Cerebral Oximetry Monitoring in Extremely Preterm Infants.

BACKGROUND: The use of cerebral oximetry monitoring in the care of extremely preterm infants is increasing. However, evidence that its use improves clinical outcomes is lacking. METHODS: In this randomized, phase 3 trial conducted at 70 sites in 17 countries, we assigned extremely preterm infants (gestational age, <28 weeks), within 6 hours after birth, to receive treatment guided by cerebral oximetry monitoring for the first 72 hours after birth or to receive usual care. The primary outcome was a composite of death or severe brain injury on cerebral ultrasonography at 36 weeks' postmenstrual age. Serious adverse events that were assessed were death, severe brain injury, bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, and late-onset sepsis. RESULTS: A total of 1601 infants underwent randomization and 1579 (98.6%) were evaluated for the primary outcome. At 36 weeks' postmenstrual age, death or severe brain injury had occurred in 272 of 772 infants (35.2%) in the cerebral oximetry group, as compared with 274 of 807 infants (34.0%) in the usual-care group (relative risk with cerebral oximetry, 1.03; 95% confidence interval, 0.90 to 1.18; P = 0.64). The incidence of serious adverse events did not differ between the two groups. CONCLUSIONS: In extremely preterm infants, treatment guided by cerebral oximetry monitoring for the first 72 hours after birth was not associated with a lower incidence of death or severe brain injury at 36 weeks' postmenstrual age than usual care. (Funded by the Elsass Foundation and others; SafeBoosC-III ClinicalTrials.gov number, NCT03770741.).

Efecto de la velocidad de crecimiento intrahospitalaria en la somatometría a los 2 años en niños con peso de nacimiento menor de 1500 gramos / Effect of intrahospital growth rate on somatometric measurements at 2 years old in children with a birth weight of less than 1500 grams

Objetivo. Determinar la asociación de la velocidad de crecimiento (VC) intrahospitalaria y la fortificación de leche humana con la somatometría y el riesgo de muerte tras el alta o discapacidad grave a los 2 años de edad corregida (EC). Población y método. Análisis retrospectivo de la VC y evolución posterior. Se incluyeron los recién nacidos del período 1990-2015, con peso al nacer < 1500 g. Se excluyeron neonatos con patología que afectaba al crecimiento. Se estudió una cohorte global y dos subcohortes: los nacidos en 1990-2001 (sin fortificación) y los nacidos en 2002-2015 (fortificada). La VC se calculó según la fórmula de Fenton y se consideró adecuada si resultó > 12 g/kg/día. Resultados. Se reclutaron 1194 pacientes. La VC adecuada se asoció a mayor mediana de peso a los 2 años de EC en la cohorte global (11 400 g [10 300-12 500] versus 11 000 g [10 000-12 140], p = 0,02. La cohorte 2002-2015 alcanzó mayor talla media (86,42 ± 4,03 cm versus 85,56 ± 4,01, p = 0,02) y mayor porcentaje de prematuros que alcanzaron un crecimiento compensatorio (catch-up) a los 2 años de EC en la cohorte global con VC adecuada (62,50 % versus 34,69 %, p < 0,02). No se encontraron diferencias en el riesgo de muerte tras el alta o discapacidad grave a los 2 años de EC con VC adecuada (OR: 0,79; IC95 %: 0,47-1,12) ni al considerarse el análisis por subcohortes. Conclusiones. Una VC adecuada se asoció con mejor crecimiento, pero no con menor riesgo de muerte tras el alta o discapacidad grave. La cohorte fortificada alcanzó mayor talla media a los 2 años de EC.

Objective. To determine the association between intrahospital growth rate (GR) and breast milk fortification and somatometry, and risk for death after discharge or severe disability at 2 years of corrected age (CA). Population and method. Retrospective analysis of GR and subsequent course. Infants born in the 1990-2015 period with a birth weight < 1500 g were included. Infants with diseases affecting growth were excluded. An overall cohort and 2 sub-cohorts were studied: infants born in the 1990-2001 period (without fortification) and 2002-2015 period (with fortification). The GR was estimated and deemed adequate if > 12 g/kg/day. Results. A total of 1194 patients were recruited. An adequate GR was associated with a higher median weight at 2 years of CA in the overall cohort (11 400 g [10 300-12 500] versus 11 000 g [10 000-12 140], p = 0.02). The 2002-2015 cohort reached a higher mean height (86.42 ± 4.03 cm versus 85.56 ± 4.01, p = 0.02). More preterm infants caught-up growth at 2 years of CA in the overall cohort with an adequate GR (62.50 % versus 34.69 %, p < 0.02). No differences were observed in the risk for death after discharge or severe disability at 2 years of CA with an adequate GR (OR: 0.79; 95 % confidence interval: 0.47-1.12). Conclusions. An adequate GR was associated with improved growth, but not with a lower risk for death after discharge or severe disability. The cohort with fortified breast milk reached a higher mean height at 2 years of CA

Effect of intrahospital growth rate on somatometric measurements at 2 years old in children with a birth weight of less than 1500 grams. / Efecto de la velocidad de crecimiento intrahospitalaria en la somatometría a los 2 años en niños con peso de nacimiento menor de 1500 gramos.

Objective: To determine the association between intrahospital growth rate (GR) and breast milk fortification and somatometry, and risk for death after discharge or severe disability at 2 years of corrected age (CA). Population and method: Retrospective analysis of GR and subsequent course. Infants born in the 1990-2015 period with a birth weight < 1500 g were included. Infants with diseases affecting growth were excluded. An overall cohort and 2 sub-cohorts were studied: infants born in the 1990-2001 period (without fortification) and 2002-2015 period (with fortification). The GR was estimated and deemed adequate if > 12 g/kg/day. Results: A total of 1194 patients were recruited. An adequate GR was associated with a higher median weight at 2 years of CA in the overall cohort (11 400 g [10 300-12 500] versus 11 000 g [10 000-12 140], p = 0.02). The 2002-2015 cohort reached a higher mean height (86.42 ± 4.03 cm versus 85.56 ± 4.01, p = 0.02). More preterm infants caught-up growth at 2 years of CA in the overall cohort with an adequate GR (62.50 % versus 34.69 %, p < 0.02). No differences were observed in the risk for death after discharge or severe disability at 2 years of CA with an adequate GR (OR: 0.79; 95 % confidence interval: 0.47-1.12). Conclusions: An adequate GR was associated with improved growth, but not with a lower risk for death after discharge or severe disability. The cohort with fortified breast milk reached a higher mean height at 2 years of CA.

Objetivo. Determinar la asociación de la velocidad de crecimiento (VC) intrahospitalaria y la fortificación de leche humana con la somatometría y el riesgo de muerte tras el alta o discapacidad grave a los 2 años de edad corregida (EC). Población y método. Análisis retrospectivo de la VC y evolución posterior. Se incluyeron los recién nacidos del período 1990-2015, con peso al nacer < 1500 g. Se excluyeron neonatos con patología que afectaba al crecimiento. Se estudió una cohorte global y dos subcohortes: los nacidos en 1990-2001 (sin fortificación) y los nacidos en 2002-2015 (fortificada). La VC se calculó según la fórmula de Fenton y se consideró adecuada si resultó > 12 g/kg/día. Resultados. Se reclutaron 1194 pacientes. La VC adecuada se asoció a mayor mediana de peso a los 2 años de EC en la cohorte global (11 400 g [10 300-12 500] versus 11 000 g [10 000-12 140], p = 0,02. La cohorte 2002-2015 alcanzó mayor talla media (86,42 ± 4,03 cm versus 85,56 ± 4,01, p = 0,02) y mayor porcentaje de prematuros que alcanzaron un crecimiento compensatorio (catch-up) a los 2 años de EC en la cohorte global con VC adecuada (62,50 % versus 34,69 %, p < 0,02). No se encontraron diferencias en el riesgo de muerte tras el alta o discapacidad grave a los 2 años de EC con VC adecuada (OR: 0,79; IC95 %: 0,47-1,12) ni al considerarse el análisis por subcohortes. Conclusiones. Una VC adecuada se asoció con mejor crecimiento, pero no con menor riesgo de muerte tras el alta o discapacidad grave. La cohorte fortificada alcanzó mayor talla media a los 2 años de EC.

[The use of strength and difficulties questionnaire in psychosocial evaluation and attention deficit hyperactivity disorder screening in preterm infants]. / Uso del Strength and Difficulties Questionnaire en prematuros para su evaluación psicosocial y cribado del trastorno por déficit de atención e hiperactividad.

INTRODUCTION: Behavioural disorders and learning disabilities are often recognised in<1,500g or<32 weeks very low birth weight (VLBW) infants. There is very limited data in the Spanish population. OBJECTIVE: To determine the presence of psychosocial disorders in preterm infants at 6 years of age, as assessed by the strength and difficulties (SDQ) questionnaire, in comparison to a reference population. To set a cut-off value to use SDQ as a screening tool for attention deficit hyperactivity disorder (ADHD) in the preterm child. PARTICIPANTS AND METHODS: A prospective observational study was conducted on premature children assessed at 6 years of age using the SDQ. Perinatal variables, neurodevelopment, and diagnosis of ADHD, according to the DSM-5, were collected. RESULTS: A total of 214 children who met all the requirements, were included. When compared with the reference population they had significantly higher scores in emotional symptoms, in peer relationships, and in the total score of the test. The hyperactivity scale and the total test score are good predictors of a diagnosis of ADHD, with an area under the ROC curve of 0.83 (95% CI: 0.76-0.90) for hyperactivity, and 0.87 (95% CI: 0.80-0.93) for the total score. The scores for hyperactivity and the total test, from which the screening for ADHD could be considered positive would be≥6 and≥13 respectively, and a combination of hyperactivity≥5 and total score≥12. CONCLUSIONS: Preterm children are at higher risk of emotional and peer relationship problems than those born full term. The SDQ test could be used for ADHD screening.

Model that predicted death or disabilities in premature infants was valid at seven years of age.

AIM: Validated a model that used bronchopulmonary dysplasia (BPD), brain injuries measured using ultrasound and retinopathy of prematurity (ROP) to predict late death or disability in premature infants at seven years of age. METHODS: A retrospective study was performed at the 12 de Octubre Hospital neonatal unit in Madrid. A logistic model was applied to estimate the independent prognostic contribution of each morbidity, and the effect that the combination of morbidities had on the seven-year outcomes. The analysis was performed on the total cohort from 1991 to 2008 and on two subcohorts from 1991 to 1998 and 1999 to 2008. RESULTS: A total of 1001 children were included with a mean birth weight of 922 ± 208 g. Severe ROP was strongly associated with poor neurodevelopment, with an odds ratio (OR) 3.17 and 95% confidence interval (CI) of 1.56-6.50, and so was BPD (OR 1.52, 95% CI: 1.03-2.2). The combination of two neonatal morbidities increased the risk of a poor outcome (OR 4.44, 95% CI: 1.51-7.86). The model behaved differently in the two subcohorts. CONCLUSION: The prognostic model predicted a poor outcome at seven years of age when the subjects had at least two of the three morbidities.