Variation in very preterm extrauterine growth in a European multicountry cohort.

OBJECTIVE: Extrauterine growth restriction (EUGR) among very preterm infants is related to poor neurodevelopment, but lack of consensus on EUGR measurement constrains international research. Our aim was to compare EUGR prevalence in a European very preterm cohort using commonly used measures. DESIGN: Population-based observational study. SETTING: 19 regions in 11 European countries. PATIENTS: 6792 very preterm infants born before 32 weeks' gestational age (GA) surviving to discharge. MAIN OUTCOME MEASURES: We investigated two measures based on discharge-weight percentiles with (1) Fenton and (2) Intergrowth (IG) charts and two based on growth velocity (1) birth weight and discharge-weight Z-score differences using Fenton charts and (2) weight-gain velocity using Patel's model. We estimated country-level relative risks of EUGR adjusting for maternal and neonatal characteristics and associations with population differences in healthy newborn size, measured by mean national birth weight at 40 weeks' GA. RESULTS: About twofold differences in EUGR prevalence were observed between countries for all indicators and these persisted after case-mix adjustment. Discharge weight <10th percentile using Fenton charts varied from 24% (Sweden) to 60% (Portugal) and using IG from 13% (Sweden) to 43% (Portugal), while low weight-gain velocity ranged from 35% (Germany) to 62% (UK). Mean term birth weight strongly correlated with both percentile-based measures (Spearman's rho=-0.90 Fenton, -0.84 IG, p<0.01), but not Patel's weight-gain velocity (rho: -0.38, p=0.25). CONCLUSIONS: Very preterm infants have a high prevalence of EUGR, with wide variations between countries in Europe. Variability associated with mean term birth weight when using common postnatal growth charts complicates international benchmarking.

Wide variation in severe neonatal morbidity among very preterm infants in European regions.

OBJECTIVE: To investigate the variation in severe neonatal morbidity among very preterm (VPT) infants across European regions and whether morbidity rates are higher in regions with low compared with high mortality rates. DESIGN: Area-based cohort study of all births before 32 weeks of gestational age. SETTING: 16 regions in 11 European countries in 2011/2012. PATIENTS: Survivors to discharge from neonatal care (n=6422). MAIN OUTCOME MEASURES: Severe neonatal morbidity was defined as intraventricular haemorrhage grades III and IV, cystic periventricular leukomalacia, surgical necrotizing enterocolitis and retinopathy of prematurity grades ≥3. A secondary outcome included severe bronchopulmonary dysplasia (BPD), data available in 14 regions. Common definitions for neonatal morbidities were established before data abstraction from medical records. Regional severe neonatal morbidity rates were correlated with regional in-hospital mortality rates for live births after adjustment on maternal and neonatal characteristics. RESULTS: 10.6% of survivors had a severe neonatal morbidity without severe BPD (regional range 6.4%-23.5%) and 13.8% including severe BPD (regional range 10.0%-23.5%). Adjusted inhospital mortality was 13.7% (regional range 8.4%-18.8%). Differences between regions remained significant after consideration of maternal and neonatal characteristics (P<0.001) and severe neonatal morbidity rates were not correlated with mortality rates (P=0.50). CONCLUSION: Severe neonatal morbidity rates for VPT survivors varied widely across European regions and were independent of mortality rates.

Monitoring of haemoglobin oxygen saturation in healthy infants using a new generation pulse oximeter which takes motion artifacts into account.

UNLABELLED: The aim of this study was to establish normal values for overnight oxygen saturation (SpO2) in healthy term infants using an oximeter which takes into account motion artifacts and to compare these to normal values collected with a previous generation oximeter not correcting for motion artifacts. We recorded overnight SpO2 in 26 term, healthy infants (median age 136 days, range 6-364 days) in the home environment using the Nellcor Symphony N 3000 pulse oximeter with an averaging time of 3 s. A sample rate of 5 s was chosen. Motion artifacts were excluded from the analysis. Data were compared with those from a previous study, using the same inclusion and exclusion criteria with the Oxford Medilog. Median (quartiles) SpO2 was 98% (97%-99%). Median percentage of study time below SpO2 94% was 0.2% (0.1%-0.7%); median percentage of study time below SpO2 90% was 0.0% (0.0%-0.01%). Median SpO2with the Oxford oximeter was 97% (96%-98%); percentage of study time below SpO2 94% was 8% (2%-14%); percentage of study time below SpO2 90% was 2% (0%-4%). These data were compared with the Nellcor Symphony data: differences in median SpO2 were significant ( P<0.05); differences in percentage of time below SpO2 94% and 90% were also statistically significant ( P<0.001). CONCLUSION: we established normal values of oxygen saturation in healthy term infants using the Nellcor Symphony 3000 pulse oximeter. Care should be taken in interpreting values obtained with different types of pulse oximeters.