and brain MRI were read by masked central readers, in a large cohort (n = 480) of infants <28 weeks’ gestation surviving to near term in the Neonatal Research Network. Outcomes included NDI or death after neuroimaging, and significant gross motor impairment or death, with NDI defined as cognitive composite score <70, significant gross motor impairment, and severe hearing or visual impairment. Multivariable models evaluated the relative predictive value of neuroimaging while controlling for other factors. RESULTS: Of 480 infants, 15 died and 20 were lost. Increasing severity of WMA and significant cerebellar lesions on MRI were associated with adverse outcomes. Cerebellar lesions were rarely identified by CUS. In full multivariable models, both late CUS and MRI, but not early CUS, remained independently associated with NDI or death (MRI cerebellar lesions: odds ratio, 3.0 [95% confidence interval: 1.3–6.8]; late CUS: odds ratio, 9.8 [95% confidence interval: 2.8–35]), and significant gross motor impairment or death. In models that did not include late CUS, MRI moderate-severe WMA was independently associated with adverse outcomes. CONCLUSIONS: Both late CUS and near-term MRI abnormalities were associated with outcomes, independent of early CUS and other factors, underscoring the relative prognostic value of near-term neuroimaging. PMID:25554820

  13. Neuroimaging and neurodevelopmental outcome in extremely preterm infants.

    PubMed

    Hintz, Susan R; Barnes, Patrick D; Bulas, Dorothy; Slovis, Thomas L; Finer, Neil N; Wrage, Lisa A; Das, Abhik; Tyson, Jon E; Stevenson, David K; Carlo, Waldemar A; Walsh, Michele C; Laptook, Abbot R; Yoder, Bradley A; Van Meurs, Krisa P; Faix, Roger G; Rich, Wade; Newman, Nancy S; Cheng, Helen; Heyne, Roy J; Vohr, Betty R; Acarregui, Michael J; Vaucher, Yvonne E; Pappas, Athina; Peralta-Carcelen, Myriam; Wilson-Costello, Deanne E; Evans, Patricia W; Goldstein, Ricki F; Myers, Gary J; Poindexter, Brenda B; McGowan, Elisabeth C; Adams-Chapman, Ira; Fuller, Janell; Higgins, Rosemary D

    2015-01-01

    Extremely preterm infants are at risk for neurodevelopmental impairment (NDI). Early cranial ultrasound (CUS) is usual practice, but near-term brain MRI has been reported to better predict outcomes. We prospectively evaluated MRI white matter abnormality (WMA) and cerebellar lesions, and serial CUS adverse findings as predictors of outcomes at 18 to 22 months' corrected age. Early and late CUS, and brain MRI were read by masked central readers, in a large cohort (n = 480) of infants <28 weeks' gestation surviving to near term in the Neonatal Research Network. Outcomes included NDI or death after neuroimaging, and significant gross motor impairment or death, with NDI defined as cognitive composite score <70, significant gross motor impairment, and severe hearing or visual impairment. Multivariable models evaluated the relative predictive value of neuroimaging while controlling for other factors. Of 480 infants, 15 died and 20 were lost. Increasing severity of WMA and significant cerebellar lesions on MRI were associated with adverse outcomes. Cerebellar lesions were rarely identified by CUS. In full multivariable models, both late CUS and MRI, but not early CUS, remained independently associated with NDI or death (MRI cerebellar lesions: odds ratio, 3.0 [95% confidence interval: 1.3-6.8]; late CUS: odds ratio, 9.8 [95% confidence interval: 2.8-35]), and significant gross motor impairment or death. In models that did not include late CUS, MRI moderate-severe WMA was independently associated with adverse outcomes. Both late CUS and near-term MRI abnormalities were associated with outcomes, independent of early CUS and other factors, underscoring the relative prognostic value of near-term neuroimaging. Copyright © 2015 by the American Academy of Pediatrics.

  14. Visual performance and brain structures in the developing brain of pre-term infants.

    PubMed

    Ramenghi, Luca Antonio; Ricci, Daniela; Mercuri, Eugenio; Groppo, Michela; De Carli, Agnese; Ometto, Alessandra; Fumagalli, Monica; Bassi, Laura; Pisoni, Silvia; Cioni, Giovanni; Mosca, Fabio

    2010-07-01

    , there have been considerable advances in our understanding of the development of vision in pre-term infants during early infancy. This has mainly been due to the development of age-specific tests assessing various aspects of visual function, from ophthalmological examination to more cortical aspects of vision, such as the ability to process orientation or different aspects of visual attention [1-7]. Improvements in understanding very early and specific neurological impairments in neurological functions have been reported in pre-term infants, known to be at risk of developing visual and visual-perceptual impairment. These impairments are due not only to retinopathy, a common finding in premature infants, but also to cerebral (central) visual impairment, secondary to brain lesions affecting the central visual pathway.

  15. Considerations in meeting protein needs of the human milk-fed preterm infant.

    PubMed

    Wagner, Julie; Hanson, Corrine; Anderson-Berry, Ann

    2014-08-01

    Preterm infants provided with sufficient nutrition to achieve intrauterine growth rates have the greatest potential for optimal neurodevelopment. Although human milk is the preferred feeding for preterm infants, unfortified human milk provides insufficient nutrition for the very low-birth-weight infant. Even after fortification with human milk fortifier, human milk often fails to meet the high protein needs of the smallest preterm infants, and additional protein supplementation must be provided. Although substantial evidence exists to support quantitative protein goals for human milk-fed preterm infants, the optimal type of protein for use in human milk fortification remains uncertain. This question was addressed through a PubMed literature search of prospective clinical trials conducted since 1990 in preterm or low-birth-weight infant populations. The following 3 different aspects of protein quality were evaluated: whey-to-casein ratio, hydrolyzed versus intact protein, and bovine milk protein versus human milk protein. Because of a scarcity of current studies conducted with fortified human milk, studies examining protein quality using preterm infant formulas were included to address certain components of the clinical question. Twenty-six studies were included in the review study. No definite advantage was found for any specific whey-to-casein ratio. Protein hydrolyzate products with appropriate formulations can support adequate growth and biochemical indicators of nutrition status and may reduce gastrointestinal transit time, gastroesophageal reflux events, and later incidence of atopic dermatitis in some infants. Plasma amino acid levels similar to those of infants fed exclusive human milk-based diets can be achieved with products composed of a mixture of bovine proteins, peptides, and amino acids formulated to replicate the amino acid composition of human milk. Growth and biochemical indicators of nutrition status are similar for infants fed human milk

  16. Prem Baby Triple P a new parenting intervention for parents of infants born very preterm: acceptability and barriers.

    PubMed

    Ferrari, Alize J; Whittingham, Koa; Boyd, Roslyn; Sanders, Matthew; Colditz, Paul

    2011-12-01

    Over 10% of preterm infants develop major disabilities, 50% develop behavioural problems and 40% need special education (Huddy et al., 2001; Webster, 2003). Prem Baby Triple P is a new variant of the Positive Parenting Program (Triple P) adapted specifically for parents of very preterm infants. The aim of this study is to assess the acceptability of Prem Baby Triple P to parents of infants born preterm and to test whether parental attributions and parental perception of infant health/developmental status are barriers to intervention acceptability. One hundred and twenty-three parents of preterm infants participated, 83 parents of very preterm infants and 40 parents of preterm infants. In addition, 32 parents of term infants participated as a comparison group. The acceptability of Prem Baby Triple P was moderately high and did not differ significantly across the three groups. Parental attributions were not found to be barriers to intervention acceptability and parental perceptions that their infant is less healthy/developmentally delayed facilitated Prem Baby Triple P acceptance in parents of infants born very preterm. This suggests that the planned Prem Baby Triple P content is acceptable to parents of infants born very preterm and sensitised to medical and developmental issues. These findings, as social validation data, will contribute towards the further development of Prem Baby Triple P and a future randomised controlled trial.

  17. Influence of maternal breast milk ingestion on acquisition of the intestinal microbiome in preterm infants.

    PubMed

    Gregory, Katherine E; Samuel, Buck S; Houghteling, Pearl; Shan, Guru; Ausubel, Frederick M; Sadreyev, Ruslan I; Walker, W Allan

    2016-12-30

    The initial acquisition and early development of the intestinal microbiome during infancy are important to human health across the lifespan. Mode of birth, antibiotic administration, environment of care, and nutrition have all been shown to play a role in the assembly of the intestinal microbiome during early life. For preterm infants, who are disproportionately at risk of inflammatory intestinal disease (i.e., necrotizing enterocolitis), a unique set of clinical factors influence the establishment of the microbiome. The purpose of this study was to establish the influence of nutritional exposures on the intestinal microbiome in a cohort of preterm infants early in life. Principal component analysis of 199 samples from 30 preterm infants (<32 weeks) over the first 60 days following birth showed that the intestinal microbiome was influenced by postnatal time (p < 0.001, R (2) = 0.13), birth weight (p < 0.001, R (2) = 0.08), and nutrition (p < 0.001, R (2) = 0.21). Infants who were fed breast milk had a greater initial bacterial diversity and a more gradual acquisition of diversity compared to infants who were fed infant formula. The microbiome of infants fed breast milk were more similar regardless of birth weight (p = 0.049), in contrast to the microbiome of infants fed infant formula, which clustered differently based on birth weight (p < 0.001). By adjusting for differences in gut maturity, an ordered succession of microbial phylotypes was observed in breast milk-fed infants, which appeared to be disrupted in those fed infant formula. Supplementation with pasteurized donor human milk was partially successful in promoting a microbiome more similar to breast milk-fed infants and moderating rapid increases in bacterial diversity. The preterm infant intestinal microbiome is influenced by postnatal time, birth weight, gestational age, and nutrition. Feeding with breast milk appears to mask the influence of birth weight, suggesting a

  18. Rescue high-frequency jet ventilation versus conventional ventilation for severe pulmonary dysfunction in preterm infants.

    PubMed

    Rojas-Reyes, Maria Ximena; Orrego-Rojas, Paola A

    2015-10-16

    treatment failed. Investigators found no statistically significant differences in overall mortality (including survival after cross-over) between the two groups (RR 1.07, 95% confidence interval (CI) 0.67 to 1.72). In a secondary analysis of infants up to the time of cross-over, rescue treatment with HFJV was associated with lower mortality (RR 0.66, 95% CI 0.45 to 0.97). Researchers reported no significant differences in the incidence of CLD among survivors at 28 days of age, nor in the incidence of intraventricular haemorrhage, new air leaks, airway obstruction and necrotising tracheobronchitis. Study authors reported no significant differences in overall mortality between rescue high-frequency jet ventilation and conventional ventilation and presented highly imprecise results for important adverse effects such as intraventricular haemorrhage, new air leaks, airway obstruction and necrotising tracheobronchitis.The overall quality of evidence is affected by limitations in trial design and by imprecision due to the small number of infants in the included study. Existing evidence does not support the use of high-frequency jet ventilation as rescue therapy in preterm infants.Studies that target populations at greatest risk and that have sufficient power to assess important outcomes are needed. These trials should incorporate long-term pulmonary and neurodevelopmental outcomes.

  19. Antenatal Determinants of Bronchopulmonary Dysplasia and Late Respiratory Disease in Preterm Infants.

    PubMed

    Morrow, Lindsey A; Wagner, Brandie D; Ingram, David A; Poindexter, Brenda B; Schibler, Kurt; Cotten, C Michael; Dagle, John; Sontag, Marci K; Mourani, Peter M; Abman, Steven H

    2017-08-01

    Mechanisms contributing to chronic lung disease after preterm birth are incompletely understood. To identify antenatal risk factors associated with increased risk for bronchopulmonary dysplasia (BPD) and respiratory disease during early childhood after preterm birth, we performed a prospective, longitudinal study of 587 preterm infants with gestational age less than 34 weeks and birth weights between 500 and 1,250 g. Data collected included perinatal information and assessments during the neonatal intensive care unit admission and longitudinal follow-up by questionnaire until 2 years of age. After adjusting for covariates, we found that maternal smoking prior to preterm birth increased the odds of having an infant with BPD by twofold (P = 0.02). Maternal smoking was associated with prolonged mechanical ventilation and respiratory support during the neonatal intensive care unit admission. Preexisting hypertension was associated with a twofold (P = 0.04) increase in odds for BPD. Lower gestational age and birth weight z-scores were associated with BPD. Preterm infants who were exposed to maternal smoking had higher rates of late respiratory disease during childhood. Twenty-two percent of infants diagnosed with BPD and 34% of preterm infants without BPD had no clinical signs of late respiratory disease during early childhood. We conclude that maternal smoking and hypertension increase the odds for developing BPD after preterm birth, and that maternal smoking is strongly associated with increased odds for late respiratory morbidities during early childhood. These findings suggest that in addition to the BPD diagnosis at 36 weeks, other factors modulate late respiratory outcomes during childhood. We speculate that measures to reduce maternal smoking not only will lower the risk for preterm birth but also will improve late respiratory morbidities after preterm birth.

  20. Insulin-like growth factor 1 has multisystem effects on foetal and preterm infant development.

    PubMed

    Hellström, Ann; Ley, David; Hansen-Pupp, Ingrid; Hallberg, Boubou; Löfqvist, Chatarina; van Marter, Linda; van Weissenbruch, Mirjam; Ramenghi, Luca A; Beardsall, Kathryn; Dunger, David; Hård, Anna-Lena; Smith, Lois E H

    2016-06-01

    Poor postnatal growth after preterm birth does not match the normal rapid growth in utero and is associated with preterm morbidities. Insulin-like growth factor 1 (IGF-1) axis is the major hormonal mediator of growth in utero, and levels of IGF-1 are often very low after preterm birth. We reviewed the role of IGF-1 in foetal development and the corresponding preterm perinatal period to highlight the potential clinical importance of IGF-1 deficiency in preterm morbidities. There is a rationale for clinical trials to evaluate the potential benefits of IGF-1 replacement in very preterm infants. ©2016 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.

  1. Kinesthetic stimulation for treating apnea in preterm infants.

    PubMed

    Osborn, D A; Henderson-Smart, D J

    2000-01-01

    This section is under preparation and will be included in the next issue. Main question: in preterm infants with apnea, does the use of kinesthetic stimulation lead to clinically important reductions in clinical apnea and bradycardia (>50% reduction in number of episodes), use of mechanical ventilation (IPPV) or continuous positive airways pressure (CPAP), and neurodevelopmental disability, without clinically important side effects. The standard search strategy of the Neonatal Review Group was used. This included searches of the Oxford Database of Perinatal Trials, Cochrane Controlled Trials Register, MEDLINE, previous reviews including cross references, abstracts, conferences, symposia proceedings, expert informants, and journal handsearching mainly in the English language. All trials using random or quasi-random patient allocation in which kinesthetic stimulation in preterm infants was compared to placebo or no treatment for apnea of prematurity were included. Standard methods of the Cochrane Collaboration and its Neonatal Review Group were used with separate evaluation of trial quality, data extraction by both authors and synthesis of data using relative risk and weighted mean difference. As all three trials were crossover trials, the data were extracted from all exposure periods and combined where appropriate. Measures of severity of apnea as well as the response to treatment were consistent with an evaluation of 'clinical apnea', as defined by the American Academy of Pediatrics (Nelson 1978). Three crossover studies (Korner 1978, Tuck 1982 and Jirapaet 1993) were identified that compared a form of kinesthetic stimulation to control for the treatment of apnea of prematurity. Clinically significant apnea: None of the three studies showed an important reduction (>50%) in clinical apnea. Using a lower threshold (>25%), the study by Korner 1978 found less apnea and bradycardia in infants receiving kinesthetic stimulation. Tuck 1982 demonstrated reductions in the

  2. Progesterone for preterm birth prevention.

    PubMed

    Ransom, Carla E; Murtha, Amy P

    2012-03-01

    Preterm birth—delivery before 37 weeks of gestation—is the second leading cause of infant mortality in the United States after congenital malformations. Spontaneous preterm birth, due to either preterm labor or preterm premature membrane rupture, encompasses approximately 75% of all preterm births, almost 400,000 births per year. Since the 1960s, different formulations of progesterone have been investigated for preterm birth prevention. This article addresses the use of progesterone for the prevention of preterm birth, including selection of candidates for progesterone, pharmacokinetics, dosing, and formulations. This article aims to provide a practical guide for using progesterone in clinical practice.

  3. Case report of a central venous access device-associated thrombosis with aortic embolism in a preterm infant.

    PubMed

    Biermayr, Marlene; Brunner, Barbara; Maurer, Kathrin; Trawoeger, Rudolf; Kiechl-Kohlendorfer, Ursula; Neubauer, Vera

    2016-09-06

    Thrombosis in neonates is commonly a central venous access device (CVAD) associated complication. Furthermore, a patent foramen ovale (PFO) is frequently seen in preterm infants. Even though a coincidence of both is not unusual, detaching of the thrombus and organisation of an aortic embolism has not been described until now. Treatment recommendations of CVAD-associated thrombosis in neonates do not consider frequently seen complications of preterm infants e.g. intraventricular haemorrhage. This is the first case of a very preterm infant with pre-existing intraventricular haemorrhage, who developed a CVAD-associated thrombosis and thromboembolic complications. The authors report on a very preterm girl with a pre-existing intraventricular haemorrhage and a CVAD-associated thrombus that, after removal of the CVAD, led to assumed pulmonary embolism and to an extended aortic embolism with consequent cerebral stroke. The girl was treated with unfractionated heparin (UFH) for about 50 days. During the further in-hospital stay the girl developed a mild bronchopulmonary dysplasia. Follow-up revealed clinical signs of cerebral palsy. Even though preterm infants are often diagnosed with a PFO which constitutes the risk for paradoxical embolism, such complications do not occur frequently due to the physiological heart pressure proportion. Nevertheless, it is important to monitor vital parameters and cerebral perfusion after removing a CVAD with confirmed associated thrombosis, because thromboembolic complications are possible. If practicable, patients with a confirmed CVAD-associated thrombosis should be anticoagulated before removing the CVAD. However, in our patient it was rational to remove the CVAD without prior anticoagulation due to the pre-existing intraventricular haemorrhage. There are various treatment recommendations for thrombosis or embolism in infants. However, there are no clear recommendations in very preterm infants with a high risk of cerebral bleeding

  4. Economic evaluation of inhaled nitric oxide in preterm infants undergoing mechanical ventilation.

    PubMed

    Zupancic, John A F; Hibbs, Anna Maria; Palermo, Lisa; Truog, William E; Cnaan, Avital; Black, Dennis M; Ballard, Philip L; Wadlinger, Sandra R; Ballard, Roberta A

    2009-11-01

    In the previously reported Nitric Oxide for Chronic Lung Disease (NO CLD) trial, ventilated preterm infants who received a course of inhaled nitric oxide (iNO) between 7 and 21 days of life had a significant improvement in survival without bronchopulmonary dysplasia (BPD), as well as a shorter duration of admission and ventilation. However, the price for the drug may be a barrier to widespread use. We sought to estimate the incremental cost-effectiveness of iNO therapy to prevent BPD in infants of <1250 g birth weight. We used patient-level data from the NO CLD randomized trial. The study took a third-party payer perspective and measured costs and effects through hospital discharge. We applied previously reported hospital per-diem costs stratified according to intensity of ventilatory support, nitric oxide costs from standard market prices, and professional (physician) fees from the Medicare fee schedule. We compared log transformed costs by using multivariable modeling and performed incremental cost-effectiveness analysis with estimation of uncertainty through nonparametric bootstrapping. The mean cost per infant was $193125 in the placebo group and $194702 in the iNO group (adjusted P = .17). The point estimate for the incremental cost per additional survivor without BPD was $21297. For infants in whom iNO was initiated between 7 and 14 days of life, the mean cost per infant was $187407 in the placebo group and $181525 in the iNO group (adjusted P = .46). In this group of early treated infants, there was a 71% probability that iNO actually decreased costs while improving outcomes. Despite its higher price relative to many other neonatal therapies, iNO in this trial was not associated with higher costs of care, an effect that is likely due to its impact on length of stay and ventilation. Indeed, for infants who receive nitric oxide between 7 and 14 days of life, the therapy seemed to lower costs while improving outcomes.

  5. Medical morbidities and DNA methylation of NR3C1 in preterm infants

    PubMed Central

    Giarraputo, James; DeLoach, Jordan; Padbury, James; Uzun, Alper; Marsit, Carmen; Hawes, Katheleen; Lester, Barry

    2017-01-01

    Background: Although there are no accepted “normal” levels of circulating cortisol in preterm infants, critically ill preterm infants show lower cortisol levels than healthy preterm infants. The regulation of cortisol reactivity by epigenetic changes in glucocorticoid receptor gene (NR3C1) expression has been demonstrated. This study aims to examine the relationship between medical morbidities in preterm infants and DNA methylation of NR3C1. Methods: Pyrosequencing was used to determine DNA methylation in CpG sites 1-4 of promoter region 1F of NR3C1. Cluster analysis placed 67 preterm infants born <1,500 g into groups based on medical morbidities. The DNA methylation pattern was compared across groups. Results: Cluster analysis identified a high medical risk cluster and a low medical risk cluster. A Mann-Whitney U-test showed lower methylation at CpG1 for infants in the high-risk group (M = 0.336, SE = 0.084) than infants in the low-risk group (M = 0.617, SE = 0.109, P = 0.032). The false discovery rate was low (q = 0.025). Cohen's D effect size was moderate (0.525). Conclusion: Decreased DNA methylation of CpG1 of NR3C1 in high-risk infants may allow for increased binding of transcription factors involved in the stress response, repair and regulation of NR3C1. This may ensure healthy growth in high-risk preterm infants over increasing cortisol levels. PMID:27653086

  6. Safety of therapeutics used in management of patent ductus arteriosus in preterm infants.

    PubMed

    Oncel, Mehmet Yekta; Erdeve, Omer

    2015-01-01

    Patent ductus arteriosus (PDA) is the most common cardiac condition in preterm infants. The most commonly used drugs for this purpose are cyclooxygenase inhibitors, mainly indomethacin and ibuprofen, which block the conversion of arachidonic acid to prostaglandins. On the other hand, several adverse effects have been reported with such medications, including peripheral vasoconstriction, gastrointestinal bleeding and perforation, weakened platelet aggregation, hyperbilirubinemia and renal failure. The role of oral paracetamol as an alternative treatment for the closure of PDA has gained importance in recent years. In this review, we aimed to determine safety of therapeutic drugs used in management of PDA in preterm infants rather than their efficacy in ductal closure. Two worldwide commonly used therapeutics (indomethacin and ibuprofen) and a new alternative medication as paracetamol are discussed. Ibuprofen seems to be the first choice due to its higher safety profile, as it is associated with fewer gastrointestinal and renal side effects than indomethacin. Recent studies suggest that paracetamol may be a medical alternative in the management of PDA with low adverse events and side effects.

  7. Dynamic Changes in DNA Methylation Occur during the First Year of Life in Preterm Infants.

    PubMed

    Piyasena, Chinthika; Cartier, Jessy; Provençal, Nadine; Wiechmann, Tobias; Khulan, Batbayar; Sunderasan, Raju; Menon, Gopi; Seckl, Jonathan R; Reynolds, Rebecca M; Binder, Elisabeth B; Drake, Amanda J

    2016-01-01

    Preterm birth associates with a substantially increased risk of later cardiovascular disease and neurodevelopmental disorders. Understanding underlying mechanisms will facilitate the development of screening and intervention strategies to reduce disease risk. Changes in DNA methylation have been proposed as one mechanism linking the early environment with later disease risk. We tested the hypothesis that preterm birth associates with altered DNA methylation in genes encoding insulin-like growth factor 2 (IGF2) and FK506-binding protein 5 (FKBP5), which appear particularly vulnerable to early life adversity. Fifty preterm infants were seen and assessed at birth, term equivalent age, 3 months and 1-year corrected ages; 40 term infants were seen at birth, 3 months and 1 year. Saliva was collected for DNA extraction at birth, term, and 1 year. Pyrosequencing of bisulfite-converted DNA was performed to measure DNA methylation at specific CpG sites within the IGF2 and FKBP5 loci. Weight and head circumference was reduced in preterm infants at all time points. Preterm infants had a higher percentage body fat at term-corrected age, but this difference was not persistent. DNA methylation at the differentially methylated region (DMR) of IGF2 (IGF2DMR2) and FKBP5 was lower in preterm infants at birth- and term-corrected age compared to term infants at birth. IGF2DMR2 and FKBP5 methylation was related to birthweight SD score in preterm infants. Among preterm infants, social deprivation was an independent contributor toward reducing DNA methylation at IGF2DMR2 at birth- and term-corrected age and maternal smoking was associated with reduced DNA methylation at FKBP5 at birth. There were no persistent differences in DNA methylation at 1 year of age. Changes in DNA methylation were identified at key regions of IGF2/H19 and FKBP5 in preterm infants in early life. Potential contributing factors include maternal smoking and social deprivation. However, these changes did not

  8. [Intracranial blood flow velocities evaluated by color Doppler (duplex) in preterm infants].

    PubMed

    de Assis, Marcelo Cardoso; Machado, Helio Rubens

    2004-03-01

    In order to ascertain the blood flow velocities in the intracranial arteries we evaluated 73 preterm neonates during a period ranging from June 1994 to March 1999. These preterm infants were divided in two separate groups, 18 healthy and 55 with intracranial hemorrhage. They were subjected to sequential measurements of blood flow velocities in the intracranial arteries. The gestational age of the whole group varied from 28 to 36 weeks and birth weights between 720 and 2530 g. The diagnosis of the intracerebral hemorrhages in these preterm neonates were done using high resolution gray and color scale transfontanellar ultrasonography brain scans. The ultrasound evaluations were performed in the initial 3rd, 7th and 14th day of life. The 73 preterm infants were evaluated with sequential measurements of blood flow velocity in the intracranial arteries using the Doppler technique through the anterior fontanelle. Doppler evaluation of the cerebral vessels were performed on days 3, 7, 30 and 90 of life. These evaluations were performed in the six intracranial arteries, meaning: right and left anterior and middle cerebral arteries and right and left internal carotid arteries. Doppler recordings were made using Duplex Color-Doppler system, pulse echo probe of 3,5; 5,0 and 7,5 MHz. Measuring the blood flow velocity in the cerebral arteries we obtained a maximum systolic velocity and end diastolic velocity with a rate in meters per second (m/s) for each cardiac cycle. After obtaining these numerical values for these velocities we obtained the resistance index (RI) or Pourcelot index. In a progressive way as the resistance index (RI) values were being obtained in each stage of this study they were also being checked in the cerebral arteries of healthy preterm infants and infants with intracranial hemorrhages. We also analyzed in a comparative method the values of the resistive index between the two groups of preterm infants observing their behaviour. The results obtained when

  9. Comforting touch in the very preterm hospitalized infant: an integrative review.

    PubMed

    Smith, Joan Renaud

    2012-12-01

    Infants born prematurely lose the protection of the uterus at a time of fetal development when the brain is growing and organizing exponentially. Environmental factors such as stress in the neonatal intensive care unit (NICU) may play a role in altered brain maturation and neurobehavioral outcomes. Strategies aimed at reducing stress and promoting infant well-being are essential to improve neurologic and behavioral outcomes. Infant massage is a developmentally supported strategy aimed at promoting relaxation. However, despite the well-documented benefits of infant massage, infants born very preterm (≤30 weeks' gestation) are often excluded from these studies, leaving neonatal clinicians and families without guidance in how to provide a stress-reducing supplemental touch. Much of the touch in the NICU is a procedural touch, and infants born very preterm often miss out on comforting touch stimulation. A systematic review of the literature is presented with an aim to explore the research that examines the various comforting touch therapies used on hospitalized NICU infants born very preterm within the first few days of postnatal life. The purpose of this review was to identify appropriate stress-reducing comforting touch techniques for physiologically fragile very preterm infants in order to inform and provide guidance to neonatal clinicians and families.

  10. The Impact of Temporally Patterned Stimulation on the Development of Preterm Infants.

    ERIC Educational Resources Information Center

    Barnard, Kathryn E.; Bee, Helen L.

    1983-01-01

    Tests the hypothesis that appropriately timed stimulation provided to preterm infants would aid self-regulating and lead to quiet sleep. It was expected that effects of self-regulation would be evident in infant development interaction and performance. Stimulation consisted of a gentle horizontal movement and a heartbeat sound presented on…

  11. Visual and Cardiac Responses to Animate and Inanimate Faces by Young Term and Preterm Infants.

    ERIC Educational Resources Information Center

    Field, Tiffany Martini

    1979-01-01

    Infants' looking and looking-away behaviors, as well as cardiac responses to mothers' spontaneous and imitative faces and to dolls' animated and still faces, were recorded for 18 term and 19 preterm infants when they were three months old. (JMB)

  12. Characterization of Ureaplasmas Isolated from Preterm Infants with and without Bronchopulmonary Dysplasia

    PubMed Central

    Katz, Brenda; Patel, Padma; Duffy, Lynn; Schelonka, Robert L.; Dimmitt, Reed A.; Waites, Ken B.

    2005-01-01

    A PCR assay was used to analyze endotracheal aspirates from preterm infants for Ureaplasma parvum versus U. urealyticum. U. parvum was detected more often than U. urealyticum. There was no significant difference or trend in the prevalence of either species between infants with or without bronchopulmonary dysplasia when isolated alone. PMID:16145157

  13. Evaluation of air-displacement plethysmography for body composition assessment in preterm infants

    USDA-ARS?s Scientific Manuscript database

    Adiposity may contribute to the future risk of disease. The aim of this study was to evaluate the accuracy and reliability of an air-displacement plethysmography (ADP) system to estimate percentage fat mass (%FM) in preterm infants and to evaluate interdevice reliability in infants. A total of 70 pr...

  14. Factors Associated With Preterm Infants' Circadian Sleep/Wake Patterns at the Hospital.

    PubMed

    Lan, Hsiang-Yun; Yin, Ti; Chen, Jyu-Lin; Chang, Yue-Cune; Liaw, Jen-Jiuan

    2017-08-01

    This prospective repeated-measures study explored potential factors (postmenstrual age, body weight, gender, chronological age, illness severity, and circadian rhythm) related to preterm infants' circadian sleep/wake patterns. Circadian sleep/wake patterns were measured using an Actiwatch for 3 continuous days in preterm infants (gestational age of 28-36.4 weeks) in a neonatal intensive care unit and hospital nursery. Potential factors associated with circadian sleep/wake patterns were analyzed using the generalized estimating equation. For our sample of 30 preterm infants, better sleep/wake patterns were associated with male gender, younger postmenstrual and chronological age, lower body weight, and less illness severity. Preterm infants' total sleep time ( B = 41.828, p < .01) and percentage of sleep time ( B = 3.711, p < .01) were significantly longer at night than during the day. These findings can help clinicians recognize preterm infants' sleep problems, signaling the need to provide individualized support to maintain these infants' sleep quality during their early life.

  15. Apoptosis and proliferation in lungs of ventilated and oxygen-treated preterm infants.

    PubMed

    May, M; Ströbel, P; Preisshofen, T; Seidenspinner, S; Marx, A; Speer, C P

    2004-01-01

    Apoptosis and proliferation and the effect of exogenous surfactant on these processes were investigated in the lungs of mechanically ventilated/oxygen-treated preterm infants with respiratory distress syndrome and stillborn foetuses. Apoptotic and proliferation indices were determined in lung tissue sections from 27 ventilated/oxygen-treated preterm infants and 29 stillborn foetuses. The effect of exogenous surfactant on apoptosis and proliferation was studied in 16 ventilated preterm infants; 11 untreated infants served as control. Apoptotic and proliferating cells were identified by double labelling combining terminal deoxynucleotidyltransferase-mediated deoxyuridine triphosphate nick end-labelling or Ki-67 with cell marker proteins. Pathways to cell death were explored by immunolabelling of cleaved caspases-3, -8 and -9. In the lungs of ventilated/oxygen-treated preterm infants, the numbers of apoptotic and proliferating cells increased significantly compared to the respective numbers in the lungs of stillborn foetuses. Apoptosis was detected in alveolar epithelial cells, whereas epithelial, endothelial and smooth muscle cells proliferated. Surfactant treatment reduced apoptosis induced by ventilation/oxygen-treatment; however, the decrease was not significant. Caspases-8 and -9 do not contribute to ventilation-induced apoptosis, whereas caspase-3 is involved. In conclusion, ventilation/oxygen-treatment induces epithelial cell apoptosis and proliferation of epithelial, endothelial and smooth muscle cells in the lungs of preterm infants.

  16. A new type of swaddling clothing improved development of preterm infants in neonatal intensive care units.

    PubMed

    Kitase, Yuma; Sato, Yoshiaki; Takahashi, Hirokazu; Shimizu, Misaki; Ishikawa, Chie; Yamamoto, Hikaru; Hayakawa, Masahiro

    2017-09-01

    Preterm infants undergo stress owing to essential treatments and exposure to the extrauterine environment in neonatal intensive care units. The aim of this study was to enable preterm infants to maintain adequate positioning with a newly developed swaddling clothing, in order to improve low muscle tone and sleep quality, and to confirm the safety of the clothing. This prospective clinical trial included an intervention group (preterm infants wearing bag-shaped clothing, allowing only exposure of the head, n=27), and a control group (preterm infants managed only with conventional swaddling, n=12). We used the Dubowitz method to analyze behavior, recorded the frequency of vomiting and apnea in both groups, and assessed the sleep state in the intervention group. Muscle tone and total score for the Dubowitz method significantly improved in the intervention group, compared with those in the control group. We evaluated the sleep state before and after the introduction of the device in the intervention group, and State 1 increased from 53.5% to 69.2% after introduction. No significant difference was seen in the frequency of vomiting and apnea between the groups. The new swaddling clothing with enhanced stretch capacity improved the muscle tone and increased sleep time by decreasing the state level of preterm infants. This is an effective tool to assist in infant development in neonatal intensive care units. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Hemodynamic Effects of Nasal Intermittent Positive Pressure Ventilation in Preterm Infants

    PubMed Central

    Chang, Hung-Yang; Cheng, Kun-Shan; Lung, Hou-Ling; Li, Sung-Tse; Lin, Chien-Yu; Lee, Hung-Chang; Lee, Ching-Hsiao; Hung, Hsiao-Fang

    2016-01-01

    Abstract Nasal intermittent positive pressure ventilation (NIPPV) and nasal continuous positive airway pressure (NCPAP) have proven to be effective modes of noninvasive respiratory support in preterm infants. Although they are increasingly used in neonatal intensive care, their hemodynamic consequences have not been fully evaluated. The aim of this study was to investigate the hemodynamic changes between NIPPV and NCPAP in preterm infants. This prospective observational study enrolled clinically stable preterm infants requiring respiratory support received NCPAP and nonsynchronized NIPPV at 40/minute for 30 minutes each, in random order. Cardiac function and cerebral hemodynamics were assessed by ultrasonography after each study period. The patients continued the study ventilation during measurements. Twenty infants with a mean gestational age of 27 weeks (range, 25–32 weeks) and birth weight of 974 g were examined at a median postnatal age of 20 days (range, 9–28 days). There were no significant differences between the NCPAP and NIPPV groups in right (302 vs 292 mL/kg/min, respectively) and left ventricular output (310 vs 319 mL/kg/min, respectively), superior vena cava flow (103 vs 111 mL/kg/min, respectively), or anterior cerebral artery flow velocity. NIPPV did not have a significant effect on the hemodynamics of stable preterm infants. Future studies assessing the effect of NIPPV on circulation should focus on less stable and very preterm infants. PMID:26871833

  18. Extremely Preterm Infant Skin Care: A Transformation of Practice Aimed to Prevent Harm.

    PubMed

    Johnson, Deanna E

    2016-10-01

    The skin of extremely preterm infants is underdeveloped and has poor barrier function. Skin maintenance interventions initiated in the neonatal intensive care unit (NICU) have immediate and lifelong implications when the potential for infection, allergen sensitization, and altered aesthetic outcomes are considered. In addition, the high-level medical needs of extremely preterm infants demand skin-level medical interventions that too often result in unintended skin harm. We describe the use of a harm prevention, or consequence-centered, approach to skin care, which facilitates safer practice for extremely premature infants. Neonatal and pediatric Advanced Practice Registered Nurses (APRN) came together for monthly meetings to review the evidence around best skin care practices for extremely preterm infants, with an emphasis on reduction of skin harm. Findings were focused on the population of interest and clinical implementation strategies. Skin care for extremely preterm infants remains overlooked by current literature. However, clinical practice pearls were extracted and applied in a manner that promotes safer skin care practices in the NICU. Gentle adhesives, such as silicone tapes and hydrogel-backed electrodes, can help to reduce medical adhesive-related skin injuries. Diaper wipes are not appropriate for use among extremely preterm infants, as many ingredients may contain potential allergens. Skin cleansers should be pH neutral to the skin and the prophylactic use of petrolatum-based emollients should be avoided. Further exploration and understanding of skin care practices that examine issues of true risk versus hypothetical risk of harm.

  19. Citrobacter freundii brain abscess in a preterm infant: a case report and literature review.

    PubMed

    Plakkal, Nishad; Soraisham, Amuchou Singh; Amin, Harish

    2013-04-01

    Intracranial abscesses are serious conditions but uncommon in preterm neonates. Citrobacter species are an uncommon cause of bacterial meningitis in neonates, but are associated with brain abscesses in a majority of cases. We report a preterm infant who developed Citrobacter freundii meningitis with brain abscess, who was successfully treated with antibiotics and surgical drainage. The infant had normal neurological outcome at follow-up. We report this case to highlight the importance of serial neuroimaging in the diagnosis of cerebral abscess in infants with Citrobacter meningitis.

  20. Osteopenia of Prematurity: Does Physical Activity Improve Bone Mineralization in Preterm Infants?

    PubMed

    Stalnaker, Kelsey A; Poskey, Gail A

    2016-01-01

    Bone mineralization of preterm infants is significantly less than full-term infants at birth, placing preterm infants at risk for osteopenia of prematurity and other metabolic bone diseases. Advances in nutritional supplementation and standard nursing care alone have been unsuccessful in improving bone mineralization postnatally. Research supports a daily physical activity protocol of passive range of motion and gentle joint compression when combined with adequate nutritional supplementation reduces osteopenia of prematurity. This article provides a systematic review of the current evidence surrounding early physical activity and neonatal massage for the treatment of osteopenia and indicates the need for universal handling protocols in caring for this unique population.

  1. Neutral and Acidic Oligosaccharides Supplementation Does Not Increase the Vaccine Antibody Response in Preterm Infants in a Randomized Clinical Trial

    PubMed Central

    van den Berg, Jolice P.; Westerbeek, Elisabeth A. M.; van der Klis, Fiona R. M.; Berbers, Guy A. M.; Lafeber, Harrie N.; van Elburg, Ruurd M.

    2013-01-01

    Background In preterm infants, a decreased immunological response and lower serological effectiveness are observed after immunizations due to ineffectiveness of both humoral and cellular immune mechanisms. Objective To determine the effect of 80% neutral oligosaccharides [small-chain galacto-oligosaccharides/long-chain fructo-oligosaccharides (scGOS/lcFOS)] in combination with 20% pectin-derived acidic oligosaccharides (pAOS) on antibody concentrations after DTaP-IPV-Hib immunization in preterm infants. Design In this randomized clinical trial, preterm infants with gestational age <32 weeks and/or birth weight <1500 g received enteral supplementation with scGOS/lcFOS/pAOS or placebo (maltodextrin) between days 3 and 30 of life. Blood samples were collected at 5 and 12 months of age. Results In total, 113 infants were included. Baseline and nutritional characteristics were not different in both groups. Geometric mean titers were not different after prebiotic supplementation at 5 months, Ptx (37/44 EU/ml), FHA (78/96 EU/ml), Prn (78/80 EU/ml), Diphtheria (0.40/0.57 IU/ml), Tetanus (0.74/0.99 IU/ml) and Hib (0.35/0.63 µg/ml), and at 12 months Ptx (55/66 EU/ml), FHA (122/119 EU/ml), Prn (116/106 Eu/ml), Diphtheria (0.88/1.11 IU/ml), Tetanus (1.64/1.79 IU/ml) and Hib (2.91/2.55 µg/ml). Conclusions Enteral supplementation of neutral (scGOS/lcFOS) and acidic oligosaccharides (pAOS) does not improve the immunization response in preterm infants. Trial Registration Controlled-Trials.com ISRCTN16211826 ISRCTN16211826 PMID:23951035

  2. Randomised trial of iodine intake and thyroid status in preterm infants

    PubMed Central

    Rogahn, J.; Ryan, S.; Wells, J.; Fraser, B.; Squire, C.; Wild, N.; Hughes, A.; Amegavie, L.

    2000-01-01

    BACKGROUND—Low levels of circulating thyroid hormones have been associated with poorer general and neurodevelopmental outcome in preterm babies and it has been speculated that the association is causal. Low levels of circulating thyroid hormone have been reported after inadequate intake of iodine in preterm infants being fed milk formula.
AIM—To investigate whether increased iodine intake from supplemented preterm formula would improve thyroid hormone levels in preterm babies (this study) and hence improve neurodevelopmental status (planned subsequent study).
METHOD—A total of 121 preterm infants were entered into a randomised controlled trial of standard (68 µg/l) versus increased (272µg/l) iodine in preterm formula.
RESULTS—The two groups were comparable at recruitment. No evidence of an effect of the intervention on thyroid hormone levels was seen up to 41 weeks after conception.
CONCLUSION—Calls for increased iodine content of preterm infant formulas are not justified by this study.
 PMID:10952698

  3. Influence of test weighing before/after nursing on breastfeeding in preterm infants.

    PubMed

    Funkquist, Eva-Lotta; Tuvemo, Torsten; Jonsson, Björn; Serenius, Fredrik; Nyqvist, Kerstin Hedberg

    2010-02-01

    Swedish hospitals apply various regimens for preterm infants' nutrition in connection with their mothers' establishment of breastfeeding. Milk intake is assessed either by test weighing before and after breastfeeding or by observing the infant's suckling behavior (ie, clinical indices). These differing policies may lead to differences in infants' feeding progress. The purpose of this study was to compare effects on breastfeeding and weight gain of preterm infants, depending on whether the volume of breast milk intake when suckled in the hospital was estimated by "clinical indices" or determined by test weighing. Sixty-four infants treated at a unit applying test weighing were compared with 59 infants treated at a unit assessing milk intake by "clinical indices." A retrospective, descriptive, and comparative design was used to explore the consequences of different nutrition regimens. Data were obtained from a review of hospital medical records. The infants treated at the hospital where test weighing was practiced attained exclusive breastfeeding at an earlier postmenstrual age (PMA) and were also discharged at an earlier PMA. However, the 2 study units were alike regarding the proportion of infants attaining exclusive breastfeeding, the postnatal age when this occurred, and the weight pattern in hospital. To establish breastfeeding in preterm infants, test weighing before and after breastfeeding and gradual reduction of supplementation are both applicable regimens. Mothers can be encouraged to choose either of them, although test weighing may help infants attain exclusive breastfeeding at an earlier PMA.

  4. The effect of massage on heart rate variability in preterm infants

    PubMed Central

    Smith, SL.; Lux, R.; Haley, S.; Slater, H.; Beechy, J.; Moyer-Mileur, LJ.

    2012-01-01

    Objective To test the hypothesis that massage would improve autonomic nervous system (ANS) function as measured by heart rate variability (HRV) in preterm infants. Study Design Medically stable, 29- to 32-week preterm infants (17 massage, 20 control) were enrolled in a masked, randomized longitudinal study. Licensed massage therapists provided the massage or control condition twice a day for 4 weeks. Weekly HRV, a measure of ANS development and function, was analyzed using SPSS generalized estimating equations. Results Infant characteristics were similar between groups. HRV improved in massaged infants but not in the control infants (P<0.05). Massaged males had a greater improvement in HRV than females (P<0.05). HRV in massaged infants was on a trajectory comparable to term-born infants by study completion. Conclusion Massage-improved HRV in a homogeneous sample of hospitalized, medically stable, preterm male infants and may improve infant response to exogenous stressors. We speculate that massage improves ANS function in these infants. PMID:22538325

  5. Comparative Network Analysis of Preterm vs. Full-Term Infant-Mother Interactions

    PubMed Central

    Kalmár, Magda; Tóth, Ildikó; Krishna, Sandeep; Jensen, Mogens H.; Semsey, Szabolcs

    2013-01-01

    Several studies have reported that interactions of mothers with preterm infants show differential characteristics compared to that of mothers with full-term infants. Interaction of preterm dyads is often reported as less harmonious. However, observations and explanations concerning the underlying mechanisms are inconsistent. In this work 30 preterm and 42 full-term mother-infant dyads were observed at one year of age. Free play interactions were videotaped and coded using a micro-analytic coding system. The video records were coded at one second resolution and studied by a novel approach using network analysis tools. The advantage of our approach is that it reveals the patterns of behavioral transitions in the interactions. We found that the most frequent behavioral transitions are the same in the two groups. However, we have identified several high and lower frequency transitions which occur significantly more often in the preterm or full-term group. Our analysis also suggests that the variability of behavioral transitions is significantly higher in the preterm group. This higher variability is mostly resulted from the diversity of transitions involving non-harmonious behaviors. We have identified a maladaptive pattern in the maternal behavior in the preterm group, involving intrusiveness and disengagement. Application of the approach reported in this paper to longitudinal data could elucidate whether these maladaptive maternal behavioral changes place the infant at risk for later emotional, cognitive and behavioral disturbance. PMID:23805298

  6. Antenatal magnesium sulfate and neurodevelopmental outcome of preterm infants born to preeclamptic mothers.

    PubMed

    Bozkurt, Ozlem; Eras, Zeynep; Canpolat, Fuat Emre; Oguz, Serife Suna; Uras, Nurdan; Dilmen, Ugur

    2016-01-01

    Previous studies demonstrated that magnesium sulfate is associated with better neurological outcome and decreased cerebral palsy rates in preterm newborns. The aim of this study is to assess the effects of antenatal magnesium sulfate on neurodevelopmental outcomes of preterm infants. Preterm newborns with a gestational age of <32 weeks whose mothers were diagnosed with preeclampsia were extracted from the hospital records and files retrospectively. The neurodevelopmental assessment was performed at 2 years of age by developmental pediatrician. The results of the infants exposed to antenatal magnesium sulfate were compared with the control group. Between the years 2010 and 2012, 387 preterm babies were born to preeclamptic mothers. Fifty-nine (15.2%) of them were exposed to antenatal magnesium sulfate. The main clinical characteristics did not differ between the groups. On the other hand, cerebral palsy was significantly lower in preterm infants exposed to magnesium sulfate compared to the control group (3.3% and 12.2%, respectively, p = 0.004). On multinominal logistic regression analysis, magnesium sulfate was not an independent significant factor to reduce CP on its own. Antenatal magnesium sulfate can be used as a neuroprotective strategy especially for the prevention of cerebral palsy in preterm infants. Future studies should be designed to support the positive effect of antenatal magnesium sulfate on neurologic development.

  7. Visual evoked potentials and dietary long chain polyunsaturated fatty acids in preterm infants.

    PubMed Central

    Faldella, G; Govoni, M; Alessandroni, R; Marchiani, E; Salvioli, G P; Biagi, P L; Spano, C

    1996-01-01

    The influence of dietary long chain polyunsaturated fatty acid (LCP) supply, and especially of docosahexaenoic acid (DHA), on evoked potential maturation, was studied in 58 healthy preterm infants using flash visual evoked potentials (VEPs), flash electroretinography (ERG), and brainstem acoustic evoked potentials (BAEPs) at 52 weeks of postconceptional age. At the same time, the fatty acid composition of red blood cell membranes was examined. The infants were fed on breast milk (n = 12), a preterm formula supplemented with LCP (PF-LCP) (n = 21), or a traditional preterm formula (PF) (n = 25). In the breast milk and PF-LCP groups the morphology and latencies of the waves that reflect the visual projecting system were similar; in the PF group the morphology was quite different and the wave latencies were significantly longer. This could mean that the maturation pattern of VEPs in preterm infants who did not receive LCP was slower. Moreover, a higher level of erythrocyte LCP, especially DHA, was found in breast milk and PF-LCP groups compared with the PF group. ERG and BAEP recordings were the same in all three groups. These results suggest that a well balanced LCP supplement in preterm formulas can positively influence the maturation of visual evoked potentials in preterm infants when breast milk is not available. PMID:8949693

  8. Preterm infants fed nutrient-enriched formula until 6 months show improved growth and development.

    PubMed

    Jeon, Ga Won; Jung, Yu Jin; Koh, Sun Young; Lee, Yeon Kyung; Kim, Kyung Ah; Shin, Son Moon; Kim, Sung Shin; Shim, Jae Won; Chang, Yun Sil; Park, Won Soon

    2011-10-01

    The purpose of the present study was to determine the effect of feeding nutri