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VLBW Infants (vlbw + infant)

Distribution by Scientific Domains

Medical Sciences	86%
Humanities and Social Sciences	13%

Selected Abstracts

How Do Mothers Feel About Their Very Low Birth Weight Infants?

INFANT MENTAL HEALTH JOURNAL, Issue 2 2006
Development 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]

Spontaneous intestinal perforation and Candida peritonitis presenting as extensive necrotizing enterocolitis

ACTA PAEDIATRICA, Issue 2 2003
NJ Robertson
Spontaneous intestinal perforation (SIP) has been increasingly reported in very-low-birthweight (VLBW) infants, although it is still less common than necrotizing enterocolitis (NEC). In around one-third of cases, SIP is associated with systemic candidiasis. We describe a case of SIP and Candida peritonitis in a VLBW infant, which was mistakenly diagnosed as NEC during the infant's short life. At laparotomy, the bowel surface was black and thought to be necrotic. As the infant was thought to have whole-bowel necrosis due to NEC, her condition was deemed incompatible with survival. At postmortem, however, the bowel wall was found to be healthy apart from a very localized patch of necrosis associated with a single perforation. The bowel was covered by a thick, black, serosal exudate consisting of fungal elements from Candida albicans. Conclusion: This case reinforces the fact that a markedly discoloured bowel is not necessarily necrotic and that the discoloration can potentially recover. [source]

Cognitive and neuropsychological outcomes: More than IQ scores

DEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 4 2002
Glen P. Aylward
Abstract Improved survival in preterm infants has broadened interest in cognitive and neuropsychological outcomes. The incidence of major disabilities (moderate/severe mental retardation, neurosensory disorders, epilepsy, cerebral palsy) has remained consistent, but high prevalence/low severity dysfunctions (learning disabilities, ADHD, borderline mental retardation, specific neuropsychological deficits, behavioral disorders) have increased. The follow-up literature contains methodologic problems that make generalizations regarding outcome difficult, and these are discussed. Although mean IQs of former VLBW infants generally are in the low average range and are 3,9 points below normal birth weight peers, these scores mask subtle deficits in: visual-motor and visual-perceptual abilities, complex language functions, academics (reading, mathematics, spelling and writing), and attentional skills. There is an increased incidence of non-verbal learning disabilities, need for special educational assistance, and behavioral disorders in children born prematurely. Males have more problems, and there is a trend for worsening outcome over time, due to emergence of more subtle deficits in response to increased performance demands. In addition to IQ and achievement testing in follow-up, there should be evaluation of executive functions and attention, language, sensorimotor functions, visuospatial processes, memory and learning, and behavioral adjustment. MRDD Research Reviews 2002;8:234,240. © 2002 Wiley-Liss, Inc. [source]

Bronchopulmonary dysplasia predicts adverse developmental and clinical outcomes in very-low-birthweight infants

DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 1 2008
Suh-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]

Heart rate variability in response to pain stimulus in VLBW infants followed longitudinally during NICU stay

DEVELOPMENTAL PSYCHOBIOLOGY, Issue 8 2009
Nikhil S. Padhye
Abstract The objective of this longitudinal study, conducted in a neonatal intensive care unit, was to characterize the response to pain of high-risk very low birth weight infants (<1,500,g) from 23 to 38 weeks post-menstrual age (PMA) by measuring heart rate variability (HRV). Heart period data were recorded before, during, and after a heel lanced or wrist venipunctured blood draw for routine clinical evaluation. Pain response to the blood draw procedure and age-related changes of HRV in low-frequency and high-frequency bands were modeled with linear mixed-effects models. HRV in both bands decreased during pain, followed by a recovery to near-baseline levels. Venipuncture and mechanical ventilation were factors that attenuated the HRV response to pain. HRV at the baseline increased with post-menstrual age but the growth rate of high-frequency power was reduced in mechanically ventilated infants. There was some evidence that low-frequency HRV response to pain improved with advancing PMA. © 2009 Wiley Periodicals, Inc. Dev Psychobiol 51: 638,649, 2009 [source]

Anxiety affects the relationship between parents and their very low birth weight infants

INFANT MENTAL HEALTH JOURNAL, Issue 3 2007
Phyllis 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?

Survey of the management of neonatal hyperglycaemia in Australasia

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 9 2007
Jane 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]

Breast feeding very-low-birthweight infants at discharge: a multicentre study using WHO definitions

PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 6 2009
Riccardo 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 period

PEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 5 2009
Annelies 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]

Antenatal steroid treatment prevents severe hyperkalemia in very low-birthweight infants*

PEDIATRICS INTERNATIONAL, Issue 6 2003
Naoki 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 prematurity

PEDIATRICS INTERNATIONAL, Issue 2 2001
Toshio 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]

Oral D-penicillamine for the prevention of retinopathy of prematurity in very low birth weight infants: a randomized, placebo-controlled trial

ACTA PAEDIATRICA, Issue 9 2010
Manjari 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 GG

ACTA PAEDIATRICA, Issue 8 2010
R 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]

Safety of magnetic resonance imaging in preterm infants

ACTA PAEDIATRICA, Issue 6 2010
I 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 2006

ACTA PAEDIATRICA, Issue 3 2010
P 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 life

ACTA PAEDIATRICA, Issue 1 2010
N 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 infants

ACTA PAEDIATRICA, Issue 11 2009
Markus 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]

Variations of Apgar score of very low birth weight infants in different neonatal intensive care units

ACTA PAEDIATRICA, Issue 9 2009
Mario 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]

Early iron supplementation in very low birth weight infants , a randomized controlled trial

ACTA PAEDIATRICA, Issue 6 2009
Mari 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]

Parental and perinatal factors affecting childhood anthropometry of very-low-birth-weight premature infants: a population-based survey

ACTA PAEDIATRICA, Issue 6 2009
Imad R Makhoul
Abstract Background: The perinatal,neonatal course of very-low-birth-weight (VLBW) infants might affect their childhood growth. We evaluated the effect of parental anthropometry and perinatal and neonatal morbidity of VLBW neonates on their childhood growth. Methods: We obtained parental anthropometry, height and weight at age 6,10.5 years of 334 children born as VLBW infants. Parental, perinatal and neonatal data of these children were tested for association with childhood anthropometry. Results: (1) Maternal and paternal weight standard deviation score (SDS) and discharge weight (DW) SDS were associated with childhood weight SDS (R2= 0.111, p < 0.00001); (2) Maternal and paternal height SDS, corrected gestational age (GA) at discharge, maternal assisted reproduction and SGA status were associated with childhood height SDS (R2= 0.208, p < 0.00001); (3) paternal weight SDS, DW SDS and surfactant therapy were associated with childhood body mass index (BMI) SDS (R2= 0.096, p < 0.00001). 31.1% of VLBW infants had DW SDS < ,1.88, and are to be considered small for gestational age (,SGA'). One quarter of these infants did not catch up by age 6,10.5 years. Conclusion: Childhood anthropometry of VLBW infants depends on parental anthropometry, postnatal respiratory morbidity and growth parameters at birth and at discharge. Almost one-third of VLBW premature infants had growth restriction at discharge from neonatal intensive care unit (NICU), a quarter of whom did not catch up by age 6,10.5 years. [source]

Neonatal outcome of VLBW infants in Berlin, Germany

ACTA PAEDIATRICA, Issue 4 2009
Norbert Teig
No abstract is available for this article. [source]

Body temperature measurement in VLBW infants by continuous skin measurement is a good or even better alternative than continuous rectal measurement

ACTA PAEDIATRICA, Issue 2 2009
RDG Van Der Spek
Abstract Background: An inadequate body temperature in preterm infants influences morbidity and mortality. Continuous rectal measurement is a reliable method to measure body temperature but might have adverse effects and is even contra-indicated in case of low platelets or necrotising enterocolitis. A save and non-invasive method to measure body temperature is the transcutaneous ,zero heat flow' method. Aim: We hypothesised that for monitoring body temperature in very low birth weight (VLBW) infants, central measurement of temperature by way of the zero heat flow principle is just as reliable as rectal temperature. Methods: Twenty-six infants, birth weight between 520 g and 1250 g, gestational age 25.28,32.28 weeks were provided with an insulated continuous skin probe with ,zero heat flow' and a continuous rectal probe. Both measurements were registered every hour over a period of 48 h. The sample size was calculated to detect a difference of less than or equal to 0.20°C. Results: 1205 of the 1248 temperature measurements were analysed. At any moment, skin temperature was higher or equal when compared to rectal temperature. Mean skin temperature was 0.13°C (SD 0.33) higher than mean rectal temperature (t -test, p < 0.001). Correlation between rectal and skin temperature was 0.82 (p , 0.05). Conclusion: In VLBW infants, temperature measurement by ,zero heat flow' method is just as reliable as by rectal method. [source]

Total serum bilirubin levels during cyclooxygenase inhibitor treatment for patent ductus arteriosus in preterm infants

ACTA PAEDIATRICA, Issue 1 2009
C Rheinlaender
Abstract Aim: To determine whether ibuprofen use in VLBW infants is associated with increased serum bilirubin levels and impaired neurodevelopmental outcome at 2 years of age compared to indomethacin. Methods: We retrospectively evaluated bilirubin data and outcome parameters of 178 VLBW infants treated with COX inhibitors for a haemodynamically relevant patent ductus arteriosus (PDA) between 1998 and 2003 in a single institution. In our department ibuprofen replaced indomethacin for PDA treatment in 2001, while clinical and echocardiagraphic criteria for the indication of PDA invention have remained unchanged. Results: Ibuprofen and indomethacin therapy groups did not differ in their baseline clinical profile. Peak serum bilirubin concentration was 10.2 mg/dL in the ibuprofen group and 8.6 mg/dL in the indomethacin group (p < 0.01), while phototherapy duration did not differ. At 2 years of age neurodevelopmental outcome was similar in both groups. In a single case analysis, four cases of adverse neurodevelopmental outcome despite inconspicuous clinical course were identified in the ibuprofen group. Conclusion: In VLBW infants with PDA, ibuprofen treatment was associated with higher bilirubin levels than indomethacin. [source]

Nasal high-frequency ventilation for premature infants

ACTA PAEDIATRICA, Issue 11 2008
Tarah T Colaizy
Abstract Aim: To assess the use of nasal high-frequency ventilation (HFV) to provide noninvasive ventilatory support for very low birthweight (VLBW) infants. Study Design: VLBW infants, >7 days of age on nasal continuous positive airway pressure (CPAP), were placed on nasal HFV for 2 h using the Infant Star high-frequency ventilator (Mallinckrodt, Inc., St. Louis, MO, USA). Mean airway pressure was set to equal the previous level of CPAP, and amplitude was adjusted to obtain chest wall vibration. Capillary blood was sampled before starting HFV and after 2 h to determine change in pH and partial pressure of carbon dioxide (pCO2). Results: Fourteen subjects were studied, 10 males and 4 females. Gestational age was 26,30 weeks (median 27). Age at study was 18,147 days (median 30). Median birth weight was 955 g; median weight at study was 1605 g. Nasal CPAP pressure was 4,7 cm H2O (mean 5). Amplitude was 30,60 (median 50). After 2 h, PCO2 (mean 45 torr) was significantly lower than initial PCO2 (mean 50 torr) (p = 0.01), and pH had increased significantly (7.40 vs. 7.37, p = 0.04). Conclusions: Nasal HFV is effective in decreasing pCO2 in stable premature infants requiring nasal CPAP support. Long-term use of nasal HFV requires further study. [source]

Growth and neurodevelopment outcome of very low birth weight infants delivered by preeclamptic mothers

ACTA PAEDIATRICA, Issue 12 2007
Rita C Silveira
Abstract Aim: To investigate growth and neurodevelopment outcome of very low birth weight (VLBW) infants delivered by preeclamptic mothers. Methods: A cohort including all VLBW infants delivered between December 2003 and May 2005 was followed up to 12 and 18 months corrected age (CA). Exclusion criteria: death before 1 year corrected age, major malformations, deafness and blindness. Weight, length and head circumference were plotted on NCHS curves. Bayley Scales were performed at 12 and 18 months CA. Results: 40 infants in preeclamptic and 46 in control groups were studied. Birth weight and gestational age were 1148 g ± 236 and 1195 g ± 240, and 31.3 weeks ± 1 and 30.6 weeks ± 2 for preeclamptic and control groups, respectively. At 12 and 18 months, CA, weight for age (Z score) was significantly higher in control than in preeclamptic. PDI scores were higher in preeclamptic than in controls at 18 months CA. Conclusions: Catch-up of body weight did not occur in the first 18 months CA in preeclamptic infants. Neurodevelopment outcome was better in infants delivered by preeclamptic mothers than in controls at 18 months CA. [source]

Spontaneous localized intestinal perforation and intestinal dilatation in very-low-birthweight infants

ACTA PAEDIATRICA, Issue 11 2006
Tsugumichi Koshinaga
Abstract Aim: To elucidate how spontaneous localized intestinal perforation (SLIP) is related to intestinal morphological features such as dilatation in very-low-birthweight (VLBW) infants. Methods: The medical records of 13 VLBW infants (<1500 g) undergoing laparotomy between 1983 and 2003 for presumed SLIP were retrospectively reviewed. Clinical findings including maternal, prenatal and perinatal factors were analysed, and the clinical and surgical findings upon laparotomy were compared. Results: Postnatal pathological conditions included patent ductus arteriosus (n= 7), sepsis (n= 2), respiratory distress syndrome (n= 7), intraventricular haemorrhage (n= 2), an indwelling catheter via the umbilical vein (n= 1) and pneumonia (n= 1). Indomethacin was used in seven neonates with patent ductus arteriosus, and dexamethasone preventive therapy was employed in one neonate for bronchopulmonary dysplasia. Operative findings revealed a localized small punched-out perforation in the ileum. Five patients had intestinal dilatation: two with a perforation in the middle of the dilated intestine, and three with a perforation proximal to the region of dilatation. The muscularis propria was absent in the dilated intestine of four patients. Conclusion: This study found no significant relationship between perforation and dilatation of the intestine. Perforation may occur in any portion of the ischaemic intestine when circulatory failure becomes severe, and is not necessarily restricted to the dilated intestine. We believe that SLIP and intestinal dilatation may occur on the same basis in low-birthweight infants; however, the disease process may be aetiologically different. [source]

Vasopressin in catecholamine-resistant septic and cardiogenic shock in very-low-birthweight infants

ACTA PAEDIATRICA, Issue 10 2006
Sascha Meyer
Abstract Aim: To evaluate vasopressin as a rescue therapy in catecholamine-refractory septic and cardiogenic shock in very-low-birthweight (VLBW) infants. Methods: Prospective assessment of vasopressin therapy in three VLBW infants with catecholamine-refractory septic shock (24+.6 wk, 600 g) and cardiogenic shock (26+.1 wk, 890 g; 26+.1 wk, 880 g) at a university hospital. Results: Adequate systemic arterial blood pressure could only be restored after vasopressin administration as a continuous infusion over a 36-h period in the preterm suffering from septic shock; in the two neonates with cardiogenic shock, only a transient stabilization in mean arterial pressure was observed, which did not impact on the poor prognosis. Conclusion: Although vasopressin appears to be a suitable rescue therapy in catecholamine-resistant septic shock in VLBW infants, further evaluation in controlled clinical trials is warranted. [source]

Transcutaneous bilirubinometry in very low birthweight infants

ACTA PAEDIATRICA, Issue 7 2004
L Karolyi
Aim: To evaluate whether transcutaneous bilirubinometry (TcB) would be a reliable and efficient screening technique for hyperbilirubinaemia in very low birthweight (VLBW, ±1500 g) infants in an intensive care unit setting. Methods: TcB measurements (Minolta Airshield Jaundice Meter JM-102, Osaka, Japan) were obtained immediately before or within 10min following routine blood sampling for plasma bilirubin concentration measurements in 124 VLBW infants not receiving phototherapy. The relationship between the two techniques was analysed by linear regression analysis. A plasma bilirubin ±150 ,mol/1 was defined as hyperbilirubinaemia. The sensitivity and specificity of possible TcB cut-off readings to detect hyperbilirubinaemia was evaluated. Results: There was a significant correlation between the measurements of both techniques (p < 0.0001, r= 0.68). In the present study, a TcB cut-off reading of 14 would have reduced the need for plasma bilirubin measurements by 26% without missing true hyperbilirubinaemia. Conclusion: The data suggest that TcB will improve VLBW infant care in an intensive care unit setting by reducing the need for invasive bilirubin concentration measurements. [source]

Postnatal and postprandial changes in plasma concentrations of glicentin in term and preterm infants

ACTA PAEDIATRICA, Issue 10 2003
R Tadokoro
Aim: To examined the changes in basal plasma concentrations of glicentin in developing children and the postnatal and postprandial changes in plasma glicentin levels in infants. Methods: Glicentin, an active component of enteroglucagon, is considered to have a significant trophic action on the intestinal mucosa. Fasting plasma concentrations of glicentin in healthy children and in term and preterm infants were measured before and 30 min after feeding during the first 14 d of life. Results: Plasma basal concentrations of glicentin in children under 1 y of age were significantly higher than those in children aged 1 to 15 y. Plasma basal concentrations of glicentin at 5 or 6 d (2496 and 2190 pg/ml) and at 14 d (2987 and 2817 pg/ml) after birth were significantly higher than those at 1 or 2 d (1098 and 1240 pg/ml) after birth in normal birthweight (NBW) and low-birthweight (LBW) infants. There was no significant difference in the glicentin level between infants at 1 or 2 d (1864 pg/ml) and at 5 or 6 d (1910 pg/ml) after birth in very-low birthweight (VLBW) infants, but the levels at 14 d (3310 pg/ml) after birth were significantly higher than either of those levels. Plasma glicentin concentrations after feeding were significantly higher than those before feeding at 1 or 2 d and at 5 or 6 d after birth in NBW and LBW infants, but a significant increase in the plasma glicentin level after feeding was first observed at 14 d after birth in VLBW infants. There were no significant differences in the basal plasma (2401 and 2718 pg/ml) and postprandial (3007 and 3912 pg/ml) glicentin levels between breastfed and formula-fed infants. Conclusion: The results of the study suggest that glicentin may play an important role in intestinal mucosal growth in the early period of life, although its role in VLBW infants should be further investigated. [source]