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Postmenstrual Age (postmenstrual + age)
Selected AbstractsAltered body composition in preterm infants at hospital dischargeACTA PAEDIATRICA, Issue 8 2009Richard J Cooke Abstract Aim:, To test the hypotheses that body size is reduced and body composition altered in preterm infants at hospital discharge. Methods:, Preterm infants (,34 weeks gestation, ,1750 g at birth) were enrolled. Body weight, length and head circumference were converted to standard deviation or z- scores. Body composition was measured using dual emission X-ray absorptiometry. The results were analysed using standard statistics. Results:, One hundred and forty-nine infants (birth weight = 1406 ± 248 g, gestation = 31 ± 1.7 weeks) were studied. Postmenstrual age at discharge was 37 ± 1.2 weeks. Z -scores for head circumference, weight and length differed (,0.1 ± 0.6 > ,1.4 ± 0.6 > ,1.9 ± 0.6; p < 0.0001). Global fat-free mass was less in study infants than the reference infant at the same weight (2062 < 2252 g; p < 0.0001) or gestation (2062 < 2667 g; p < 0.0001). Global fat mass was greater in study infants than the reference infant at the same weight (307 > 198 g, 13 > 8%) or gestation (307 > 273 g; 13 > 9%; p < 0.0001). Changes in central fat mass closely paralleled those in global fat mass (r2 = 0.76, p < 0.0001). Conclusion:, Reduced linear growth and a reduced fat-free mass suggest that dietary protein needs were not met before discharge. A reduced fat-free mass coupled with an increased global and central fat mass echoes concerns about the development of insulin resistance and metabolic syndrome X in these high-risk infants. [source] Characterization of the developmental stages of sucking in preterm infants during bottle feedingACTA PAEDIATRICA, Issue 7 2000C Lau It is acknowledged that the difficulty many preterm infants have in feeding orally results from their immature sucking skills. However, little is known regarding the development of sucking in these infants. The aim of this study was to demonstrate that the bottle-feeding performance of preterm infants is positively correlated with the developmental stage of their sucking. Infants' oral-motor skills were followed longitudinally using a special nipple/bottle system which monitored the suction and expression/compression component of sucking. The maturational process was rated into five primary stages based on the presence/absence of suction and the rhythmicity of the two components of sucking, suction and expression/compression. This five-point scale was used to characterize the developmental stage of sucking of each infant. Outcomes of feeding performance consisted of overall transfer (percent total volume transfered/volume to be taken) and rate of transfer (ml/min). Assessments were conducted when infants were taking 1-2, 3-5 and 6-8 oral feedings per day. Significant positive correlations were observed between the five stages of sucking and postmenstrual age, the defined feeding outcomes, and the number of daily oral feedings. Overall transfer and rate of transfer were enhanced when infants reached the more mature stages of sucking. We have demonstrated that oral feeding performance improves as infants' sucking skills mature. In addition, we propose that the present five-point sucking scale may be used to assess the developmental stages of sucking of preterm infants. Such knowledge would facilitate the management of oral feeding in these infants. [source] Bronchopulmonary dysplasia predicts adverse developmental and clinical outcomes in very-low-birthweight infantsDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 1 2008Suh-Fang Jeng PT ScD This study examined the developmental and clinical outcomes in very-low-birthweight (VLBW; ,1500g) infants with and without bronchopulmonary dysplasia (BPD) throughout infancy, and assessed if BPD predicted poor developmental outcome beyond the effects of other risk factors. One hundred and three VLBW infants (53 males, 50 females; mean gestational age 28wks [SD 2] birthweight 1041g [SD 261]) were graded for severity of BPD according to the American National Institutes of Health (NIH) consensus definition. Neuro-development was assessed using the Neonatal Neurobehavioral Examination-Chinese version, at 36 and 39 weeks' postmenstrual age, and the 2nd edition of the Bayley Scales of Infant Development at 6 and 12 months' corrected age. Clinical outcome was measured by means of rehospitalization for pulmonary causes and treatment with pulmonary medications. Compared with infants without BPD, infants with BPD had higher rates of clinical morbidity, and those with severe BPD further exhibited higher incidences of developmental delay throughout infancy. BPD predicts poor 1-year developmental and clinical outcomes in VLBW infants for which effects are well correlated to the NIH consensus definition. [source] Abnormalities in the coordination of respiration and swallow in preterm infants with bronchopulmonary dysplasiaDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 7 2006Ira H Gewolb MD Individual rhythms of suck, swallow, and respiration are disrupted in preterm infants with bronchopulmonary dysplasia (BPD). Integration of respiration into suck-swallow efforts is critical for establishing coordinated suckle feeding. This study quantitatively assessed the coordination of respiration and swallow in infants with and without BPD. Thirty-four preterm infants of 26 to 33 weeks'gestational age were included: 14 participants with BPD (eight males, six females) and 20 comparison participants without BDP (10 males, 10 females). Participants were studied at postmenstrual age 32 to 40 weeks and postnatal age 2 to 12 weeks using digital recordings of pharyngeal pressure, nasal thermistor flow, and thoraco-abdominal plethysmography. The coefficients of variation (COV; standard deviation/mean) of the swallow-breath (SW-BR) and breath-breath (BR-BR) intervals during swallow runs, the percentage of,apneic swallows'(runs of ,3 swallows without interposed breaths), and phase relationships of respiration and swallow were used to quantify rhythmic coordination and integration of respiration into feeding episodes. Apneic swallows were significantly increased after 35 weeks in infants with BPD (mean 13.4% [SE 2.4]) compared with non-BDP infants (6.7% [SE 1.8];p < 0.05), as were SW-BR phase relationships involving apnea. The BPD cohort also had significantly higher SW-BR COV and BR-BR COV than non-BPD infants, indicating less rhythmic coordination of swallowing and respiration during feeding. Results emphasize the need for frequent rests and closer monitoring when feeding infants with respiratory compromise. Quantitative assessment of the underlying rhythms involved in feeding may be predictive of longer-term feeding and neurological problems. [source] Experience with remifentanil,sevoflurane balanced anesthesia for abdominal surgery in neonates and children less than 2 yearsPEDIATRIC ANESTHESIA, Issue 6 2008FABRICE MICHEL MD Summary Background:, Few data report remifentanil use in the neonatal population. We described here our experience with remifentanil,sevoflurane balanced anesthesia in neonates and children less than 2 years who underwent general anesthesia for abdominal surgery. Methods:, We retrospectively studied the pattern of remifentanil infusion associated with sevoflurane inhalation in preterm neonates (PTN; n = 18) (born before 37 weeks of gestation and <45 weeks of postmenstrual age), full-term neonates (FTN; n = 21) (born after 37 weeks of gestation and less than 29 days old) and older children up to 2 years (CUT; n = 24). We recorded heart rate (HR), mean arterial pressure (MAP), mean remifentanil dose and sevoflurane concentration before incision and at 5, 10, 20, 30, 45, 60, 90, and 105 min after incision. Results:, We observed that remifentanil doses used during surgery were lower in PTN than in both FTN and CUT and lower in FTN than in CUT. This was because of a progressive decrease in remifentanil dose during anesthesia in PTN and FTN. Conversely, remifentanil doses increased in CUT during anesthesia. Sevoflurane concentrations were higher in CUT group than in PTN and FTN groups. MAP and HR did not vary in the three groups during anesthesia. Conclusions:, Remifentanil,sevoflurane anesthesia can be used for general anesthesia in neonates. We observed that anesthetists used lower doses of remifantanil and lower concentrations of sevoflurane in neonates compared with the older children. [source] Early administration of surfactant in spontaneous breathing with nCPAP: feasibility and outcome in extremely premature infants (postmenstrual age ,27 weeks)PEDIATRIC ANESTHESIA, Issue 4 2007ANGELA KRIBS MD Summary Background:, Spontaneous breathing supported by nasal continuous positive airway pressure (nCPAP) is thought to have some advantages compared with mechanical ventilation in extremely premature infants. In addition, early or prophylactic surfactant administration has been shown to be superior to delayed use. A strategy to combine these two principles was tested in our neonatal intensive care unit (NICU). The aim of this feasibility study was to describe the procedure and compare short-term results with a historical control. Methods:, The study took place in a level III NICU. In the observational period all extremely premature infants with clinical signs of moderate to severe respiratory distress syndrome despite nCPAP received 100 mg·kg,1 of a natural surfactant preparation via an intratracheal catheter during spontaneous breathing. In the historical control period those infants were intubated and ventilated to receive surfactant. Results:, Twenty-nine of 42 infants fulfilled the criteria and were treated with the new approach. In five cases ventilation with manual bag was necessary after administration of surfactant but all infants could be retransferred to nCPAP within a few minutes. Ten infants were intubated later during the first 3 days. Mortality was 7% in the group of infants treated in this way and 12% in all infants treated during the observational period. Mortality was 35% in the historical control period. Morbidity was within ranges reported by other authors. Conclusions:, Surfactant administration during nCPAP is feasible. First results indicate that early complications are rare. This warrants a prospective randomized trial. [source] Extremely preterm infants tolerate skin-to-skin contact during the first weeks of lifeACTA PAEDIATRICA, Issue 8 2010Ragnhild Maastrup Abstract Aim:, To determine if clinically stable extremely preterm infants can maintain their temperature during skin-to-skin contact and to screen for other negative effects. Methods:, Continuous measurement of 22 stable infants' physical parameters 2 h before, during, and 2 h after skin-to-skin-contact. Mean gestational age at birth was 25 weeks and 4 days, mean post-natal age was 8 days, postmenstrual age was 26 weeks and 6 days, and mean actual weight 702 g. Mean duration of skin-to-skin-contact was 98 min. 16 infants were skin-to-skin with the mother, five with the father and one with an older sister. Results:, There were no significant differences in mean skin temperature, heart rate, respiration rate, or oxygen saturation before, during, and after skin-to-skin contact. While staying within normal range, the mean skin temperature increased 0.1°C during skin-to-skin contact with the mother and decreased 0.3°C during skin-to-skin contact with the father (p = 0.011) (without post-hoc correction). Conclusion:, Clinically stable, extremely preterm infants can keep adequate skin temperature and adequate physical stability during skin-to-skin contact with their parents. [source] Retinopathy of prematurity: postmenstrual age at threshold in a transitional economy is similar to that in developed countriesCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 2 2008Susan Mary Carden FRANZCO Abstract Background:, To analyse the timing of threshold disease in infants requiring treatment for retinopathy of prematurity in a transitional economy. Methods:, Design: Retrospective, observational, cohort study. Setting: National Hospital of Paediatrics, Hanoi, Vietnam. Study population: Premature infants in the Neonatal ward requiring laser treatment for threshold retinopathy of prematurity. Main outcome measures: Chronological age and postmenstrual age at treatment. Results:, From January 2002 to November 2004, 42 infants from the National Hospital of Paediatrics required laser surgery for threshold retinopathy of prematurity. The mean ± standard deviation (SD) of birth weight was 1369 ± 184 g (range 1000,1700); the mean ± SD of gestation at birth was 30 ± 1.8 weeks (range 27,34); and the mean ± SD of postmenstrual age at which treatment occurred in these infants was 36.2 ± 2.5 weeks (range 31.4,42). A further 58 infants were transferred from other hospitals for laser surgery between January 2004 and October 2004. The mean ± SD of birth weight was 1325.5 ± 237.2 g (range 800,1900); the mean ± SD of gestation at birth was 30 ± 1.7 weeks (range 28,35); and the mean ± SD of postmenstrual age at which treatment was given in these infants was 36.3 ± 2.3 weeks (range 32.71,44.3). Discussions:, Despite the relative maturity of the gestation of these infants compared with infants in developed countries who develop severe retinopathy of prematurity, the timing of treatment for threshold disease appears to be related to postmenstrual age. [source] Nasal continuous positive airway pressure for neonatal back transferACTA PAEDIATRICA, Issue 6 2006Bibian N Ofoegbu Abstract We report the use of nasal continuous positive airway pressure (nCPAP) for neonatal back transfer of 51 babies. nCPAP may be used to provide safe respiratory support during back transportation of infants. Babies transferred on nCPAP were significantly smaller and of younger postmenstrual age than historical comparators who had to wait for transfer until independent of nCPAP. nCPAP transferred babies spent significantly less time on the intensive care unit. [source] Preschool outcome in children born very prematurely and cared for according to the Newborn Individualized Developmental Care and Assessment Program (NIDCAP)ACTA PAEDIATRICA, Issue 4 2004B Westrup Aim: Care based on the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) has been reported to exert a positive impact on the development of prematurely born infants. The aim of the present investigation was to determine the effect of such care on the development at preschool age of children born with a gestational age of less than 32 wk. Methods: All surviving infants in a randomised controlled trial with infants born at a postmenstrual age less than 32 wk (11 in the NIDCAP group and 15 in the control group) were examined at 66.3 (6.0) mo corrected for prematurity [mean (SD)]. In the assessment we employed the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R) for cognition, Movement Assessment Battery for Children (Movement ABC) for motor function, subtests of the NEPSY test battery for attention and distractibility, and the WHO definitions of impairment, disability and handicap. Exact binary logistic regression was employed. Results: There were no significant differences between the intervention group in Full-Scale IQ 93.4 (14.2) [mean (SD)] versus the control group 89.6 (27.2), Verbal IQ 93.6 (16.4) versus 93.7 (26.8) or Performance IQ 94.3 (14.7) versus 86.3 (24.8). In the NIDCAP group 8/13 (62%) survived without disability and for the children with conventional care this ratio was 7/19 (37%). The corresponding ratios for surviving without mental retardation were 10/13 (77%) and 11/19 (58%), and for surviving without attention deficits 10/13 (77%) and 10/19 (53%). Overall, the differences were not statistically significant, although the odds ratio for surviving with normal behaviour was statistical significant after correcting for group imbalances in gestational age, gender, growth retardation and educational level of the parents. Conclusion: Our trial suggests a positive impact by NIDCAP on behaviour at preschool age in a sample of infants born very prematurely. However, due to problems of recruitment less than half of the anticipated subjects were included in the study, which implies a low power and calls for caution in interpreting our findings. Larger trials in different cultural contexts are warranted. [source] Implementation of a nation-wide automated auditory brainstem response hearing screening programme in neonatal intensive care unitsACTA PAEDIATRICA, Issue 3 2003HLM van Straaten Aim: As part of a future national neonatal hearing screening programme in the Netherlands, automated auditory brainstem response (AABR) hearing screening was implemented in seven neonatal intensive care units (NICUs). The objective was to evaluate key outcomes of this programme: participation rate, first stage success rate, pass/referral rates, rescreening compliance, diagnostic referral rates, age of first diagnostic evaluation and prevalence of congenital hearing loss (CHL). Methods: This prospective cohort study collected data on 2513 survivors. NICU graduates with one or more risk factors according to the Joint Committee on Infant Hearing were included in a two-stage AABR hearing screening programme. Conventional ABR was used to establish a diagnosis of CHL. Results: A total of 2513 newborns enrolled in the programme with a median gestational age of 31.6 (range 24,43) wk and a median birthweight of 1450 (range 510,4820) g. In 25 (1%) cases parents refused screening. Four out of 2513 newborns were initially lost; 2484 newborns have been tested initially. A final 98% participation rate (2465/2513) was obtained for the whole programme. After a median postmenstrual age at the first test of 33.7 (range 27,54) wk, a pass rate of 2284/2484 (92%) resulted at the first stage. The rescreening compliance after the first test was 92% (184/200). A referral rate for diagnostic ABR of 3.1% (77/2484) resulted. Of the 77 referrals 14 (18.2%) had normal screening thresholds, 15 (19.5%) had unilateral CHL and 48 (62.3%) had bilateral CHL. The prevalence of unilateral CHL was 0.6% (15/2484) and of bilateral CHL 1.9% (48/2484). Conclusion: A financially supported two-stage AABR hearing screening programme can be successfully incorporated in NICU centres and detects a high prevalence of CHL in NICU graduates. Neonatal hearing screening should be part of standard clinical practice in all NICU infants. [source] How Do Mothers Feel About Their Very Low Birth Weight Infants?INFANT MENTAL HEALTH JOURNAL, Issue 2 2006Development of a New Measure The early relationship between a mother and her very low birth weight (VLBW; <1.5 kg) infant may be difficult to evaluate. Therefore, we aimed to develop a useful and practical method to describe a mother's early relationship with her VLBW infant. Mothers (mean age=27 years, 46% married) of 119 singleton VLBW infants (mean BW=1,056 g, mean GA=28 weeks) admitted to the neonatal ICU at Rainbow Babies and Children's Hospital completed a novel questionnaire regarding their feelings about their infant at 3 weeks' postnatal age, and at 35 weeks', 40 weeks' (term), and 4 months' postmenstrual ages. Factor analysis of initial interview data was used to construct subscales to measure unique domains hypothesized to underpin the beginning maternal,infant relationship. Three subscales were identified: (a) The Worry subscale focuses on the mother's concerns about her infant's current medical condition and future development, (b) the Enjoyment subscale examines the mother's positive feelings about and responsiveness to her infant, and (c) the Separation Anxiety subscale examines the mother's mental anxiety about being physically separated from her infant. Statistical and clinical validation of the subscales produced positive supporting evidence that the subscales are a meaningful measure of the mother,infant relationship. We have developed a unique and practical measure for describing the early mother,VLBW infant relationship. [source] | ||||||||||