scholarly journals Care practices and outcomes of extremely preterm neonates born at 22–24 weeks –A single centre experience

2021 ◽  
pp. 1-8
Author(s):  
V.V. Ramaswamy ◽  
V.I. Oommen ◽  
A. Gupta ◽  
N. Weerapperuma ◽  
S. Zivanovic ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Periventricular Leukomalacia ◽  
Survival Rates ◽  
Preterm Neonates ◽  
High Frequency Ventilation ◽  
Risk Of Death ◽  
Extremely Preterm ◽  
Frequency Ventilation ◽  
Level 3 ◽  
Care Practices

BACKGROUND: Wide variation in the care practices and survival rates of neonates born at peri-viable gestational ages of 22 +0 –24 +6 weeks exists. This study elucidates the postnatal risk factors for morbidity/mortality, contrasts the care practices and short-term outcomes of this vulnerable group of preterm neonates from a single center with others. METHODS: Retrospective study of neonates born at 22 +0 –24 +6 weeks in a level 3 neonatal intensive care unit in UK, over a period of 4 years (2016–2019). RESULTS: 94 neonates given active care studied. Survival until discharge was 51.1%(22–23 wks –44%, 24 wks –59.1%) and survival with no major brain injury (MBI) [grade III/IV IVH, cystic periventricular leukomalacia] was 38.3%(22–23 wks –32%, 24 wks –45.4%). Of those who survived until discharge, 75%had no MBI (22–23 wks –72.7%, 24 wks –76.9%). Neonates requiring significant respiratory support within first 72 hours as well as needing rescue high frequency ventilation had significantly high risk of mortality or MBI [aOR –7.17 (2.24–25.79), p = 0.00; 4.76 (1.43–20.00), p = 0.01]. CONCLUSIONS: Survival rate differed from other centres. MBI was low amongst survivors. Severe respiratory disease in the initial days was associated with a higher risk of death or MBI.

Pulmonary Mechanics in Preterm Neonates With Respiratory Failure Treated With High-Frequency Oscillatory Ventilation Compared With Conventional Mechanical Ventilation

PEDIATRICS ◽  
1991 ◽  
Vol 87 (4) ◽  
pp. 487-493
Author(s):  
Soraya Abbasi ◽  
Vinod K. Bhutani ◽  
Alan R. Spitzer ◽  
William W. Fox
Keyword(s):  
Mechanical Ventilation ◽  
Bronchopulmonary Dysplasia ◽  
High Frequency ◽  
Conventional Mechanical Ventilation ◽  
High Frequency Oscillatory Ventilation ◽  
Preterm Neonates ◽  
High Frequency Ventilation ◽  
Pulmonary Mechanics ◽  
Frequency Ventilation ◽  
High Frequency Oscillatory

Pulmonary mechanics were measured in 43 preterm neonates (mean ± SD values of birth weight 1.2 ± 0.3 kg, gestational age 30 ± 2 weeks) with respiratory failure who were concurrently randomly assigned to receive conventional mechanical ventilation (n = 22) or high-frequency ventilation (n = 21). The incidence of bronchopulmonary dysplasia was comparable in the two groups (high-frequency ventilation 57%, conventional ventilation 50%). Pulmonary functions were determined at 0.5, 1.0, 2.0, and 4.0 weeks postnatal ages. Data were collected while subjects were in a nonsedated state during spontaneous breathing. These sequential data show similar patterns of change in pulmonary mechanics during high-frequency ventilation and conventional mechanical ventilation irrespective of gestational age, birth weight stratification, or bronchopulmonary dysplasia. There was no significant difference in the pulmonary functions with either mode of ventilation during the acute phase (≤4 weeks) of respiratory disease. When evaluated by the clinical diagnosis of bronchopulmonary dysplasia, the pulmonary data suggested a less severe dysfunction in the high-frequency oscillatory ventilation-treated bronchopulmonary dysplasia group compared with the conventional mechanical ventilation-treated group. These results indicate that high-frequency oscillatory ventilation in preterm neonates does not reduce the risk of acute lung injury; however, the magnitude of the pulmonary dysfunction in the first 2 weeks of life merits a reevaluation.

Fathers' Visitation of Very Low Birth Weight Infants in the Neonatal Intensive Care Unit during the First Week of Life

2020 ◽  
Author(s):  
Khushbu Patel ◽  
Lindsay Cortright ◽  
Dmitry Tumin ◽  
John A. Kohler
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Preterm Neonates ◽  
Vlbw Infants ◽  
Extremely Preterm

Abstract Background The perceived fragility of extremely preterm neonates may deter paternal visitation early during the neonatal intensive care unit (NICU) stay. We retrospectively analyzed the correlation between paternal visitation of very low birth weight (VLBW) infants in our NICU and sociodemographic characteristics. Study Design We identified inborn VLBW infants admitted to our NICU from 2017 to 2018. The rate of visit days in the first week of life was analyzed using Spearman's correlation and Poisson's regression. Results The analysis included 292 infants (median gestational age [GA]: 29 weeks), with fathers present on a median of 3 days of the first week of life. GA was not correlated with visitation (rho = –0.04). On multivariable regression, fathers visited less frequently if they did not live with the mother or if the mother lived 25 to 75 km from the hospital versus < 25 km. Conclusion Fathers' visitation in our NICU was constrained by socioeconomic factors rather than VLBW infants' characteristics.

scholarly journals Preterm Nutrition and Clinical Outcomes

2020 ◽  
Vol 7 ◽  
pp. 2333794X2093785
Author(s):  
Netsanet Workneh Gidi ◽  
Amha Mekasha ◽  
Assaye K. Nigussie ◽  
Robert L. Goldenberg ◽  
Elizabeth M. McClure ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Preterm Infants ◽  
Enteral Feeding ◽  
Low Income ◽  
Neonatal Intensive Care ◽  
Low Income Countries ◽  
Preterm Neonates ◽  
Risk Of Death ◽  
Increased Risk ◽  
Preterm Formula

Background. In low-income countries, preterm nutrition is often inadequately addressed. The aim of the study was to assess the patterns of feeding and associated clinical outcomes of preterm neonates admitted to neonatal intensive care units in Ethiopia. Method. This was a multicenter, prospective study. Infants’ clinical characteristics at birth, daily monitoring of feeding history, and weight measurements were collected. An outcome assessment was completed at 28 days. Result. For this analysis, 2560 infants (53% male) were eligible. The mean (SD) gestational age was 33.1 (2.2) weeks. During the hospital stay the proportion of infants on breast milk only, preterm formula, term formula, and mixed feeding was 58%, 27.4%, 1.6%, and 34.1%, respectively. Delay in enteral feeding was associated with increased risk of death (odds ratio [OR] = 1.92, 95% confidence interval [CI] = 1.33-2.78; P < .001) and (OR = 5.06, 95% CI = 3.23-7.87; P < .001) for 1 to 3 and 4 to 6 days of delay in enteral feeding, respectively, after adjusting for possible confounders. The length of delay in enteral feeding was associated with increased risk of hypoglycemia (OR = 1.2, 95% CI = 1.1-1.2; P = .005). The mortality rate was lower in hospitals providing preterm formula more often ( P = .04). Half of the infants continued losing weight at the time of discharge. Conclusion. Delayed enteral feeding significantly increases the risk of mortality before discharge and hypoglycemia in preterm infants in resource-limited settings. Ensuring adequate nutritional support of preterm infants is highly needed.

scholarly journals Preterm Birth and Inflammation

2021 ◽  
Author(s):  
Melinda Matyas
Keyword(s):  
Intraventricular Hemorrhage ◽  
Defense Mechanisms ◽  
Periventricular Leukomalacia ◽  
Preterm Births ◽  
Immune Defense ◽  
Preterm Neonates ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Adaptation Processes ◽  
Immature Immune System

Half of all preterm births are caused or triggered by an inflammation at fetal-maternal interface. The sustained inflammation that preterm neonates are exposed is generated by maternal chorioamnionitis, premature rupture of membranes. This inflammation will facilitate the preterm labor, but also plays an important role in development of disease like: bronchopulmonary dysplasia, necrotizing enterocolitis, retinopathy of prematurity, intraventricular hemorrhage and periventricular leukomalacia. Preterm neonates have immature immune system. The fragile co-regulation between immune defense mechanisms and immunosuppression (tolerance) is often disturbed at this category of patients. They are at high risk of sepsis due to this imbalance between the defense and suppression mechanisms but also several injuries can contribute to the onset or perpetuation of sustained inflammation. They experience altered antigen exposure in contact with hospital-specific germs, artificial devices, drugs, nutritional antigens, and hypoxia or hyperoxia. This is more significant at extremely preterm infants less than 28 weeks of gestation as they have not developed adaptation processes to tolerate maternal and self-antigens.

scholarly journals Approaches at Community Level for Care of the Preterm Neonates in Low-Income Countries

2021 ◽  
Author(s):  
Pontius Bayo ◽  
Juliet Ajok
Keyword(s):  
Low Income ◽  
Neonatal Intensive Care ◽  
Health Workers ◽  
Economic Status ◽  
Scale Up ◽  
Survival Rates ◽  
Low Income Countries ◽  
Easy Access ◽  
Preterm Neonates ◽  
Preterm Babies

The survival of preterm babies has significantly improved over the last several decades in the high-income countries because of the availability of Neonatal Intensive Care Units (NICU’s) in both large and small hospitals, presence of specially trained physicians, nurses, and other health care personnel with easy access to sophisticated equipment. However, the bigger public health advances that saw improvements in socio-economic status of the populations, improvements in education and sanitation conditions and reductions in malnutrition and rates of infectious diseases were probably the main reasons for this improved survival rates for preterm neonates. Low in-come countries are currently highest bearers of the burden of preterm morbidity and mortality. The current preventive and care interventions do not reach all the neonates and their mothers, the coverage has remained low, access is poor and the quality of care is low. The aim of this chapter is to propose ideas on how the current preterm neonatal care interventions can be adapted for community scale up through community-based health system structures like community health workers to improve survival of neonates who have been delivered from home or after they have been discharged from hospital.

scholarly journals Doxapram Use for Apnoea of Prematurity in Neonatal Intensive Care

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
S. A. Prins ◽  
S. J. A. Pans ◽  
M. M. van Weissenbruch ◽  
F. J. Walther ◽  
S. H. P. Simons
Keyword(s):  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Periventricular Leukomalacia ◽  
Ductus Arteriosus ◽  
Neonatal Morbidity ◽  
Preterm Neonates ◽  
Short Term ◽  
Prospective Trials ◽  
Care Outcome

Apnoea of prematurity is treated with noninvasive respiratory therapy and methylxanthines. For therapy unresponsive apnoea doxapram is often prescibed in preterm neonates. The duration, dosage and route of administration of doxapram together with its efficacy was evaluated in two Dutch neonatal intensive care. Outcome concerning short-term safety and neonatal morbidity were evaluated. During 5 years, 122 of 1,501 admitted newborns <32 weeks of gestational age received doxapram. 64.8% of patients did not need intubation after doxapram. 25% of treated neonates were <27 weeks of gestation. A positive response to doxapram therapy on apnoea was associated with longer duration of doxapram usage (P<0.001), lower mean doses (P<0.003), and less days of intensive care (median 33 versus 42 days;P<0.002). No patients died during doxapram therapy. Incidence of necrotizing enterocolitis, intraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity, persistent ductus arteriosus, or worsening of pulmonary condition did not increase during doxapram therapy. Doxapram is frequently used for apnoea of prematurity, despite a lack of data on short-term efficacy and long-term safety. Until efficacy and safety are confirmed in prospective trials, doxapram should be used with caution.

scholarly journals Ten-year trend of care practices, morbidities and survival of very preterm neonates in the Malaysian National Neonatal Registry: a retrospective cohort study

2021 ◽  
Vol 5 (1) ◽  
pp. e001149
Author(s):  
Nem Yun Boo ◽  
Seok Chiong Chee ◽  
Siew Hong Neoh ◽  
Eric Boon-Kuang Ang ◽  
Ee Lee Ang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Neonatal Intensive Care ◽  
Surfactant Therapy ◽  
Preterm Neonates ◽  
Very Preterm ◽  
Increased Risk ◽  
Care Practices

ObjectivesTo determine a 10-year trend of survival, morbidities and care practices, and predictors of in-hospital mortality in very preterm neonates (VPTN, gestation 22 to <32 weeks) in the Malaysian National Neonatal Registry.DesignRetrospective cohort study.Setting43 Malaysian neonatal intensive care units.Patients29 010 VPTN (without major malformations) admitted between 1 January 2009 and 31 December 2018.Main outcome measuresCare practices, survival, admission hypothermia (AH, <36.5°C), late-onset sepsis (LOS), pneumothorax, necrotising enterocolitis grade 2 or 3 (NEC), severe intraventricular haemorrhage (sIVH, grade 3 or 4) and bronchopulmonary dysplasia (BPD).ResultsDuring this 10-year period, there was increased use of antenatal steroid (ANS), lower segment caesarean section (LSCS) and early continuous positive airway pressure (eCPAP); but decreased use of surfactant therapy. Survival had increased from 72% to -83.9%. The following morbidities had decreased: LOS (from 27.9% to 7.1%), pneumothorax (from 6.0% to 2.7%), NEC (from 8.1% to 4.7%) and sIVH (from 12.2% to 7.5%). However, moderately severe AH (32.0°C–35.9°C) and BPD had increased. Multiple logistic regression analyses showed that lower birth weight, no ANS, no LSCS, admission to neonatal intensive care unit with <100 VPTN admissions/year, no surfactant therapy, no eCPAP, moderate and severe AH, LOS, pneumothorax, NEC and sIVH were significant predictors of mortality.ConclusionSurvival and major morbidities had improved modestly. Failure to use ANS, LSCS, eCPAP and surfactant therapy, and failure to prevent AH and LOS increased risk of mortality.

Diagnostic accuracy of capnography during high-frequency ventilation in neonatal intensive care units

2015 ◽  
Vol 51 (5) ◽  
pp. 510-516 ◽  
Author(s):  
Amir Kugelman ◽  
Ruben Bromiker ◽  
Arieh Riskin ◽  
Irit Shoris ◽  
Michal Ronen ◽  
...  
Keyword(s):  
Intensive Care ◽  
Diagnostic Accuracy ◽  
Intensive Care Units ◽  
High Frequency ◽  
Neonatal Intensive Care ◽  
Neonatal Intensive Care Units ◽  
High Frequency Ventilation ◽  
Frequency Ventilation
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