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VLBW
Terms modified by VLBW Selected AbstractsBudesonide delivered by dosimetric jet nebulization to preterm very low birthweight infants at high risk for development of chronic lung diseaseACTA PAEDIATRICA, Issue 12 2000B Jónsson We investigated the effect of an aerosolized corticosteroid (budesonide) on the oxygen requirement of infants at high risk for developing chronic lung disease (CLD) in a randomized, double-blind study. The study objective was to attain a 30% decrease in FiO2 levels in the budesonide treatment group after 14 d of therapy. Thirty very low birthweight (VLBW) infants (median (range)) gestational age 26 wk (23,29) and birthweight 805 g (525,1227) were randomized. Inclusion criteria were mechanical ventilation on day 6 of life, or if extubated on nasal continuous positive airway pressure with FiO2± 0.3. The budesonide (PulmicortÔ dose was 500 ,g bid, or placebo. The aerosol was delivered with a dosimetric jet nebulizer, with variable inspiratory time and breath sensitivity. Inhalations were started on day 7 of life. Twenty-seven patients completed the study. A significant lowering of the FiO2 levels at 21 d of life was not detected. Infants who received budesonide were more often extubated during the study period (7/8 vs 2/9) and had a greater relative change from baseline in their oxygenation index (budesonide decreased 26% vs placebo increased 60%). Subsequent use of intravenous dexamethasone or inhaled budesonide in the treatment group was significantly less. All patients required O2 supplementation on day 28 of life. At 36 wk postconceptual age, 61% of infants in the budesonide group needed supplemental O2 as opposed to 79% in the placebo group. No side effects on growth or adrenal function were observed Conclusion: We conclude that inhaled budesonide aerosol via dosimetric jet nebulizer started on day 7 of life for infants at high risk for developing CLD decreases the need for mechanical ventilation similar to intravenous dexamethasone, but without significant side effects. [source] Magnetic resonance imaging at term and neuromotor outcome in preterm infantsACTA PAEDIATRICA, Issue 3 2000AM Valkama In order to evaluate the value of neonatal brain magnetic resonance imaging (MRI) for predicting neuromotor outcome in very low birthweight (VLBW) preterm infants, 51 such infants with gestational age <34 wk underwent brain MRI at term age. Myelination, parenchymal lesions (haemorrhage, leukomalacia, infarction, reduction of white matter), parenchymal lesions without subependymal haemorrhage, ventricular/brain ratios and widths of the extracerebral spaces were assessed. The MRI findings were compared with cranial ultrasound (US) performed at term. Infants' neuromotor development was followed up until 18 mo corrected age. Parenchymal lesions seen in MRI at term predicted cerebral palsy (CP) with 100% sensitivity and 79% specificity, the corresponding figures for US being 67% and 85%, respectively. Parenchymal lesions in MRI, excluding subependymal haemorrhages, predicted CP with a sensitivity of 82% and a specificity of 97%, the corresponding figures for US being 58% and 100%, respectively. Delayed myelination, ventricular/brain ratios and widths of the extracerebral spaces failed to predict CP. Term age is a good time for neuroradiological examinations in prematurely born high-risk infants. Parenchymal lesions seen in MRI are reliable predictors for CP. [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] Factors associated with microcephaly at school age in a very-low-birthweight populationDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 12 2003Claudia A Chiriboga MD MPH The neonatal predictors of microcephaly, defined as a head circumference <5th centile in children born preterm, has not been systematically assessed. Children were drawn from the Developmental Epidemiology Network (DEN) cohort of very low-birth weight children (VLBW: 500,1500g) born from 1991 to 1993 at three sites in the USA. Neurological assessments were carried out among 198 singleton children (mean age 6 years 8 months, SD 0.5 years). Ninety-six children (48.5%) were male. Microcephaly was observed in 30 children (15%) and, using multivariate analysis, it was found to be associated with gestational age <26 weeks and bronchopulmonary dysplasia (BPD). Sonography-defined white-matter damage (WMD, i.e. echolucency or echodensities) was not associated with increased odds of microcephaly, while occurrence of intraventricular hemorrhage (IVH) was in univariate but not multivariate analysis. In analyses that excluded children with IVH/WMD, odds of microcephaly increased in dose-related fashion according to number of days on ventilator: >5 days, OR=4.5; 95%CI=1.4 to 15; >10 days, OR=5.7; 95%CI=1.7 to 19; >15 days OR=8.3; 95% CI=2.3 to 29.2. Among children without BPD, microcephaly was not associated with differences in IQ, while IQ scores among children with BPD or any ventilation were disproportionately lower among those with microcephaly. In multivariate analyses predicting IQ at age 7 years, microcephaly was found to modify the association between neonatal lung disease and IQ. [source] The role of maternal responsiveness in predicting infant affect during the still face paradigm with infants born very low birth weightINFANT MENTAL HEALTH JOURNAL, Issue 2 2008Sarah J. Erickson There is limited empirical literature addressing infants' response to a standardized stressor with infants born very low birth weight (VLBW). The purpose of this study was to assess the relative strength of maternal responsiveness in predicting infant affect in response to the Still Face (SF) paradigm in a cross-sectional cohort of ethnically diverse infants born VLBW and their mothers (N = 50; infants 6,8 months old). Infant affect and maternal responsiveness were coded in 1-s intervals while dyads participated in the SF. In addition, perinatal medical status, developmental status, and infant temperament were assessed. Findings revealed that positive infant affect during and after the SF stressor were strongly associated with baseline infant positive affect and maternal responsiveness at the reunion episode, respectively. In contrast, when predicting negative infant affect during and after the SF stressor, prior infant negative affect was strongly and uniquely significant. Infant positive affect, negative affect, and maternal responsiveness were not significantly associated with gender, infant perinatal medical history, developmental status, or temperament. Future research is warranted to determine how these findings relate to infants' stress reactions in naturalistic settings and if relationship-focused interventions may reverse infant negative emotionality, enhance positive emotionality, and thereby improve self-regulation and longer term social and cognitive developmental outcomes in medically at-risk infants. [source] Anxiety affects the relationship between parents and their very low birth weight infantsINFANT MENTAL HEALTH JOURNAL, Issue 3 2007Phyllis Zelkowitz The goal of this study was to examine the medical and sociodemographic factors associated with parental anxiety following the birth of a very low birth weight infant (VLBW, below 1500 g), and to determine the impact of anxiety on the behavior of parents with their VLBW infants in the Neonatal Intensive Care Unit (NICU). The parents of 88 VLBW infants were recruited through the NICU of a tertiary-care hospital, approximately 2 weeks following delivery. Parents completed self-report questionnaires measuring anxiety, marital quality, and social support. Prior to discharge, each parent was observed twice during a feeding interaction with the infant. Maternal anxiety was greater when their infants were smaller in terms of birth weight and younger in gestational age. Maternal education, marital status, and country of origin, as well as social support and marital quality, were also associated with anxiety. Paternal anxiety was not related to socioeconomic status or infant medical risk, but was associated with country of origin, social support, and marital quality. For both mothers and fathers, anxiety was a better predictor of parental behavior than was infant medical risk. These findings suggest the need to intervene with anxious parents in order to promote satisfactory parent-infant relationships. [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] The influence of prematurity, maternal anxiety, and infants' neurobiological risk on mother,infant interactionsINFANT MENTAL HEALTH JOURNAL, Issue 5 2005Gesine Schmücker In this study, we investigated how the birth of a very low birth weight preterm (VLBW) infant influences the mother,infant interaction at 3 months. We also focused on the impact of the infant's neurobiological risk and maternal anxiety, and their interaction. The comparison of the VLBW preterm sample (n = 79) with an external full-term sample (n = 35) showed mother,infant interactions of the families with the preterm infant to be more vocally responsive during the interaction, but less facially responsive during the interaction. Additionally, higher levels of maternal anxiety were associated with preterm infants being less facially responsive in interaction with their mother. While neurobiological risk of the infant played a part in this association, with higher risk infants also being less facially responsive, the relationship with maternal anxiety and the mother,child interaction was stronger. How these findings may influence therapeutic interventions is discussed. [source] Attention Problems in Very Low Birth Weight Preschoolers: Are New Screening Measures Needed for This Special Population?JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING, Issue 2 2007Deborah Winders Davis DNS PROBLEM:,Children born prematurely have been shown to have a range of problems that often result in delayed academic achievement. METHODS:,The current study assessed both attention problem scores (Child Behavior Checklist) and actual performance on tasks tapping three attention networks in a sample of children (n = 94) born with very low birth weights (VLBW; , 1500 grams). FINDINGS:,Attention problem scores were extremely low and did not predict children's actual attention performance. CONCLUSIONS:,A body of research is developing that suggests VLBW children may have specific, yet subtle, attention problems that may differ from those of other children. [source] Survey of the management of neonatal hyperglycaemia in AustralasiaJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 9 2007Jane M Alsweiler Aim: Hyperglycaemia is a common problem in very low birthweight (VLBW) preterm neonates and has been associated with an increase in intraventricular haemorrhage and mortality. There are few data to guide clinicians on the best range of blood glucose levels to aim for when treating hyperglycaemic preterm babies with insulin. The aim of this study was to survey all Australasian tertiary neonatal intensive care units for their current practice in the definition and management of neonatal hyperglycaemia to aid in the design of a randomised controlled trial of the effect of tight glycaemic control on long-term outcome in VLBW babies. Methods: An online survey was sent to the 27 tertiary neonatal units in Australasia asking the respondents for details of their unit's definition and management of hyperglycaemia in VLBW infants. Results: Twenty-three tertiary neonatal units responded to the questionnaire. There were six different definitions of hyperglycaemia, with most units defining neonatal hyperglycaemia as a blood glucose level greater than 10 mM. There were large variations in the criteria for commencing insulin (blood glucose level 8,15 mM ± glycosuria) and target blood glucose ranges for babies on insulin (ranging from 2.5,8 mM to 8,15 mM). Conclusions: There is a wide variation in the management of neonatal hyperglycaemia between tertiary neonatal units in Australasia. This reflects the paucity of data available in this area. Further research on the management of neonatal hyperglycaemia is needed. [source] Chest physiotherapy and porencephalic brain lesions in very preterm infantsJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 6 2001DB Knight Objective: National Women's Hospital is one of two hospitals to report a destructive brain lesion, namely encephaloclastic porencephaly (ECPE), in extremely preterm infants. It has been associated with non-cephalic presentation, early hypotension and the number of chest physiotherapy treatments in the first month. The aim of the present study was to determine the temporal relationship between ECPE and chest physiotherapy use in very low-birth weight (VLBW) infants in our unit. Methodology: Cerebral ultrasound scan reports, post-mortem reports, clinical and physiotherapy records and, if indicated, original ultrasound films were reviewed for all VLBW babies admitted between 1985 and 1998. Results: Over the 14 year period in question, 2219 babies with a birth weight , 1500 g were admitted. Encephaloclastic porencephaly was found in only the 13 previously reported babies born between 1992 and 1994. Encephaloclastic porencephaly was excluded in 1564 (70%) babies. In 621 (28%) babies who did not have late ultrasound scans, ECPE was thought to be unlikely either because the babies never had any chest physiotherapy (n = 479) or because they had chest physiotherapy but were known to be neurodevelopmentally normal on follow up (n = 142). Data were incomplete for 21 babies (0.9%). The number of chest physiotherapy treatments per baby decreased from a median of 95 prior to 1989 to 38 and the age of starting treatment increased from 5 to 8 days after 1990. The use of chest physiotherapy ceased in 1995. Conclusions: Encephaloclastic porencephaly emerged as a problem at a time when the use of chest physiotherapy had decreased. The cluster of cases seen between 1992 and 1994, although associated with the number of chest physiotherapy treatments given, began to appear because of some other factor. [source] Predictors of neurodevelopmental outcome of Malaysian very low birthweight children at 4 years of ageJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 4 2001LC Ong Objective: To determine neonatal, early developmental and social risk factors that predict the neurocognitive and behavioural outcome of very low birthweight (VLBW) preschool children at four years of age. Methodology: From a cohort of 151 eligible VLBW survivors born in Kuala Lumpur Maternity Hospital, 116 (76.8%) were prospectively followed up from birth till four years. A standardised neurological examination was performed at one and four years to determine the presence of impairment and cerebral palsy, respectively. Cognitive development was assessed using the Mental Scale of the Bayley Scales of Infant Development (MDI) at one year and the Weschler Preschool and Primary Scale of Intelligence-Revised (WIPPSI-R) at four years. Motor coordination was assessed using the Movement Assessment Battery for Children (Movement-ABC). Mothers completed the Child Behaviour Checklist (CBCL) and Parenting Stress Index (PSI) questionnaires. Logistic and multiple regression analyses were used to determine factors associated with cerebral palsy, IQ scores, Movement-ABC and CBCL scores. Results: Factors associated with cerebral palsy were lower MDI scores at one year (P = 0.001) and late neonatal cranial ultrasound abnormalities (P = 0.036). Minor (P = 0.016) or major impairment (P = 0.003) at one year of age and a low level of paternal education (P = 0.01) were associated with poor motor function on the Movement-ABC scale. Lower levels of maternal education (P < 0.001), impairment at one year (P = 0.002) and late neonatal cranial ultrasound abnormalities (P = 0.039) predicted Full Scale IQ scores. Higher PSI scores (P = 0.001), younger mothers (P = 0.003) and late neonatal cranial ultrasound abnormalities (P = 0.009) were associated with worsened child behaviour scores on the CBCL scale. Conclusion: Social factors and the caregiving environment were important determinants of cognitive and behavioural outcome. Cranial ultrasound abnormalities in the late neonatal period and the developmental status at one year might be useful in identifying high risk infants in need of long-term surveillance. [source] Breast feeding very-low-birthweight infants at discharge: a multicentre study using WHO definitionsPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 6 2009Riccardo Davanzo Summary Human milk has several advantages in the nutrition of very-low-birthweight (VLBW) infants. However, there are limited data on breast feeding (BF) in neonatal intensive care units (NICU). The aim of this study was to identify a practical definition of BF rate in VLBW infants and to test its applicability and reproducibility in Italian NICUs. The study population included all VLBW infants discharged from 12 level 3 NICUs, over a 12-month period. Type of feeding was recorded according to the World Health Organisation (WHO) definition, with a 72-h recall period. We enrolled 594 VLBW infants. Mean birthweight was 1105 g (SD: 267), mean gestational age was 29.2 weeks (SD: 2.7) and mean length of stay in NICUs was 62.5 days (SD: 56.5). At discharge, 30.5% of VLBW infants were exclusively breast fed, 0.2% were predominantly breast fed, 23.8% were on complementary feeding and 45.5% were exclusively formula fed. A wide variability in BF rates was seen between centres. Among exclusively breast-fed VLBW infants, only 10% sucked directly and exclusively at the breast. WHO definitions can be used to assess type of feeding at discharge from NICUs. We speculate that common feeding definitions may allow both comparisons among different NICUs and ratings of quality improvement programmes. [source] Cytokine profiles in 1-yr-old very low-birth-weight infants after enteral glutamine supplementation in the neonatal periodPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 5 2009Annelies Van Zwol In a previous study, we found that glutamine-enriched enteral nutrition in 102 very low-birth-weight (VLBW) infants decreased both the incidence of serious neonatal infections and atopic dermatitis during the first year of life. The aims of this follow-up study were to determine whether these beneficial effects are attended by changes in Th1 and Th2 cytokine profiles at age 1 yr. Furthermore, we studied changes in cytokine profiles during the first year of life in these VLBW infants. In total, 89 infants were eligible for the follow-up study (12 died, 1 exclusion due to a chromosomal abnormality). Th1 (IFN-,, TNF- , and IL-2) and Th2 cytokine (IL-10, IL-5, and IL-4) profiles following in vitro whole blood stimulation were measured at 1 yr. Cytokine profiles were measured in 59/89 (66%) infants. Glutamine-enriched enteral nutrition in neonatal period did not influence cytokine profiles at 1 yr. Cytokine profiles were not different in infants with and without allergic or infectious diseases. The beneficial effect of glutamine-enriched enteral nutrition on the incidence of serious neonatal infections and atopic dermatitis during the first year of life is not related to changes in the Th1 and Th2 cytokine profiles. Both Th1 and Th2 cytokine profiles increased during the first year of life in this cohort of VLBW infants. [source] Episodes of hypoxemia during synchronized intermittent mandatory ventilation in ventilator-dependent very low birth weight infantsPEDIATRIC PULMONOLOGY, Issue 1 2005Steve R.E. Firme MD Abstract Distinct patterns of asynchrony, and episodes of hypoxemia, may occur in a spontaneously breathing preterm infant during conventional intermittent mandatory ventilation (IMV) on traditional time-cycled, pressure-limited ventilators. Synchronized IMV (SIMV) and assist/control ventilation are frequent modes of patient-triggered ventilation used with infant ventilators. The objective of this study was to use computerized pulse oximetry to quantify the occurrence of episodes of hypoxemia (oxygen desaturation) during SIMV vs. IMV, in preterm infants ,1,250 g who required mechanical ventilation at ,14 days of age. We performed a randomized, crossover study with each infant being randomized to IMV or SIMV (Infant Star ventilator) for initial testing for a 1-hr period. Patients were subsequently tested on the alternate modality after a stabilization period of 10 min at the same ventilator and fractional inspired oxygen concentration (FiO2) settings. Pulse oximetry data were obtained with a Nellcor N-200 monitor, a microcomputer, and a software program (SatMaster). An investigator blinded to the randomized assignment evaluated all measurements. Eighteen very low birth weight (VLBW) infants with a birth weight of 777,±,39 g (mean,±,SEM) and gestational age 25.1,±,0.3 weeks were studied. The average pulse oximeter oxygen saturation (SaO2) was higher on SIMV than IMV (P,<,0.01). During SIMV, these infants had significantly fewer episodes of hypoxemia (duration of episodes of oxygen desaturation as a percentage of scorable recording time) to 86,90% SaO2 (P,<,0.01), 81,85% SaO2 (P,<,0.01), and 76,80% SaO2 (P,<,0.05) when compared to IMV. There was also a significant decrease in percentage of time of desaturation to SaO2,<,90% (P,=,0.002),,<,85% SaO2 (P,=,0.003), and <80% SaO2 (P,=,0.02) during SIMV vs. IMV. Our preliminary findings indicate that the use of SIMV in a population of VLBW ventilator-dependent infants (,14 days of age) results in better oxygenation and decreased episodes of hypoxemia as compared to IMV. © 2005 Wiley-Liss, Inc. [source] Antenatal steroid treatment prevents severe hyperkalemia in very low-birthweight infants*PEDIATRICS INTERNATIONAL, Issue 6 2003Naoki Uga AbstractBackground:,Hyperkalemia is seen quite often in very low-birthweight (VLBW) infants and concentrations sometimes become high enough to cause cardiac arrhythmia. The purpose of the present study was to identify factors that increase serum concentrations of potassium in VLBW infants. Methods:,Retrospective comparative analysis was performed on 140 VLBW infants who had been admitted to the Toho University Perinatal Center between January 1993 and December 1999 and needed mechanical ventilation for respiratory distress. Serum concentrations of potassium at 24 and 48 h of age were compared in two groups of infants, those whose mothers did and did not receive antenatal steroid treatment. Risk factors for severe hyperkalemia were analyzed by multiple linear regression models and Pearson's partial correlation analysis. Results:,Antenatal steroid treatment reduced serum potassium concentrations significantly at 24 and 48 h, as well as the incidence of cardiac arrhythmia and necessity for glucose insulin treatment for severe hyperkalemia. Multiple linear regression showed the serum potassium concentration at 24 h of age was associated with antenatal steroid hormone treatment, 24 h fluid intake volume, serum sodium concentrations at 24 h, gestational weeks and sampling site. Serum concentration of potassium at 48 h of age was associated with blood urea nitrogen, gestational week, serum sodium concentration at 48 h of age and fluid intake between 24 and 48 h of age. Urine output volume and serum creatinine concentrations were not correlated with potassium concentrations at either age. Conclusion:,Antenatal steroid hormone treatment can reduce early hyperkalemia in VLBW infants and also the incidence of cardiac arrhythmia and the use of glucose insulin treatment. [source] Low-dose doxapram therapy for idiopathic apnea of prematurityPEDIATRICS INTERNATIONAL, Issue 2 2001Toshio Yamazaki AbstractBackground: Doxapram is contraindicated for newborn infants in Japan because of its serious side effects. However, because of encouraging results of recent studies regarding the efficacy and safety of therapy for apnea of prematurity (AOP) with lower doses of doxapram than those previously proposed, approximately 60% of Japanese neonatologists continue to use doxapram at small doses. Caution is warranted because the sample sizes of the former studies are inadequate to evaluate doxapram for both its beneficial and harmful effects. Therefore, we conducted the present study in order to investigate the efficacy and harmful events of low-dose doxapram therapy for idiopathic AOP in very low-birth weight (VLBW) infants in a larger population. Methods: One hundred and six VLBW infants with idiopathic AOP were treated with doxapram at a dose of 0.2,1.0 mg/kg per h in combination with methylxanthines and the frequency of apnea and secondary outcomes were compared with a group of control infants. Results: An approximate 80% reduction in the frequency of apnea was found with only minimal side effects following low-dose doxapram. Although there were no significant differences in secondary outcomes between the doxapram-treated and control groups, mortality in doxapram-treated infants was significantly lower than that in control infants. Conclusions: Patients with AOP unresponsive to treatment with methylxanthines may benefit from the addition of low-dose doxapram. [source] Guiding Mothers' Management of Health Problems of Very Low Birth-Weight InfantsPUBLIC HEALTH NURSING, Issue 3 2006F.A.A.N., Karen A. Pridham Ph.D. ABSTRACT Objective: Explore the feasibility, usefulness, and outcomes of a pilot program to support mothers in developing competencies for managing health problems of their very low birth-weight (VLBW) infants in partnership with the primary care clinician (PCC). Design: In a randomized study, mothers who received guided participation (GP) and printed guidelines for managing VLBW infant health problems were compared with mothers who received only the guidelines and standard care (GL group). Sample: All mothers (GP=20; GL=11) were at least 18 years old and English speaking. Infants were all VLBW (,1,500 g). Intervention: GP began during the infant's neonatal intensive care unit stay and continued with public health nurses (PHNs) and a family service clinician through the infant's first 4 postterm months. Measurements: Intervention feasibility and usefulness were assessed with maternal and clinician feedback. Outcomes included maternal and clinician appraisal of mothers' use of clinical resources and mothers' perceptions of primary-care quality and the family-PCC relationship. Results: Intervention feasibility and usefulness were supported. GP and GL groups did not differ significantly on outcomes. Conclusions: Findings indicate a longer intervention period, GP organized by infant problem episodes, and enhancement of the PHN role in the context of interdisciplinary and interagency collaboration. [source] Visual fields and optic disc morphology in very low birthweight adolescents examined with magnetic resonance imaging of the brainACTA OPHTHALMOLOGICA, Issue 8 2009Kerstin Hellgren Abstract. Purpose:, We aimed to evaluate visual fields (VFs) and optic disc morphology in very low birthweight (VLBW) adolescents compared with age- and gender-matched controls, and to relate the findings to magnetic resonance imaging (MRI) results. Methods:, Fifty-nine VLBW adolescents and 55 age- and gender-matched controls with normal birthweight were examined. Visual fields were tested using computerized rarebit perimetry (RB). Optic nerve and retinal vessel morphology were evaluated by digital image analysis of fundus photographs. Brain MRI was conducted in the VLBW subjects. Results:, Ten of the 57 VLBW subjects (p = 0.022) had subnormal VF results defined as a mean hit rate below the fifth percentile of the controls (i.e. < 89%). All of these also had significantly lower mean hit rates (p = 0.039) in the inferior hemifield. Sixteen of 57 (28%) VLBW subjects had white matter damage of immaturity (WMDI) on MRI. Six of 15 subjects with WMDI (who underwent VF testing) also had subnormal RB results, compared with four of 39 with normal MRI findings (p = 0.02). The mean neural retinal rim area was 9% smaller (p = 0.018) in the VLBW group than in the control group. The VLBW adolescents had a significantly higher index for tortuosity of arterioles than the controls (p < 0.001). Conclusions:, In the present study, 18% of all VLBW adolescents and 40% of those with WMDI had subnormal RB VF findings. The VLBW group had increased arterial tortuosity and a somewhat smaller (9%) mean neural retinal rim area than the control group. Thus sequels to VLBW appear to persist in adolescence. [source] Oral D-penicillamine for the prevention of retinopathy of prematurity in very low birth weight infants: a randomized, placebo-controlled trialACTA PAEDIATRICA, Issue 9 2010Manjari Tandon Abstract Purpose:, To compare prophylactic enteral D-penicillamine (DPA) with placebo for prevention of ,retinopathy of prematurity (ROP) or death' among very low birth weight (VLBW) infants. Methods:, This was a double-blind, single-centre, randomized, placebo-controlled trial with stratification (for birth weight <1250 and ,1250 g) and blocking. Inborn neonates with birth weight 750,1500 g, gestation ,32 weeks, age ,5 days, who tolerated feeds were eligible. Neonates with gastro-intestinal malformations, life-threatening malformations and necrotizing enterocolitis were excluded. Enrolled subjects were randomly allocated to receive oral DPA suspension at 100 mg/kg/dose 8 h for 3 days, followed by 50 mg/kg/day for another 11 days or placebo. The primary outcome was ,any ROP or death'. Secondary outcomes included any ROP, treatable ROP, adverse effects and feed intolerance. Results:, A total of 88 subjects were enrolled. Baseline characteristics were similar with the exception of multiple gestation. There were no significant differences in primary and secondary outcomes, even after adjusting for multiple gestation and on sub-group analysis. No adverse reaction was noted. Conclusion:, Prophylactic enterally administered DPA suspension in a dose 100 mg/kg/dose 8 h for 3 days, followed by 50 mg/kg once per day for next 11 days, does not prevent ,any stage ROP or death' or ,ROP requiring treatment' in VLBW infants. DPA is well tolerated and does not have any major short-term adverse effects. [source] Incidence of necrotizing enterocolitis in very-low-birth-weight infants related to the use of Lactobacillus GGACTA PAEDIATRICA, Issue 8 2010R Luoto ABSTRACT Background:, One of the five level III neonatal intensive care units (NICU) in Finland has used prophylactic Lactobacillus GG (LGG) for very-low-birth-weight (VLBW) infants since 1997. Aim:, To examine retrospectively the incidence of necrotizing enterocolitis (NEC) in all five university hospital NICUs in Finland in relation to the use of LGG during the years each unit has belonged to the Vermont Oxford Network (VON). Methods:, The incidence of NEC was analysed from the national database and from the VON databases separately in all five level III NICUs and additionally in three groups according to the probiotic practice in the hospitals: prophylactic LGG group, probiotics ,on demand' group and no probiotics group. Results:, The incidence of NEC was 4.6% vs. 3.3% vs. 1.8% in the prophylactic LGG group, the probiotics ,on demand' group and the no probiotics group, respectively; p = 0.0090, chi-square. LGG had no influence on the clinical course of NEC. Conclusions:, The results of this retrospective report failed to show that LGG prophylaxis protects VLBW infants from the occurrence of NEC, in contrast to previously published results. Our results call for more research regarding effective ways to administer probiotics, including data on appropriate bacteria, strain, dose and timing of administration to achieve clinically robust effects. [source] Renal function and volume of infants born with a very low birth-weight: a preliminary cross-sectional studyACTA PAEDIATRICA, Issue 8 2010M Zaffanello Abstract Aim:, The aim of our study was to compare the function and volumes of kidneys of very low birth-weight (VLBW) and of extremely low birth-weight (ELBW) infants at pre-school ages. Patients and methods:, We did a revision of the neonatal records of infants born in our hospital that weighed ,1500 g at birth. The children were divided into two groups according to their weight at birth: ELBW (<1000 g) and VLBW (1000,1500 g). At the age of 5.7 ± 1.4 years, the children underwent clinical, laboratory and ultrasound renal assessments. Results:, Sixty-nine children fulfilled the requirements for the study. The rate of neonatal treatment with aminoglycosides was higher in ELBW preterms. Renal function parameters, i.e. estimated glomerular filtration rate and albuminuria, did not differ between the two groups of children. Urinary ,1-microglobulin excretion was significantly higher and kidneys were significantly smaller in the ELBW group than in the VLBW group. Conclusion:, No impairment or differences in renal parameters were found in pre-school children born ELBW compared with those born with VLBW, except for differences in kidney volume, renal cortical thickness and urinary ,1-microglobulin excretion. Thus, patients born with ELBW would require a longer follow-up period. [source] Safety of magnetic resonance imaging in preterm infantsACTA PAEDIATRICA, Issue 6 2010I Benavente-Fernández Abstract Aim:, As we progress in our knowledge of preterm brain injury, cohort studies are focusing in neuroimaging preterm infants in the first days of life. Magnetic resonance (MR) is the most powerful neuroimaging modality and valuable in understanding perinatal brain injury. The main purpose of the study is to evaluate the safety of MR imaging in very low birth weight (VLBW) infants at our hospital settings where the scanner is located at some distance from the neonatal intensive care unit (NICU). Subjects and methods:, This is a prospective study of 33 VLBW infants who underwent early MR imaging (MRI), within 10 days after birth and term corrected age MRI. The study period included June to December 2008. Results:, A total of 46 MRI were performed on 33 preterm infants. The mean total time the infants stayed in the bore of the magnet was 13.04 min. No incidences occurred during transfer or during the scans, and no significant changes were found in heart rate, oxygen saturation and temperature. Conclusions:, At our hospital settings, the process of transport and MR imaging have been proven to be safe and not to disturb any of the variables measured. MRI should not be restricted to centres with neonatal MR system or MR-compatible incubator, as long as the process is coordinated and supervised by a multidisciplinary team. [source] Cognitive outcome at 2 years of age in Finnish infants with very low birth weight born between 2001 and 2006ACTA PAEDIATRICA, Issue 3 2010P Munck Abstract Aim:, To study cognitive outcome of premature, very low birth weight (VLBW) infants in relation to parental education and neonatal data. Methods:, A regional cohort of 182 VLBW infants born between 2001 and 2006 was followed up. Brain ultrasounds (US) were examined serially until term age and brain magnetic resonance imaging at term age. Neurological status was examined systematically. Cognitive development was assessed using the Mental Developmental Index (MDI) of Bayley Scales at 2 years of corrected age. A total of 192 healthy full-term (FT) controls were assessed with the MDI at 2 years of age. Results:, The mean MDI in VLBW infants was 101.7 (SD 15.4), which was lower compared with FT controls (109.8, SD 11.7, p < 0.001). In regression analysis of the demographic and medical data of VLBW infants, postnatal corticosteroids (p = 0.04), intestinal perforation (p = 0.03) and major brain pathology (p = 0.02) were negatively associated with the MDI. In VLBW infants, the prevalence of neurodevelopmental impairment was 9.9% (3.3% MDI below 70, 7.1% cerebral palsy, 2.2% hearing aid, no blind infants). Conclusion:, Cognitive development of VLBW infants seemed to have improved in comparison with earlier publications, but it differed from the FT controls. Neonatal factors affected cognitive development. Therefore, updated regional follow-up data are important for clinicians. [source] IGF-I, leptin and active ghrelin levels in very low birth weight infants during the first 8 weeks of lifeACTA PAEDIATRICA, Issue 1 2010N Ohkawa Abstract Aim:, We investigated the relationship between plasma insulin-like growth factor I (IGF-I), leptin, active ghrelin levels, and postnatal growth in very low birth weight (VLBW) infants. Method:, Plasma IGF-I, leptin, and active ghrelin levels were measured at birth and at 2, 4, 6 and 8 weeks after birth in 61 VLBW infants, including 31 appropriate-for-gestational-age (AGA) and 30 small-for-gestational-age (SGA) infants. Results:, Insulin-like growth factor I levels were the lowest at birth, but increased gradually over the first 8 weeks of life. IGF-I was positively correlated with body weight, body length and body mass index at all time points. Leptin levels did not change over the study period. Ghrelin levels were significantly lower at birth; however, there were no significant differences between the levels after 2 weeks of age. Leptin and ghrelin levels were not correlated with anthropometrical measures. IGF-I levels at birth were significantly lower in SGA than in AGA infants, but the leptin and ghrelin levels were not significantly different between the two groups. Conclusion:, Insulin-like growth factor I is related to length and weight gain in the prenatal and the early postnatal periods in VLBW infants, but this does not appear to be the case for leptin and ghrelin. [source] Intestinal flora in very low-birth weight infantsACTA PAEDIATRICA, Issue 11 2009Markus V. Björkström Abstract Aim:, To study the early faecal microbiota in very low-birth weight infants (VLBW, <1500 g), possible associations between faecal microbiota and faecal calprotectin (f-calprotectin) and to describe the faecal microbiota in cases with necrotizing enterocolitis (NEC) before diagnosis. Methods:, Stool samples from the first weeks of life were analysed in 48 VLBW infants. Bacterial cultures were performed and f-calprotectin concentrations were measured. In three NEC cases, cultures were performed on stool samples obtained before diagnosis. Results:, Bifidobacteria and lactobacilli were often identified in the first stool sample, 55% and 71% of cases, respectively within the first week of life. A positive correlation between lactic acid bacteria (LAB) and volume of enteral feed was found. Other bacteria often identified were Escherichia coli, Enterococcus and Staphyloccus sp. F-calprotectin was not associated with any bacterial species. All NEC cases had an early colonization of LAB. Prior to onset of disease, all cases had a high colonization of non- E. coli Gram-negative species. Conclusion:, In contrast to the previous studies in VLBW infants, we found an early colonization with LAB. We speculate that this may be due to early feeding of non-pasteurized breast milk. [source] Age of sitting unsupported and independent walking in very low birth weight preterm infants with normal motor development at 2 yearsACTA PAEDIATRICA, Issue 11 2009MA Marín Gabriel Abstract Aims:, The aims of this study is to (i) determine the age of sitting unsupported and independent walking in preterm infants with birth weight under 1500 g (very low birth weight, VLBW); (ii) estimate differences between VLBW children and a reference population and (iii) estimate the association between clinical characteristics and late age at sitting and walking. Methods:, A longitudinal study was conducted of a cohort of 876 children with VLBW. The World Health Organization (WHO) motor development study population was used as a reference. Ages for both skills were established by interview with parents. Means were compared with t -test, ANOVA and Bonferroni adjustment where appropriate. Results:, The inclusion criteria were complied with 694 patients; 50% of VLBW sat at 7 m corrected age (CA) and walked at 13 m CA. Both motor skills were acquired later (7.3 ± 1.5 and 13.6 ± 2.8 m) compared with the control group (6 ± 1.1 and 12.1 ± 1.8 m). Weight or head circumference at birth below the 10th percentile or the presence of bronchopulmonary dysplasia were associated with delayed acquisition of both skills. Conclusion:, Very low birth weight infants typically sit unsupported and walk later than term infants. Tables describing reference values for milestones acquisition for different categories of infants (gestational age, birth weight and other determinants) may contribute to inform the decision making process on access to available resources. [source] Variations of Apgar score of very low birth weight infants in different neonatal intensive care unitsACTA PAEDIATRICA, Issue 9 2009Mario Rüdiger Abstract Objective:, The Apgar score should be an objective method to assess the state of newborns; however, its applicability in preterm infants is hampered by large variations among different observers. The study tested whether physicians that give low scores to written case descriptions also apply lower scores to preterm infants. Patients and Methods:, Descriptions (BMJ 2004; 329: 143,4) were sent to 14 neonatal units. Physicians were asked to evaluate the Apgar (case score). From seven units Apgar scores of all very low birth weight infants (VLBW) born between January 2004 and December 2006 were obtained from charts (clinical score). Results:, In total, 121 physicians from 14 institutions (median 9, range 3,15) replied: 24 residents with <6-month and 28 with >6-month neonatal experience, and 69 consultants. The assessment of the case scores was very heterogeneous with large variations in respiration, muscle tone and reflexes. Clinical scores were obtained from 1000 VLBW infants. The score depended on the gestational age, with a median of 4 at 24 and 7 at 27 weeks. With one exception, centres that assigned low case scores had also low clinical scores. Conclusion:, There is considerable variation in assigning Apgar scores. Definitions are required to apply the Apgar score to infants under clinical conditions such as preterm delivery, resuscitation or artificial ventilation. [source] Most very low birth weight subjects do well as adultsACTA PAEDIATRICA, Issue 9 2009P-O Gäddlin Abstract Aim:, To study health, quality of life, educational level and occupation in very low birth weight (VLBW) children in early adulthood and the relationship of the findings to neonatal risk factors and later handicap. Methods:, This is a prospective long-term follow-up study of a regional cohort of 20-year-old VLBW subjects (n = 77) of all surviving VLBW children (n = 86) and 69/86 term controls born in 1987,1988 in the south-east of Sweden. Postal questionnaires were used: 1. A study-specific form, 2. Medical Outcomes Study, Short Form (SF-36), 3. Sense of Coherence. Results:, VLBW subjects did not differ significantly from their controls in self-perceived health, use of tobacco, education, occupation and way of living, or scoring on SF-36 and Sense of Coherence. Sixteen had cerebral palsy, attention deficit hyperactivity disorder or isolated mental retardation, and these subjects differed significantly from controls on SF-36 in physical functioning and physical health score, but not on Sense of Coherence. VLBW subjects were significantly lighter and shorter than their controls. Extremely low birth weight (ELBW), bronchopulmonary dysplasia and intraventricular haemorrhage were significantly associated with poorer scores on physical function. Conclusion:, The 20-year old VLBW subjects reported perceived health and managed transition to adulthood similar to controls. Handicapped subjects had poorer self-perceived physical function. ELBW and severe neonatal complications were associated with poorer self-perceived physical health. [source] Early iron supplementation in very low birth weight infants , a randomized controlled trialACTA PAEDIATRICA, Issue 6 2009Mari Jeeva Sankar Abstract Aim: To evaluate if supplementing iron at 2 weeks of age improves serum ferritin and/or haematological parameters at 2 months of life in very low birth weight (VLBW) infants. Methods: Preterm VLBW infants who received at least 100 mL/kg/day of oral feeds by day 14 of life were randomized to either ,early iron' (3,4 mg/kg/day orally from 2 weeks) or ,control' (no iron until 60 days) groups. Infants were followed up fortnightly and all morbidities were prospectively recorded. Serum ferritin was measured at 60 days by enzyme immunoassay method. Results: Forty-six infants were included in the study; primary outcome was available for 42 infants. There was no difference in either serum ferritin (mean: 50.8 vs. 45.3 ,g/L; adjusted difference in means: 5.8, 95% CI: ,3.0, 14.6; p = 0.19) or haematocrit (32.5 ± 5.3 vs. 30.8 ± 6.3%; p = 0.35) at 60 days between the early iron and control groups. The magnitude of fall in serum ferritin from baseline to the end of study period was also not different between the groups (4.9 vs. 13.8 ,g/L; difference in means: 8.8; 95% CI: ,0.3, 17.9; p = 0.06). The requirement of blood transfusions (9.5 vs. 13%; p = 0.63) and a composite outcome of common neonatal morbidities (19% vs. 21.7%; p = 0.55) were also not different between the two groups. Conclusion: Supplementing iron at 2 weeks of age in preterm VLBW infants did not improve either serum ferritin or the haematological parameters at 2 months when compared to the standard practice of starting iron from 8 weeks of age. [source] | |||||||||||||