Relationship between biparietal diameter/ventricular ratio and neurodevelopmental outcomes in non-handicapped very preterm infants.

PURPOSE: Preterm infants are at high risk for brain damage and long-term neurodevelopmental problems. Cranial ultrasonography is the main neuroimaging technique for very low birth weight infants. Ventricle size and its ratio to brain volume contribute very important information about the central nervous system of preterm babies. We calculated biparietal diameter/ventricular ratio of preterm infants using cranial ultrasonography and evaluate the relationship between this ratio and neurodevelopment. METHODS: Cranial measurements were derived using routine ultrasonographic scanning. Transverse brain length, or biparietal diameter (BPD), was considered a representation of the total brain, ventricular index (VI) and thalamo-occipital distance (TOD) length were used to represent the ventricles, and their ratio was accepted as a measure of the tissue portion of the brain. The ratio of BPD to the sum of left and right VI and TOD values was recorded as BPD/(VI+TOD) ratio. RESULTS: Data from a total of 482 patients were analyzed. The mean gestational age was 27.6 (24-29.6) weeks and the mean birth weight was 1010 (350-1390) g. The mean BPD/(VI+TOD) ratio was 32.90 (± 2.32). At 24 months corrected age, the patients' mean MDI score was 78.64 (± 13.29) and mean PDI score was 79.49 (± 14.31). When patients with and without NDI were compared, there were significant differences between the groups in terms of BPD/(VI+TOD) ratio, MDI, and PDI (p < 0.001, p < 0.001, p < 0.001, respectively). CONCLUSION: The BPD/ventricle ratio can be calculated using two-dimensional measurements in VLBW infants and reduced BPD/ventricle ratio was associated with poor neurodevelopmental outcomes. TRIAL REGISTRATION: NCT02848755.

Developmental outcomes of very low birthweight infants with non-hemorrhagic ventricular dilatations and the relationships thereof with absolute brain volumes measured via two-dimensional ultrasonography.

PURPOSE: We calculated the brain volumes of preterm infants using two-dimensional cranial ultrasonography and explored the relationships thereof with neurodevelopment. METHODS: Cranial measurements were derived using routine ultrasonographic scanning. The brain was considered to be an ellipsoid and estimated absolute brain volumes (EABVs) were calculated by substracting the volumes of the two lateral ventricles from the total brain volumes. RESULTS: We enrolled preterm infants of mean gestational age 28 ± 2 weeks and mean birthweight 973 ± 187 g. Twenty-one exhibited dilated ventricles; their EABVs were lower than normal (206 ± 11 cm3 vs. 275 ± 17 cm3, p < 0.001). The mental development indices were similar (74 ± 5 vs. 78 ± 14, p = 0.069), but the psychomotor development indices (PDIs) differed significantly (77 ± 7 vs. 86 ± 17, p = 0.001). We found a slight positive correlation between the PDI and EABV (r = + 0.258, p = 0.012). CONCLUSION: The EABV can be calculated using two-dimensional measurements and low EABV found to be associated with poor neurological outcomes. TRIAL REGISTRATION: NCT02848755.

The Effects of Antenatal Steroid Treatment on Preterm Infants' Early Laboratory Analysis.

OBJECTIVES: We assessed the effects of antenatal steroid treatment on preterm laboratory analysis conducted in the first 24 hours of life. METHODS: Medical records of inborn preterm infants whose gestational age was ≤32 weeks were retrospectively reviewed in this study. Preterm infants whose mothers received antenatal betamethasone treatment of either 12 mg or 24 mg and who did not were divided into two groups. Maternal and neonatal demographic characteristics, all preterm morbidities and mortality rates, early laboratory examinations were compared between the two groups. RESULTS: Medical records of 603 infants between 2008 and 2013 were retrospectively reviewed. Data from 515 infants were analyzed. Three hundred and four infants (n=304) were in the antenatal steroid treatment (AST) group and 211 infants were in the group that did not receive the treatment. The incidence of preeclampsia and oligohydramnios was significantly higher in the AST group. Intubation in the delivery room rates decreased in the AST group. APGAR scores at five minutes were significantly higher in the AST group. White blood counts (WBC) significantly decreased, whereas the platelet counts were higher in the AST group. Serum C-reactive protein (CRP) and Interleukin-6 (IL-6) levels did not differ between groups. CONCLUSION: We did not demonstrate any relationship between inflammatory markers and antenatal steroid treatment in preterm infants.

Hearing screening failure rate in newborn infants with hypoxic ischemic encephalopathy.

OBJECTIVE: The objective of this study was to establish the local incidence of hearing screening failure rate in newborns with all three stages of hypoxic ischemic encephalopathy (HIE). METHODS: This retrospective cohort study was undertaken in a tertiary neonatal intensive care unit. Medical records and hearing secreening test results were collected for two years. RESULTS: One hundred and ninety seven infants diagnosed with HIE, 20 of them died, 177 screened. Thirty five of 177 (19%) infants failed in screening test for hearing. Screening failure rate was 10/51 (19%), 20/105 (19%) and 5/21 (23%) in stage 1, 2 and 3, respectively and did not differ between HIE stages (p = 0.88). Furthermore failure rates were similar between infants who received therapeutic hypothermia or not (20% vs 19%, p = 0.84). CONCLUSION: Hearing screening failure rate in HIE is quite high even in Stage 1 infants. Management and treatment of these infants should be made carefully concerning additional risks for hearing loss and long term follow-up even in Stage 1 HIE infants should be planned strictly.

Turkish Neonatal Society guideline on the management of respiratory distress syndrome and surfactant treatment.

Respiratory distress syndrome is the leading cause of respiratory failure in preterm infants. The incidence and severity of respiratory distress syndrome are inversely related to the gestational age of the newborn. The major underlying pathophysiologic mechanisms are surfactant deficiency and anatomic, structural immaturity of the lung. Recent improvements such as antenatal steroid treatment to enhance pulmonary maturity, appropriate resuscitation facilitated by placental transfusion and immediate use of continuous positive airway pressure for alveolar recruitment, early rescue administration of surfactant, ventilation with gentler modes to minimize damage to the immature lungs, and the other supportive therapies have significantly decreased respiratory distress syndrome-related morbidity and mortality. This guideline was addressed to overview the mentioned improvements in order to standardize respiratory distress syndrome management in neonatal intensive care units in Turkey.

Preeclampsia is an independent risk factor for spontaneous intestinal perforation in very preterm infants.

BACKGROUND: Spontaneous intestinal perforation (SIP) is an important surgical emergency in preterm infants. AIMS: To evaluate the effect of maternal preeclampsia on development of SIP in premature infants. STUDY DESIGN: Retrospective observational study in a large tertiary neonatal intensive care unit. SUBJECTS: The preterm infants of ≤32 weeks of gestational age and birthweight ≤1500 g who were hospitalized were enrolled. OUTCOME MEASURES: The primary outcome was to determine the association between preeclampsia and SIP. RESULTS: A total of 22 infants had SIP diagnosis. The incidence of SIP in infants born to preeclamptic mothers (6.2%) was significantly higher compared with those born to normotensive mothers (0.2%). In multinominal logistic regression model, preeclampsia was found to be an independent risk factor of SIP with an odds ratio of 13.5 (95% confidence interval 2.82-65.1). CONCLUSIONS: Maternal preeclampsia seemed to be an independent risk factor for development of SIP in premature infants.