Long-term pulmonary outcomes of young adults born prematurely: a Polish prospective cohort study PREMATURITAS 20.

BACKGROUND: The long-term consequences of prematurity are often not sufficiently recognized. To address this gap, a prospective cohort study, which is a continuation of the multicenter Polish study PREMATURITAS, was conducted, utilizing unique clinical data from 20 years ago. OBJECTIVE: The main goal was to evaluate lung function, detect any structural abnormalities using lung ultrasound, and assess psychological well-being in young adults born between 24 and 34 weeks of gestational age (GA). Additionally, the study aimed to investigate potential associations between perinatal risk factors and abnormalities observed in pulmonary function tests (PFTs) during adulthood. METHODS: The young survivors underwent a comprehensive set of PFTs, a lung ultrasound, along with the quality of life assessment. Information regarding the neonatal period and respiratory complications was obtained from the baseline data collected in the PREMATURITAS study. RESULTS: A total of 52 young adults, with a mean age of 21.6 years, underwent PFTs. They were divided into two groups based on GA: 24-28 weeks (n = 12) and 29-34 weeks (n = 40). The subgroup born more prematurely had significantly higher lung clearance index (LCI), compared to the other subgroup (p = 0.013). LCI ≥ 6.99 was more frequently observed in the more premature group (50% vs. 12.5%, p = 0.005), those who did not receive prenatal steroids (p = 0.020), with a diagnosis of Respiratory Distress Syndrome (p = 0.034), those who received surfactant (p = 0.026), and mechanically ventilated ≥ 7 days (p = 0.005). Additionally, elevated LCI was associated with the diagnosis of asthma (p = 0.010). CONCLUSIONS: The findings suggest pulmonary effects due to prematurity persist into adulthood and their insult on small airway function. Regular follow-up evaluations of young survivors born preterm should include assessments of PFTs. Specifically, the use of LCI can provide valuable insights into long-term pulmonary impairment.

Use of Fibrin Glue in the Treatment of Persistent Pneumothorax in Premature Infants at the Limit of Viability: Ethical Issues and Two and A Half Years Follow-Up.

INTRODUCTION: Due to the extreme immaturity of many internal organs, including lungs, infants at the limit of viability are more predisposed to a pneumothorax (PTX). In some cases, PTX becomes persistent. Previously, only a few attempts of PTX treatment with fibrin glue were reported. However, its impact on further lung development is unknown. CASE REPORT: We present a case of an extremely preterm infant with persistent PTX who was successfully treated with fibrin glue. In addition, we present a two-and-a-half-year corrected age follow-up focusing on respiratory problems, motor development and sensory organs. Furthermore, we touch upon the related ethical issues. CONCLUSIONS: Fibrin glue should be used to treat persistent PTX even in an extremely preterm infant. No adverse effects were observed. At the two-and-a-half-year corrected age follow-up, despite severe bronchopulmonary dysplasia development, no serious pulmonary problems were observed. However, the child's development is uncertain. This situation raises important ethical issues concerning saving the lives of infants at the limit of viability.

Feeding behaivour problems in infants born preterm: a psychological perspective. Preliminary report.

AIM: The study was aimed at exploring feeding behaviour problems reported by parents of premature infants during the first 12 months corrected age. MATERIAL AND METHODS: A subsample of families enrolled in a larger, prospective project on psychological and biological predictors of self-regulation in preterm children participated in the study. The material consisted of data collected from 40 families of preterm infants in the first and fourth and then at six and twelve months corrected age. The children were divided into two groups according to their gestational age: group 1 - 22 children born before 29th week (mean gestational age 26 Hbd and mean birth weight 905 g) and group 2 - 18 children born between 29th and 34th week (mean gestational age 31 Hbd and mean birth weight 1531 g). Semi-structured interviews and daily activity diaries were used. Qualitative, exploratory analysis of parental descriptions of child's feeding behaviour was performed. RESULTS: No feeding behaviour problems were reported in 31.8% infants in group 1 and 44.4% in group 2, whereas chronic feeding behaviour problems - in the case of 5 infants in group 1 (22.7%) and just in one child in group 2 (5.6%). There was a significant association between "gastrointestinal complications of prematurity" and parental reports of feeding behaviour problems at two and more evaluation times. No relationship was found with such variables as: group, child's gender, method of feeding, mother's postnatal depression, or other complications of prematurity. Six major categories of feeding problems were identified: 1) early regulatory problems, 2) pain and/ or excessive spitting, 3) insufficient weight gain, 4) poor eater, 5) difficulties introducing new taste or consistency, and 6) difficulties with introducing self-feeding. These categories occurred with varying frequencies depending on the child's gestational age and the assessment time. CONCLUSION: The results point to an interesting diversity and dynamics of feeding behaviour difficulties in babies born preterm. It was shown that extremely low gestational age as well as gastrointestinal complications of prematurity may contribute to increased parental reports of feeding behaviour difficulties. Further research is needed to disentangle divergent underlying mechanisms of different feeding behaviour problems and describe possible challenges they may imply to the child, parents and their relationship.

[Optimalisation of netilmicin dosage based on therapeutic drug monitoring during the first days of life in very preterm neonates (gestational age 23-32 weeks)]. / Optymalizacja dawkowania netylmycyny w oparciu o terapie monitorowana stezeniem antybiotyku w pierwszych dniach zycia u noworodków bardzo niedojrzalych (23-32 tygodnie ciazy).

AIM: The aim of this study was to optimalise netilmicin dosage in low and very low birthweight premature neonates, based on drug serum concentrations obtained during therapeutic drug monitoring (TDM). PATIENTS AND METHODS: Prospective study of 55 neonates born at gestational age 23-32 (GA) and birthweight between 480 g to 1780 g, with suspected intrauterine infection, in whom netilmicin serum concentration was monitored. Initially the antibiotic was administered every 24 hours (group I: n=16; mean GA=28+/-3 weeks). Peak level was measured 30 minutes after completion of infusion after the 2(nd) dose of the drug, and trough level was measured immediately before administration of the 3(rd) dose of the drug. Due to excessive trough levels, the dosing regimen was modified, prolonging the interval between doses to 48 hours. Such dosing regimen was used in neonates, enrolled in group II (n=39; mean GA=28+/-2 weeks). Pharmacokinetic parameters were evaluated in order to find correlations between them and neonatal maturity, birthweight and creatinine serum concentration. Serum netilmicin concentration was measured by fluorescence polarization immunoassay (FPIA), using TDx/FLx (Abbott Laboratories). Creatinine concentration was measured on the 3(rd) day of life using Cobas Integra 400. All children in the study underwent the first hearing examinations under 3 months of age. After excluding changes which could affect hearing ability, behavioural examination was conducted. If its result was inconclusive or abnormal, the child was referred for ABR (auditory brain stem response) examination. The children were followed-up until they were 2 years old. RESULTS: Netilmicin peak levels in both groups were within the recommended range (11.33+/-3.27 microg/mL in group I; 13.35+/-5.67 microg/mL in group II). Safe trough level was exceeded in 81.2% neonates in group I and 28.2% in group II. This was observed in the most immature neonates: born 23-27(th) GA, with mean birthweight 805+/-293 g, in whom trough level was on average 2.93 microg/mL and t(0.5) was 20.8 hours. Negative correlation was found between trough level and gestational age (r=-0.524; p<0.001) and birthweight (r= -0.293; p=0.030). Negative correlations was also found between t(0.5) and gestational age (r= -0.489; p<0.001) and birthweight (r=-0.320; p=0.016). No child was diagnosed with hearing impairment in group II and one case in group I. CONCLUSIONS: The results indicate that netilmicin dosage of 6 mg/kg every 48 h can ensure the desired trough and peak levels in premature neonates without the necessity of routine monitoring of antibiotic concentration. However, in very premature neonates (

[Current views on cerebral palsy in preterm neonates on the basis of literature search and own data from the PREMATURITAS study]. / Wspólczesne poglady na mózgowe porazenie dzieciece u noworodkówprzedwczesnie urodzonych na podstawie przegladu pismiennictwa i obserwacji prowadzonych w ramach badania PREMATURITAS.

Recent literature concerning the epidemiology and the risk factors of cerebral palsy was reviewed. This search indicates that the prevalence of CP has stabilized in the last few years. Some studies have shown its tendency to decrease, especially in the group of preterm babies born later than 27 weeks of gestation. The important finding is that improvement of the survival rate in the VLBW infants does not increase CP morbidity. Other diagnostic procedures are discussed but head ultrascan remains the golden standard in CP diagnosis during the first 12 months of life, followed by MRI in the second year of life. The first part of this paper is a comparison between the epidemiological studies EPICURE and EPIPAGE from England and France and the Polish regional programme PREMATURITAS. In this study long-term development of preterm infants was evaluated. In all three studies the prevalence of CP was similar, but in the Polish programme the incidence of tetraplegia was highest. The principal factor behind this difference are more frequent changes in the head scan in the Polish study, in form of periventricular leucomalacia (PVL III degree) and IV grade intraventricular haemorrhage (IVH IV grade).

[Prevalence of group B streptococcal colonization in pregnant women and their newborns based on the results of examination of patients in the Obstetric and Gynecology Department of the National Research Institute of Mother and Child--a pilot study]. / Czestosc wystepowania kolonizacji paciorkowcami beta hemolizujacymi grupy B kobiet ciezarnych i noworodkow--okreslona na podstawie badan przeprowadzonych u pacjentek Polikliniki i Kliniki Poloznictwa i Ginekologii Instytutu Matki i Dziecka--badanie pilotazowe.

UNLABELLED: Group B streptococcus is a main cause of perinatal infections and neonatal sepsis. In Poland there is no epidemiological data of the prevalence group B streptococcal colonization in pregnant women and the risk for their newborns. OBJECTIVES: The aim of the study is to define the prevalence of streptococcal B colonization in pregnant women and their newborns. MATERIALS AND METHODS: The pregnant women and their newborns from Obstetric and Gynecology Department of National Research Institute of Mother and Child were included to our study during 2001 and 2002 years. Cervical, vaginal and perianal swab were obtained. Women with positive cultures were treated with antibiotic during labor. The external swabs of their neonate were obtained. RESULTS: 1678 pregnant women took part in our study. The GBS (streptococcus agalactiae) colonization was found in 331 women. The prevalence of pregnant women group B streptococcal colonization in the study is 19.7%. 70 of 203 neonates form mothers with positive results of our screening, had the GBS colonization confirmed. The prevalence of confirmed streptococcal colonization in neonates was 34.5%. One newborn developed early onset neonatal sepsis, during the study period. CONCLUSIONS: The prevalence of pregnant women group B streptococcal colonization about 20%. For the prevention of newborns intrapartum infections a major thing is the prevalence of the transmission risk to newborns from mothers with a GBS colonization and the appropriate intrapartum management.