Correlation between echocardiographic superior vena cava flow and short-term outcome in infants with asphyxia

Objectives

To assess the relationship between superior vena cava (SVC) flow and short-term outcome in infants with perinatal asphyxia.

Methods

Infants in sequence born after more than 35 weeks of gestation who had been hospitalized at the NICU and normal neonatal wards of Wakayama Medical University between May 2005 and September 2010 were recruited for this observational cohort study. The study eligibility criterion was the presence of perinatal asphyxia, as evidenced by abnormal fetal heart rate monitoring and an Apgar score of 7 or less at 1 min or need for resuscitation using positive pressure ventilation. SVC flow was measured in the first three days of life by Doppler echocardiography as described by Kluckow and Evans. Short-term outcome was defined as poor if MRI demonstrated bilateral lesions of the basal ganglia and thalamus and/or multicystic encephalomalacia due to hypoxic ischemia.

Results

In the head cooling group, SVC flow in infants with a good outcome was lower than that in infants with a poor outcome at 12 h (36.9 ± 7.7 vs 113.4 ± 42.4 ml/kg/min (p = 0.01)), 24 h (75.2 ± 25.3 vs 155.6 ± 45.7 ml/kg/min (p = 0.03)), and 48 h (92.5 ± 34.2 vs 161.1 ± 46.7 ml/kg/min (p = 0.04)) after birth. SVC flow decreased promptly after introduction of head cooling in infants who had a good outcome, whereas it increased gradually after head cooling in those who had a poor outcome.

Conclusion

We speculate that regulation of brain circulation is disrupted in infants with asphyxia who show a poor outcome.     

Sunflower oil versus no oil moderate pressure massage leads to greater increases in weight in preterm neonates who are low birth weight

Background

Growth velocity is one of the most important problems in low birth weight (LBW) neonates.

Aims

The purpose of this study was to compare the effects of body massage with and without sunflower oil on the growth of LBW preterm neonates in Iran.

Study design

A single-blinded randomized clinical trial

Subjects

This study examined neonates admitted to NICU with gestational age of 33–37 weeks and birth weight of 1500–1999 g, without birth asphyxia and medically stable

Outcome measures

Neonates were randomly assigned to two groups to receive moderate pressure massage alone or the same massage with sunflower oil by their mothers, three times a day for 14 consecutive days. The primary variables were increases in mean of growth parameters (weight, height and head circumference) that were evaluated 14 days after intervention, at ages 1 and 2 months. Secondary variables were clinical side effects.

Results

Fifty-four neonates including 25 girls and 29 boys with mean gestational age of 35.3 ± 1.26 weeks were evaluated. Means of gestational age, birth weight and length of NICU stay were not different in both groups. In the oil massage group, mean weight at ages 1 month (mean ± SD: 2339 ± 135 vs. 2201 ± 93 g, P = 0.04) and 2 months (mean ± SD: 3301 ± 237 vs. 3005 ± 305 g, P = 0.005) was significantly greater than that of the body massage group. No adverse events were seen in the two groups.

Conclusion

Sunflower oil massage might be used as an effective and safe intervention for weight gain in LBW preterm neonates.     

Acute cardiovascular responses in preterm infants at 34–39 weeks of gestational age

Background

Premature infants demonstrate immature physiological control mechanisms; however their acute cardiovascular control has not yet been widely studied.

Aim

The aim of this study was to analyze heart rate (HR) and blood pressure (BP) control in preterm infants.

Subjects

Twenty preterm infants with a mean gestational age of 31 ± 2.4 (26–34) weeks at birth were evaluated at a gestational age of 36 ± 1.5 (34–39) weeks. Results were compared to twenty, healthy, full-term, control infants studied at the age of 12 ± 3 weeks.

Outcome measures

HR and BP responses to 45° head-up tilt and side motion tests during non-rapid eye movement sleep were analyzed. In addition, HR responses to spontaneous arousals from non-rapid eye movement sleep were evaluated.

Results

Preterm infants showed significantly smaller initial HR and BP responses compared with controls in head-up tilt (HR p = 0.0005, systolic BP p = 0.02, diastolic BP p = 0.01) and side motion tests (HR p = 0.002, systolic BP p < 0.0001, diastolic BP p < 0.0001). Furthermore, in tilt tests, preterm infants presented with greater intersubject variability in BP responses than controls (systolic BP p = 0.009, diastolic BP p = 0005). Preterm HR responses to spontaneous arousals were similar to controls.

Conclusions

This study indicates immature vestibulo-mediated cardiovascular control in preterm infants compared with term infants. This is seen as attenuated BP responses to side motion test and more labile acute BP control to postural challenge.     

Pre-eclampsia—An additional risk factor for cognitive impairment at school age after intrauterine growth restriction and very preterm birth

Objective

To explore the possible influence of pre-eclampsia on cognitive outcome in children born very preterm after intrauterine growth restriction (IUGR) and abnormal umbilical artery blood flow.

Methods

Cognitive function was evaluated at 5–8 years of age with Wechsler scales in 34 children born before 30 gestational weeks after IUGR (PT-IUGR) (11 children were exposed to maternal pre-eclampsia, 23 non-exposed) and in 34 children with no maternal pre-eclampsia and birth weight appropriate-for-gestational age (PT-AGA) matched for gestational age at birth, gender and age at examination.

Results

The subjects in the PT-IUGR group exposed to maternal pre-eclampsia had lower mean verbal IQ (VIQ) (mean ± SD 74 ± 16) and lower full scale IQ (FSIQ) (70 ± 19) in comparison with both the non-exposed PT-IUGR (VIQ 89 ± 15; p = 0.013; FSIQ 83 ± 14, p = 0.029), and, the PT-AGA group (VIQ 96 ± 15, p < 0.001; FSIQ 90 ± 14, p = 0.001). The differences remained significant after adjustment for known confounders. VIQ and FSIQ did not differ between the non-exposed IUGR and PT-AGA children.

Conclusion

Fetal exposure to maternal pre-eclampsia seems to have an additional negative impact to that of IUGR on cognitive function in children born very preterm.     

Characterizing early detection of language difficulties in children born preterm

Background

The optimal age for assessing language difficulties in premature children remains unclear.

Aims

To determine the most predictive and earliest screening tool for later language difficulties on children born preterm.

Study design

A prospective population-based study in the Loire Infant Follow-up Team LIFT

Subjects

All children born < 35 weeks of gestation between 2003 and 2005 were assessed at corrected ages by four screening tools: the Ages & Stages Questionnaire (ASQ) communication scale at 18 and 24 months, the language items of Brunet Lezine test at 24 months, and the “Epreuves de Repérage des Troubles du Langage” (ERTL) at 4 years.

Outcome measures

After 5 years, the kindergarten teacher evaluated the vocabulary, grammar and pronunciation capacities of the child in comparison with the classroom performances.

Results

Among 1957 infants enrolled at discharge, 947 were assessed by their teacher with 12.2% (n = 116) of language difficulties. Full data at all time points were available for 426 infants. The area under curve of the receiver operator characteristic curve obtained for the ASQ communication scale at 18 months was significantly lower (0.65 ± 0.09) than that obtained at 24 months (0.77 ± 0.08) and the languages items of Brunet Lezine test at 24 months (0.77 ± 0.08), and the ERTL at 4 years (0.76 ± 0.09). The optimal cut-off value for ASQ communication at 24 months is ≤ 45 [sensitivity of 0.79 (95%CI: 0.70–0.86); specificity of 0.63 (95%CI: 0.59–0.66)].

Conclusions

The Ages & Stages Questionnaire communication scale at 24 corrected months appears as an acceptable test at an early time point to identify preterm children at risk of later language difficulties.     

Transitional hemodynamics in preterm infants with a respiratory management strategy directed at avoidance of mechanical ventilation

Background

Early respiratory management of very low birth weight infants has changed over recent years to a practice of early use of CPAP with early selective surfactant administration, and decreased use of mechanical ventilation. One strategy is to use the combination of surfactant and prompt extubation to nasal continuous positive airway pressure (INtubate, SURfactant, Extubate, or INSURE). The aim of this study is to describe blood flow and ductal flow in a prospective cohort during the transitional period when this respiratory management strategy is used.

Methods

Inborn infants < 29 week gestation underwent INSURE within 30 min of birth using 200 mg/kg Curosurf. Blood pressure and blood flow parameters (RVO, LVO, SVC flow, ductus arteriosus) were measured at 6, 24 and 72 h of age and information on morbidity was collected.

Results

Sixty-eight infants with a median (range) weight of 940 (450–1380) g were studied. 13 (19%) patients needed mechanical ventilation within 72 h of life (INSURE failure). Blood flows and blood pressure were within reported ranges. Eleven (16%) patients had a blood pressure < gestational age and 9 (13%) patients had low blood flow.

Conclusion

These data show a low prevalence of low blood pressure and low blood flow in the first 3 days after INSURE as compared to cohorts where mechanical ventilation was preferred during transition. We speculate that altered ventilation strategies have helped decrease the incidence of low blood flow and low blood pressure.     

Pain evaluation after a non-nociceptive stimulus in preterm infants during the first 28 days of life

Background

Protective mechanisms that modulate and lead to habituation to pain are immature in preterm newborn infants.

Aims

To evaluate if a routine non-painful handling will be perceived as painful throughout the neonatal period in newborn infants with 28–32 weeks of gestational age.

Study design

Prospective cohort study.

Subjects

36 preterm infants without malformations evaluated for pain during a diaper change.

Outcome measures

Patients were studied at three times (5 min prior, during, and 3 min after the diaper change) during five moments (72 h, 7, 14, 21 and 28 days of life) by evaluation of heart rate, oxygen saturation and 3 validated pain assessment tools: the Neonatal Infant Pain Scale (NIPS), the Behavioral Indicators of Infant Pain (BIIP) and Premature Infant Pain Profile (PIPP). Results were analyzed by repeated measures ANOVA adjusted for gender, gestational age at birth, number of painful procedures and use of opioids.

Results

Patients had, at birth, mean gestational age of 30.2 ± 1.4 weeks, birthweight of 1257 ± 238 g, with 50% males. Analysis of pain assessment tools did not show increase of pain presence or pain scores at the five sequential evaluation moments. The variation of oxygen saturation during the three study times was similar at the different post-natal ages, but heart rate variation increased significantly from 72 h until the 28th day of life.

Conclusions

In preterm infants, the non-nociceptive handling does not trigger pain responses even after 28 days of neonatal care, which includes the experience of repetitive procedural pain.     

Is meconium stained amniotic fluid related to occult myocardial injury in term low risk pregnancies?

Aim

The present study aimed to compare Troponin T (Tp T) levels of infants born with meconium stained amniotic fluid (MSAF) to those with clear amniotic fluid.

Study design

Case–control study

Subjects

Thirty-five women who had delivery complicated by MSAF between 37 and 41 weeks of gestation were defined as the study group and women with healthy uncomplicated pregnancies with clear amniotic fluid who were matched for age, parity, and gestational age were defined as the control group.

Outcome measures

Cord blood Tp T level, gas analysis and neonatal outcomes were compared between groups.

Results

Tp T levels of the study and control groups were 0.026 ± 0.013 ng/ml and 0.031 ± 0.016 ng/ml, respectively. The difference was not statistically significant (p = 0.132). On the other hand, the study group had a statistically lower HCO₃ level (21.80 vs 23.60 mmol/l ) and higher rate of base deficit (4.85 vs 3.25 mmol/l) than the control group.

Conclusion

The presence of meconium during labor is not related to occult myocardial injury in low-risk term pregnancies.     

The effect of socioeconomic status on the language outcome of preterm infants at toddler age

Background

Independently, both prematurity and low socioeconomic status (SES) compromise language outcome but less is known regarding the effects of low SES on outcome of prior preterm infants at toddler age.

Aim

To assess SES effects on the language outcome of prior preterm infants at toddler age.

Study design

Retrospective chart review of infants born at ≤ 32 weeks, matched for gestational age (GA), birth weight (BW), chronic lung disease (CLD), periventricular leukomalacia (PVL), right and left intraventricular hemorrhage (IVH-R, L), and age at Bayley Scales of Infant Development III (BSID-III) testing.

Subjects

Using insurance status as a proxy for SES, 65 children with private insurance (P-Ins) were matched with 65 children with Medicaid-type insurance (M-Ins).

Outcome measures

Bayley Scales of Infant Development-III Language Composite.

Results

M-Ins vs. P-Ins were similar in GA, BW, and age at BSID-III testing (mean 22.6 months adjusted), as well as other matched characteristics (all p ≥ 0.16). BSID-III Language Composite scores were lower in M-Ins than P-Ins (87.9 ± 11.3 vs. 101.9 ± 13.6) with a clinically significant effect size of 0.93 (p < 0.001). Overall, 45% of M-Ins exhibited mild to moderate language delay compared to 8% of P-Ins. Receptive and Expressive subscale scores also were lower in M-Ins than in P-Ins (both p < 0.001).

Conclusions

In this preterm cohort, by toddler age, M-Ins was associated with lower scores on measures of overall language as well as receptive and expressive language skills. Our findings, showing such an early influence of SES on language outcome in a cohort matched for biomedical risk, suggest that very early language interventions may be especially important for low SES preterm toddlers.     

Efficacy of saccharomyces boulardii on necrotizing enterocolitis or sepsis in very low birth weight infants: A randomised controlled trial

Background

Probiotics have strain specific effects and the effects of fungi in preventing diseases in preterm infants have been investigated poorly. Saccharomyces boulardii is a yeast which acts both as a probiotic and a polyamine producer.

Aim

The objective of this study was to investigate the efficacy of S. boulardii in preventing necrotizing enterocolitis (NEC) or sepsis in very low birth weight infants.

Study design and subjects

A prospective, double blind, placebo controlled trial was conducted in preterm infants (≤ 32 GWs, ≤ 1500 g birth weight). They were randomized either to receive feeding supplementation with S. boulardii 50 mg/kg every 12 h or placebo, starting with the first feed until discharged.

Outcome measures

Necrotizing enterocolitis (NEC) or sepsis and NEC or death.

Results

Birth weight and gestational age of the study (n = 104) and the control (n = 104) groups were 1126 ± 232 vs 1162 ± 216 g and 28.8 ± 2.2 vs 28.7 ± 2.1 weeks, respectively. Neither the incidence of stage ≥ 2 NEC or death nor stage ≥ 2 NEC or late onset culture proven sepsis was significantly lower in the study group when compared with the control group (9.6% vs 7.7%, p = 0.62; 28.8% vs 23%, p = 0.34). Time to reach 100 mL/kg/day of enteral feeding (11.9 ± 7 vs 12.6 ± 7 days, p = 0.37) was not different between the groups.

Conclusions

Saccharomyces boulardii did not decrease the incidence of NEC or sepsis.     

Newborn length predicts early infant linear growth retardation and disproportionately high weight gain in a low-income population

Background

Stunting is prevalent by the age of 6 months in the indigenous population of the Western Highlands of Guatemala.

Aim

The objective of this study was to determine the time course and predictors of linear growth failure and weight-for-age in early infancy.

Study design and subjects

One hundred and forty eight term newborns had measurements of length and weight in their homes, repeated at 3 and 6 months. Maternal measurements were also obtained.

Results

Mean ± SD length-for-age Z-score (LAZ) declined from newborn − 1.0 ± 1.01 to − 2.20 ± 1.05 and − 2.26 ± 1.01 at 3 and 6 months respectively. Stunting rates for newborn, 3 and 6 months were 47%, 53% and 56% respectively. A multiple regression model (R² = 0.64) demonstrated that the major predictor of LAZ at 3 months was newborn LAZ with the other predictors being newborn weight-for-age Z-score (WAZ), gender and maternal education ∗ maternal age interaction. Because WAZ remained essentially constant and LAZ declined during the same period, weight-for-length Z-score (WLZ) increased from − 0.44 to + 1.28 from birth to 3 months. The more severe the linear growth failure, the greater WAZ was in proportion to the LAZ.

Conclusion

The primary conclusion is that impaired fetal linear growth is the major predictor of early infant linear growth failure indicating that prevention needs to start with maternal interventions.     

Correlation between regular mouthing movements and heart rate patterns during non-rapid eye movement periods in normal human fetuses between 32 and 40 weeks of gestation

Background

Regular mouthing movements (RMMs) are observed during fetal non-rapid eye movement (NREM) periods.

Aim

To determine the correlation between RMM and fetal heart rate (FHR) patterns during NREM periods.

Study design

Fetal eye and mouth movements and FHR patterns were observed and recorded.

Subjects

50 normal singleton pregnancies between 32 and 40 weeks of gestation.

Outcome measures

Changes in the power spectrum ratio of 3-minute blocks of RMM clusters, FHR with RMM clusters (HR +), and FHR without RMM clusters (HR −) were calculated at a frequency band of 0.02 Hz among 3 gestational age groups: group 1, 32–34 weeks gestation; group 2, 35–37 weeks gestation; group 3, 38–40 weeks gestation. We calculated the percentage of cases showing dominant peak ratios of RMM and HR + in the same frequency band, the maximum correlation coefficient, and its lag time.

Results

In group 3, the dominant peaks of both RM and HR + were present at the same frequency band, 0.06–0.08 Hz; this was not seen in the other groups' relative power spectral patterns. The percentage of cases showing dominant peaks of RMM and HR + in the same frequency band increased with advancing gestational age. The maximum correlation coefficient in groups 1 (0.28 ± 0.11) and 3 (0.45 ± 0.14) differed significantly (p < 0.05).

Conclusions

The correlation between RMM and FHR patterns became stronger, and their rhythmicity was similar, from 38 to 40 gestational weeks, suggesting that a common center starts to govern both patterns at approximately 38 weeks gestation.     

Autonomic cardiovascular control in hypotensive critically ill preterm infants is impaired during the first days of life

Background

The first days after preterm birth are a critical period of cardiovascular instability, where hypotension is common. We assessed autonomic cardiovascular function by measuring heart rate variability (HRV), blood pressure variability (BPV) and baroreflex sensitivity (BRS) and hypothesised that these would be impaired in preterm infants born at younger gestational ages. In addition, we speculated that impaired cardiovascular control could be used as a marker of circulatory failure such as is manifest as hypotension.

Methods

23 preterm infants (11 M/12 F) born between 23 and 35 weeks (mean 27 ± 0.6 weeks) gestational age with indwelling arterial catheters were recruited. Infants were studied over the first 3 days of life with heart rate and blood pressure (BP) analysed beat to beat in the frequency domain in 2 minute epochs of artefact free data during active sleep. Data were compared with one way ANOVA.

Results

Gestational age was correlated with all HRV indices but not BPV or BRS. 9 babies received inotropes. Gestational age between the inotrope group and the non-inotrope group was not different. BP and RR interval were lower in the inotrope group (40.7 ± 1.5 vs 47.1 ± 1.5 mm Hg, p < 0.05 and 395 ± 14 vs 426 ± 11 ms, p < 0.08). BRS was also lower in the inotrope group (3.8 ± 0.9 vs 6.9 ± 1.6 ms/mm Hg) as was LF/HF HRV (5.7 ± 1.3 vs 13.6 ± 2.8, p < 0.05).

Conclusions

In the first 3 days after birth, infants receiving inotropes had significantly impaired cardiovascular control compared to those who did not receive treatment, indicating that these infants maybe predisposed to increased vulnerability to circulatory instability.     

Effect of neonatal hemoglobin concentration on long-term outcome of infants affected by fetomaternal hemorrhage

Background

Fetomaternal hemorrhage (FMH) can cause severe morbidity. However, perinatal risk factors for long-term poor outcome due to FMH have not been extensively studied.

Aims

To determine which FMH infants are likely to have neurological sequelae.

Study design

A single-center retrospective observational study. Perinatal factors, including demographic characteristics, Kleihauer–Betke test, blood gas analysis, and neonatal blood hemoglobin concentration ([Hb]), were analyzed in association with long-term outcomes.

Subjects

All 18 neonates referred to a Neonatal Intensive Care Unit of Kagoshima City Hospital and diagnosed with FMH during a 15-year study period. All had a neonatal [Hb] < 7.5 g/dL and 15 of 17 neonates tested had Kleihauer–Betke test result > 4.0%.

Outcome measures

Poor long-term outcome was defined as any of the following determined at 12 month old or more: cerebral palsy, mental retardation, attention deficit/hyperactivity disorder, and epilepsy.

Results

Nine of the 18 neonates exhibited poor outcomes. Among demographic characteristics and blood variables compared between two groups with poor and favorable outcomes, significant differences were observed in [Hb] (3.6 ± 1.4 vs. 5.4 ± 1.1 g/dL, P = 0.01), pH (7.09 ± 0.11 vs. 7.25 ± 0.13, P = 0.02) and base deficits (17.5 ± 5.4 vs. 10.4 ± 6.0 mmol/L, P = 0.02) in neonatal blood, and a number of infants with [Hb] ≤ 4.5 g/dL (78%[7/9] vs. 22%[2/9], P = 0.03), respectively. The base deficit in neonatal arterial blood increased significantly with decreasing neonatal [Hb].

Conclusions

Severe anemia causing severe base deficit is associated with neurological sequelae in FMH infants.     

Motor skills at 23 years of age in young adults born preterm with very low birth weight

Background

Motor skills have previously not been reported in young adults born with very low birth weight (VLBW), although they are commonly reported in children and adolescents.

Aim

To compare fine and gross motor skills in VLBW young adults with matched term-born controls, and to study longitudinal changes in the VLBW group.

Study design

A geographically based follow-up study of a VLBW group and a control group.

Subjects

Thirty-six VLBW (birth weight ≤ 1500 g) young adults, including four participants with cerebral palsy (CP), and 37 matched controls (birth weight ≥ 10th centile) were examined at 14 and 23 years of age.

Outcome measures

Fine and gross motor skills were assessed using Grooved Pegboard test (GP), Trail Making Test-5 (TMT-5), Movement Assessment Battery for Children-2 (Movement ABC-2) and High-level Mobility Assessment Tool (HiMAT).

Results

VLBW young adults were slower than controls on GP (p = 0.026) and TMT-5 (p < 0.001). Mean total Movement ABC-2 score was 69.7 ± 20.2 in the VLBW group compared with 74.1 ± 14.4 in the control group (p = 0.017). Differences were also seen in manual dexterity and balance. Additionally, HiMAT showed reduced balance and speed in gross motor skills in the VLBW group. The proportion of participants with motor problems did not change between age 14 and 23. After exclusion of participants with CP, scores were essentially the same.

Conclusion

VLBW young adults had overall poorer fine and gross motor skills compared with controls. Reduced speed seemed to be an underlying problem. Longitudinal findings indicate that VLBW children have not outgrown their motor problems when entering adulthood.     

The influence of perinatal asphyxia on peripheral oxygenation and perfusion in neonates

Background

Perinatal asphyxia influences peripheral oxygenation and perfusion in neonates.

Objectives

The aim was to investigate the influence of perinatal asphyxia on peripheral oxygenation and perfusion in neonates by using near-infrared spectroscopy (NIRS).

Methods

Prospective observational study. Neonates with gestational age > 34 weeks and birth weight > 2000 g without infection or congenital malformations were included. Peripheral muscle NIRS measurements in combination with venous occlusion were performed once in the first 48 h of life. Tissue oxygenation index (TOI), mixed venous oxygenation (SvO2), fractional oxygen extraction (FOE), haemoglobin flow (Hbflow), oxygen delivery (DO2) and oxygen consumption (VO2) were assessed. Furthermore arterial oxygen saturation, heart rate, blood pressure and temperatures were measured. Neonates with a UapH ≤ 7.15 and an Apgar 5 ≤ 6 were compared to neonates with a UapH ≥ 7.15, an Apgar 5 ≥ 7 (control group) and a UapH was correlated to NIRS parameters.

Results

8 asphyxiated neonates were compared to 30 neonates in the control group. TOI (67.7 ± 5.5%) and DO2 (29.0 ± 14.2 μmol/100 mL/min) were significantly lower in asphyxiated neonates compared to the controls (TOI 71.8 ± 4.9%, p = 0.045; DO2 43.9 ± 16.9 μmol/100 mL/min, p = 0.028) and FOE was significantly higher (0.33 ± 0.05) compared to the controls (0.28 ± 0.06, p = 0.028). Furthermore significant correlations between UapH and DO2 (r = 0.78, p = 0.022), VO2 (r = 0.80, p = 0.018) and FOE (r = − 0.75, p = 0.034) in the asphyxiated group were found.

Conclusion

Peripheral oxygenation and perfusion measured with NIRS are compromised in neonates with perinatal asphyxia with worsening of parameters and degree of acidosis in the umbilical cord blood.     

Advanced intrauterine growth restriction is associated with reduced excretion of asymmetric dimethylarginine

Background

High blood levels of asymmetric dimethylarginine (ADMA) are associated with future development of adverse cardiovascular events. The ADMA/symmetric dimethylarginine (SDMA) ratio is a marker of ADMA catabolism, with a high ADMA/SDMA ratio being suggestive of reduced ADMA excretion.

Aims

This study aimed a) to verify the presence of a statistically significant difference between ADMA/SDMA ratio levels in a group of young adult subjects who were born preterm with an extremely low birth weight (ex-ELBW) and a group of healthy adults born at term and b) to seek correlations between ADMA/SDMA ratio levels in ex-ELBW and anthropometric and clinical parameters (gender, chronological age, gestational age, birth weight, and length of stay in the Neonatal Intensive Care Unit).

Subjects, study design, outcome measures

Thirty-seven ex-ELBW subjects (11 males [M] and 26 females [F], aged 17–28 years, mean age: 22.2 ± 1.8 years) were compared with 37 controls (11 M and 26 F). ADMA/SDMA ratio levels were assessed for each patient included in the study.

Results

ADMA/SDMA ratio in ex-ELBW subjects was higher compared to controls (1.42 ± 0.31 vs 0.95 ± 0.14, p < 0.002) and inversely correlated with birth weight (r = − 0.68, p < 0.0001) and gestational age (r = − 0.54, p < 0.0005).

Conclusions

ADMA catabolism is significantly decreased in ex-ELBW subjects compared to controls, underlining a probable correlation with restriction of intrauterine growth. These results suggest the onset of early circulatory dysfunction predictive of increased cardiovascular risk in ex-ELBW.     

Neurodevelopmental outcome in Congenital Diaphragmatic Hernia survivors during the first three years

Objective

To determine neurodevelopmental outcome in Congenital Diaphragmatic Hernia (CDH) survivors during the first three years of life.

Methods

Admitted CDH patients were assessed at the age of 12 (n = 18) and 36 months (n = 15) using the Bayley Scales of Infant and Toddler Development Third Edition. Neurodevelopmental results of CDH patients were compared with published norms and with a healthy matched control group.

Results

At 12 months, receptive language was mildly delayed in 6% of patients and 6% of patients demonstrated mildly delay in expressive language and gross motor skills. Eighteen percent of CDH patients had severely delayed scores for gross motor skills. At 36 months, expressive language scores were mildly delayed in 21% of patients. When compared to the control group, CDH patients had similar neurodevelopmental scores at 12 and 36 months of age.

Conclusion

CDH is not necessarily associated with impaired neurodevelopmental outcomes during the first three years of life.

Summary

The aim of this study was to describe neurodevelopmental outcomes in Congenital Diaphragmatic Hernia (CDH) survivors. At 12 months, three (18%) patients had severely delayed scores for gross motor skills. At 36 months, expressive language scores were mildly delayed in three (21%) patients. Neurodevelopmental outcomes of CDH patients were no different to healthy matched controls at 12 and 36 months.     

Longitudinal follow-up of ventricular performance in healthy neonates

Background

Specific follow-up of newly introduced echocardiographic parameters in healthy neonates and infants is limited.

Aim

To prospectively describe follow-up of left ventricular (LV) tissue Doppler imaging (TDI) and speckle tracking strain parameters in healthy subjects up to two months after birth.

Design

This is a longitudinal follow-up study.

Subjects

Twenty-eight (10 male) healthy newborns were included and underwent transthoracic echocardiography 1–3 days, 3 weeks and 6–7 weeks after birth.

Outcome measures

In each echocardiogram, parameters describing cardiac growth, including LV mass (LVM), were assessed. Additionally, TDI derived peak systolic velocity (S′) and peak early (E′) and late (A′) diastolic velocities were assessed in the basal LV free wall and interventricular septum (IVS). Finally LV longitudinal, radial and circumferential global peak strain parameters were assessed using speckle tracking strain imaging.

Results

LVM significantly increased during follow-up (7.6 ± 2.4 versus 12.4 ± 3.2 g, p = 0.002). Similarly at 1–3 days versus 6–7 weeks after birth, an increase in LV and IVS systolic (LV S′ 4.1 ± 1.5 versus 6.3 ± 1.5 cm/s, p = 0.001; IVS S′ 3.6 ± 0.9 versus 6.4 ± 1.3 cm/s, p < 0.001) and diastolic (LV E′ 6.1 ± 2.2 versus 9.7 ± 2.9 cm/s, p = 0.002; IVS E′ 5.1 ± 1.4 versus 10.7 ± 3.3 cm/s, p < 0.001) TDI parameters was observed. In contrast, global peak longitudinal, radial and circumferential strain parameters did not significantly change during follow-up.

Conclusions

A significant increase in LV systolic and diastolic TDI parameters was observed up to two months after birth. Yet this increase may be (cardiac) growth-dependent. No significant changes were observed in speckle tracking strain derived global peak strain parameters; this may render the technique particularly valuable in evaluation of LV systolic performance during periods of significant growth, such as the neonatal period.