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 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 Preterm Morbidity and Mortality by Gestational Age. A Birth Population-Based Study

2020 ◽  
Author(s):  
Bo Sun ◽  
Xiaojing Guo ◽  
Xiaoqiong Li ◽  
Tingting Qi ◽  
Zhaojun Pan ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Death Rate ◽  
Preterm Births ◽  
Population Based ◽  
Morbidity And Mortality ◽  
Preterm Neonates ◽  
Hospital Death ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Abstract Background: Despite 15-17 million of annual births in China, there is a paucity of information on preterm morbidity and mortality. We characterized the outcome of preterm births and hospitalized preterm infants by gestational age (GA) in Huai’an in 2015, an emerging prefectural region of China.Methods: Of 59,245 regional total births, clinical data on 2,651 preterm births and 1,941 hospitalized preterm neonates were extracted from Huai’an Women and Children’s Hospital (HWCH) and non-HWCH hospitals in 2018-2020. Preterm morbidity and mortality rates were characterized and compared by hospital categories and GA spectra. Death risks of preterm births and hospitalized preterm infants in the whole region were analyzed with multivariable logistic regression.Results: The incidences of extreme, very, moderate, late and total preterm of the regional total births were 1.4, 5.3, 7.2, 30.8 and 44.7‰, with all-death rates being 1.0, 1.6, 0.6, 1.1 and 4.3‰, respectively, of the regional total births. There were 1,025 (52.8% of whole region) preterm admissions in HWCH, with significantly lower in-hospital death rate of inborn (33/802) than out-born (23/223) infants. Compared to non-HWCH, four-fold more neonates in HWCH were under critical care with higher death rate, including most extremely preterm infants. Significant all-death risks were found for the total preterm births in BW < 1,000g, II-III degree of amniotic fluid contamination, Apgar-5 min < 7, and birth defects (BD). For the hospitalized preterm infants, significant in-hospital death risks were found in out-born of HWCH, GA < 32 weeks, Apgar-5 min < 7, BD, necrotizing enterocolitis and ventilation, whereas born in HWCH, antenatal glucocorticoids, cesarean delivery and surfactant use were protective factors against death.Conclusions: The integrated data revealed GA-specific morbidity and mortality on the basis of total preterm births and their hospitalization, demonstrating the efficacy of leading referral center and whole regional perinatal-neonatal network in China. The concept and protocol of our current study should be extended to gain comprehensive understanding in the world-wide campaign for prevention of preterm birth.

Antenatal Exposure to Magnesium Sulfate and Spontaneous Intestinal Perforation and Necrotizing Enterocolitis in Extremely Preterm Neonates

2017 ◽  
Vol 34 (12) ◽  
pp. 1227-1233 ◽  
Author(s):  
Mohamed Shalabi ◽  
Adel Mohamed ◽  
Brigitte Lemyre ◽  
Khalid Aziz ◽  
Daniel Faucher ◽  
...  
Keyword(s):  
Magnesium Sulfate ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Intestinal Perforation ◽  
Preterm Neonates ◽  
Network Database ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Using Data ◽  
Spontaneous Intestinal Perforation

Background There have been recent concerns regarding the higher rates of spontaneous intestinal perforation (SIP) in preterm infants that have been exposed to intrapartum magnesium sulfate (MgSO4). Objective To assess the association between intrapartum MgSO4 exposure and necrotizing enterocolitis (NEC) and/or SIP in extremely preterm neonates. Design A retrospective cohort study was conducted using data from the Canadian Neonatal Network database. Infants born at < 28 weeks' gestation admitted to neonatal units in Canada between 2011 and 2014 were divided into two groups: those exposed antenatally to MgSO4 and those unexposed. Stratified analyses for infants born between 22 and 25 weeks' gestation and those born between 26 and 27 weeks' gestation were conducted. The primary outcome was intestinal injury, identified as either NEC or SIP. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated using multivariable logistic regression. Results We compared 2,300 unexposed infants with 2,055 exposed infants. There was no difference in the odds of NEC (9.88% exposed vs. 9.59% unexposed; aOR: 0.92; 95% CI: 0.75–1.14) or SIP (3.4% exposed vs. 3.39% unexposed; aOR: 1.05; 95% CI: 0.75–1.48) between the two groups. Conclusion Antenatal exposure to MgSO4 was not associated with NEC or SIP in extremely preterm infants.

scholarly journals Elevated Interleukin-6 Concentration and Alterations of the Coagulation System Are Associated with the Development of Intraventricular Hemorrhage in Extremely Preterm Infants

Neonatology ◽  
2012 ◽  
Vol 102 (4) ◽  
pp. 270-275 ◽  
Author(s):  
Christine Poralla ◽  
Hans-Jörg Hertfelder ◽  
Johannes Oldenburg ◽  
Andreas Müller ◽  
Peter Bartmann ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Interleukin 6 ◽  
Intraventricular Hemorrhage ◽  
Coagulation System ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

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.

scholarly journals Lateral Kangaroo Care in Hemodynamic Stability of Extremely Preterm Infants: Protocol Study for a Non-Inferiority Randomized Controlled Trial CANGULAT

2021 ◽  
Vol 19 (1) ◽  
pp. 293
Author(s):  
Laura Collados-Gómez ◽  
Laura Esteban-Gonzalo ◽  
Candelas López-López ◽  
Lucía Jiménez-Fernández ◽  
Salvador Piris-Borregas ◽  
...  
Keyword(s):  
Premature Infant ◽  
Prone Position ◽  
Gestational Age ◽  
Intraventricular Hemorrhage ◽  
Lateral Position ◽  
Control Group ◽  
Kangaroo Care ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Experimental Group

Introduction: This study aims to assess the efficacy of the modified kangaroo care lateral position on the thermal stability of preterm neonates versus conventional kangaroo care prone position. Material and methods: A non-inferiority randomized parallel clinical trial. Kangaroo care will be performed in a lateral position for the experimental group and in a prone position for the control group preterm. The study will take place at the neonatal intensive care unit (NICU) of a University Hospital. The participants will be extremely premature infants (under 28 weeks of gestational age) along the first five days of life, hemodynamically stable, with mother or father willing to do kangaroo care and give their written consent to participate in the study. The sample size calculated was 35 participants in each group. When the premature infant is hemodynamically stable and one of the parents stays in the NICU, the patient will be randomized into two groups: an experimental group or a control group. The primary outcome is premature infant axillary temperature. Neonatal pain level and intraventricular hemorrhage are secondary outcomes. Discussion: There is no scientific evidence on modified kangaroo care lateral position. Furthermore, there is little evidence of increased intraventricular hemorrhage association with the lateral head position necessary in conventional or prone kangaroo care in extremely premature newborns. Kangaroo care is a priority intervention in neonatal units increasing the time of use more and more, making postural changes necessary to optimize comfort and minimize risks with kangaroo care lateral position as an alternative to conventional prone position kangaroo care. Meanwhile, it is essential to ensure that the conventional kangaroo care prone position, which requires the head to lay sideways, is a safe position in terms of preventing intraventricular hemorrhage in the first five days of life of children under 28 weeks of gestational age. Trial registration at clinicaltrials.gov: NCT03990116.

Mortality and significant neurosensory impairment in preterm infants: an international comparison

2021 ◽  
pp. fetalneonatal-2021-322288
Author(s):  
Marie Chevallier ◽  
Thierry Debillon ◽  
Brian A Darlow ◽  
Anne R Synnes ◽  
Véronique Pierrat ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Population Based ◽  
Preterm Neonates ◽  
Composite Outcome ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Observational Cohort ◽  
Baseline Characteristics ◽  
French Cohort

ObjectiveTo compare mortality and rates of significant neurosensory impairment (sNSI) at 18–36 months’ corrected age in infants born extremely preterm across three international cohorts.DesignRetrospective analysis of prospectively collected neonatal and follow-up data.SettingThree population-based observational cohort studies: the Australian and New Zealand Neonatal Network (ANZNN), the Canadian Neonatal and Follow-up Networks (CNN/CNFUN) and the French cohort Etude (Epidémiologique sur les Petits Ages Gestationnels: EPIPAGE-2).PatientsExtremely preterm neonates of <28 weeks’ gestation in year 2011.Main outcome measuresPrimary outcome was composite of mortality or sNSI defined by cerebral palsy with no independent walking, disabling hearing loss and bilateral blindness.ResultsOverall, 3055 infants (ANZNN n=960, CNN/CNFUN n=1019, EPIPAGE-2 n=1076) were included in the study. Primary composite outcome rates were 21.3%, 20.6% and 28.4%; mortality rates were 18.7%, 17.4% and 26.3%; and rates of sNSI among survivors were 4.3%, 5.3% and 3.3% for ANZNN, CNN/CNFUN and EPIPAGE-2, respectively. Adjusted for gestational age and multiple births, EPIPAGE-2 had higher odds of composite outcome compared with ANZNN (OR 1.71, 95% CI 1.38 to 2.13) and CNN/CNFUN (OR 1.72, 95% CI 1.39 to 2.12). EPIPAGE-2 did have a trend of lower odds of sNDI but far short of compensating for the significant increase in mortality odds. These differences may be related to variations in perinatal approach and practices (and not to differences in infants’ baseline characteristics).ConclusionsComposite outcome of mortality or sNSI for extremely preterm infants differed across high-income countries with similar baseline characteristics and access to healthcare.

scholarly journals Predictive Role of Urinary Metabolic Profile for Abnormal MRI Score in Preterm Neonates

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Maria Luisa Tataranno ◽  
Serafina Perrone ◽  
Mariangela Longini ◽  
Caterina Coviello ◽  
Maria Tassini ◽  
...  
Keyword(s):  
At Risk ◽  
Preterm Infants ◽  
Early Identification ◽  
Metabolic Profile ◽  
Area Under The Curve ◽  
Preterm Neonates ◽  
Resonance Spectroscopy ◽  
Equivalent Age ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Background and Objective. Early identification of neonates at risk for brain injury is important to start appropriate intervention. Urinary metabolomics is a source of potential, noninvasive biomarkers of brain disease. We studied the urinary metabolic profile at 2 and 10 days in preterm neonates with normal/mild and moderate/severe MRI abnormalities at term equivalent age.Methods. Urine samples were collected at two and 10 days after birth in 30 extremely preterm infants and analyzed using proton magnetic resonance spectroscopy. A 3 T MRI was performed at term equivalent age, and images were scored for white matter (WM), cortical grey matter (cGM), deep GM, and cerebellar abnormalities. Infants were divided in two groups: normal/mild and moderately/severely abnormal MRI scores.Results. No significant clustering was seen between normal/mild and moderate/severe MRI scores for all regions at both time points. The ROC curves distinguished neonates at 2 and 10 days who later developed a markedly less mature cGM score from the others (2 d: area under the curve (AUC) = 0.72, specificity (SP) = 65%, sensitivity (SE) = 75% and 10 d: AUC = 0.80, SP = 78%, SE = 80%) and a moderately to severely abnormal WM score (2 d: AUC = 0.71, specificity (SP) = 80%, sensitivity (SE) = 72% and 10 d: AUC = 0.69, SP = 64%, SE = 89%).Conclusions. Early urinary spectra of preterm infants were able to discriminate metabolic profiles in patients with moderately/severely abnormal cGM and WM scores at term equivalent age. Urine spectra are promising for early identification of neonates at risk of brain damage and allow understanding of the pathogenesis of altered brain development.

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