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1.
BMC Pregnancy Childbirth ; 21(1): 767, 2021 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-34772364

RESUMO

BACKGROUND: The COVID-19 pandemic led to regional or nationwide lockdowns as part of risk mitigation measurements in many countries worldwide. Recent studies suggest an unexpected and unprecedented decrease in preterm births during the initial COVID-19 lockdowns in the first half of 2020. The objective of the current study was to assess the effects of the two months of the initial national COVID-19 lockdown period on the incidence of very and extremely preterm birth in the Netherlands, stratified by either spontaneous or iatrogenic onset of delivery, in both singleton and multiple pregnancies. METHODS: Retrospective cohort study using data from all 10 perinatal centers in the Netherlands on very and extremely preterm births during the initial COVID-19 lockdown from March 15 to May 15, 2020. Incidences of very and extremely preterm birth were calculated using an estimate of the total number of births in the Netherlands in this period. As reference, we used data from the corresponding calendar period in 2015-2018 from the national perinatal registry (Perined). We differentiated between spontaneous versus iatrogenic onset of delivery and between singleton versus multiple pregnancies. RESULTS: The incidence of total preterm birth < 32 weeks in singleton pregnancies was 6.1‰ in the study period in 2020 versus 6.5‰ in the corresponding period in 2015-2018. The decrease in preterm births in singletons was solely due to a significant decrease in iatrogenic preterm births, both < 32 weeks (OR 0.71; 95%CI 0.53 to 0.95) and < 28 weeks (OR 0.53; 95%CI 0.29 to 0.97). For multiple pregnancies, an increase in preterm births < 28 weeks was observed (OR 2.43; 95%CI 1.35 to 4.39). CONCLUSION: This study shows a decrease in iatrogenic preterm births during the initial COVID-19-related lockdown in the Netherlands in singletons. Future studies should focus on the mechanism of action of lockdown measures and reduction of preterm birth and the effects of perinatal outcome.


Assuntos
COVID-19/prevenção & controle , Trabalho de Parto Induzido/tendências , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Feminino , Política de Saúde , Humanos , Doença Iatrogênica/epidemiologia , Incidência , Lactente Extremamente Prematuro , Recém-Nascido , Modelos Logísticos , Países Baixos/epidemiologia , Gravidez , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/tendências , Fatores de Proteção , Estudos Retrospectivos , Fatores de Risco
2.
J Med Econ ; 24(1): 1290-1298, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34709122

RESUMO

BACKGROUND: Extremely preterm (EP) infants have high rates of respiratory morbidity and correspondingly high healthcare resource utilization. OBJECTIVES: Data from the PHARMO Perinatal Research Network were analyzed to quantify the burden of EP birth in the Netherlands. METHODS: A retrospective analysis included infants <28 weeks gestational age with a birth record in the Perinatal Registry (1999-2015) and data in the PHARMO Database Network. Outcomes of interest included select comorbidities, hospital readmissions, and costs of hospitalization and medication up to 1- and 2-years corrected age. Outcomes were stratified by birth period (1999-2005, 2000-2009, 2010-2015) and by diagnosis of bronchopulmonary dysplasia (BPD) and chronic lung disease (CLD). RESULTS: The cohort included 168 EP infants (37 born 1999-2005, 51 born 2006-2009, 80 born 2010-2015). Median (Q1-Q3) birth weights decreased by birth period from 970 (840-1,035) g in 1999-2005 to 853 (695-983) g in 2010-2015. Overall, BPD and CLD were reported during the birth hospitalization in 40% and 29% of infants, respectively; rates of BPD increased and rates of CLD decreased by birth period. Eighty-four percent of EP infants had an additional comorbidity. Mean (standard deviation) costs of birth hospitalization were €110,600 (€73,000) for 1999-2005, €119,350 (€60,650) for 2006-2009, and €138,800 (€130,100) for 2010-2015. Birth hospitalization and total costs for up to 1- and 2-years corrected age were higher for infants with BPD and/or CLD than for those without either complication. CONCLUSION: Healthcare resource utilization and costs for EP infants, especially for those with respiratory morbidities, increased between 1999 and 2015. Future cost-effectiveness analyses are essential to determine the economic impact of this change and underscore the need for new therapeutic interventions to decrease clinical sequelae in this vulnerable population.


Assuntos
Displasia Broncopulmonar , Nascimento Prematuro , Displasia Broncopulmonar/epidemiologia , Atenção à Saúde , Feminino , Idade Gestacional , Humanos , Lactente , Lactente Extremamente Prematuro , Recém-Nascido , Morbidade , Países Baixos/epidemiologia , Gravidez , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos
3.
Nutrients ; 13(10)2021 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-34684410

RESUMO

BACKGROUND: Determining optimal nutritional regimens in extremely preterm infants remains challenging. This study aimed to evaluate the effect of a new nutritional regimen and individual macronutrient intake on white matter integrity and neurodevelopmental outcome. METHODS: Two retrospective cohorts of extremely preterm infants (gestational age < 28 weeks) were included. Cohort B (n = 79) received a new nutritional regimen, with more rapidly increased, higher protein intake compared to cohort A (n = 99). Individual protein, lipid, and caloric intakes were calculated for the first 28 postnatal days. Diffusion tensor imaging was performed at term-equivalent age, and cognitive and motor development were evaluated at 2 years corrected age (CA) (Bayley-III-NL) and 5.9 years chronological age (WPPSI-III-NL, MABC-2-NL). RESULTS: Compared to cohort A, infants in cohort B had significantly higher protein intake (3.4 g/kg/day vs. 2.7 g/kg/day) and higher fractional anisotropy (FA) in several white matter tracts but lower motor scores at 2 years CA (mean (SD) 103 (12) vs. 109 (12)). Higher protein intake was associated with higher FA and lower motor scores at 2 years CA (B = -6.7, p = 0.001). However, motor scores at 2 years CA were still within the normal range and differences were not sustained at 5.9 years. There were no significant associations with lipid or caloric intake. CONCLUSION: In extremely preterm born infants, postnatal protein intake seems important for white matter development but does not necessarily improve long-term cognitive and motor development.


Assuntos
Cognição , Dieta , Proteínas na Dieta/administração & dosagem , Ingestão de Alimentos , Lactente Extremamente Prematuro/crescimento & desenvolvimento , Destreza Motora , Substância Branca/crescimento & desenvolvimento , Anisotropia , Imagem de Tensor de Difusão , Ingestão de Energia , Feminino , Humanos , Fórmulas Infantis , Recém-Nascido , Masculino , Estudos Retrospectivos , Substância Branca/diagnóstico por imagem
4.
BMC Pediatr ; 21(1): 420, 2021 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-34556084

RESUMO

BACKGROUND: In-utero weight gain can be achieved in very preterm infants through rapid advancement of enteral feeds without increasing risk of necrotizing enterocolitis. There are concerns, however, that such rapid weight gain may lead to an increased childhood adiposity risk, although long-term data are sparse. DESIGN: This retrospective observational study included two well-characterized cohorts comprising 145 infants born at < 28 weeks or with < 1000 g birth weight. We investigated associations between advancing enteral feeding volumes in daily increments of 15-20 ml/kg (Cohort 1, n = 84, born in 2006/2007) vs. 25-30 ml/kg (Cohort 2, n = 61, born in 2010) and growth up to 5 years of age. RESULTS: There was no significant difference in anthropometric parameters post discharge to 5 years between both cohorts. Standard deviation score (SDS) weight and SDS BMI at the age of 5 years remained lower than in the reference population. SDS weight decreased from discharge to about 10-12 months postnatal age and returned to birth values by age 5 years. There was a catch-up for SDS length/height from discharge to 5 years; SDS head circumference decreased from birth to 5 years. Multiple regression analyses revealed that for all anthropometric parameters SDS at birth was the most important predictor for SDS at 5 years. Early parenteral protein intake may be another important factor, at least for head growth. CONCLUSIONS: Growth was similar in both cohorts without benefit from more accelerated feeding advancement in cohort 2. In both cohorts, early enteral nutrition was associated with in-hospital weight gain as in utero, a drop in weight SDS post discharge and catch-up to birth SDS until age 5 years, remaining below the reference population. Length showed catch-up form discharge to 5 years, whereas head circumference progressively deviated from the reference population. Increased parenteral protein supplementation may be needed to accompany early enteral feeding advancements.


Assuntos
Nutrição Enteral , Enterocolite Necrosante , Adolescente , Assistência ao Convalescente , Criança , Pré-Escolar , Humanos , Lactente , Lactente Extremamente Prematuro , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Alta do Paciente
5.
BMC Pediatr ; 21(1): 402, 2021 09 13.
Artigo em Inglês | MEDLINE | ID: mdl-34517869

RESUMO

BACKGROUND: Very preterm children generally perform poorly in executive functions and particularly in working memory. Adaptive training tasks encouraging these children to work continuously on their personal working memory capacity can be very useful. Above all in preschool-age children, several cognitive training programs focused on improving working memory capacity. Cogmed is a computerized visuospatial cognitive training program that improves working memory in children and adolescents with attention-deficit/hyperactivity disorder. The main objective is to assess the long-term effects (18 months) of cognitive training (Cogmed) on visuospatial processing in preschool-age very preterm children with working memory impairment. METHODS: The EPIREMED study is a prospective, randomized, controlled, multicentric trial nested in a population based epidemiological survey. An intervention group (Cogmed cognitive training) and a control group (standard care management) will compare children aged 5½ to 6 years, born between 24- and 34-weeks' gestational age, with a global intelligence quotient > 70 and a working memory index < 85. The study will include 166 children from national study EPIPAGE-2 (Epidemiological Study on Small Gestational Ages). The intervention consists of 25 sessions administered over a 5- to 8-week period. The primary endpoint will be the visuospatial processing, assessed by the score of the visuospatial index: score of the WPPSI-IV (Wechsler Preschool and Primary Scale of Intelligence). The secondary endpoints will allow to assess the executive functions, language and abilities, infant behavior, quality of life assessment, school performance and parental anxiety. DISCUSSION: This project's primary goal is to demonstrate the necessity of early visuospatial memory assessment within the vulnerable population of very preterm children, and to prove the feasibility and efficacy of computerized cognitive training using online software programs. A better global neuropsychological development improvement (visuospatial processing and other far transfer) can be expected with an improvement in learning and decreased behavioral problems. In the long term, these improvements might also reduce those global costs linked to the consequences of extreme prematurity. TRIAL REGISTRATION: NCT02757794 (registered on 2nd May 2016 at ClinicalTrial.gov).


Assuntos
Lactente Extremamente Prematuro , Memória de Curto Prazo , Adolescente , Criança , Pré-Escolar , Humanos , Recém-Nascido , Transtornos da Memória , Estudos Prospectivos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
BMC Med Ethics ; 22(1): 129, 2021 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-34563198

RESUMO

BACKGROUND: Deciding whether to resuscitate extremely preterm infants (EPIs) is clinically and ethically problematic. The aim of the study was to understand neonatologists' clinical-ethical decision-making for resuscitation of EPIs. METHODS: We conducted a qualitative study in Belgium, following a constructivist account of the Grounded Theory. We conducted 20 in-depth, face-to-face, semi-structured interviews with neonatologists. Data analysis followed the qualitative analysis guide of Leuven. RESULTS: The main principles guiding participants' decision-making were EPIs' best interest and respect for parents' autonomy. Participants agreed that justice as resource allocation should not be considered in resuscitation decision-making. The main ethical challenge for participants was dealing with the conflict between EPIs' best interest and respect for parents' autonomy. This conflict was most prominent when parents and clinicians disagreed about births within the gray zone (24-25 weeks). Participants' coping strategies included setting limits on extent of EPI care provided and rigidly following established guidelines. However, these strategies were not always feasible or successful. Although rare, these situations often led to long-lasting moral distress. CONCLUSIONS: Participants' clinical-ethical reasoning for resuscitation of EPIs can be mainly characterized as an attempt to balance EPIs' best interest and respect for parents' autonomy. This approach could explain why neonatologists considered conflicts between these principles as their main ethical challenge and why lack of resolution increases the risk of moral distress. Therefore, more research is needed to better understand moral distress in EPI resuscitation decisions. CLINICAL TRIAL REGISTRATION: The study received ethical approval from the ethics committee of UZ/KU Leuven (S62867). Confidentiality of personal information and anonymity was guaranteed in accordance with the General Data Protection Regulation of 25 May 2018.


Assuntos
Lactente Extremamente Prematuro , Neonatologistas , Tomada de Decisões , Humanos , Recém-Nascido , Pais , Pesquisa Qualitativa , Ressuscitação , Ordens quanto à Conduta (Ética Médica)
7.
Lancet Child Adolesc Health ; 5(10): 719-728, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34450109

RESUMO

BACKGROUND: Intrauterine and postnatal weight are widely regarded as biomarkers of fetal and neonatal wellbeing, but optimal weight gain following preterm birth is unknown. We aimed to describe changes over time in birthweight and postnatal weight gain in very and extremely preterm babies, in relation to major morbidity and healthy survival. METHODS: In this cohort study, we used whole-population data from the UK National Neonatal Research Database for infants below 32 weeks gestation admitted to neonatal units in England and Wales between Jan 1, 2008, and Dec 31, 2019. We used non-linear Gaussian process to estimate monthly trends, and Bayesian multilevel regression to estimate unadjusted and adjusted coefficients. We evaluated birthweight; weight change from birth to 14 days; weight at 36 weeks postmenstrual age; associated Z scores; and longitudinal weights for babies surviving to 36 weeks postmenstrual age with and without major morbidities. We adjusted birthweight for antenatal, perinatal, and demographic variables. We additionally adjusted change in weight at 14 days and weight at 36 weeks postmenstrual age, and their Z scores, for postnatal variables. FINDINGS: The cohort comprised 90 817 infants. Over the 12-year period, mean differences adjusted for antenatal, perinatal, demographic, and postnatal variables were 0 g (95% compatibility interval -7 to 7) for birthweight (-0·01 [-0·05 to 0·03] for change in associated Z score); 39 g (26 to 51) for change in weight from birth to 14 days (0·14 [0·08 to 0·19] for change in associated Z score); and 105 g (81 to 128) for weight at 36 weeks postmenstrual age (0·27 [0·21 to 0·33] for change in associated Z score). Greater weight at 36 weeks postmenstrual age was robust to additional adjustment for enteral nutritional intake. In babies surviving without major morbidity, weight velocity in all gestational age groups stabilised at around 34 weeks postmenstrual age at 16-25 g per day along parallel percentile lines. INTERPRETATION: The birthweight of very and extremely preterm babies has remained stable over 12 years. Early postnatal weight loss has decreased, and subsequent weight gain has increased, but weight at 36 weeks postmenstrual age is consistently below birth percentile. In babies without major morbidity, weight velocity follows a consistent trajectory, offering opportunity to construct novel preterm growth curves despite lack of knowledge of optimal postnatal weight gain. FUNDING: UK Medical Research Council.


Assuntos
Peso ao Nascer/fisiologia , Lactente Extremamente Prematuro/crescimento & desenvolvimento , Ganho de Peso , Bases de Dados Factuais , Inglaterra , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido de Peso Extremamente Baixo ao Nascer/crescimento & desenvolvimento , Recém-Nascido , Estudos Longitudinais , Masculino , País de Gales
8.
Acta Paediatr ; 110(11): 3021-3029, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34346114

RESUMO

AIM: This study assessed the self-reported health perception and use of health care by adults born very preterm before 30 weeks of gestation. METHODS: The participants were part of a cross-sectional observational study that assessed the global health of young adults aged 18-29 years born very preterm in Quebec, Canada. Health perception was explored from 2011 to 2016 using the second Short-Form 36 Health Survey (SF-36v2), and objective health measures were obtained. Further in-depth open-ended questions were asked in 2018. RESULTS: The 101 preterm subjects had similar perceptions of their health to 105 term-born controls, according to the SF-36v2, despite significantly more adverse health conditions. Their healthcare use was similar. However, the later in-depth questionnaire showed that 23% of 45 preterm subjects and 3% of 34 term-born subjects perceived their health as poorer than the general population. Major factors that could improve their respective health were lifestyle habits (74% vs. 81%) and eliminating specific adverse symptoms (52% vs. 27%). Only 10% of preterm individuals had been asked about their perinatal history by physicians. CONCLUSION: Adults born very preterm said their health was poorer than the general population and identified specific factors that should be addressed during routine health monitoring.


Assuntos
Lactente Extremamente Prematuro , Percepção , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Gravidez , Autorrelato , Inquéritos e Questionários , Adulto Jovem
9.
J Perinatol ; 41(10): 2519-2525, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34453113

RESUMO

OBJECTIVE: Evaluate the association of late treatment with acetaminophen vs. immediate surgical ligation with death or neurodevelopmental impairment (NDI) among extremely low gestational age neonates (ELGANs) with persistent patent ductus arteriosus (pPDA). STUDY DESIGN: Retrospective comparative epoch study of ELGANs with pPDA being considered for surgical ligation. ELGANs in epoch 1 (2009-2012) were referred for ligation, while infants in epoch 2 (2012-2015) were treated with oral acetaminophen and referred for ligation in the absence of improvement. The primary outcome was a composite of death/NDI at 18-24 months. RESULTS: Ninety-two ELGANs with median[IQR] GA 25.2 weeks [24.4, 26.3] had pPDA (43 in epoch 1, 49 in -epoch 2) with acetaminophen-exposed neonates receiving 7 days [7, 7] of treatment. ELGANs in epoch 2 had reduced ligation (aOR 0.30; 95%CI: [0.11, 0.87]), but there was no difference in death/NDI (aOR 1.03; 95%CI: [0.30, 3.56]). CONCLUSIONS: Late treatment with acetaminophen to avoid surgery for pPDA is associated with reduced ligation but no difference in death/NDI, supporting the safety and effectiveness of this approach.


Assuntos
Acetaminofen , Permeabilidade do Canal Arterial , Permeabilidade do Canal Arterial/tratamento farmacológico , Permeabilidade do Canal Arterial/cirurgia , Idade Gestacional , Humanos , Lactente , Lactente Extremamente Prematuro , Recém-Nascido , Ligadura , Estudos Retrospectivos , Resultado do Tratamento
10.
eNeuro ; 8(5)2021.
Artigo em Inglês | MEDLINE | ID: mdl-34373253

RESUMO

Children born very preterm (<33 weeks of gestation) are at a higher risk of developing socio-emotional difficulties compared with those born at term. In this longitudinal study, we tested the hypothesis that diffusion characteristics of white matter (WM) tracts implicated in socio-emotional processing assessed in the neonatal period are associated with socio-emotional development in 151 very preterm children previously enrolled into the Evaluation of Preterm Imaging study (EudraCT 2009-011602-42). All children underwent diffusion tensor imaging at term-equivalent age and fractional anisotropy (FA) was quantified in the uncinate fasciculus (UF), inferior fronto-occipital fasciculus (IFOF), inferior longitudinal fasciculus (ILF), and superior longitudinal fasciculus (SLF). Children's socio-emotional development was evaluated at preschool age (median = 4.63 years). Exploratory factor analysis conducted on the outcome variables revealed a three-factor structure, with latent constructs summarized as: "emotion moderation," "social function," and "empathy." Results of linear regression analyses, adjusting for full-scale IQ and clinical and socio-demographic variables, showed an association between lower FA in the right UF and higher "emotion moderation" scores (ß = -0.280; p < 0.001), which was mainly driven by negative affectivity scores (ß = -0.281; p = 0.001). Results further showed an association between higher full-scale IQ and better social functioning (ß = -0.334, p < 0.001). Girls had higher empathy scores than boys (ß = -0.341, p = 0.006). These findings suggest that early alterations of diffusion characteristics of the UF could represent a biological substrate underlying the link between very preterm birth and emotional dysregulation in childhood and beyond.


Assuntos
Nascimento Prematuro , Substância Branca , Criança , Pré-Escolar , Imagem de Tensor de Difusão , Emoções , Feminino , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Estudos Longitudinais , Masculino , Gravidez , Substância Branca/diagnóstico por imagem
11.
Pediatrics ; 148(3)2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34380775

RESUMO

OBJECTIVES: Preterm birth has been linked with increased risk of autism spectrum disorder (ASD); however, potential causality, sex-specific differences, and association with early term birth are unclear. We examined whether preterm and early term birth are associated with ASD in a large population-based cohort. METHODS: A national cohort study was conducted of all 4 061 795 singleton infants born in Sweden during 1973-2013 who survived to age 1 year, who were followed-up for ASD identified from nationwide outpatient and inpatient diagnoses through 2015. Poisson regression was used to determine prevalence ratios for ASD associated with gestational age at birth, adjusting for confounders. Cosibling analyses were used to assess the influence of unmeasured shared familial (genetic and/or environmental) factors. RESULTS: ASD prevalences by gestational age at birth were 6.1% for extremely preterm (22-27 weeks), 2.6% for very to moderate preterm (28-33 weeks), 1.9% for late preterm (34-36 weeks), 2.1% for all preterm (<37 weeks), 1.6% for early term (37-38 weeks), and 1.4% for term (39-41 weeks). The adjusted prevalence ratios comparing extremely preterm, all preterm, or early term versus term, respectively, were 3.72 (95% confidence interval, 3.27-4.23), 1.35 (1.30-1.40), and 1.11 (1.08-1.13) among boys and 4.19 (3.45-5.09), 1.53 (1.45-1.62), and 1.16 (1.12-1.20) among girls (P < .001 for each). These associations were only slightly attenuated after controlling for shared familial factors. CONCLUSIONS: In this national cohort, preterm and early term birth were associated with increased risk of ASD in boys and girls. These associations were largely independent of covariates and shared familial factors, consistent with a potential causal relationship.


Assuntos
Transtorno do Espectro Autista/epidemiologia , Nascimento Prematuro/epidemiologia , Nascimento a Termo , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Masculino , Gravidez , Prevalência , Sistema de Registros , Irmãos , Suécia/epidemiologia
12.
Pediatrics ; 148(3)2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34452979

RESUMO

BACKGROUND AND OBJECTIVES: Children born very preterm (<32 weeks' gestation) have more neurodevelopmental problems compared with term-born peers. Aberrant fidgety movements (FMs) are associated with adverse motor outcomes in children born very preterm. However, associations of aberrant FMs combined with additional movements and postures to give a motor optimality score-revised (MOS-R) with school-aged cognitive and motor outcomes are unclear. Our aim with this study was to determine those associations. METHODS: Of 118 infants born <30 weeks' gestation recruited into a randomized controlled trial of early intervention, 97 had a general movements assessment at 3 months' corrected age and were eligible for this study. Early motor repertoire including FMs and MOS-R were scored from videos of infant's spontaneous movement at 3 months' corrected age. At 8 years' corrected age, cognitive and motor performances were evaluated. Associations of early FMs and MOS-R with outcomes at 8 years were determined using linear regression. RESULTS: Seventy-eight (80%) infants with early motor repertoire data had neurodevelopmental assessments at 8 years. A higher MOS-R, and favorable components of the individual subscales of the MOS-R, including the presence of normal FMs, were associated with better performance for general cognition, attention, working memory, executive function and motor function at 8 years; eg, presence of normal FMs was associated with a 21.6 points higher general conceptual ability score (95% confidence interval: 12.8-30.5; P < .001) compared with absent FMs. CONCLUSIONS: Favorable early motor repertoire of infants born <30 weeks is strongly associated with improved cognitive and motor performance at 8 years.


Assuntos
Cognição/fisiologia , Lactente Extremamente Prematuro/fisiologia , Desempenho Psicomotor/fisiologia , Criança , Transtornos Cognitivos/prevenção & controle , Intervenção Médica Precoce , Feminino , Seguimentos , Humanos , Recém-Nascido , Masculino , Transtornos das Habilidades Motoras/prevenção & controle , Exame Neurológico , Testes Neuropsicológicos
13.
Matern Child Health J ; 25(10): 1638-1645, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34387796

RESUMO

INTRODUCTION: Extremely preterm births (EPT), require complex decision making and significant medical interventions. While environmental factors such as ambient temperature extremes have been associated with preterm births, little is known of the environmental associations with EPT births. The objective of this study is to explore whether ambient temperature is associated with increased risk of EPT birth. METHODS: Birth records for 315,226 infants born in Queensland Australia (2007-2015) were matched to average maximum and minimum temperature for the last month of pregnancy. Odds ratios and 95% confidence intervals were calculated using a generalised linear model. Population attributable risk was calculated for a 5% reduction in maximum temperature. RESULTS: Each one degree increase in maximum [aOR 1.03 (95% CI 1.01, 1.05)] and minimum temperature [aOR 1.02 (95% CI 1.01, 1.04)] was associated with an increase in odds for EPT birth. Increased odds for EPT births was found for maternal smoking [aOR 1.46 (95% CI 1.23, 1.72)], increasing plurality [OR 6.38 (95% CI 5.48, 7.42)] and stillbirth [aOR 342.99 (95% CI 295.53, 398.06)]. When stratified by birth status, the association was only found for live births. DISCUSSION: Higher temperatures are associated with small increases in the odds of delivering an infant in the EPT period. The risk may be enhanced for women who smoke during pregnancy. Women at an increased risk of preterm births should be counselled around methods to reduce their exposure to excessive heat.


Assuntos
Nascimento Prematuro , Feminino , Humanos , Lactente , Lactente Extremamente Prematuro , Recém-Nascido , Nascido Vivo , Gravidez , Nascimento Prematuro/epidemiologia , Natimorto , Temperatura
14.
Sleep Med ; 85: 157-165, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34333198

RESUMO

AIM: To determine whether children born extremely preterm are at increased risk for sleep disturbances and to explore relationships between extremely preterm birth, sleep and attention-deficit/hyperactivity disorder (ADHD) symptoms and emotional symptoms. METHOD: EPICure2 cohort study. Parents of 165 children born ≤26 weeks' gestation (53% male) and 121 children born at term (43% male) completed the Children's Sleep Habits Questionnaire, sleep disordered breathing subscale of the Pediatric Sleep Questionnaire, the emotional problems scale of the Strengths and Difficulties Questionnaire and the ADHD Rating Scale-5 at 11 years of age. RESULTS: Extremely preterm children had greater habitual snoring (adjusted odds ratio 6.8; 95% confidence interval 2.3, 20.3), less frequently fell asleep within 20 minutes (Cohen's d 0.33), higher night wakings (d 0.44) and daytime sleepiness scores (d 0.40) than term-born children; there was no between-group difference in sleep duration scores. Among children without severe disability, night wakings scores partially mediated the relationship between preterm birth and inattention (additional 5% of variance explained), hyperactivity/impulsivity (13%) and emotional problems (9%). Snoring partially mediated the relationship between preterm birth, hyperactivity/impulsivity and inattention (additional 1-5% of variance). CONCLUSION: Children born extremely preterm are at increased risk of disturbed sleep compared to term-born children. As night wakings partially mediated the relationship between preterm birth and ADHD symptoms and emotional problems, reducing sleep disturbance may improve sleep and reduce attention and emotional problems in this population.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Nascimento Prematuro , Transtornos do Sono-Vigília , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Criança , Estudos de Coortes , Feminino , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Masculino , Gravidez , Sono , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/etiologia , Inquéritos e Questionários
15.
Acta Paediatr ; 110(11): 3030-3039, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34289173

RESUMO

AIM: To investigate the ability of the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III), scores to predict later Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV), performances in a cohort of children born extremely preterm. METHODS: 323 children, born <27 gestational weeks, were tested with the Bayley-III at corrected age 2.5 years and with the WISC-IV at 6.5 years. Regression analyses investigated the association between Bayley-III scores and WISC-IV full-scale intelligence quotient (IQ). The ability of Bayley-III Cognitive Index scores to predict low IQ was evaluated using receiver operating characteristic curves. RESULTS: Bayley-III Cognitive Index scores and IQ had a moderately positive correlation and accounted for 38% of the IQ variance. Using a Bayley-III cut-off score of 70, the sensitivity to detect children with IQ<70 was 18%, and false positive rate was 7%. A Bayley-III cut-off score of 85 corresponded to sensitivity and false positive rates of 44% and 7%, respectively. CONCLUSIONS: Results emphasise the relative importance of Bayley-III Cognitive Index scores as predictors of IQ. An 85 score cut-off for suspecting subnormal IQ is supported. A less conservative threshold would increase identification of true cases yet increase the risk of wrongly diagnosing children.


Assuntos
Desenvolvimento Infantil , Lactente Extremamente Prematuro , Criança , Pré-Escolar , Cognição , Deficiências do Desenvolvimento , Feminino , Humanos , Lactente , Recém-Nascido , Inteligência , Testes Neuropsicológicos
16.
17.
Pediatr Surg Int ; 37(11): 1607-1612, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34304286

RESUMO

INTRODUCTION: Intestinal malrotation is life-threatening and often presents during infancy with bilious vomiting. The prevalence and presentation among extremely premature infants are unknown. METHODS: We retrospectively reviewed all infants born at less than 28 weeks' gestation diagnosed with symptomatic intestinal malrotation in a tertiary neonatal intensive care unit over a 10-year period (2010-2020). RESULTS: Seven of 514 (1.4%) extremely premature infants developed symptomatic intestinal malrotation during this period. All were non-syndromic. In comparison, the prevalence of symptomatic intestinal malrotation in 7382 infants ≥ 28 weeks' gestation admitted during the same period was 0.2%. Intestinal malrotation was confirmed at laparotomy in all extremely premature infants and six of seven had midgut volvulus. All but one presented with marked abdominal distension; none had bilious vomiting and only three had bilious gastric aspirates. A subacute onset with non-specific features such as recurrent apnoea and bradycardia, feed intolerance, and intermittent abdominal distension was common. All infants underwent a Ladd procedure. Two required extensive bowel resection resulting in short gut syndrome and three underwent further surgery for adhesive small bowel obstruction. One patient died at 10 months of age from respiratory failure but the others were well 1-3 years later. CONCLUSIONS: Symptomatic intestinal malrotation in extremely premature infants has a relatively high prevalence. It may present with marked abdominal distension without bilious vomiting, demanding a high index of suspicion. An atypical presentation, potential alternative abdominal pathologies, coexisting comorbidities, and concerns about survival in these fragile babies may deter the surgeon despite the opportunity of a good outcome.


Assuntos
Anormalidades do Sistema Digestório , Obstrução Intestinal , Volvo Intestinal , Pré-Escolar , Anormalidades do Sistema Digestório/complicações , Anormalidades do Sistema Digestório/epidemiologia , Anormalidades do Sistema Digestório/cirurgia , Humanos , Lactente , Lactente Extremamente Prematuro , Recém-Nascido , Volvo Intestinal/complicações , Volvo Intestinal/diagnóstico , Volvo Intestinal/epidemiologia , Estudos Retrospectivos
19.
Clin Pharmacol Ther ; 110(4): 1087-1095, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34314519

RESUMO

In preterm infants, a high risk of hemodynamically significant patent ductus arteriosus (PDA) exists and its persistence is associated with an increased risk of severe morbidity. Current pharmacological options include ibuprofen or indomethacin. However, treatment by indomethacin or ibuprofen of a large PDA was shown to reduce early pulmonary hemorrhage and later medical treatment but had no effect on neonatal death or morbidity. Early prophylactic treatment of ductus arteriosus by paracetamol seems to be an attractive opportunity to reduce life-threatening morbidity. However, there are currently no data regarding the pharmacokinetics (PK) and pharmacodynamics of paracetamol in preterm neonates in this potential new indication. In this study, we aimed to develop a population PK model for paracetamol and investigate the relationship between paracetamol exposure levels and time to contraction of the ductus. Data were modeled using Monolix software. A one-compartment model adequately described the paracetamol concentration-time course. A Weibull model adequately described the time to contraction of the ductus. Our results suggest that the dosage used in this study (i.e., first day 42.5 mg/kg, then 30 mg/kg/day) allows for reaching the maximum inhibition response from paracetamol regarding the time to close the ductus. However, this study pointed out a lower effect of paracetamol on extremely preterm neonates (below 27 weeks). Therefore, a dose-finding study focusing specifically on extremely preterm neonates with treatment efficacy and toxicity is strongly needed.


Assuntos
Acetaminofen/farmacocinética , Analgésicos não Narcóticos/farmacocinética , Permeabilidade do Canal Arterial/tratamento farmacológico , Lactente Extremamente Prematuro/metabolismo , Recém-Nascido Prematuro/metabolismo , Acetaminofen/uso terapêutico , Administração Intravenosa , Analgésicos não Narcóticos/uso terapêutico , Permeabilidade do Canal Arterial/diagnóstico por imagem , Ecocardiografia , Feminino , Humanos , Recém-Nascido , Masculino , Fatores de Tempo
20.
J Pediatr ; 238: 110-117.e2, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34214587

RESUMO

OBJECTIVE: To establish longitudinal reference values for cerebral ventricular size in the most vulnerable patients at risk for intraventricular hemorrhage (IVH) and posthemorrhagic ventricular dilatation (PHVD). STUDY DESIGN: This retrospective study included neurologically healthy preterm neonates born at 230/7-266/7 weeks of gestational age between September 2011 and April 2019. Patients were treated at 2 Austrian tertiary centers, Medical University of Vienna and Medical University of Innsbruck. All available cerebral ultrasound scans until 30 weeks corrected age were analyzed. Ventricular measurements included ventricular index, anterior horn width (AHW), and thalamo-occipital distance (TOD) and longitudinal percentiles were created. RESULTS: The study cohort consisted of 244 preterm neonates, with a median gestational age of 253/7 weeks (IQR, 244/7-260/7 weeks) and a median birth weight of 735 g (IQR, 644-849 g). A total of 993 ultrasound scans were available for analysis, resulting in >1800 measurements of ventricular index, AHW, and TOD. Special attention was given to the 97th percentile as well as 2 mm and 4 mm above the 97th percentile, which are used internationally as cutoffs for intervention in the presence of PHVD. CONCLUSIONS: We present percentile charts based on a cohort of extremely premature infants including neonates born at the border of viability suited to follow-up the most vulnerable patients at risk for IVH and PHVD. Furthermore, we provide an extensive literature research and comparison of all available reference values, focusing on ventricular index, AHW, and TOD.


Assuntos
Ventrículos Cerebrais/anatomia & histologia , Lactente Extremamente Prematuro , Ventrículos Cerebrais/diagnóstico por imagem , Feminino , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Valores de Referência , Estudos Retrospectivos , Ultrassonografia/métodos
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