scholarly journals Preterm Brain Injury, Antenatal Triggers, and Therapeutics: Timing Is Key

Cells ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. 1871 ◽  
Author(s):  
Daan R.M.G. Ophelders ◽  
Ruth Gussenhoven ◽  
Luise Klein ◽  
Reint K. Jellema ◽  
Rob J.J. Westerlaken ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Brain Injury ◽  
Preterm Infants ◽  
Critical Role ◽  
Perinatal Brain Injury ◽  
Preclinical Research ◽  
Mortality And Morbidity ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Hypoxia Ischemia

With a worldwide incidence of 15 million cases, preterm birth is a major contributor to neonatal mortality and morbidity, and concomitant social and economic burden Preterm infants are predisposed to life-long neurological disorders due to the immaturity of the brain. The risks are inversely proportional to maturity at birth. In the majority of extremely preterm infants (<28 weeks’ gestation), perinatal brain injury is associated with exposure to multiple inflammatory perinatal triggers that include antenatal infection (i.e., chorioamnionitis), hypoxia-ischemia, and various postnatal injurious triggers (i.e., oxidative stress, sepsis, mechanical ventilation, hemodynamic instability). These perinatal insults cause a self-perpetuating cascade of peripheral and cerebral inflammation that plays a critical role in the etiology of diffuse white and grey matter injuries that underlies a spectrum of connectivity deficits in survivors from extremely preterm birth. This review focuses on chorioamnionitis and hypoxia-ischemia, which are two important antenatal risk factors for preterm brain injury, and highlights the latest insights on its pathophysiology, potential treatment, and future perspectives to narrow the translational gap between preclinical research and clinical applications.

SNAP-II for prediction of mortality and morbidity in extremely preterm infants

2018 ◽  
Vol 32 (16) ◽  
pp. 2694-2701 ◽  
Author(s):  
Marc Beltempo ◽  
Prakesh S. Shah ◽  
Xiang Y. Ye ◽  
Jehier Afifi ◽  
Shoo Lee ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Mortality And Morbidity ◽  
Prediction Of Mortality ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

scholarly journals Preterm birth and sustained inflammation: consequences for the neonate

2020 ◽  
Vol 42 (4) ◽  
pp. 451-468 ◽  
Author(s):  
Alexander Humberg ◽  
◽  
Ingmar Fortmann ◽  
Bastian Siller ◽  
Matthias Volkmar Kopp ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Preterm Infants ◽  
Defense Mechanisms ◽  
Preterm Births ◽  
Immune Defense ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Organ Systems ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Abstract Almost half of all preterm births are caused or triggered by an inflammatory process at the feto-maternal interface resulting in preterm labor or rupture of membranes with or without chorioamnionitis (“first inflammatory hit”). Preterm babies have highly vulnerable body surfaces and immature organ systems. They are postnatally confronted with a drastically altered antigen exposure including hospital-specific microbes, artificial devices, drugs, nutritional antigens, and hypoxia or hyperoxia (“second inflammatory hit”). This is of particular importance to extremely preterm infants born before 28 weeks, as they have not experienced important “third-trimester” adaptation processes to tolerate maternal and self-antigens. Instead of a balanced adaptation to extrauterine life, the delicate co-regulation between immune defense mechanisms and immunosuppression (tolerance) to allow microbiome establishment is therefore often disturbed. Hence, preterm infants are predisposed to sepsis but also to several injurious conditions that can contribute to the onset or perpetuation of sustained inflammation (SI). This is a continuing challenge to clinicians involved in the care of preterm infants, as SI is regarded as a crucial mediator for mortality and the development of morbidities in preterm infants. This review will outline the (i) role of inflammation for short-term consequences of preterm birth and (ii) the effect of SI on organ development and long-term outcome.

scholarly journals Admission Temperature and Associated Mortality and Morbidity among Moderately and Extremely Preterm Infants

2018 ◽  
Vol 192 ◽  
pp. 53-59.e2 ◽  
Author(s):  
Abbot R. Laptook ◽  
Edward F. Bell ◽  
Seetha Shankaran ◽  
Nansi S. Boghossian ◽  
Myra H. Wyckoff ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Mortality And Morbidity ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

scholarly journals Association of early postnatal transfer and birth outside a tertiary hospital with mortality and severe brain injury in extremely preterm infants: observational cohort study with propensity score matching

BMJ ◽  
2019 ◽  
pp. l5678 ◽  
Author(s):  
Kjell Helenius ◽  
Nicholas Longford ◽  
Liisa Lehtonen ◽  
Neena Modi ◽  
Chris Gale
Keyword(s):  
Brain Injury ◽  
Preterm Infants ◽  
Tertiary Care ◽  
Tertiary Hospital ◽  
Severe Brain Injury ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Significant Difference ◽  
Transfer Group ◽  
Upward Transfer

Abstract Objective To determine if postnatal transfer or birth in a non-tertiary hospital is associated with adverse outcomes. Design Observational cohort study with propensity score matching. Setting National health service neonatal care in England; population data held in the National Neonatal Research Database. Participants Extremely preterm infants born at less than 28 gestational weeks between 2008 and 2015 (n=17 577) grouped based on birth hospital and transfer within 48 hours of birth: upward transfer (non-tertiary to tertiary hospital, n=2158), non-tertiary care (born in non-tertiary hospital; not transferred, n=2668), and controls (born in tertiary hospital; not transferred, n=10 866). Infants were matched on propensity scores and predefined background variables to form subgroups with near identical distributions of confounders. Infants transferred between tertiary hospitals (horizontal transfer) were separately matched to controls in a 1:5 ratio. Main outcome measures Death, severe brain injury, and survival without severe brain injury. Results 2181 infants, 727 from each group (upward transfer, non-tertiary care, and control) were well matched. Compared with controls, infants in the upward transfer group had no significant difference in the odds of death before discharge (odds ratio 1.22, 95% confidence interval 0.92 to 1.61) but significantly higher odds of severe brain injury (2.32, 1.78 to 3.06; number needed to treat (NNT) 8) and significantly lower odds of survival without severe brain injury (0.60, 0.47 to 0.76; NNT 9). Compared with controls, infants in the non-tertiary care group had significantly higher odds of death (1.34, 1.02 to 1.77; NNT 20) but no significant difference in the odds of severe brain injury (0.95, 0.70 to 1.30) or survival without severe brain injury (0.82, 0.64 to 1.05). Compared with infants in the upward transfer group, infants in the non-tertiary care group had no significant difference in death before discharge (1.10, 0.84 to 1.44) but significantly lower odds of severe brain injury (0.41, 0.31 to 0.53; NNT 8) and significantly higher odds of survival without severe brain injury (1.37, 1.09 to 1.73; NNT 14). No significant differences were found in outcomes between the horizontal transfer group (n=305) and controls (n=1525). Conclusions In extremely preterm infants, birth in a non-tertiary hospital and transfer within 48 hours are associated with poor outcomes when compared with birth in a tertiary setting. We recommend perinatal services promote pathways that facilitate delivery of extremely preterm infants in tertiary hospitals in preference to postnatal transfer.

Admission Systolic Blood Pressure and Outcomes in Preterm Infants of ≤ 26 Weeks' Gestation

2017 ◽  
Vol 34 (13) ◽  
pp. 1271-1278 ◽  
Author(s):  
Yanyu Lyu ◽  
Xiang Ye ◽  
Tetsuya Isayama ◽  
Ruben Alvaro ◽  
Chuks Nwaesei ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Brain Injury ◽  
Preterm Infants ◽  
Gestational Age ◽  
Early Mortality ◽  
Composite Outcome ◽  
Severe Brain Injury ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
The Relationship

Objective To examine the relationship between admission systolic blood pressure (SBP) and adverse neonatal outcomes. Specifically, we aimed to identify the optimal SBP that is associated with the lowest rates of adverse outcomes in extremely preterm infants of ≤ 26 weeks' gestation. Methods In this retrospective study, inborn neonates born at ≤ 26 weeks' gestational age and admitted to tertiary neonatal units participating in the Canadian Neonatal Network between 2003 and 2009 were included. The primary outcome was early mortality (≤ 7 days). Secondary outcomes included severe brain injury, late mortality, and a composite outcome defined as early mortality or severe brain injury. Nonlinear multivariable logistic regression models examined the relationship between admission SBP and outcomes. Results Admission SBP demonstrated a U-shaped relationship with early mortality, severe brain injury, and composite outcome after adjustment for confounders (p < 0.01). The lowest risks of early mortality, severe brain injury, and composite outcome occurred at admission SBPs of 51, 55, and 54 mm Hg, respectively. Conclusion In extremely preterm infants of ≤ 26 weeks' gestational age, the relationship between admission SBP, and early mortality and severe brain injury was “U-shaped.” The optimal admission SBP associated with lowest rates of adverse outcome was between 51 and 55 mm Hg.

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