scholarly journals A Web-Based Calculator for the Prediction of Severe Neurodevelopmental Impairment in Preterm Infants Using Clinical and Imaging Characteristics

Children ◽  
2018 ◽  
Vol 5 (11) ◽  
pp. 151
Author(s):  
Zachary Vesoulis ◽  
Nathalie El Ters ◽  
Maja Herco ◽  
Halana Whitehead ◽  
Amit Mathur
Keyword(s):  
Preterm Infants ◽  
Predictive Value ◽  
White Matter Injury ◽  
Delivery Mode ◽  
Clinical Factors ◽  
Binary Logistic Regression Model ◽  
Neurodevelopmental Outcomes ◽  
Web Based ◽  
Antenatal Steroids ◽  
Imaging Characteristics

Although the most common forms of brain injury in preterm infants have been associated with adverse neurodevelopmental outcomes, existing MRI scoring systems lack specificity, do not incorporate clinical factors, and are technically challenging to perform. The objective of this study was to develop a web-based, clinically-focused prediction system which differentiates severe neurodevelopmental outcomes from normal-moderate outcomes at two years. Infants were retrospectively identified as those who were born ≤30 weeks gestation and who had MRI imaging at term-equivalent age and neurodevelopmental testing at 18–24 months. Each MRI was scored on injury in three domains (intraventricular hemorrhage, white matter injury, and cerebellar hemorrhage) and clinical factors that were strongly predictive of an outcome were investigated. A binary logistic regression model was then generated from the composite of clinical and imaging components. A total of 154 infants were included (mean gestational age = 26.1 ± 1.8 weeks, birth weight = 889.1 ± 226.2 g). The final model (imaging score + ventilator days + delivery mode + antenatal steroids + retinopathy of prematurity requiring surgery) had strong discriminatory power for severe disability (AUC = 0.850), with a PPV (positive predictive value) of 76% and an NPV (negative predictive value) of 90%. Available as a web-based tool, it can be useful for prognostication and targeting early intervention services to infants who may benefit the most from such services.

scholarly journals A Web-Based Calculator for Prediction of Severe Neurodevelopmental Impairment in Preterm Infants Using Clinical and Imaging Characteristics

2018 ◽  
Author(s):  
Zachary A. Vesoulis ◽  
Nathalie M. El Ters ◽  
Maja Herco ◽  
Halana V. Whitehead ◽  
Amit M. Mathur
Keyword(s):  
Preterm Infants ◽  
Scoring Systems ◽  
White Matter Injury ◽  
Delivery Mode ◽  
Clinical Factors ◽  
Binary Logistic Regression Model ◽  
Neurodevelopmental Outcomes ◽  
Web Based ◽  
Antenatal Steroids ◽  
Imaging Characteristics

Although the most common forms of brain injury in preterm infants have been associated with adverse neurodevelopmental outcomes, existing MRI scoring systems lack specificity, do not incorporate clinical factors, and are technically challenging to perform. The objective of this study was to develop a web-based, clinically-focused prediction system which differentiates severe from normal-moderate neurodevelopmental outcomes at two years.  Infants were retrospectively identified as those who were born ≤30 weeks gestation, had MR imaging at term-equivalent age, and neurodevelopmental testing at 18-24 months.  Each MRI was scored on injury in three domains (intraventricular hemorrhage, white matter injury, and cerebellar hemorrhage) and clinical factors strongly predictive of outcome were investigated.  A binary logistic regression model was then generated from the composite of clinical and imaging components.  A total of 154 infants were included (mean GA = 26.1±1.8 weeks, BW = 889.1±226.2 grams).  The final model (imaging score + ventilator days + delivery mode + antenatal steroids + ROP requiring surgery) had strong discriminatory power for severe disability (AUC=0.850), with a PPV of 76% and NPV of 90%.  Available as a web-based tool, it can be useful for prognostication and targeting early intervention services to infants who may benefit most from such services.

scholarly journals Neurodevelopmental Outcomes at 18 Months of Corrected Age for Late Preterm Infants Born at 34 and 35 Gestational Weeks

2021 ◽  
Vol 18 (2) ◽  
pp. 640 ◽  
Author(s):  
Ruka Nakasone ◽  
Kazumichi Fujioka ◽  
Yuki Kyono ◽  
Asumi Yoshida ◽  
Takumi Kido ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Late Preterm ◽  
Psychomotor Development ◽  
Youden Index ◽  
Chromosomal Anomalies ◽  
Clinical Factors ◽  
Neurodevelopmental Outcomes ◽  
Late Preterm Infants ◽  
Significant Difference ◽  
Severe Hyperbilirubinemia

To date, the difference in neurodevelopmental outcomes between late preterm infants (LPI) born at 34 and 35 gestational weeks (LPI-34 and LPI-35, respectively) has not been elucidated. This retrospective study aimed to evaluate neurodevelopmental outcomes at 18 months of corrected age for LPI-34 and LPI-35, and to elucidate factors predicting neurodevelopmental impairment (NDI). Records of all LPI-34 (n = 93) and LPI-35 (n = 121) admitted to our facility from 2013 to 2017 were reviewed. Patients with congenital or chromosomal anomalies, severe neonatal asphyxia, and without developmental quotient (DQ) data were excluded. Psychomotor development was assessed as a DQ using the Kyoto Scale of Psychological Development at 18 months of corrected age. NDI was defined as DQ < 80 or when severe neurodevelopmental problems made neurodevelopmental assessment impossible. We compared the clinical characteristics and DQ values between LPI-34 (n = 62) and LPI-35 (n = 73). To elucidate the factors predicting NDI at 18 months of corrected age, we compared clinical factors between the NDI (n = 17) and non-NDI (n = 118) groups. No significant difference was observed in DQ values at 18 months of corrected age between the groups in each area and overall. Among clinical factors, male sex, intraventricular hemorrhage (IVH), hyperbilirubinemia, and severe hyperbilirubinemia had a higher prevalence in the NDI group than in the non-NDI group, and IVH and/or severe hyperbilirubinemia showed the highest Youden Index values for predicting NDI. Based on the results of this study, we can conclude that no significant difference in neurodevelopmental outcomes at 18 months of corrected age was observed between LPI-34 and LPI-35. Patients with severe hyperbilirubinemia and/or IVH should be considered to be at high risk for developing NDI.

scholarly journals Predictive Value of Cranial Ultrasound for Neurodevelopmental Outcomes of Very Preterm Infants with Brain Injury

2018 ◽  
Vol 131 (8) ◽  
pp. 920-926 ◽  
Author(s):  
Xue-Hua Zhang ◽  
Shi-Jun Qiu ◽  
Wen-Juan Chen ◽  
Xi-Rong Gao ◽  
Ya Li ◽  
...  
Keyword(s):  
Brain Injury ◽  
Preterm Infants ◽  
Predictive Value ◽  
Cranial Ultrasound ◽  
Neurodevelopmental Outcomes ◽  
Very Preterm Infants ◽  
Very Preterm

Neurodevelopmental Outcomes in Preterm Infants with White Matter Injury Using a New MRI Classification

Neonatology ◽  
2019 ◽  
Vol 116 (3) ◽  
pp. 227-235 ◽  
Author(s):  
Miriam Martinez-Biarge ◽  
Floris Groenendaal ◽  
Karina J. Kersbergen ◽  
Manon J.N.L. Benders ◽  
Francesca Foti ◽  
...  
Keyword(s):  
White Matter ◽  
Preterm Infants ◽  
White Matter Injury ◽  
Neurodevelopmental Outcomes

scholarly journals Diagnostic value of urine soluble triggering receptor expressed on myeloid cells (sTREM-1) for late-onset neonatal sepsis in infected preterm neonates

2018 ◽  
Vol 46 (4) ◽  
pp. 1606-1616 ◽  
Author(s):  
Senem Alkan Ozdemir ◽  
Esra Arun Ozer ◽  
Ozkan Ilhan ◽  
Sumer Sutcuoglu ◽  
Mansur Tatlı
Keyword(s):  
Preterm Infants ◽  
Predictive Value ◽  
Late Onset ◽  
Fatal Outcome ◽  
Myeloid Cells ◽  
Diagnostic Value ◽  
Sepsis Group ◽  
Preterm Neonates ◽  
Delivery Mode ◽  
Suspected Sepsis

Objective Sepsis is a complex clinical condition caused by a dysregulated immune response to an infection resulting in a fatal outcome. This study aimed to investigate the value of urine soluble triggering receptor expressed on myeloid cells (sTREM-1) for diagnosing culture-proven sepsis in preterm infants. Methods Preterm neonates were evaluated for late-onset sepsis (LOS). Laboratory investigations were performed. Urine sTREM-1 samples and blood cultures were synchronously collected. Using blood culture results, preterm neonates were divided into the culture-proven group and suspected sepsis group. Results A total of preterm 62 infants were included in the study; 31 had culture-proven sepsis and 31 were suspected as having sepsis. There were no significant differences in gestational age, sex, birth weight, and delivery mode between the groups. Neonates in the culture-proven group had significantly higher urine sTREM-1 levels than did those in the suspected sepsis group. Using a cut-off point for a urine sTREM-1 level of 78.5 pg/mL, the sensitivity was 0.90, specificity was 0.78, positive predictive value was 0.68, and negative predictive value was 0.94. Conclusions The present study highlights the role of urine sTREM-1 levels in LOS. Urine sTREM-1 may be a reliable and sensitive marker in detecting sepsis in preterm infants.

scholarly journals Circulating glucocorticoid bioactivity and serum cortisol concentrations in premature infants: the influence of exogenous glucocorticoids and clinical factors

2007 ◽  
Vol 156 (5) ◽  
pp. 577-583 ◽  
Author(s):  
Päivi Nykänen ◽  
Taneli Raivio ◽  
Kirsti Heinonen ◽  
Olli A Jänne ◽  
Raimo Voutilainen
Keyword(s):  
Preterm Infants ◽  
Premature Infants ◽  
Treatment Strategies ◽  
Serum Cortisol ◽  
Treatment Modalities ◽  
Clinical Factors ◽  
Glucocorticoid Treatment ◽  
Improve Treatment ◽  
Antenatal Steroids ◽  
Postmenstrual Age

Objective: Glucocorticoids are widely used before preterm delivery and in preterm infants may bear serious adverse effects. Better knowledge about the circulating glucocorticoid milieu after glucocorticoid treatment could improve treatment modalities. Therefore, we investigated the influence of exogenous glucocorticoids and clinical factors on serum cortisol (F) levels and circulating glucocorticoid bioactivity (GBA) in preterm infants. Design: Eighty-nine infants (gestational age (GA) 23.6–33.1 weeks at birth) were enrolled in a prospective cohort study in two tertiary neonatal centres. Methods: Cord, day of birth (D0), fourth day (D4) and 36 weeks postmenstrual age serum F and GBA levels were measured. Results: The cord GBA was 5.8-fold and D0 GBA 2.3-fold higher in the infants exposed to antenatal steroids within 12 h before birth when compared with those unexposed or exposed >7 days before birth (95% CI 3.8–8.6; P<0.0001, and 1.8–3.0; P<0.0001 respectively). In the infants treated with early postnatal dexamethasone, D4 GBA was 1.7-fold (1.3–2.2; P<0.0005) higher when compared with levels in the infants without this treatment. Clinical factors indicating perinatal distress, such as Apgar scores <7 and low GA, were associated with higher cord, D0 and D4 serum F levels. Conclusions: Both ante- and postnatally administered glucocorticoids increase circulating GBA not attributable to endogenous F. Perinatal distress and preceding glucocorticoid treatment need to be taken into account when circulating glucocorticoid milieu is evaluated in preterm infants. The GBA assay may prove to be a useful instrument in the development of new glucocorticoid treatment strategies.

scholarly journals Web-Based Intervention to Teach Developmentally Supportive Care to Parents of Preterm Infants: Feasibility and Acceptability Study (Preprint)

2017 ◽  
Author(s):  
Thuy Mai Luu ◽  
Li Feng Xie ◽  
Perrine Peckre ◽  
Sylvana Cote ◽  
Thierry Karsenti ◽  
...  
Keyword(s):  
Child Development ◽  
Supportive Care ◽  
Preterm Infants ◽  
User Satisfaction ◽  
Well Being ◽  
Oral Feeding ◽  
Neurodevelopmental Outcomes ◽  
Web Based ◽  
Child Neurodevelopment ◽  
Developmentally Supportive Care

BACKGROUND Preterm birth affects 8% to 11% of the population and conveys a significant risk of developmental delays. Intervention programs that support child development have been shown to have a positive impact on early motor and cognitive development and on parental well-being. However, these programs are often difficult to implement in a real-life setting due to lack of resources. Hence, our multidisciplinary team developed Mieux Agir au Quotidien (MAQ) to teach developmentally supportive care to parents of preterm infants with the goal of improving child development and parental outcomes. Our intervention included 3 in-person workshops that occurred prior to hospital discharge and a Web-based platform with written and videotaped materials that addressed 5 main themes: (1) infant behavioral cues, (2) flexion positioning; (3) oral feeding support, (4) parent-infant interactions, and (5) anticipation of developmental milestones. OBJECTIVE This study aimed to test the feasibility and acceptability of the intervention by parents of preterm infants and assess clinical benefits on child neurodevelopment and parental outcomes during the first year of life. METHODS A total of 107 infants born at <30 weeks and admitted to Sainte-Justine Hospital neonatal intensive care unit and their parents were enrolled in a nonrandomized controlled before-and-after interventional study (intervention n=55, comparison n=52). Acceptability of the program was assessed with a user satisfaction questionnaire. When the infants were at 4 months’ corrected age, all parents completed questionnaires on infant temperament, parenting stress, sense of competence, and parenting satisfaction. At 12 months’ corrected age, neurodevelopmental testing was performed on infants using the Alberta Infant Motor Scale and the Bayley Scales of Infant and Toddler Development, Third Edition. Comparisons between the 2 groups were done using independent t tests, Wilcoxon rank-sum tests, and Fisher exact tests. RESULTS The majority of parents (43/45) were satisfied with the intervention program and all would recommend MAQ to others. MAQ met their need for evidence-based information that proved useful to support their child development. No difference in parental or child neurodevelopmental outcomes was detected in this pilot study for most outcomes except for higher median scores for parental coercive behaviors in the intervention group, although proportions scoring in the coercive range did not differ. CONCLUSIONS Acceptability of the program was high among parents thus supporting the relevance of such intervention. A larger study using a randomized controlled trial design is needed to better document impact on parent and children and investigate how Web-based technologies can efficiently complement individualized intervention to alleviate the burden on health care resources.

Antenatal steroids, delivery mode, and intraventricular hemorrhage in preterm infants

1995 ◽  
Vol 172 (3) ◽  
pp. 795-800 ◽  
Author(s):  
Laura R. Ment ◽  
William Oh ◽  
Richard A. Ehrenkranz ◽  
Alistair G.S. Philip ◽  
Charles C. Duncan ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Intraventricular Hemorrhage ◽  
Delivery Mode ◽  
Antenatal Steroids
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