Intra- and extrauterine maturation of amplitude-integrated electroencephalographic activity in preterm infants younger than 30 weeks of gestation

OBJECTIVE: To prospectively investigate the longitudinal changes of amplitude-integrated electroencephalographic (aEEG) activity in preterm infants <30 weeks gestational age (GA). METHODS: Infants (GA <30 weeks) without evidence of neurological abnormalities had weekly aEEG recordings performed. The relative duration of the three aEEG patterns (discontinuous low voltage, discontinuous high voltage and continuous) was determined and the influence of GA and postnatal age (PNA) on the occurrence of each pattern was assessed. RESULTS: Ninety-eight infants (median GA 26 weeks; range 23-29 weeks) were studied. With higher GA (OR 1.68, 95% CI 1.33-2.13) and PNA (OR 1.91, 95% CI 1.53-2.38), the likelihood for the occurrence of continuous activity increased. The discontinuous low-voltage pattern was less likely to occur with increasing GA (OR 0.68, 95% CI 0.55-0.83) and PNA (OR 0.70, 95% CI 0.61-0.81). CONCLUSION: Maturation of aEEG activity in preterm infants is influenced by both GA and PNA.     

Risk factors associated with extubation failure in preterm infants with very low birth weight

Repeated endotracheal intubation is associated with complications and additional risks for a preterm infant. The aim of this study was to determine the risk factors related to extubation failure (EF) in preterm newborns.

Comparison of different growth curves in the assessment of extrauterine growth restriction in very low birth weight preterm infants

BackgroundPreterm infants are at risk of extrauterine growth restriction (EUGR) and associated complications in the long term. Growth curves are important in assessing postnatal growth in these infants. The aim of this study was to determine the prevalence of EUGR in preterm infants and the factors associated with EUGR using two different growth curves.MethodsWe retrospectively evaluated 596 preterm infants with birth weight ≤1500 g. Small for gestational age (SGA) was defined as birth weight <10th percentile for gestational age. EUGR was defined as discharge weight z score <?2. All z scores were determined using both the Fenton 2013 and Intergrowth-21st (IG-21) growth curves.ResultsThe infants’ median gestational age was 28 weeks (27–29) and median birth weight was 1080 g (900–1243). The prevalence of SGA was 9.2% with IG-21 curves and 5% with Fenton curves (p < 0.001). The median discharge weight was 2060 g (1860–2363). The prevalence of EUGR was significantly higher with the Fenton curves than with the IG-21 curves (38% vs. 31.7%, p < 0.001). The mean discharge weight z score was ?1.82±1.29 with Fenton and ?1.44±1.49 with IG-21 curves. In multivariate analysis, significant risk factors for EUGR according to the Fenton curves were SGA (odds ratio [OR]: 19.15, 95% confidence interval [CI]: 4.4–82.59), respiratory distress syndrome (RDS) (OR 1.64, 95% CI 1.12–2.4), late neonatal sepsis (LNS) (OR: 2.27, 95% CI: 1.5–3.44), and >16 days to full enteral feeding (OR: 1.8, 95% CI: 1.22–2.68). Similarly, independent risk factors for EUGR according to the IG-21 curve were SGA (OR: 16.3, 95% CI: 7.23–36.9), RDS (OR: 1.81, 95% CI: 1.16–2.83), LNS (OR: 2.29, 95% CI: 1.43–3.68), and >16 days to full enteral feeding (OR: 2.11, 95% CI: 1.38–3.23).ConclusionThe growth curves used for diagnosis may lead to differences in EUGR rates in intensive care units and the factors identified as associated with EUGR. At-risk infants should be evaluated for EUGR and their weight and nutritional support should be monitored carefully. Comparisons of long-term outcomes are needed to assess the suitability of growth curves used for EUGR follow-up.     

Nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure in neonates: A systematic review and meta-analysis

Objective

To compare the efficacy and safety of Nasal intermittent positive pressure ventilation (NIPPV) and Nasal continuous positive airway pressure (nCPAP) in neonates.

Methods

Standard search strategy for the Cochrane Neonatal Review Group was performed. The participants were both preterm and term infants suffering from neonatal respiratory distress syndrome or experiencing apnea of prematurity.

Results

14 eligible andomized controlled trials involving 1052 newborn infants were included. The study quality and evidence validity was defined as moderate. As compared with nCPAP, NIPPV significantly reduced the incidence of endotracheal ventilation (OR=0.44, 95%CI:0.31–0.63), increased the successful rate of extubation (OR=0.15, 95%CI:0.08–0.31), and had a better outcome indicated by decreased death and/or bronchopulmonary dysplasia (OR=0.57, 95%CI:0.37–0.88). Moreover, NIPPV decreased the number of apneic episodes of prematurity (WMD=?0.48, 95%CI:?0.58–0.37), and marginally decreased the incidence of bronchopulmonary dysplasia (OR=0.63, 95%CI:0.39–1.00). No side effects specifically associated with NIPPV were reported.

Conclusions

NIPPV could be used to reduce endotracheal ventilation, increase successful extubation, decrease the rate of apnea of prematurity, and have better outcome indicated by fewer death and/or bronchopulmonary dysplasia in preterm and term newborn infants.     

不同胎龄及出生体重早产儿血游离肉碱变化特点

目的检测不同胎龄及出生体重早产儿血游离肉碱（FC）浓度,为制定早产儿FC补充治疗方案提供依据。方法选取3 368例早产儿为研究对象。根据胎龄（GA）分为超早产（EPTB,GA<28周）组（n=39）、极早产（VPTB,28≤GA < 32周）组（n=405）、中期早产（MPTB,32≤GA<34周）组（n=507）、晚期早产（LPTB,34≤GA<37周）组（n=2 417）;根据出生体重（BW）分为超低出生体重（ELBW,BW < 1 000 g）组（n=36）、极低出生体重（VLBW,1 000 g≤BW < 1 500 g）组（n=387）、低出生体重组（LBW,1 500 g≤BW < 2 500 g）组（n=1 873）、正常出生体重（NBW,2 500 g≤BW≤4 000 g）组（n=1 072）。于生后72 h~7 d内采血进行FC浓度测定并进行比较。结果 EPTB、VPTB组FC浓度明显高于MPTB、LPTB组（P < 0.05）,MPTB组FC浓度明显高于LPTB组（P < 0.05）;胎龄越小,FC的95%医学参考范围下限越高。ELBW、VLBW组FC浓度明显高于LBW、NBW组（P < 0.05）,LBW组FC浓度明显高于NBW组（P < 0.05）;出生体重越低,FC的95%医学参考范围下限越高。结论极/超早产儿、极/超低出生体重儿血FC浓度明显升高,并且随着胎龄及出生体重的增加呈明显下降的趋势。     

InSure技术治疗极早产儿呼吸窘迫综合征失败的高危因素分析

目的 分析InSure 技术治疗极早产儿呼吸窘迫综合征（RDS）失败的高危因素。方法 回顾分析应用InSure 技术治疗的71 例RDS 极早产儿的临床资料,其中治疗成功组42 例,失败组29 例,比较两组患儿的一般情况,并行多因素logistic 回归分析。结果 InSure 技术失败率为41%。失败组在出生体重、产前糖皮质激素使用率、经阴道分娩率明显低于成功组（PP2、PaO2/FiO2、PaO2/PAO2 均明显低于成功组（P2 较成功组明显增高（POR=22.240、95%CI=2.124~232.901）、PaCO2>54 mm Hg（OR=9.360、95%CI=1.958~44.741）、及PaO2/FiO2OR=6.570、95%CI=1.027~42.003）是InSure 技术治疗RDS 失败的独立危险因素。此外,失败组氧疗时间、住院时间及BPD 发生率均明显高于成功组（P结论 InSure技术治疗极早产儿RDS 失败的高危因素包括低出生体重、高PaCO2 及低PaO2/FiO2。     

Interactive Effects of Infant Gestational Age and Infant Fussiness on the Risk of Maternal Depressive Symptoms in a Nationally Representative Sample

ObjectiveTo examine the interactive effects of gestational age and infant fussiness on the risk of maternal depressive symptoms in a nationally representative sample.MethodsOur sample included 8200 children from the Early Childhood Longitudinal Study, Birth Cohort. Gestational age categories were very preterm (VPT, 24–31 weeks), moderate/late preterm (MLPT, 32–36 weeks) and full term (FT, 37–41 weeks). Maternal depressive symptoms (categorized as nondepressed/mild/moderate-severe), from the modified Center for Epidemiological Studies Depression Questionnaire, and infant fussiness (categorized as fussy/not fussy) were assessed at 9 months from parent-report questionnaires. We examined the interactive effects of infant fussiness and gestational age categories and estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) of maternal depressive symptoms using multinomial logistic regression.ResultsInfant fussiness interacted with gestational age categories in predicting maternal depressive symptoms (P = .04), with severity varying by gestational age and infant fussiness. Compared with mothers of VPT infants without fussiness, mothers of VPT infants with fussiness had greater odds of mild depressive symptoms (aOR, 2.32; 95% CI, 1.19–4.53). Similarly, compared with mothers of MLPT and FT infants without fussiness, mothers of fussy MLPT and FT infants had greater odds of moderate-severe symptoms (aOR, 2.30; 95% CI, 1.40–3.80, and aOR, 1.74; 95% CI, 1.40–2.16, respectively).ConclusionsMothers of MLPT and FT infants with fussiness had increased odds of moderate-severe depressive symptoms, and mothers of VPT infants with fussiness had increased risk of mild symptoms. Early screening for infant fussiness in preterm and FT may help identify mothers with depressive symptoms in need of support.     

Intrauterine growth and gestational age in preterm infants with cerebral palsy

In a case-control study, gestational age and intrauterine growth of 191 preterm singleton infants 1971–1982 with cerebral palsy were compared to all preterm live-born singletons in Denmark in 1982 (N = 2203). The distribution of gestational age among preterm cases was slightly bimodal with maximum values at 29 and 32 weeks. The risk for cerebral palsy was highest in the infants with gestational age 28–30 weeks (OR = 5.6 (4.0 – 7.8), 95% confidence interval). Birth weight deviation, in the 34–36 weeks infants, expressed as the number of standard deviations from the mean birth weight for gestational age, was more negative in cases than in controls (P < 0.001). The frequency of small for gestational age (SGA) was 13% in cases and 9% in controls (OR = 1.5 (0.96 – 2.3), 95% confidence interval). The odds for cerebral palsy being SGA, was lower in 28–30 weeks (OR = 0.22 (0.06 – 0.86), 95% confidence interval), the same in 31–33 weeks (OR = 0.83 (0.35 – 2.0), 95% confidence interval) and higher in 34–36 weeks (OR = 5.2 (2.9 – 9.5), 95% confidence interval). In conclusion, preterm infants with cerebral palsy are born earlier than other preterm infants. Small for gestational age is associated with cerebral palsy in preterm infants only above 33 weeks.     

Neonatal antecedents for cerebral palsy in extremely preterm babies and interaction with maternal factors

BACKGROUND: Preterm delivery is associated with an increased risk of cerebral palsy (CP). The greatest risk is for infants born <28 weeks' gestation. AIMS: To identify significant neonatal risk factors for CP and explore the interactions between antenatal and neonatal risk factors, among extremely preterm infants of 27 weeks' gestation or less. STUDY DESIGN: Nested case control design. METHODS: Infants born between 1989 and 1996, at 24-27 weeks' gestation, were evaluated: 30 with CP at 2 years corrected age and 120 control infants matched for gestation age. Neonatal variables were compared using matched analyses with the interaction between antenatal and neonatal factors being examined using logistic regression analyses. RESULTS: Risk factors for CP on matched analyses included patent ductus arteriosus requiring surgical ligation, peri-intraventricular haemorrhage, moderate to severe ventricular dilatation, periventricular leukomalacia (PVL) and need for home oxygen. Independent neonatal predictors were ventricular dilatation (OR 7.3; 95% CI 1.6, 32.3), PVL (OR 29.8; 95% CI 5.6, 159.1) and home oxygen use (OR 3.4; 95% CI 1.2, 9.4). No interaction terms in the logistic models were significant between the previously identified pregnancy risk factors of absence of antenatal steroids and intrauterine growth restriction and the neonatal risk factors. CONCLUSIONS: PVL is the most powerful independent predictor of CP in extremely preterm infants of 27 weeks' gestation or less and appears to be uninfluenced by antenatal factors.     

Effect of non-human neutral and acidic oligosaccharides on allergic and infectious diseases in preterm infants

Short-term supplementation of non-human neutral and acidic oligosaccharides during the first postnatal weeks may enhance the maturation of the immune response in preterm infants and may lead to less allergic and infectious diseases during the first year of life. In a randomized controlled trial, 113 preterm infants (gestational age <32 weeks and/or birth weight <1500 g) were allocated to receive enteral neutral and acidic oligosaccharide supplementation or placebo between days 3 and 30 of life. The median age at follow-up was not different in both groups: 12 months corrected age (interquartile range [IQR], 11–15) in the prebiotic mixture group and 12 months corrected age in the placebo group (IQR, 10–19), respectively. In addition, baseline patient, maternal, and environmental characteristics were not different between the prebiotic mixture (n?=?48) and placebo (n?=?46) group. Incidence of allergic and infectious diseases was assessed by validated questionnaires. In total, 94/98 (96 %) of the eligible, surviving infants participated in this follow-up study. The incidence of atopic dermatitis (odds ratio [OR], 0.80; 95 % confidence interval [CI], 0.24–2.67), bronchial hyper-reactivity (OR, 1.04; 95 % CI, 0.38–2.87) and infections of the upper respiratory (OR, 0.95; 95 % CI, 0.37–2.44), lower respiratory (OR, 1.03; 95 % CI, 0.37–2.88), and gastrointestinal (OR, 1.77; 95 % CI, 0.55–5.73) tract was not different between the groups. Adjustment for potential confounding factors did not change the results of the primary analysis. Conclusion: Short-term enteral supplementation of non-human neutral and acidic oligosaccharides during the neonatal period in preterm infants does not decrease the incidence of allergic and infectious diseases during the first year of life.     

Predictive factors of exclusive breastfeeding attrition at Week 6 post-partum among mothers of preterm infants based on the theory of planned behaviour

Breastfeeding plays an important role in the growth and development of preterm infants, and exclusive breastfeeding (EBF) in the first 6 weeks post-partum is the key to continuous breastfeeding. This study was designed to explore the influencing factors that contribute to breastfeeding attrition among mothers of preterm infants at Week 6 post-partum based on the theory of planned behaviour (TPB). We herein adopted a prospective observational study design in which 97 mothers who exclusively breastfed at Week 6 post-partum at a tertiary specialised hospital in Shanghai from June 2021 to February 2022 were taken as the EBF group, and 179 mothers without EBF were assigned to the EBF attrition group. Through an extensive literature review and expert consultation, we determined the possible factors influencing EBF attrition, analysed those factors that showed statistical significance in our univariate analysis by applying binary logistic regression, and constructed a nomogram model for predicting EBF attrition. The results revealed that negative breastfeeding sentiment (odds ratio [OR] = 1.006; 95% confidence interval [CI], 1.000–1.011) generated a greater risk of breastfeeding attrition. However, positive breastfeeding sentiment (OR = 0.991; 95% CI, 0.983–0.999), social and professional support (OR = 0.993; 95% CI, 0.987–0.999), breastfeeding control (OR = 0.945; 95% CI, 0.896–0.996), knowledge (OR = 0.893; 95% CI, 0.799–0.998), and intention to EBF at Week 6 post-partum (OR = 0.522; 95% CI, 0.276–0.988) were the protective factors and facilitated the development of our nomogram model. The Hosmer–Lemeshow goodness-of-fit test generated a χ² value of 11.344 (p = 0.183) and an area under the curve of 0.822 (95% CI, 0.771–0.873). The C-index was 0.800 in the internal bootstrap validation, indicating that the nomogram model possessed favourable predictive accuracy and discrimination.     

胎龄≤32周早产儿低血糖的危险因素分析

目的 探讨胎龄≤32周早产儿出生后发生低血糖的危险因素。方法 回顾性纳入2017年1月至2020年6月入住新生儿重症监护病房的86例胎龄≤32周低血糖早产儿作为低血糖组,随机选取同期住院监测血糖正常的早产儿172例为对照组。采用单因素分析与多因素logistic回归分析筛选早产儿低血糖的危险因素。结果 研究期间早产儿共计515例,其中低血糖86例（16.7%）。低血糖组小于胎龄儿（SGA）、剖宫产出生、孕母高血压、产前使用激素的比例均高于对照组（P < 0.05）,而出生体重及血糖检测前已静脉使用葡萄糖的比例均低于对照组（P < 0.05）。SGA（OR=4.311,95% CI：1.285~14.462）、孕母高血压（OR=2.469,95% CI：1.310~4.652）和产前使用激素（OR=6.337,95% CI：1.430~28.095）为早产儿低血糖的危险因素（P < 0.05）,静脉使用葡萄糖（OR=0.318,95% CI：0.171~0.591）为早产儿低血糖的保护因素（P < 0.05）。结论 SGA、孕母高血压和产前使用激素可增加胎龄≤32周早产儿早期发生低血糖的风险;对胎龄≤32周早产儿,建议生后尽早静脉使用葡萄糖,以减少低血糖的发生。     

Trends in outcomes for very preterm infants in the southern region of Sweden over a 10-year period

Aim: To investigate trends in mortality and morbidity in very preterm infants.
Methods: Population-based perinatal register; liveborn infants 22 + 0 to 31 + 6 gestational weeks were investigated (time period 1995–2004). Time trends for mortality and common morbidities were explored using logistic regression analyses.
Results: Data from 1614 liveborn infants were included. There was an increase in live born infants below 25 gestational weeks, annual odds ratio (OR) 1.15 (95% CI: 1.08–1.23) and a decrease in mortality annual OR 0.82 (95% CI: 0.69–0.98). The rates of bronchopulmonary dysplasia (BPD) and sepsis increased during the study period, annual ORs of 1.10 (95% CI: 1.04–1.17) and 1.09 (95% CI: 1.03–1.16). The duration of mechanical ventilation increased for surviving infants <25 gestational weeks (p = 0.003), while the duration of continuous positive airway pressure (CPAP) increased for infants <28 gestational weeks (p = <0.001). There were no changes in the rates of intraventricular haemorrhages (IVH, 3–4), retinopathy of prematurity (ROP, 3–5), seizures or necrotizing enterocolitis (NEC).
Conclusion: During the 10-year period changes in mortality and morbidity were most pronounced for infants with GA <28 gestational weeks. The increasing rate of sepsis was present in infants <28 gestational weeks, whereas the increase in BPD was demonstrated in the whole study population <32 gestational weeks.     

Allergic diseases among very preterm infants according to nutrition after hospital discharge

To cite this article: Zachariassen G, Faerk J, Esberg BH, Fenger‐Gron J, Mortensen S, Christesen HT, Halken S. Allergic diseases among very preterm infants according to nutrition after hospital discharge. Pediatr Allergy Immunol 2011; 22 : 515–520. To determine whether a cow’s milk‐based human milk fortifier (HMF) added to mother’s milk while breastfeeding or a cow’s milk‐based preterm formula compared to exclusively mother’s milk after hospital discharge, increases the incidence of developing allergic diseases among very preterm infants (VPI) during the first year of life. Of a cohort of 324 VPI (gestational age 24–32 wk), the exclusively breastfed VPI were shortly before discharge randomized to breastfeeding without fortification or supplementing with a fortifier. Those not breastfed were fed a preterm formula. The intervention period was from discharge until 4 months corrected age (CA). Follow‐up was performed at 4 and 12 months CA including specific IgE to a panel of allergens at 4 months CA. The incidence during and prevalence at 12 months CA of recurrent wheezing (RW) was 39.2% and 32.7%, while atopic dermatitis (AD) was 18.0% and 12.1%, respectively. Predisposition to allergic disease increased the risk of developing AD (p = 0.04) [OR 2.6 (95% CI 1.0–6.4)] and the risk of developing RW (p = 0.02) [OR 2.7 (95% CI 1.2–6.3)]. Boys had an increased risk of developing RW (p = 0.003) [OR 3.1 (95% CI 1.5–6.5)]. No difference was found between nutrition groups. None developed food allergy. Compared to exclusively breastfed, VPI supplemented with HMF or fed exclusively a preterm formula for 4 months did not have an increased risk of developing allergic diseases during the first year of life.     

Functional connectivity in preterm infants derived from EEG coherence analysis

ObjectiveTo quantify the neuronal connectivity in preterm infants between homologous channels of both hemispheres.MethodsEEG coherence analysis was performed on serial EEG recordings collected from preterm infants with normal neurological follow-up. The coherence spectrum was divided in frequency bands: δnewborn(0–2 Hz), θnewborn(2–6 Hz), α_newborn(6–13 Hz), β_newborn(13–30 Hz). Coherence values were evaluated as a function of gestational age (GA) and postnatal maturation.ResultsAll spectra show two clear peaks in the δ_newborn and θ_newborn-band, corresponding to the delta and theta EEG waves observed in preterm infants. In the δ_newborn-band the peak magnitude coherence decreases with GA and postnatal maturation for all channels. In the θ_newborn-band, the peak magnitude coherence decreases with GA for all channels, but increases with postnatal maturation for the frontal polar channels. In the β_newborn-band a modest magnitude coherence peak was observed in the occipital channels, which decreases with GA.ConclusionsInterhemispherical connectivity develops analogously with electrocortical maturation: signal intensities at low frequencies decrease with GA and postnatal maturation, but increase at high frequencies with postnatal maturation. In addition, peak magnitude coherence is a clear trend indicator for brain maturation.SignificanceCoherence analysis can aid in the clinical assessment of the functional connectivity of the infant brain with maturation.     

Erythropoietin and retinopathy of prematurity: a meta-analysis

We performed a meta-analysis to study the association between erythropoietin (EPO) and the development of retinopathy of prematurity (ROP) in preterm newborn infants. Studies were identified through PubMed (1966–) and ISI databases (1965–) literature searches. Results and effect sizes are expressed as odds ratio (OR) with 95 % confidence intervals (CI). Fourteen studies identified to the meta-analysis, including 3,484 preterm newborn infants. A total of 563 of 1,221 babies treated with EPO had ROP (46.1 %) vs. 420 of 1,134 babies without EPO (37.0 %). No significant difference was found in the ROP risk between the two groups, with the OR 1.592 (95 % CI 0.901–2.812). A total of 192 of 1,298 babies treated with EPO had severe ROP (stage 3–4) (14.8 %) vs. 166 of 1,199 babies without EPO (13.8 %). The OR was 1.203 (95 % CI 0.763–1.896). No significant publication bias was found. Sensitivity analyses showed the results were robust. Conclusion: Our meta-analysis indicates that EPO treatment is not associated with the development of ROP in preterm infants. But this conclusion should be confirmed by further high-quality researches.     

Invasive mechanical ventilation and biomarkers as predictors of bronchopulmonary dysplasia in preterm infants

ObjectivesTo evaluate the impact of invasive mechanical ventilation associated with two serum inflammatory cytokines and clinical indicators, on the second day of life, as predictors of bronchopulmonary dysplasia in very low birth weight preterm infants. It was hypothesized that the use of invasive mechanical ventilation in the first hours of life is associated with biomarkers that may predict the chances of preterm infants to develop bronchopulmonary dysplasia.MethodsProspective cohort of 40 preterm infants with gestational age <34 weeks and birth weight <1500 g. The following were analyzed: clinical variables; types of ventilator support used (there is a higher occurrence of bronchopulmonary dysplasia when oxygen supplementation is performed by long periods of invasive mechanical ventilation); hospitalization time; quantification of two cytokines (granulocyte and macrophage colony stimulating factor [GM-CSF] and eotaxin) in blood between 36 and 48 h of life. The preterm infants were divided in two groups: with and without bronchopulmonary dysplasia.ResultsThe GM-CSF levels presented a significantly higher value in the bronchopulmonary dysplasia group (p = 0.002), while eotaxin presented higher levels in the group without bronchopulmonary dysplasia (p = 0.02). The use of continuous invasive mechanical ventilation was associated with increased ratios between GM-CSF and eotaxin (100% sensitivity and 80% specificity; receiver operating characteristic area = 0.9013, CI = 0.7791–1.024, p < 0.0001).ConclusionsThe duration of invasive mechanical ventilation performed in the first 48 h of life in the very low birth weight infants is a significant clinical predictor of bronchopulmonary dysplasia. The use of continuous invasive mechanical ventilation was associated with increased ratios between GM-CSF and eotaxin, suggesting increased lung injury and consequent progression of the disease.     

Chronic lung disease of prematurity and early childhood wheezing: Is foetal inflammatory response syndrome to blame?

BackgroundLong-lasting respiratory symptoms have a huge impact on the quality of life in prematurely born children.AimsWe aimed to investigate the perinatal and maternal risk factors involved in the development of chronic respiratory morbidity in preterm infants, with an emphasis on the importance of Foetal Inflammatory Response Syndrome (FIRS).Study designProspective cohort study.SubjectsDemographic, antenatal, delivery and outcomes data were collected from 262 infants with less than 32 completed weeks of gestational age, over a 10-year period.Outcome measuresPresence of chronic lung disease of prematurity and early childhood wheezing.ResultsIn multivariate logistic regression analysis the presence of FIRS appears to be the most important risk factor for both, chronic lung disease of prematurity (OR 31.05, 95% CI 10.7–87.75, p < 0.001) and early childhood wheezing (OR 5.63, 95% CI 2.42–13.05, p = 0.01). In the alternative regression model for early childhood wheezing, with chronic lung disease included as a variable, the statistical significance of FIRS completely vanished (OR 1.15, 95% CI 0.39–3.34, p = 0.79), whilst chronic lung disease became the most important risk factor (OR 23.45, 95% CI 8.5–63.25, p < 0.001).ConclusionsPrenatal and early neonatal events are of utmost importance in the development of chronic respiratory symptoms in children. The influence of FIRS on the development of chronic respiratory symptoms goes far beyond its impact on gestational age and may be related to direct inflammation-mediated lung tissue damage. CLD appears to be an intermittent step on the way from FIRS to ECW.     

Provider and Practice Factors Associated With On-Time HPV Vaccination in Primary Care

BackgroundIn 2018, only one third of girls and boys completed the 2-dose series of the human papillomavirus vaccine by their 13th birthday, the target for on-time vaccination. The study objective was to identify key patient, provider and practice-level factors associated with on-time vaccination in the primary care setting.MethodsWe examined data from 20 primary care pediatric practices (89 providers) in St. Louis including: the percentage of eligible patients with on-time vaccination assessed from medical records; providers’ knowledge, attitudes and behaviors regarding on-time vaccination assessed with a survey; and practice-level strategies used to optimize vaccine delivery assessed with a 19-item vaccine delivery system score (VDSS). Factors that increased on-time vaccination were identified using logistic regression, controlling for clustering within providers.ResultsCompletion of on-time vaccination occurred in 1347/3125 (43.10%) of patients (95% confidence interval [CI], 41.36%–44.86%) and varied among practices (7.39%–64.24%) and among providers (2.63%–82.50%). Independent predictors for higher completion of on-time vaccination included more frequent use by providers of the announcement style for vaccine recommendation (odds ratio [OR] 1.18, 95% CI, 1.04, 1.35), higher provider self-efficacy to deliver the vaccine according to guideline recommendations if parents were hesitant (OR 1.21, 95% CI, 1.05, 1.40), and higher VDSS (OR 1.20, 95% CI, 1.10, 1.31).ConclusionsProvider and practice-level factors were identified that may represent modifiable targets for improvement in on-time vaccine uptake. Future research is needed to test interventions built on these findings.     

Impact of urine osmolality/urine sodium on the timing of diuretic phase and non-invasive ventilation support: Differences from late preterm to term neonates

BackgroundExtracellular fluid retained in the lungs lead to respiratory distress in both late preterm (LP) and term neonates. The relationship between urine parameters toward the diuresis and the duration of ventilation postnatally is unknown. To find the correlation between the diuretic phase with urine parameters in the first 4 days after birth and the duration of non-invasive ventilation (NIV).MethodsSerial measurements of urine osmolality (Uosm), urine sodium (U_Na), and urine output (U/O) in neonates were collected at 5 time periods (T1:0–12 postnatal hours, T2:12–24 postnatal hours, T3:24–48 postnatal hours, T4:48–72 postnatal hours, T5:72–96 postnatal hours) were recorded. The correlations were analyzed in late preterm and term neonates.ResultsNinety-seven neonates were included. Negative correlation between Uosm and U/O were observed. LP neonates (n=26) and term neonates (n=71) had differences with Uosm at T2, U_Na at T4, T5, and U/O at T2, T3. Factors of U/O < 1 ml/kg/hr at T1 (odds ratio (OR) = 20.0; 95% confidence interval (CI) 1.796-222.776; p = 0.015) or Uosm > 273 mOsm/L at T1 (OR = 9.0; 95% CI 1.031-78.574; p = 0.047) in LP neonates and U_Na > 26.5 mEq/L at T5 (OR = 23.625; 95% CI 2.683-79.276; p < 0.01) in term neonates were associated with prolonged NIV use (> 120 hours).ConclusionWe speculate the significant correlation between Uosm/U_Na and the diuretic phase. The LP neonates acquire earlier diuretic phase than the term neonates. The Uosm/U_Na in the first few postnatal days had the correlation with the duration of NIV support.