[USING INFORMATION FROM COMPUTERIZED MEDICAL FILES TO DETERMINE THE RISK OF POOR OUTCOME IN EXTREMELY PRETERM INFANTS].

INTRODUCTION: During the last two decades preterm deliveries have been rising with increasing numbers of survivors at risk of abnormal outcomes. Characterization of risk factors for abnormal outcome is important for caregivers and patients' families. We hypothesized that it is possible to evaluate significant risk factors from computerized files early in life. OBJECTIVES: To evaluate data from computerized files that could help identify children born preterm at increased risk of abnormal outcomes without a neurodevelopmental exam. METHODS: This is a retrospective cohort study including children born at less than 29 weeks gestation and/or less than 1000 grams. The long term outcome was defined using data from the local child developmental center. Risk factors were retrieved from computerized files from birth until 3 years of age and assessed using univariate and multivariate analysis. RESULTS: A total of 74 children were included in the study; 30 with abnormal outcomes. The following parameters: Bedouin origin (p = 0.033), low 1 minute Apgar score (p = 0.044), late sepsis (p = 0.017), exposure to x-rays (p = 0.033), hospital based specialist visits (p = 0.017) and hospitalization (p = 0.035) were more common in the abnormal outcome group or increased its risk in univariate analysis. Bedouin origin (OR = 3.81-5.11), late sepsis (OR = 4.07-4.94) and hospital based specialist visits (OR = 4.67, 95% CI = 1.11-19.55) increased more than fourfold the risk of abnormal outcomes in multivariate analysis. CONCLUSIONS: This study has important implications as Bedouin origin and llate sepsis can be determined before discharge. Furthermore, follow-up of high risk children should be locally accessible. Prevention of late sepsis is of upmost importance, as well as awareness of specialists to the follow-up status of children born preterm.

The effect of changing respiratory rate settings on CO2 levels during nasal intermittent positive pressure ventilation (NIPPV) in premature infants.

OBJECTIVE: To examine the change in CO2, when applying NIPPV with either a low or a high rate in stable premature infants. STUDY DESIGN: Prospective, controlled, crossover study. Preterm infants on NIPPV were monitored by tcCO2 during two rate changes switching every hour between high (30 bpm) and low (10 bpm) set rates. RESULTS: Fifty premature infants (mean ± SD: 28.3 ± 2.4 weeks' gestation) were enrolled. Each infant had two rate changes; therefore, a hundred rate changes were studied. The mean change in tcCO2, i.e., ΔtcCO2 (95% confidence-interval), was -1.1 (-2.3 to 0.1) mmHg for increasing rate from low to high, and 0.46 (-0.49 to 1.41) mmHg for decreasing rate from high to low. CONCLUSION: Multiplying or dividing the rate settings by three did not significantly change the tcCO2 readings an hour after the change. These findings could affect the management of ventilation settings of NIPPV in premature infants. CLINICAL TRIAL REGISTRY: ClinicalTrials.gov ID: NCT04836689 , The name of the trial registry: "Influence of Respiratory Rate Settings on CO2 Levels During Nasal Intermittent Positive Pressure Ventilation (NIPPV)."