Ferraris, Laurent, Couturier, Jeanne, Eckert, Catherine, Delannoy, Johanne, Barbut, Frédéric, Butel, Marie-José, and Aires, Julio
PLoS ONE. 2/20/2019, Vol. 14 Issue 2, p1-10. 10p.
CLOSTRIDIUM difficile, PREMATURE infants -- Diseases, CAPILLARY electrophoresis, POLYMERASE chain reaction, and HOSPITAL care
Background: Premature neonates (PN) present multiple risk factors for high frequencies and high levels of colonization by C. difficile, yet data is missing about this specific pediatric population. Here, we investigated PN C. difficile carriage and colonization dynamics, analyzed the impact of perinatal determinants on colonization, and characterized the isolates. Methods: A one year longitudinal monocentric prospective cohort study was performed on 121 PN. C. difficile strains isolated from fecal samples on selective medium were identified and characterized by PCR (tpi housekeeping gene; tcdA and tcdB, and binary toxin genes), capillary gel-based electrophoresis PCR-ribotyping, and Multi-Locus Variable-number tandem-repeat Analysis (MLVA). Results: Of the 379 samples analyzed, 199 (52%) were C. difficile culture positive with the mean levels of C. difficile colonization decreasing significantly (P = .027) over time. During hospitalization, C. difficile colonization frequency increased up to 61% with 95% of the strains belonging to both non-toxigenic PCR-ribotypes (RTs) FR082 (35%) and 032 (60%). After hospital discharge, if a higher diversity in RTs was observed, RTs FR082 and 032 remained predominant (respectively 40% and 28%). MLVA showed clonal relationship within each FR082 and 032 RTs. Ten toxigenic strains (5%) were isolated, all tcdA+/tcdB+ except for one tcdA-/tcdB+, and all being acquired after hospitalization. At 1 week, the only factors found to be linked with a higher frequency of C. difficile colonization were a higher gestational age (P = 0.006) and a higher birth weight (P = 0.016). Conclusion: The dynamics of C. difficile colonization in PN followed a specific pattern. C. difficile colonization rapidly occurred after birth with a low diversity of non-toxigenic RTs. After hospitalization, non-toxigenic RTs diversity increased. Sporadic carriage of toxigenic strains was observed after hospitalization. [ABSTRACT FROM AUTHOR]
Zhou, Dan, Shi, Fang, Xiong, Ying, Zhou, Min, Wan, Huajing, and Liu, Hanmin
European Journal of Pediatrics. Jan2019, Vol. 178 Issue 1, p81-87. 7p. 2 Charts, 3 Graphs.
BRONCHOPULMONARY dysplasia, PREMATURE infants -- Diseases, CHEMOKINES, TH2 cells, EOTAXIN, INFLAMMATION, PREMATURE infants, LONGITUDINAL method, RESEARCH funding, and T cells
Bronchopulmonary dysplasia (BPD) is one of the most common chronic inflammatory lung disease of premature infants, with serious short- and long-term consequences. Early identification of premature infants at risk of BPD is critical to preventing the pathogenesis of disease. Thus, in the present study, we recruited 126 premature infants, collected peripheral blood samples at different time points during early life, and measured the concentration of Th1 (MCP-1, IP-10, and MIG) and Th2 (eotaxin-1, eotaxin-2, and MCP-4) chemokines in serum. We found serum eotaxin-2 levels were significantly higher in the BPD group than in the non-BPD group on day 1 [1662 pg/ml vs. 1221 pg/ml, P < 0.05], day 7 [1533 pg/ml vs. 1089 pg/ml, P < 0.05], and day 14 [1246 pg/ml vs. 704 pg/ml, P < 0.05] after birth, and serum MCP-4 levels were also significantly higher in the BPD group than in the non-BPD group on day 1 [186 pg/ml vs. 128 pg/ml, P < 0.05], day 7 [199 pg/ml vs. 101 pg/ml, P < 0.05], and day 14 [238 pg/ml vs. 106 pg/ml, P < 0.05] of life.Conclusions: Increased levels of Th2 chemokines, eotaxin-2, and MCP-4, are associated with BPD in premature infants. What is Known: • The pathogenesis of BPD is multifactorial and it is difficult to predict and prevent. • Previous studies have demonstrated that inflammation plays a major role in the pathogenesis of BPD. What is New: • Increased Th2 chemokines, eotaxin-2 and MCP-4, were associated with BPD in premature infants. • Abnormal Th1/Th2 response in early life maybe associated with the subsequent development of BPD, which provide a new insight to understand the pathogenesis of the disease. [ABSTRACT FROM AUTHOR]
AUTISM spectrum disorders, PREMATURE infants -- Diseases, PREGNANCY, and COGNITION
Despite the higher prevalence of autism spectrum disorder (ASD) in children born preterm, valid screening tools for use in preterm populations are lacking. We aimed to evaluate the screening accuracy of the Brief Infant Toddler Social-Emotional Assessment (BITSEA) and to compare it to the Pervasive Developmental Disorders Screening Test-II, Stage 2, Developmental Clinic Screener (PDDST-II-DCS) in identifying ASD diagnosis in toddlers born at < 30 weeks' gestation. Caregivers (94% mothers) of 555 children completed questionnaires (BITSEA, PDDST-II-DCS, socio-demographics) when the children (58% male) were 18-36 months. Medical charts were abstracted 3.5 years later and showed that 4% (n = 24) of children had an ASD diagnosis. BITSEA competence (sensitivity = .74; specificity = .76) and ASD (sensitivity = .70; specificity = .73) subscales demonstrated better accuracy in identifying ASD compared to the recommended PDDST-II-DCS cut-score (sensitivity = .73; specificity = .64), specifically as it related to specificity. Additional studies are needed in other preterm populations to replicate these findings. [ABSTRACT FROM AUTHOR]
Zuidberg, Mark R J, Shriwise, Amanda, Boer, Lisanne M de, and Johansen, Anne S
European Journal of Public Health; Dec2020, Vol. 30 Issue 6, p1072-1077, 6p
CONCEPTUAL structures, HEALTH services accessibility, HEALTH status indicators, PREMATURE infants -- Diseases, INFANT mortality, LIFE expectancy, MEDICAL policy, OBESITY, PUBLIC health, QUALITY assurance, SUSTAINABLE development, QUANTITATIVE research, SOCIOECONOMIC factors, WELL-being, DESCRIPTIVE statistics, and EVALUATION
Background Health 2020 is the regional health policy framework of the World Health Organization (WHO) Regional Office for Europe. The goals of Health 2020 are to improve health and well-being, reduce health inequalities and strengthen public health. To gain insight into the Health 2020 targets needing extra attention in coming years, we assessed progress under Health 2020 in the WHO European Region. Methods Quantitative methods were used to assess progress in 50 out of 53 Member States of the WHO European Region in 2005, 2010 and 2015. The 16 quantitative Health 2020 indicators were rescaled from 1 to 100, with 1 indicating poor performance and 100 indicating good performance. The geometric mean of all 16 rescaled indicators was taken by Health 2020 target to compose a Health 2020 index. Results The Health 2020 index (2015) ranged from 82.8 in Sweden to 30.0 in Turkmenistan. A clear east-west gradient was observed in the WHO European Region, with countries in western parts performing relatively better than countries in eastern parts. Indicators with the largest increase between 2005 and 2015 were premature mortality, mortality external causes, life expectancy and infant mortality. However, all quintiles showed a decline on overweight. Conclusions The Health 2020 index gives a relative overview regarding the past and present performance on the Health 2020 policy framework of countries in the WHO European Region. Although improvements have been observed between 2005 and 2015, challenges remain to improve health for all in the context of the United Nations 2030 Agenda for Sustainable Development. [ABSTRACT FROM AUTHOR]
Viscardi, Rose Marie, Terrin, Michael L., Magder, Laurence S., Davis, Natalie L., Dulkerian, Susan J., Waites, Ken B., Ambalavanan, Namasivayam, Kaufman, David A., Donohue, Pamela, Tuttle, Deborah J., Weitkamp, Jorn-Hendrik, Hassan, Hazem E., and Eddington, Natalie D.
Archives of Disease in Childhood -- Fetal & Neonatal Edition; Nov2020, Vol. 108 Issue 6, pF615-F622, 8p
Objective: To test whether azithromycin eradicates Ureaplasma from the respiratory tract in preterm infants.Design: Prospective, phase IIb randomised, double-blind, placebo-controlled trial.Setting: Seven level III-IV US, academic, neonatal intensive care units (NICUs).Patients: Infants 240-286 weeks' gestation (stratified 240-266; 270-286 weeks) randomly assigned within 4 days following birth from July 2013 to August 2016.Interventions: Intravenous azithromycin 20 mg/kg or an equal volume of D5W (placebo) every 24 hours for 3 days.Main Outcome Measures: The primary efficacy outcome was Ureaplasma-free survival. Secondary outcomes were all-cause mortality, Ureaplasma clearance, physiological bronchopulmonary dysplasia (BPD) at 36 weeks' postmenstrual age, comorbidities of prematurity and duration of respiratory support.Results: One hundred and twenty-one randomised participants (azithromycin: n=60; placebo: n=61) were included in the intent-to-treat analysis (mean gestational age 26.2±1.4 weeks). Forty-four of 121 participants (36%) were Ureaplasma positive (azithromycin: n=19; placebo: n=25). Ureaplasma-free survival was 55/60 (92% (95% CI 82% to 97%)) for azithromycin compared with 37/61 (61% (95% CI 48% to 73%)) for placebo. Mortality was similar comparing the two treatment groups (5/60 (8%) vs 6/61 (10%)). Azithromycin effectively eradicated Ureaplasma in all azithromycin-assigned colonised infants, but 21/25 (84%) Ureaplasma-colonised participants receiving placebo were culture positive at one or more follow-up timepoints. Most of the neonatal mortality and morbidity was concentrated in 21 infants with lower respiratory tract Ureaplasma colonisation. In a subgroup analysis, physiological BPD-free survival was 5/10 (50%) (95% CI 19% to 81%) among azithromycin-assigned infants with lower respiratory tract Ureaplasma colonisation versus 2/11 (18%) (95% CI 2% to 52%) in placebo-treated infants.Conclusion: A 3-day azithromycin regimen effectively eradicated respiratory tract Ureaplasma colonisation in this study.Trial Registration Number: NCT01778634. [ABSTRACT FROM AUTHOR]
PREMATURE infants -- Diseases, BLOOD circulation disorders, DISEASE incidence, ETIOLOGY of diseases, RESPIRATORY distress syndrome, PERIVENTRICULAR leukomalacia, and PARENTERAL feeding
Background: Although late-onset circulatory collapse (LCC) is widely recognized in Japan, its etiology and the reason for center variation in its incidence remain unclear. This study’s objectives were to identify the perinatal and neonatal factors related to LCC and to estimate the factors related to the center variation in the incidence of LCC. Methods: Extremely preterm infants born between 2008 and 2012 who were registered in the database of the Neonatal Research Network, Japan were retrospectively analyzed. LCC was defined as a clinical diagnosis of LCC and the administration of steroids. We first identified the factors that were significantly related to LCC. We then examined the cause of the center variation in the incidence of LCC, using the standardized incidence ratios (SIRs) of LCC and individual factors. Results: The factors significantly associated with LCC included low gestational age (odds ratio [OR]: 1.13), small for date (OR: 1.43), male sex (OR: 1.26), antenatal steroid use (OR: 1.19), respiratory distress syndrome (OR: 1.25), chronic lung disease at 36 weeks (OR: 1.16), periventricular leukomalacia (PVL) (OR: 2.57), necrotizing enterocolitis (OR: 0.59), retinopathy of prematurity (ROP) (OR: 1.73), high-frequency oscillating ventilation (HFOV) use (OR: 1.31), parenteral nutrition (OR: 1.38), and red blood cell (RBC) transfusion (OR: 1.94). The SIR of LCC ranged from 0.05 to 2.94, and was positively correlated with SIRs of PVL, ROP, HFOV use and RBC transfusion. Conclusion: PVL, ROP, HFOV use and RBC transfusion were found to be correlated with the center variation in the incidence of LCC. [ABSTRACT FROM AUTHOR]
Blanken, Maarten O., Frederix, Geert W., Nibbelke, Elisabeth E., Koffijberg, Hendrik, Sanders, Elisabeth A. M., Rovers, Maroeska M., Bont, Louis, on behalf of the Dutch RSV Neonatal Network, and Dutch RSV Neonatal Network
European Journal of Pediatrics. Jan2018, Vol. 177 Issue 1, p133-144. 12p. 2 Diagrams, 3 Charts, 2 Graphs.
PREMATURE infants -- Diseases, TARGETED drug delivery, RESPIRATORY syncytial virus infections, PREVENTIVE medicine, RANDOMIZED controlled trials, THERAPEUTICS, PREMATURE infant disease prevention, ANTIVIRAL agents, MEDICAL care cost statistics, COMPARATIVE studies, COST effectiveness, DECISION making, DECISION trees, PREMATURE infants, LONGITUDINAL method, RESEARCH methodology, MEDICAL cooperation, RESEARCH, RESEARCH funding, EVALUATION research, TREATMENT effectiveness, BLIND experiment, QUALITY-adjusted life years, DIAGNOSIS, ECONOMICS, and PREVENTION
The objective of the paper is to assess the cost-effectiveness of targeted respiratory syncytial virus (RSV) prophylaxis based on a validated prediction rule with 1-year time horizon in moderately preterm infants compared to no prophylaxis. Data on health care consumption were derived from a randomised clinical trial on wheeze reduction following RSV prophylaxis and a large birth cohort study on risk prediction of RSV hospitalisation. We calculated the incremental cost-effectiveness ratio (ICER) of targeted RSV prophylaxis vs. no prophylaxis per quality-adjusted life year (QALYs) using a societal perspective, including medical and parental costs and effects. Costs and health outcomes were modelled in a decision tree analysis with sensitivity analyses. Targeted RSV prophylaxis in infants with a first-year RSV hospitalisation risk of > 10% resulted in a QALY gain of 0.02 (0.931 vs. 0.929) per patient against additional cost of €472 compared to no prophylaxis (ICER €214,748/QALY). The ICER falls below a threshold of €80,000 per QALY when RSV prophylaxis cost would be lowered from €928 (baseline) to €406 per unit. At a unit cost of €97, RSV prophylaxis would be cost saving.Conclusions: Targeted RSV prophylaxis is not cost-effective in reducing RSV burden of disease in moderately preterm infants, but it can become cost-effective if lower priced biosimilar palivizumab or a vaccine would be available. [ABSTRACT FROM AUTHOR]
Purpose: To determine the efficacy of the online monitoring tool, WINROP (https://winrop.com/) in detecting sight-threatening type 1 retinopathy of prematurity (ROP) in Indian preterm infants.Methods: Birth weight, gestational age, and weekly weight measurements of seventy preterm infants (<32 weeks gestation) born between June 2014 and August 2016 were entered into WINROP algorithm. Based on weekly weight gain, WINROP algorithm signaled an alarm to indicate that the infant is at risk for sight-threatening Type 1 ROP. ROP screening was done according to standard guidelines. The negative and positive predictive values were calculated using the sensitivity, specificity, and prevalence of ROP type 1 for the study group. 95% confidence interval (CI) was calculated.Results: Of the seventy infants enrolled in the study, 31 (44.28%) developed Type 1 ROP. WINROP alarm was signaled in 74.28% (52/70) of all infants and 90.32% (28/31) of infants treated for Type 1 ROP. The specificity was 38.46% (15/39). The positive predictive value was 53.84% (95% CI: 39.59-67.53) and negative predictive value was 83.3% (95% CI: 57.73-95.59).Conclusion: This is the first study from India using a weight gain-based algorithm for prediction of ROP. Overall sensitivity of WINROP algorithm in detecting Type 1 ROP was 90.32%. The overall specificity was 38.46%. Population-specific tweaking of algorithm may improve the result and practical utility for ophthalmologists and neonatologists. [ABSTRACT FROM AUTHOR]
Álvarez-Fuente, María, Arruza, Luis, Muro, Marta, Zozaya, Carlos, Avila, Alejandro, López-Ortego, Paloma, González-Armengod, Carmen, Torrent, Alba, Gavilán, Jose, Cerro, María, Gavilán, Jose Luis, and Del Cerro, María Jesús
European Journal of Pediatrics. Dec2017, Vol. 176 Issue 12, p1587-1593. 7p.
BRONCHOPULMONARY dysplasia, PREMATURE infants -- Diseases, OXYGEN therapy for premature infants, HIGH-frequency ventilation (Therapy), and PULMONARY hypertension
Bronchopulmonary dysplasia (BPD) is one of the most serious chronic lung diseases in infancy and one of the most important sequels of premature birth (prevalence of 15-50%). Our objective was to estimate the cost of BPD of one preterm baby, with no other major prematurity-related complications, during the first 2 years of life in Spain. Data from the Spanish Ministry of Health regarding costs of diagnosis-related group of preterm birth, hospital admissions and visits, palivizumab administration, and oxygen therapy in the year 2013 were analyzed. In 2013, 2628 preterm babies were born with a weight under 1500 g; 50.9% were males. The need for respiratory support was 2.5% needed only oxygen therapy, 39.5% required conventional mechanical ventilation, and 14.9% required high-frequency ventilation. The incidence of BPD was of 34.9%. The cost of the first 2 years of life of a preterm baby with BPD and no other major prematurity-related complications ranged between 45,049.81 € and 118,760.43 €, in Spain, depending on birth weight and gestational age. If the baby required home oxygen therapy or developed pulmonary hypertension, this cost could add up to 181,742.43 €.Conclusion: Prematurity and BPD have an elevated cost, even for public health care systems. This cost will probably increase in the coming years if the incidence and survival of preterm babies keeps rising. The development of new therapies and preventive strategies to decrease the incidence of BPD and other morbidities associated with prematurity should be a priority. What is known: • Bronchopulmonary dysplasia (BPD) is a serious chronic lung disease related with premature birth. • BPD is an increasing disease due to the up-rise in the number of premature births. What is new: • The economic cost of preterm birth and BPD has never before been estimated in Spain nor published with European data. • Preterm babies with BPD and a good clinical outcome carry also an important economic and social burden. [ABSTRACT FROM AUTHOR]
PREMATURE infants -- Diseases, KIDNEY injuries, NEONATAL intensive care, GESTATIONAL age, INFANT care, and PROGNOSIS
Background: Acute kidney injury (AKI) is a common event in the neonatal intensive care unit (NICU), especially in extremely-low-birth-weight (ELBW) infants. This cohort study investigated the incidence of and risk factors for AKI in ELBW infants and their overall survival at the postmenstrual age (PMA) of 36 weeks. Methods: All ELBW infants admitted to our NICU between January 2010 and December 2013 were enrolled. Those who died prior to 72 hours of life, had congenital renal abnormality, or had only one datum of the serum creatinine (SCr) level after the first 24 hours of life were excluded. The criteria used for the diagnosis of AKI was set according to the modified neonatal KDIGO AKI definition. Results: AKI occurred in 56% of 276 infants. Specifically, stage 1, stage 2, and stage 3 AKI occurred in 30%, 17%, and 9% of ELBW infants, respectively. High-frequency ventilation support (adjusted odds ratio [OR]: 3.4, 95% confidence interval [CI]: 1.78–6.67, p< 0.001), the presence of patent ductus arteriosus (adjusted OR: 4.3, 95% CI: 2.25–8.07, p < 0.001), lower gestational age (adjusted OR for gestational age: 0.7, 95% CI: 0.58–0.83, < 0.001), and inotropic agent use (adjusted OR: 2.6, 95% CI: 1.31–5.21, p = 0.006) were independently associated with AKI. Maternal pre-eclampsia was a protective factor (adjusted OR: 0.4, 95% CI: 0.14–0.97, p = 0.044). Infants with AKI had higher mortality before the PMA of 36 weeks with an adjusted hazard ratio (HR) of 5.34 (95% CI: 1.21–23.53, p = 0.027). Additionally, infants with stage 3 AKI had a highest HR of 10.60, 95% CI: 2.09–53.67, p = 0.004). Conclusion: AKI was a very common event (56%) in ELBW infants and was associated with a lower GA, high-frequency ventilation support, the presence of PDA, and inotropic agent use. AKI reduced survival of ELBW infants before the PMA of 36 weeks. [ABSTRACT FROM AUTHOR]
Background and purpose: In recent decades, increased neonatal survival has enabled research of long-term outcomes of those born preterm. The purpose of this article is to present the findings of an umbrella review, an examination of published systematic reviews and meta-analyses, to examine the outcomes of adolescents and adults born preterm. Methods: The research was guided by the Joanna Briggs Institute methodology for umbrella reviews. A systematic search of PubMed, CINAHL, and PsycINFO databases with the search years 2010 through September 2018 yielded 16 reviews for inclusion. Conclusions: The 16 reviews included in this umbrella review represent five clinical outcomes: neurodevelopmental (3 reviews), mental/behavioral health (5 reviews), cardiovascular (4 reviews), pulmonary (3 reviews), and life experience outcomes (4 reviews). One review included data for multiple clinical outcomes. This umbrella review highlights the adolescent and adult risks related to cognitive scores, executive function, anxiety, depression, attention-deficit hyperactivity disorder, long-term effects on systolic blood pressure, low-density lipoproteins and cholesterol levels, pulmonary symptoms, including asthma, pulmonary function, radiographic changes in the lungs, sports and leisure participation, and educational attainment and employment. Implications for practice: There is a preponderance of evidence that supports targeted screening for a history of preterm birth by all health care providers. This screening should facilitate the promotion of healthy lifestyles and improving psychosocial and neurodevelopmental difficulties through early and continued support services. Curricular and practice standards are advocated to support this change. [ABSTRACT FROM AUTHOR]
DISEASES in twins, PREMATURE infants -- Diseases, and KIDNEY injuries
Acute kidney injury (AKI) is common in critically ill premature infants. They are more susceptible to renal injury than older infants and children because of the functional and developmental immaturity of neonatal kidney. There is no unified definition for neonatal AKI. AKI in neonates is often multifactorial and may result from prenatal, perinatal, or postnatal insults as well. Serum creatinine (SCr) concentration at birth is similar to the mother's value. We present a case of prematurely born twins who were admitted to the paediatric intensive care unit because of AKI. Laboratory examination showed equally elevated levels of blood urea nitrogen (BUN) and SCr and metabolic alkalosis in both twins. High values of BUN and SCr were the result of the mother's unrecognized renal disease. On the seventh postnatal day, SCr and BUN in twins were within the normal ranges. In all cases with high SCr levels in neonates in the fi rst 72 hours after birth, it is mandatory to check the mother's renal function. [ABSTRACT FROM AUTHOR]
Ivars, Katrin, Nelson, Nina, Theodorsson, Annette, Theodorsson, Elvar, Ström, Jakob O., and Mörelius, Evalotte
PLoS ONE. 8/10/2017, Vol. 12 Issue 8, p1-15. 15p.
HYDROCORTISONE, PREMATURE infants -- Diseases, PREMATURE infants, INFANT diseases, CIRCADIAN rhythms, and HEALTH
Objectives: 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. Methods: 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. Results: 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). Conclusions: 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 circadian rhythm development is not related to behavioral regularity. [ABSTRACT FROM AUTHOR]