How to measure patient and family important outcomes in extremely preterm infants: A scoping review.

AIM: Parents of children born preterm have identified outcomes to be measured for audit and research at 18-24 months of age: child well-being, quality of life/function, socio-emotional/behavioural outcomes, respiratory, feeding, sleeping, and caregiver mental health. The aim was to identify the best tools to measure these seven domains. METHODS: Seven working groups completed literature reviews and evaluated potential tools to measure these outcomes in children aged 18-24 months. A group of experts and parents voted on the preferred tools in a workshop and by questionnaire. Consensus was 80% agreement. RESULTS: Consensus was obtained for seven brief, inexpensive, parent friendly valid measures available in English or French for use in a minimum dataset and potential alternative measures for use in funded research. CONCLUSION: Valid questionnaires and tools to measure parent-identified outcomes in young preterm children exist. This study will facilitate research and collection of data important to families.

Mild controlled hypothermia for necrotizing enterocolitis treatment to preterm neonates: low technology technique description and safety analysis.

We performed a quality improvement project to necrotizing enterocolitis (NEC) and published our results about the initiative in 2021. However, aspects on the safety of the cooling and how to do therapeutic hypothermia with low technology to preterm infants are not described in this previous reporter. Thus, we aim to describe the steps and management to apply hypothermia in preterm infants using low technology and present the safety aspects regarding the initiative. We performed a quality improvement project to NEC in a reference hospital for neonatology (intensive care unit). Forty-three preterm infants with NEC (modified Bell's stage II/III) were included: 19 in the control group (2015-2018) and 24 in the hypothermic group (2018-2020). The control group received standard treatments. The hypothermia group received standard treatment and underwent passive cooling (35.5 °C, used for 48 h after NEC diagnosis). We reported cooling safety to NEC, assessing hematological and gasometrical parameters, coagulation disorders, clinical instability, and neurological disorders. We described how to perform cooling to preterm infants using incubators' servo-control and the occurrence and management of dysthermia during the cooling. We turn-off the incubator and used the esophageal probe to monitor the temperature every 15 min; if the temperature dropped, the incubator was turned on with a rewarming speed of 0.5 °C/h. The participants' average weights and gestational ages were 1186 g and 32 weeks, respectively. There were no differences among hematological indices, serum parameters (sodium, potassium, creatinine, lactate, and bicarbonate), pH, pCO2, and pO2/FiO2 between the groups during treatment and after rewarming. We did not observe dysthermia, bradycardia, hemodynamic instability, apnea, seizure, bleeding, peri-intraventricular hemorrhage, or any alterations in ventilatory parameters due to the cooling technique in preterm babies. This simple technique was performed without intercurrences through a rigorous team evaluation, with a target cooling speed of 0.5 °C/h. The target temperature was successfully reached between the second and third hours of life with the incubator control in 21 children; ice bags were used in only three cases. The temperature was maintained at the expected level during the programmed cooling period. CONCLUSION: Mild controlled hypothermia for preterm infants with NEC is safe. The cooling of preterm infants could be performed through passive methods, using the servo-control of the incubators for temperature management. WHAT IS KNOWN: • Mild controlled hypothermia to NEC treatment is feasible and associated with a decrease in NEC surgery, short bowel, and death. • Mild controlled hypothermia to preterm is feasible and can be performed through low technology and passive cooling. WHAT IS NEW: • Mild controlled hypothermia to preterm is safe and does not associate with safety adverse effects during and after the cooling. • Preterm infants can be cooled through passive methods by just using the servo control of the incubator, presenting acceptable temperature variance, without dysthermia, achieving and remaining at the target temperature with a proper cooling speed. Mild controlled temperature for preterm infants does not need an additional cooling device.

Perinatal, neonatal, developmental and demographic predictors of intelligence at 4 years of age among low birth weight children: a panel study with a 2-year follow-up.

INTODUCTION: Childhood intelligence is an important predictor of later outcomes in life such as socioeconomic status or health. Hence, a deeper understanding of predictors of child intelligence should suggest points of intervention for children facing adversities. OBJECTIVES: The purpose of this study is to examine the predictive value of demographic, perinatal and neonatal variables after birth and developmental characteristics at age 2 for 4-year intelligence as outcome among low birth weight children. METHODS: We designed a panel study with a 2-year follow-up with 114 child-mother pairs. The outcome variable was IQ intelligence quotient at 4 years of age of LBW low birth weight children measured by the Wechsler Primary and Preschool Scales of Intelligence. Potential predictors were maternal education, family wealth, ethnic identity; sex, twin pregnancy, gestational age, birth weight, Apgar scores, maternal smoking during pregnancy; diagnosis of intravetricular haemorrhage, retinopathy of prematurity, bronchopulmonary dysplasia after birth and cognitive, language and motor development at age 2 measured by one composite score of the three Bayley Scales of Infant and Toddler Development aggregated. RESULTS: Stepwise backward regression was carried out including significant variables from the bivariate analysis. The best model included 4 predictors which accounted for 57% of the variance of the full IQ intelligence at 4-years of age. Maternal higher education was significant positive, below average family wealth and neonatal diagnosis of bronchopulmonary dysplasia were significant negative predictors in the model after birth. 2-year developmental characteristics such as cognitive, motor and language skills were positive predictors of the IQ intelligence at age 4. CONCLUSION: Sociodemographic assessment at birth and developmental assessment at two years of age are of crucial importance to recognize children at high risk for delayed cognitive development. High-risk children should be directed to supportive interventions and their development should be regulary monitored.

Timing of Antenatal Corticosteroids for Optimal Neonatal Outcomes: A Markov Decision Analysis Model.

OBJECTIVE: Antenatal corticosteroids (ACSs) are administered to pregnant individuals at high risk of preterm delivery to reduce neonatal morbidity and mortality. ACSs have a limited timeframe of effectiveness, and timing of administration can be difficult because of uncertainty surrounding the likelihood of preterm delivery. The objective of the current study was to design a decision analysis model to optimize the timing of ACS administration and identify important model variables that impact administration timing preference. METHODS: We created a Markov decision analysis model with a base case of a patient at 240 weeks gestation with antepartum hemorrhage. Decision strategies included immediate, delayed, and no ACS administration. Outcomes were based on the neonatal perspective and consisted of lifetime quality adjusted life years (QALYs). Data for model inputs were derived from current literature and clinical recommendations. RESULTS: Our base case analysis revealed a preferred strategy of delaying ACSs for 2 weeks, which maximized QALYs (39.18 lifetime discounted), driven by reduced neonatal morbidity at the expense of 0.1% more neonatal deaths, when compared with immediate ACS administration. Sensitivity analyses identified that, if the probability of delivery within the next week was >6.19%, then immediate steroids were preferred. Other important variables included gestational age, ACS effectiveness, and ACS adverse effects. CONCLUSION: ACS timing involves a trade-off between morbidity and mortality, and optimal timing depends on probability of delivery, gestational age, and risks and benefits of ACSs. Clinicians should carefully consider these factors prior to ACS administration.

Cardioventilatory Control in Preterm-born Children and the Risk of Obstructive Sleep Apnea.

RATIONALE: The contribution of ventilatory control to the pathogenesis of obstructive sleep apnea (OSA) in preterm-born children is unknown. OBJECTIVES: To characterize phenotypes of ventilatory control that are associated with the presence of OSA in preterm-born children during early childhood. METHODS: Preterm- and term-born children without comorbid conditions were enrolled. They were categorized into an OSA group and a non-OSA group on the basis of polysomnography. MEASUREMENTS AND MAIN RESULTS: Loop gain, controller gain, and plant gain, reflecting ventilatory instability, chemoreceptor sensitivity, and blood gas response to a change in ventilation, respectively, were estimated from spontaneous sighs identified during polysomnography. Cardiorespiratory coupling, a measure of brainstem maturation, was estimated by measuring the interval between inspiration and the preceding electrocardiogram R-wave. Cluster analysis was performed to develop phenotypes based on controller gain, plant gain, cardiorespiratory coupling, and gestational age. The study included 92 children, 63 of whom were born preterm (41% OSA) and 29 of whom were born at term (48% OSA). Three phenotypes of ventilatory control were derived with risks for OSA being 8%, 47%, and 77% in clusters 1, 2, and 3, respectively. There was a stepwise decrease in controller gain and an increase in plant gain from clusters 1 to 3. Children in cluster 1 had significantly higher cardiorespiratory coupling and gestational age than clusters 2 and 3. No difference in loop gain was found between clusters. CONCLUSIONS: The risk for OSA could be stratified according to controller gain, plant gain, cardiorespiratory coupling, and gestational age. These findings could guide personalized care for children at risk for OSA.

Peritoneal drainage is associated with higher survival rates for necrotizing enterocolitis in premature, extremely low birth weight infants.

BACKGROUND: To evaluate peritoneal drainage (PD) and laparotomy ± resection/ostomy (LAP) as initial approaches to the surgical management of necrotizing enterocolitis (NEC) in premature, extremely low birth weight (ELBW) infants. METHODS: Kids' Inpatient Database (2003-2012) was searched for cases of NEC (International Classification of Diseases, ninth revision, Clinical Modification [ICD-9-CM] 777.5x) in premature (<37 weeks), extremely low birth weight (<1000 g) infants. Infants were admitted at <28 days of life. Propensity score (PS)-matched analyses were performed, using end points of hospital mortality, length of stay (LOS), and cost of hospitalization. Cases were matched 1:1 on 48 confounding variables (demographic, clinical, and hospital characteristics and 39 comorbidities). RESULTS: On PS-matched comparison, PD had higher survival versus LAP, P = 0.0009. LOS and cost were higher for PD versus LAP, P < 0.003. Survival rates did not differ between PD + LAP and PD-only treatments. LOS and cost were higher for PD + LAP versus PD-only, P < 0.02. PD + LAP infants had higher survival versus LAP, P = 0.0193. LOS and cost were higher for PD + LAP, P < 0.005. CONCLUSIONS: A risk-adjusted PS-matched analysis of operative management in premature, ELBW infants with NEC found higher survival rates associated with PD placement versus LAP, whether PD was used as definitive treatment or with subsequent LAP even after controlling for potential contributors to selection bias (i.e., stability influencing management preference).

Neuropsychological Functioning in Preterm-Born Twins and Singletons at Preschool Age.

OBJECTIVES: A limited body of research is available on the relationships between multiplicity of birth and neuropsychological functioning in preterm children who were conceived in the age of assisted reproductive technology and served by the modern neonatal intensive care unit. Our chief objective was to evaluate whether, after adjustment for sociodemographic factors and perinatal complications, twin birth accounted for a unique portion of developmental outcome variance in children born at-risk in the surfactant era. METHODS: We compared the neuropsychological functioning of 77 twins and 144 singletons born preterm (<34 gestational weeks) and served by William Beaumont Hospital, Royal Oak, MI. Children were evaluated at preschool age, using standardized tests of memory, language, perceptual, and motor abilities. RESULTS: Multiple regression analyses, adjusting for sociodemographic and perinatal variables, revealed no differences on memory or motor indices between preterm twins and their singleton counterparts. In contrast, performance of language and visual processing tasks was significantly lower in twins despite reduced perinatal risk in comparison to singletons. Effect sizes ranged from .33 to .38 standard deviations for global language and visual processing ability indices, respectively. No significant group by sex interactions were observed, and comparison of first-, or second-born twins with singletons yielded medium effect sizes (Cohen's d=.56 and .40, respectively). CONCLUSIONS: The modest twin disadvantage on language and visual processing tasks at preschool-age could not be readily attributable to socioeconomic or perinatal variables. The possibility of biological or social twinning-related phenomena as mechanisms underlying the observed performance gaps are discussed. (JINS, 2016, 22, 865-877).

The influence of mode of birth on neonatal survival and maternal outcomes at extreme prematurity: A retrospective cohort study.

BACKGROUND: There is a paucity of published clinical data to guide obstetric decision-making regarding mode of birth at extreme prematurity. AIMS: To evaluate whether neonatal survival or maternal outcomes were affected by the decision to perform a caesarean section (CS) between 23 + 0 and 26 + 6 weeks' gestation. MATERIALS AND METHODS: A single-centre retrospective cohort study of all liveborn infants born with a plan for active resuscitation at 23-26 weeks' gestation was performed. Descriptive and multivariate logistic regression analyses compared outcomes after vaginal birth and CS. Subgroup analyses of nonfootling breech presentations, multiple pregnancies and singleton pregnancies in spontaneous preterm labour were performed. RESULTS: Outcomes for 625 neonates delivered by 540 mothers were analysed. A total of 300 (48%) neonates were born vaginally and 325 (52%) by CS. Mode of birth was not associated independently with survival for any multivariate analysis; gestational age at birth was an independent predictor across all analyses. Adverse maternal outcomes were documented in 112 (21%) pregnancies; the rate of severe maternal complications was low. Maternal morbidity was not affected by mode of birth. CONCLUSIONS: Mode of birth did not affect neonatal survival or the rate of maternal morbidity for deliveries at 23-26 completed weeks' gestation.

Preterm prelabour rupture of membranes: effect of latency on neonatal and maternal outcomes.

OBJECTIVES: To compare risks of infection and prematurity-related outcomes according to latency periods among women with preterm prelabour rupture of membranes (PPROM). METHODS: Women with PPROM occurring between 24+0 and 36+6 weeks of gestation were identified from a provincial population-based perinatal database in Nova Scotia. The primary outcomes included composite variables for serious maternal and neonatal infectious morbidity and neonatal prematurity-related morbidity. Logistic regression was used to quantify the relationship between latency period (< 24 hours, 24 hours to < 48 hours, 48 hours to < 7 days, and ≥ 7 days) and maternal and neonatal outcomes. Separate analyses were conducted for gestational age groups 24+0 to 33+6 weeks and 34+0 to 36+6 weeks. RESULTS: There were 4329 women included in the cohort. The composite variables representing serious maternal or neonatal infectious morbidity were not significantly associated with latency for either gestational age group. For PPROM occurring at gestational ages of 24+0 to 33+6 weeks, the odds of neonatal prematurity-related morbidity were significantly decreased at the latency periods of 48 hours or more compared with < 24 hours latency. For PPROM at 34+0 to 36+6 weeks of gestation, the odds of prematurity-related morbidity at 48 hours to < 7 days latency was decreased compared with latencies < 24 hours (OR 0.4; 95% CI 0.2 to 0.8). CONCLUSION: Postponing delivery following PPROM may contribute to less prematurity-related morbidity, even close to term, without putting mother or neonate at substantial risk for serious infectious morbidity. Generalization of these findings to other obstetric populations should be informed by the underlying risk of infection.

Objectifs : Comparer les risques d'infection et les issues associées à la prématurité en fonction des périodes de latence chez les femmes qui présentent une rupture prématurée des membranes préterme (RPMP). Méthodes : Les femmes qui ont présenté une RPMP se manifestant entre 24+0 et 36+6 semaines de gestation ont été identifiées au sein d'une base de données périnatale en population générale provinciale, en Nouvelle-Écosse. Parmi les critères d'évaluation primaires, on trouvait des variables composites représentant la morbidité infectieuse maternelle et néonatale grave, et la morbidité néonatale liée à la prématurité. Une régression logistique a été utilisée pour quantifier la relation entre la période de latence (< 24 heures, de 24 heures à < 48 heures, de 48 heures à < 7 jours et ≥ 7 jours) et les issues maternelles et néonatales. Des analyses distinctes ont été menées pour ce qui est des groupes d'âge gestationnel allant de 24+0 à 33+6 semaines et de 34+0 à 36+6 semaines. Résultats : La cohorte comptait 4 329 femmes. Les variables composites représentant la morbidité infectieuse maternelle ou néonatale grave n'ont pas été associées de façon significative à la latence dans l'un ou l'autre des groupes d'âge gestationnel. Pour ce qui est de la RPMP se manifestant aux âges gestationnels situés entre 24+0 et 33+6 semaines de gestation, la probabilité d'une morbidité néonatale liée à la prématurité était considérablement amoindrie en présence de périodes de latence de 48 heures ou plus, par comparaison avec la latence < 24 heures. Pour ce qui est de la RPMP se manifestant aux âges gestationnels situés entre 34+0 et 36+6 semaines de gestation, la probabilité d'une morbidité liée à la prématurité en présence d'une période de latence se situant entre 48 heures et < 7 jours était amoindrie, par comparaison avec les latences < 24 heures (RC, 0,4; IC à 95 %, 0,2 - 0,8). Conclusion : Le report de l'accouchement à la suite d'une RPMP pourrait contribuer à amoindrir la morbidité liée à la prématurité, même près du terme, sans exposer la mère ou le nouveau-né à un risque substantiel de morbidité infectieuse grave. La généralisation de ces constatations à d'autres populations obstétricales devrait tenir compte du risque sous-jacent d'infection.

Langerhans cell histiocytosis: Presentation in a preterm neonate.

BACKGROUND: Langerhans cell histiocytosis (LCH) is a rare disorder in which Langerhans cells (LC) accumulate in the skin or other organs and cause tumor formation or organ damage. Cutaneous lesions can vary widely and do not predict extent of systemic disease or prognosis. CASE: We present a premature infant with skin findings, multisystem involvement, and immunohistochemical markers consistent with multisystem LCH. CONCLUSION: Limited data from preterm neonates with LCH suggest that prognosis is particularly poor, with even limited cutaneous disease often rapidly progressing to become fatal, although diagnosis is not always prompt. Early diagnosis and treatment may affect prognosis.

Case Report: Coexistence of generalized arterial calcification of infancy (GACI) and maternal infections with cytomegalovirus and Toxoplasma gondii-unexpected fatal complication in a newborn.

Generalized arterial calcification of infancy (GACI) is an extremely rare autosomal recessive condition characterized by the storage of calcium at the level of internal elastic membrane of arteries. The main consequences are intimal fibrous thickening and arterial occlusion. We present the case of a preterm male infant, born from an improperly dispensed pregnancy. At birth, the newborn presented generalized edema and hypotonia, and abolished heart sounds, without response to stimulation. Despite the mechanical ventilation, the infant died 2 h after birth. The death was clinically presumed to be related to the maternal infection with cytomegalovirus (CMV) and Toxoplasma gondii. The infant's mother affirmed the history of 6 previous miscarriages and a non-consanguineous marriage. At autopsy, microscopic examination showed generalized vasculitis secondary to minimal calcification of the large and medium-sized vessels of the lungs, liver, and tongue. These findings supported the diagnosis of GACI. Hydrothorax, non-infective ascites, and necrosis of the brain parenchyma were also associated. The premature infant died due to tonsillar herniation associated with decreased vessel compliance and refractory pulmonary hypertension thus leading to congestive cardiac failure. CMV was not detected on histopathological assessment nor were signs of any other infections. To the best of our knowledge, this is the first case of GACI occurring in a baby from a mother co-infected with CMV and T. gondii.

Target oxygen saturation and development of pulmonary hypertension and increased pulmonary vascular resistance in preterm infants.

OBJECTIVE: Determine whether higher targeted oxygen levels are associated with reduced incidence of pulmonary hypertension (PH) and elevated pulmonary vascular resistance (PVR) in extremely premature infants. STUDY DESIGN: Retrospective chart review of 252 extremely preterm infants (<29 weeks), who underwent echocardiogram prior to discharge. PH rates were compared during periods (June 2012-May 2015 and June 2015-April 2016) when lower (88-92%) or higher (90-95%) oxygen saturation targets were used. PH was determined on echocardiography. The ratio of pulmonary artery acceleration time to right ventricular ejection time was computed, with values <0.31 indicative of elevated PVR. Survival analysis compared the effects of oxygen saturation group on development/resolution of PH and elevated PVR. RESULTS: The higher saturation group had significantly lower risk of developing PH (hazard ratio (HR) = 0.50, 95%CI 0.26-0.95; P = 0.03) or elevated PVR (HR = 0.55, 95%CI 0.38-0.81; P = 0.002), compared to the lower oxygen saturation group. Median time to PH development was significantly shorter in the lower saturation group than in the higher saturation group (5 days vs 12 days; P = 0.02), as was time to development of elevated PVR (4 days vs 6 days; P < 0.001). Duration of PH (P = 0.12) and elevated PVR (P = 0.86) did not differ significantly between groups. Cumulative incidence of PH (P = 0.04) and elevated PVR (P = 0.01) at 36 weeks post-menstrual age was significantly lower in the high saturation group compared to the lower saturation group. CONCLUSION: Higher targeted oxygen saturation was associated with reduced risk of PH or elevated PVR in extremely preterm infants compared to lower oxygen saturation target.

Paediatric virology and human papillomaviruses: An update.

Almost 10 years ago, in October, 2008, the scientist who reported for the first time the association between human papillomaviruses (HPV) and cervical cancer, was awarded with the Nobel prize. In the years that followed, Professor Harald zur Hausen actively supported the value of the HPV vaccination in the prevention of different types of cancer and highlighted the necessity of its introduction in both girls and boys. However, to date, in the majority of countries, HPV vaccination among male adolescents has not been implemented into the national vaccination schemes, while in several countries, including Greece, the participation rate to HPV vaccination among female adolescents still remains low. Recent data indicate that catch-up HPV vaccination among young women has been extremely useful and has exhibited a significant effect in decreasing the prevalence of HPV. While the marketed current HPV vaccines prevent anogenital HPV infection, their impact on the natural history of oral HPV and their efficacy in preventing HPV-related head and neck carcinomas need to be further investigated. Juvenile onset recurrent respiratory papillomatosis, as well as HPV-associated conjunctival papillomas continue to be observed in childhood and their clinical management involves different therapeutic approaches with controversial outcomes. This review article provides an overview of recent views and advances on HPV infections and prevention in childhood that were presented at the '4th Workshop on Paediatric Virology' on Saturday September 22, 2018 in Athens, Greece.

Fatores de risco pré-natais e perinatais de mães que tiveram partos prematuros / Prenatal and perinatal risk factors of mothers who had preterm births / Factores de riesgo prenatales y perinatales de madres que tuvieron partos prematuros

Objetivo: caracterizar a prevalência dos fatores de risco maternos, pré-natais e perinatais, bem como o suporte familiar recebido pela mãe durante a gestação, e verificar se estes estão ou não associados aos nascimentos prematuros. Método: Trata-se de um estudo transversal, quantitativo e retrospectivo, realizado em uma universidade do Distrito Federal. As coletas de dados foram realizadas em 2021 e 2022 por meio de questionários aplicados a 22 mães de bebês prematuros que atenderam aos seguintes critérios: terem dado à luz a bebês nascidos com 37 semanas ou menos e terem concordado voluntariamente em responder ao questionário. Resultados: Foi observada uma prevalência de mães com idade entre 18 e 29 anos (50%), pardas (54,54%), sem histórico de parto prematuro anterior (72,80%), com gestação única (81,81%), realizando entre 7 e 10 consultas pré-natais (45,40%), sem realizar fisioterapia pélvica (86,36%) ou exercícios físicos durante a gestação (86,36%). De acordo com a escala Apgar familiar, essas mães possuem uma família altamente funcional (81,81%). Conclusão: Os dados analisados indicam que as mães avaliadas têm uma família funcional e recebem um suporte familiar adequado. No entanto, algumas variáveis maternas, como etnia, tipo de gravidez, idade, prática de exercícios físicos e realização de fisioterapia pélvica, podem ter influência no nascimento de bebês prematuros.

Objective: to characterize the prevalence of maternal, prenatal, and perinatal risk factors, as well as family support received during pregnancy, and investigate their association with premature births. Method: This cross- sectional, quantitative, and retrospective study was conducted at a university in the Federal District. Data was collected in 2021 and 2022 through a questionnaire administered to 22 mothers of preterm infants who met the following criteria: being mothers of babies born at 37 weeks or less and voluntarily agreeing to respond to the questionnaire. Results: The majority of the mothers were aged between 18 and 29 years (50%), were of brown ethnicity (54.54%), had no history of previous premature birth (72.80%), had a single pregnancy (81.81%), had 7 to 10 prenatal consultations (45.40%), did not undergo pelvic physiotherapy (86.36%), or participate in physical exercises during pregnancy (86.36%). According to the family Apgar scale, these mothers had highly functional families (81.81%). Conclusion: The analyzed data indicate that the evaluated mothers have functional families with adequate family support. However, certain maternal variables, such as ethnicity, type of pregnancy, age, and practice of physical exercises, may influence the risk of preterm birth.

Objetivo: caracterizar la prevalencia de factores de riesgo maternos, prenatales y perinatales, y el apoyo familiar recibido durante el embarazo, e investigar su asociación con los partos prematuros. Método: Este estudio transversal, cuantitativo y retrospectivo se llevó a cabo en una universidad del Distrito Federal. Se recopiló información en 2021 y 2022 mediante un cuestionario administrado a 22 madres de bebés prematuros que cumplían con los siguientes criterios: ser madres de bebés nacidos a las 37 semanas de gestación o menos y estar dispuestas a responder voluntariamente el cuestionario. Resultados: Predominaron las madres de 18 a 29 años (50%), mestizas (54,54%), sin antecedentes de parto prematuro previo (72,80%), con embarazo único (81,81%), con 7 a 10 consultas prenatales (45,40%), que no recibieron fisioterapia pélvica (86,36%), ni realizaron ejercicios físicos durante el embarazo (86,36%). Según la escala de Apgar familiar, estas madres tenían familias altamente funcionales (81,81%). Conclusión: Los datos analizados indican que las madres evaluadas tienen familias funcionales y apoyo familiar adecuado. Sin embargo, ciertas variables maternas, como la etnia, el tipo de embarazo, la edad y la práctica de ejercicios físicos o la fisioterapia pélvica pueden influir en el riesgo de parto prematuro

Serum cytokine concentrations, chorioamnionitis and the onset of bronchopulmonary dysplasia in premature infants.

OBJECTIVE: To investigate the relationships between serum cytokine concentrations and chorioamnionitis (CAM) and CAM-related bronchopulmonary dysplasia (BPD) in premature infants. METHODS: Serum was collected at 0 and 7 days after birth from 36 premature infants born at <32 weeks of gestation. We examined the relationships between 30 cytokine concentrations and CAM, BPD, and other perinatal factors. RESULTS: On day 0, GM-CSF, IL-15, IL-17, IL-2, IL-2R, VEGF, and MIG concentrations were significantly higher in the CAM group (n = 17) than in the non-CAM group (n = 19). These concentrations had decreased by day 7 and were similar in both groups. The IL-12p70 concentration on day 0 was significantly lower in the BPD group (n = 16) than in the non-BPD group (n = 15). BPD incidence was similar between the CAM and non-CAM groups. CONCLUSIONS: These data support the hypothesis that intrauterine inflammation is not a primary risk factor for BPD. The immunological environment at birth or soon after, rather than intrauterine fetal inflammation (e.g., CAM), is a primary risk factor for BPD onset in preterm infants. Decreased inflammatory responses are particularly relevant, as indicated by the relationship between BPD and low serum IL-12p70 concentrations on day 0.

Terminal deletion of the short arm of chromosome 6 (6P25 3P 243): a literature review and case report of a Brazilian child / Deleção terminal do braço curto do cromossomo 6 (6p25 3p 243): uma revisão de literatura e relato de caso de uma criança brasileira

Introduction: Deletion syndromes are rare events in clinical practice. A chromosomal deletion occurs when seg-ments of genetic information are missing on a particular chromosome or more. The absence of some genes implies varied phenotypes, which detailed explanation is not fully elucidated yet. Objective: Report the case of a child with a terminal segment deletion of 8,9 Mb on the short arm of chromosome 6 (in 6p25.3p24.3) Methods: This case report was approved by the Ethics and Research Committee of the institution. For its preparation, the exam data provided by the patient's family were added from prenatal to early childhood and the discussion with professionals related to the case. Results: B.A.G., a two-year-old female child, the only daughter of non-consanguineous par-ents, no family history of similar diseases. She was born by premature cesarean section (GA: 35 weeks), presenting Dandy-Walker malformation, Fallot tetralogy, head circumference in the 97th percentile, and syndromic facies, with hypertelorism, low implantation of the ears, and opacity of both lenses. Conclusion: Deletions on chromosome 6 are a very rare genetic alteration. Until 2004, there were only 43 cases in the medical literature, excluding ring chromosome 6 anomalie31. Regarding the terminal deletions of the short arm, this case specifically - 6p24pter - was associated with developmental delay, brain malformations, abnormalities in the anterior chamber of the eye, hearing loss, and abnormalities in the ear, micrognathia, and heart diseases (AU)

Introdução: As síndromes de deleção são eventos raros na prática clínica. A deleção cromossômica ocorre quando segmentos de informação genética são perdidos em um ou mais cromossomos. A ausência de alguns genes implica em fenótipos variados, cuja explicação detalhada ainda não está totalmente elucidada. Objetivo: Relatar o caso de uma criança com deleção de segmento terminal de 8,9 Mb do braço curto do cromossomo 6 (em 6p25.3p24.3) Métodos: Esse relato de caso foi aprovado pelo Comitê de Ética e Pesquisa da Instituição. Para sua elaboração, foram adicionados os dados de exames fornecidos pela família do paciente desde o pré-natal até a primeira infância e a discussão com profissionais relacionados ao caso. Descrição do Caso: B.A.G., criança de dois anos, sexo femi-nino, filha única de pais não consanguíneos, sem antecedentes na família de doenças similares. Nasceu por cesárea prematura (IG 35 semanas), apresentando Síndrome de Dandy-Walker, tetralogia de Fallot, perímetro cefálico no percentil 97 e fácie sindrômica, com hipertelorismo, baixa implantação das orelhas e opacidades do cristalino bi-lateralmente. Conclusão: As deleções no cromossomo 6 são alterações genéticas de grande raridade. Até 2004, existiam apenas 43 casos na literatura médica, excluindo a anomalia do cromossomo 6 em anal 31. No que se refere às deleções terminais do braço curto, a do caso em questão - 6p24-pter - foram associadas o atraso no desenvol-vimento, malformações cerebrais, anormalidades na câmara anterior do olho, perda auditiva, anormalidades no ouvido, micrognatia e cardiopatias (AU)

Blood transfusions, increased rates of surgical NEC, and lower survival: a propensity score-matched analysis.

PURPOSE: We sought to investigate the association between blood transfusions (BT), rates of necrotizing enterocolitis requiring surgical intervention (SNEC), and survival. METHODS: Blood transfusions in premature infants were identified in the Kids' Inpatient Database (2003-2009). Propensity score-matched analysis compared SNEC outcomes in BT vs. non-BT groups. Multivariate analyses were performed to determine independent predictors of outcome. RESULTS: Overall, 663740 cases were identified and 4.9% received BT. Surgical necrotizing enterocolitis occurred in 493 cases in the BT group, while SNEC occurred in 1049 cases in the non-BT group. Propensity score analysis of 20991 BT and 20988 non-BT cases demonstrated higher SNEC rates with BT (odds ratio [OR], 1.21) vs non-BT. Surgical necrotizing enterocolitis with BT had lower survival rates (58%) vs non-BT (67%). Surgical necrotizing enterocolitis with BT had lower length of stay and total charges vs non-BT. On multivariate analyses, SNEC mortality with BT increased for lower gestational age, males (OR, 45.7), African Americans (OR, 64.4), and infants with cardiac anomalies (OR, 50.8) or bronchopulmonary dysplasia (OR, 177). Non-BT SNEC demonstrated higher mortality with lower gestational age and infants with bronchopulmonary dysplasia (OR, 6.56) or sepsis (OR, 3.66). CONCLUSION: On propensity score-matched analysis, SNEC occurs at higher rates after BT and is associated with lower survival and lower resource utilization vs SNEC without BT.

Retinopathy of prematurity screening criteria in Iran: new screening guidelines.

OBJECTIVE: To test the applicability of existing retinopathy of prematurity (ROP) guidelines on Iranian patients and to develop novel ROP screening criteria in Iran. METHODS: Both eyes of 1932 infants born ≤37 weeks of gestation and/or weighting ≤3000 g were included in this prospective cohort study that was conducted across nine neonatal intensive care units and a tertiary eye hospital ROP clinic. The patients were examined for ROP and the need for treatment (type 1 ROP or worse). All the patients were screened 4 weeks after birth or at 31 weeks of postmenstrual age, whichever was later. The patients were followed until retinal vascularisation was completed or the patients reached 50 weeks of gestational age (GA) without prethreshold ROP. A receiver operating characteristic curve was used to determine the best screening criteria for ROP. Screening criteria from other countries were applied to our patient data to determine their ability to appropriately detect ROP. MAIN OUTCOME MEASURE: Patients with ROP requiring treatment. RESULTS: The mean GA±SD and birth weight (BW)±SD of the screened patients were 32±2.7 weeks and 1713±516 g, respectively. Using criteria of GA≤32 weeks or BW ≤2000 yielded sensitivity and specificity of 100% and 26.7%, respectively, for treatment requiring ROP regardless of clinical comorbidities. Using screening recommendations of American Academy of Pediatrics would miss 25.4% of ROP and 8.4%ROP requiring treatment in our cohort. CONCLUSIONS: Other countries screening recommendations would result in a significant amount of missed cases of treatment requiring ROP when applied to Iran. As a result, we have proposed new guidelines for premature babies in Iran.

Asociación de la violencia obstétrica, control prenatal y embarazo no planeado con la prematurez / Association of obstetric violence, prenatal control, and unplanned pregnancy with prematurity

Resumen La prematurez (PM) neonatal es un problema mayor de salud pública en el mundo, debido a su frecuencia de presentación y los años de vida potencialmente perdidos; además, es la principal causa de muerte en menores de cinco años. Entre las consecuencias negativas de la PM están las discapacidades del aprendizaje, visual y auditiva. Múltiples son los factores asociados a la PM; algunos pueden ser detectados y modificados de forma oportuna en las consultas prenatales y también, en las preconcepcionales. Por otro lado, la PM no es solamente responsabilidad del prestador de los servicios de salud, sino también del sistema de salud, el cual, debe otorgar los recursos mínimos necesarios para monitorear y mantener a la embarazada en un estado óptimo de salud para evitarla, y en caso de presentarse, debe contar con la infraestructura hospitalaria básica que permita la viabilidad del producto y evitar su muerte. Aunado a lo anterior, se debe de considerar la responsabilidad de la paciente y su pareja, debido a que en ellos recae la obligación de llevar un estilo de vida saludable y acudir a las consultas preconcepcionales y control prenatal.

Abstract Neonatal prematurity (MP) is a major public health problem in the world, due to its presentation frequency and the years of life potentially lost; In addition, it is the main cause of death in children under five years of age. Among the negative consequences of MP are learning, visual and hearing disabilities. There are multiple factors associated with MP; some can be detected and modified in a timely manner in prenatal consultations and in preconception. On the other hand, MP is not only responsibility of the health service provider, but also of the health system, which must grant the minimum resources necessary to monitor and maintain the pregnant woman in an optimal state of health to avoid it, and if it occurs, the hospital must have the basic infrastructure that allows the viability of the product and prevents its death. In addition, the responsibility of the patient and her partner must be considered since they are obliged to lead a healthy lifestyle and attend preconception consultations and prenatal care.

Lung function at 6 and 18 months after preterm birth in relation to severity of bronchopulmonary dysplasia.

UNLABELLED: Many preterm infants with bronchopulmonary dysplasia (BPD) demonstrate impaired lung function and respiratory symptoms during infancy. The relationships between initial BPD severity, lung function and respiratory morbidity are not fully understood. We aimed to investigate the association between BPD severity and subsequent lung function and whether lung function impairment is related to respiratory morbidity. STUDY DESIGN AND METHODS: In this longitudinal cohort study, 55 infants born preterm (23-30 weeks of gestation) with mild or moderate/severe BPD, based on oxygen requirement at 36 gestational weeks, were followed up at 6 and 18 months postnatal age. Respiratory symptoms, such as recurrent or chronic chough and wheeze, were noted and patient records were scrutinized. Lung function was assessed by passive lung mechanics, whole body plethysmography, and tidal and raised volume rapid thoraco-abdominal compression techniques. Results were related to published normative values. RESULTS: Besides residual functional capacity (FRC) and respiratory system compliance (Cso ) assessed at 18 months, all measures of lung function were significantly below normative values. Moderate/severe BPD differed significantly from mild BPD only with respect to reduced Cso . At follow-up at 6 and 18 months, participants with respiratory symptoms showed lower; maximal forced expiratory flow at FRC (V'maxFRC) (P = 0.006, P = 0.001), forced mid-expiratory flows (MEF50 ) (P = 0.006, P = 0.048), and Cso (P = 0.004, P = 0.015) as compared to participants without symptoms. CONCLUSIONS: In the present study BPD severity did not predict lung function, but may be associated with impaired alveolarization, indicated by reduced Cso . Respiratory morbidity was associated with reduced airway function and respiratory compliance in infancy after preterm birth.