Does parental body mass index status modify the associations among birth weight,early growth and childhood adiposity?

OBJECTIVES:

To examine the associations among birth weight, infant growth and childhood adiposity, and to test whether parental weight status modifies these associations.

METHODS:

The sample was comprised of 423 participants born at term who were an appropriate size for their gestational age from the Quebec Adipose and Lifestyle Investigation in Youth (QUALITY) study, a cohort of 630 children with a parental history of obesity. Infant growth velocity from zero to two years of age was estimated using slopes from simple linear regression for weight and body mass index (BMI) Z-scores. Child anthropometrics and body composition, and parental BMI were measured from eight to 10 years of age. Associations were modelled using multiple linear regressions.

RESULTS:

Increased birth weight and growth velocity independently predicted increased childhood adiposity. Effects of infant growth velocity on later adiposity were stronger with higher maternal BMI but not with higher paternal BMI. Similar interactions with birth weight were not found.

CONCLUSIONS:

Early childhood measures of growth and the mother’s BMI score should be included in investigations on obesity risk.     

Retinopathy of prematurity: A systematic review of the literature

OBJECTIVE:

To assist in the diagnosis of retinopathy of prematurity (ROP) to facilitate treatment in a timely manner to help prevent blindness.

DATA SOURCES:

Systematic review using MEDLINE including the following key words, “retinopathy of prematurity”, “retrolental fibroplasia”, “blind”, “blindness”, “vision screening”, “cryotherapy”, “cryosurgery”, “laser” and “ablative therapy”. The bibliographies of the references found using the above techniques were scanned for references missed in the primary search.

DATA SELECTION:

Eight population-based studies examining the incidence and severity of ROP were identified. Other studies of ROP were included because they contributed to an understanding of the natural history, treatment or long term outcome of ROP.

DATA EXTRACTION:

Data was analyzed cumulatively from the population-based studies to determine the incidence of ROP. For the natural history, treatment and schedule of eye examinations, data was reported from individual studies.

DATA SYNTHESIS:

Infants at greatest risk of ROP were 1500 g or less at birth, or 30 weeks gestational age or younger. An inverse relationship existed between the incidence and severity of ROP and birth weight or gestational age. The age of onset of ROP was four to six weeks; however, a few newborns presented with an aggressive form of ROP called ’rush disease’ as early as three weeks of age. For those requiring treatment for ROP, the maximum severity was about 11 weeks of age. Long term follow-up for refractive errors was more effective between six and 12 months and again at four years.

CONCLUSION:

Very premature or very low birth weight infants are at highest risk of ROP. Based upon published information, an optimal screening schedule is recommended and a long term follow-up strategy is provided.     

Size for gestational age at birth: impact on risk for sudden infant death and other causes of death, USA 2002

Background

Small for gestational age (SGA) infants have been reported to be at higher risk for sudden infant death syndrome (SIDS).

Objective

To compare the risk of SIDS among SGA and large for gestational age (LGA) infants with that of death from other causes of sudden unexpected deaths in infancy (SUDI) and the residual “other” causes of infant death.

Methods

The 2002 US period infant birth and death certificate linked file was used to identify infant deaths classified as SIDS (ICD‐10 code R95), SUDI (ICD‐10 codes R00‐Y84 excluding R95) or all other residual codes. The 2002 race and sex‐specific birth cohorts were used to generate the 10th and 90th percentiles of birth weight for each gestational age week from 24 to 42 weeks'' gestation. Demographic variables previously identified as associated with SIDS were used in multiple logistic regression equations to determine the risk for death among SGA and LGA infants (birth weight <10th percentile and >90th percentile, respectively) independent of other potentially confounding variables.

Results

Complete data on 1956 SIDS deaths, 2012 SUDI, and 11 592 other deaths were available. The adjusted OR for SIDS, SUDI and “other” causes for SGA infants was 1.65 (95% CI 1.47 to 1.85), 1.78 (1.59 to 2.00) and 4.68 (4.49 to 4.88), respectively. The adjusted OR for LGA infants was reduced for SIDS (0.73 (0.60 to 0.89)), SUDI (0.81 (0.68 to 0.98)) and “other” (0.42 (0.38 to 0.46)).

Conclusion

Although SGA infants seem to be at slightly increased risk for SIDS or SUDI their risk for “other” residual causes is about 2.5 times higher. LGA infants seem to be at reduced risk of mortality for all causes. The mechanisms by which restricted intrauterine growth increases risk of mortality and excessive intrauterine growth offers protective effects are uncertain.Small for gestational age (SGA) infants have been reported to be at 1.4 to 2.0 times greater risk for sudden infant death syndrome (SIDS).1,2,3,4,5 Other causes of death have also been reported to be associated with being SGA by some authors,6,7 in particular, preterm SGA infants are reported to have an increased risk of death ranging from 2.4 to 3.6 times that of appropriate for gestational age (AGA) preterm infants.8,9 Other authors, however, have observed no increase in risk for other causes of death among term SGA infants after adjusting for racial disparities in birth weight.10 The mechanisms associated with the increased risk for SIDS among SGA infants remain unclear, but some investigators have suggested that the risk may be secondary to the hypoxia these infants are suspected of being exposed to in utero.11,12 Why in utero hypoxia may make an infant more vulnerable to SIDS has been hypothesised to be related to a reduction of serotonergic receptors in multiple brainstem nuclei.13,14Despite the biological plausibility of the hypoxic‐related vulnerability of SGA infants for SIDS, comparative studies of just how much greater risk such an infant has for SIDS compared with other causes of death are not replete in the literature. Thus, the purpose of this analysis was to determine whether SGA infants were at greater risk for SIDS compared with other causes of death. The risk of large for gestational age (LGA) infants for SIDS has not been closely examined and an examination of this relationship was thus included in the analysis. Because of a trend towards the reclassification of SIDS deaths to other causes of sudden unexpected causes of death (SUDI),15 the risk of SUDI excluding SIDS for SGA infants as well as the risk of the remaining residual “other” causes of death among these infants was examined for the USA for the year 2002.     

Coagulase-negative staphylococcal infections in a neonatal intensive care unit: In vivo response to cloxacillin

BACKGROUND

Following the introduction of cloxacillin and gentamicin as the first line of treatment for possible late-onset sepsis (LOS) in the authors’ neonatal intensive care unit (NICU), it was subsequently noted that very low birth weight (VLBW) infants improved clinically, despite subsequently positive blood cultures for oxacillin-resistant, coagulase-negative Staphylococcus (CONS). The results of the management of VLBW infants with CONS sepsis during one calendar year, based on clinical rather than laboratory findings, are presented.

METHODS

VLBW infants with LOS were identified through the neonatal database, and the charts of those with CONS were reviewed for antibiotic usage, antibiotic resistance pattern, clearance of CONS from the blood and NICU discharge status. Oxacillin sensitivity was determined by the presence of the mecA gene.

RESULTS

From January 1 to December 31, 2002, 27 VLBW infants, treated in the authors’ NICU for LOS due to CONS, were identified. The mean age of LOS infants with CONS was 15 days (median 12 days; range three to 54 days), the mean birth weight (± SD) was 904±247 g, and the mean gestational age at birth (± SD) was 27±2 weeks. All infants were started on cloxacillin and gentamicin, and improved clinically over the first 48 h. Six isolates were sensitive to cloxacillin. Twenty-three infants grew oxacillin-resistant CONS, eight of whom had persistence of CONS on repeat culture secondary to central lines. Two infants grew two strains of CONS. Eighteen of 22 infants (82%) with in vitro oxacillin-resistant CONS had clearance of bacteremia with cloxacillin and gentamicin. Ten infants (37%) received vancomycin, based on the authors’ guidelines. There were no cases of prolonged bacteremia requiring rifampicin. Three infants died, but none of the deaths could be attributed to CONS.

DISCUSSION

The authors describe clinical improvement with clearance of CONS using cloxacillin and gentamicin, despite laboratory results suggesting oxacillin resistance. The authors’ unit policy was based on clinical response and permitted the continuation of cloxacillin, provided that a repeat blood culture was negative. Vancomycin use was suggested for clinical deterioration or persistence of CONS. These results question the in vitro tests of resistance. Clearance of oxacillin-resistant CONS from the blood points to in vivo sensitivity, while the laboratory testing suggests in vitro resistance. The absence of subsequent positive blood cultures for CONS confirms clearance of this organism.

CONCLUSION

It was demonstrated that cloxacillin (150 mg/kg/day dose), along with gentamicin, can clear CONS from the blood within 48 h. The relationship between in vivo and in vitro sensitivities also needs to be further studied both in the laboratory and in a prospective trial.     

Does the use of glycerin laxatives decrease feeding intolerance in preterm infants?

BACKGROUND:

Glycerin laxatives are often prescribed in the neonatal population for meconium evacuation and to promote enteral feeding. However, the literature regarding their effectiveness has not been systematically reviewed.

OBJECTIVE:

To assess the effectiveness of glycerin enema or suppository in preventing feeding intolerance in preterm infants at ≤32 weeks’ gestational age or weighing ≤1500 g at birth.

METHODS:

The Medline, Embase, Cochrane Library, Scopus and Web of Science databases were searched to identify studies that evaluated glycerin enemas/suppositories for feeding intolerance. Using the Evidence Evaluation Worksheet adapted from the American Heart Association’s International Liaison Committee on Resuscitation, eligible studies were scored for quality, level of evidence and direction of support.

RESULTS:

Two clinical studies that evaluated meconium evacuation and feeding intolerance were included. One study showed no difference in the time to complete meconium evacuation or establishment of full enteral feeds, while the other showed that the times to first meconium passage and full enteral feeding were significantly shorter, and the rate of sepsis was lower in the glycerin enema group.

CONCLUSION:

The evidence regarding the effectiveness of glycerin laxatives for improving feeding tolerance is inconclusive in infants at ≤32 weeks’ gestational age or weighing ≤1500 g at birth.     

Effects of Maternal Cervical Incompetence on Morbidity and Mortality of Preterm Neonates with Birth weight Less than 2000g

Objective:

This study aimed to determine the impact of maternal cervical incompetence (with or without McDonald cerclage) on mortality and morbidity of preterm infant with birth weight <2000g.

Methods:

581 neonates were eligible for this study, 79 with cervical incompetence and 502 without it (control). Incidences of neonatal respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), neonatal necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), periventricular leukomalacia (PVL), severe asphyxia, small for gestational age (SGA), early-onset sepsis (EOS), and mortality were compared between the two groups.

Findings:

Mean gestational age was earlier in cervical incompetence group than in control (30.2±2.1 vs 30.7±1.9, P<0.05). Except lower frequency of SGA, there were no significant differences in the incidences of RDS, BPD, ROP, PVL, IVH, NEC, EOS, severe asphyxia and mortality between the two groups. Infants with no cerclage had a higher prevalence of RDS (21/66 vs 9/13, P<0.05) compared to cerclage group due to lower mean gestational age (30.68±2.1 vs 28.6±1.4, P<0.01) and birth weight (1519.5±274.6 vs 1205.8±204.4, P<0.001), and clinical neonatal outcomes of the elective cerclage were similar to emergency cerclage in cervical incompetence groups.

Conclusion:

Maternal cervical incompetence was not associated with postnatal adverse neonatal outcomes. Lower mean gestational age was a major risk associated with higher prevalence of RDS in preterm neonates with no McDonald cerclage, and emergency cerclage did not predict poor clinical neonatal outcomes.     

Very prematurely born infants wheezing at follow-up: lung function and risk factors

Objectives

To determine whether abnormalities of lung volume and/or airway function were associated with wheeze at follow‐up in infants born very prematurely and to identify risk factors for wheeze.

Design

Lung function data obtained at 1 year of age were collated from two cohorts of infants recruited into the UKOS and an RSV study, respectively.

Setting

Infant pulmonary function laboratory.

Patients

111 infants (mean gestational age 26.3 (SD 1.6) weeks).

Interventions

Lung function measurements at 1 year of age corrected for gestational age at birth. Diary cards and respiratory questionnaires were completed to document wheeze.

Main outcome measures

Functional residual capacity (FRC_pleth and FRC_He), airways resistance (R_aw), FRC_He:FRC_pleth and tidal breathing parameters (T_PTEF:T_E).

Results

The 60 infants who wheezed at follow‐up had significantly lower mean FRC_He, FRC_He:FRC_pleth and T_PTEF:T_E, but higher mean R_aw than the 51 without wheeze. Regression analysis demonstrated that gestational age, length at assessment, family history of atopy and a low FRC_He:FRC_pleth were significantly associated with wheeze.

Conclusions

Wheeze at follow‐up in very prematurely born infants is associated with gas trapping, suggesting abnormalities of the small airways.     

Short-Term Outcomes of Very Low Birth Weight Infants Born at a Tertiary Care Hospital,Istanbul, Turkey

Objective

To evaluate mortality and short-term outcomes in very low birth weight infants admitted to the tertiary neonatal intensive care unit, Istanbul, Turkey.

Methods

Study data were recorded prospectively from January 1, 2010, to December 31, 2010. The clinical findings in neonates with birth weights <1000g were compared with infants with birth weights of between 1000g and 1499g.

Findings

In the present study, survival rates were 40% and 86.2% for infants weighing <1000g and 1000g to 1499g, respectively. There was no difference between males and females with respect to mortality (P>0.05). The mean (±standard deviation) birth weight was 985.6±150.15 g and mean gestational age was 27.5±2.04 weeks. The antenatal steroid rate was 37.2%, and the Cesarean section rate was 73%. Respiratory distress syndrome was diagnosed in 89% of the infants, with a 69% surfactant administration rate. Severe intracranial hemorrhage (IVH) (grade >II) was 14%. Grade 4 periventricular leukomalacia was 10%. Twelve (24%) infants had evidence of bronchopulmonary dysplasia (BPD). Retinopathy of prematurity (stage >II) was 4%. The correlation between ROP rate and need for ventilation therapy was present (r=0.52). Proven necrotizing enterocolitis (stage >2) was not observed. Patent ductus arteriosus (PDA) was diagnosed in 67% of the neonates. BPD, IVH, and PDA were statistically higher in neonates with a birth weight <1000g.

Conclusion

Survival rate of VLBW infants increased with increasing BW. Sex was not a risk factor for mortality. The need for ventilatory therapy may be an important risk factor for ROP in infants <1500g.     

Factors associated with car seat test failure in late preterm infants: A retrospective chart review

BACKGROUND:

Professional organizations recommend car seat testing of preterm infants before discharge from hospital. Late preterm infants (LPIs, 34^0/7 to 36^6/7 weeks’ gestational age) are at the greatest risk for failure, despite often being well.

OBJECTIVE:

To determine the incidence of car seat testing failure in LPIs and associative factors.

METHODS:

A retrospective chart review was performed of inborn LPIs admitted to all levels of newborn care between July 1, 2012 and June 30, 2013. Data collected included maternal demographics, labour and delivery history, and neonatal course. Data were analyzed using backward logistic regression.

RESULTS:

A total of 511 charts were reviewed and 367 LPIs were eligible for inclusion. Of the 313 LPIs tested (mean [± SD] gestational age 36 weeks ±6 days and birth weight 2614±405 g), 80 (26%) failed (95% CI 21% to 31%). Most failed due to desaturations (≥2) of <88% for ≥10 s (n=33 [41%]). Multiple gestation was associated with failure (adjusted OR 2.45 [95% CI 1.44 to 4.18]; P=0.001), and there was a trend toward statistical significance for the variable postnatal age (0.996 [95% CI 0.99 to 1.00]; P=0.05). Infants who passed their car seat test had higher postnatal ages than those who failed (mean difference 39.4 h [95% CI 12.7 h to 66.0 h]; P=0.004).

CONCLUSION:

Twenty-six percent of LPIs failed car seat testing. Ideally, infants should be tested after an appropriate transitional period. The authors identified factors that may be important in designing future, prospective studies in this area. Future research should evaluate the clinical significance of car seat testing and resource utilization.     

Fetal growth restriction: relation to growth and obesity at the age of 9 years

Objective

To assess growth patterns of 9‐year‐old children, some of whom had intrauterine growth restriction (IUGR).

Method

75 9‐year‐old children (41 were IUGR infants) were weighed and measured at birth, at 1 year, at 2 years and at 9 years of age. Using general linear models for continuous data, changes in weight z scores were used to quantify growth rate between birth and 9 years of age.

Results

IUGR children were smaller at birth (weight z score –2.1 v 0.2 in normal children; p<0.001) but showed a greater increase in their weight between birth and 9 years (change of weight z score 1.5 v 0.4 in normal children; p = 0.001). At the age of 9 years the weight, height and body mass index (BMI) z scores were lower in IUGR children than the control children (weight z score –0.4 v 0.6, respectively; p<0.001, height z score –0.5 v 0, respectively; p = 0.002, BMI z score −0.2 v 0.7, respectively; p = 0.002). The predictors of these differences were IUGR, birth weight and maternal and paternal heights.

Conclusion

IUGR infants grow faster but remain shorter and lighter than their normal counterparts—that is, they fail to fully catch up by 9 years of age.     

A nearly continuous measure of birth weight for gestational age using a United States national reference

Background

Fully understanding the determinants and sequelae of fetal growth requires a continuous measure of birth weight adjusted for gestational age. Published United States reference data, however, provide estimates only of the median and lowest and highest 5^th and 10^th percentiles for birth weight at each gestational age. The purpose of our analysis was to create more continuous reference measures of birth weight for gestational age for use in epidemiologic analyses.

Methods

We used data from the most recent nationwide United States Natality datasets to generate multiple reference percentiles of birth weight at each completed week of gestation from 22 through 44 weeks. Gestational age was determined from last menstrual period. We analyzed data from 6,690,717 singleton infants with recorded birth weight and sex born to United States resident mothers in 1999 and 2000.

Results

Birth weight rose with greater gestational age, with increasing slopes during the third trimester and a leveling off beyond 40 weeks. Boys had higher birth weights than girls, later born children higher weights than firstborns, and infants born to non-Hispanic white mothers higher birth weights than those born to non-Hispanic black mothers. These results correspond well with previously published estimates reporting limited percentiles.

Conclusions

Our method provides comprehensive reference values of birth weight at 22 through 44 completed weeks of gestation, derived from broadly based nationwide data. Other approaches require assumptions of normality or of a functional relationship between gestational age and birth weight, which may not be appropriate. These data should prove useful for researchers investigating the predictors and outcomes of altered fetal growth.

     

Changes in Perinatal Care and Predictors of In-Hospital Mortality for Very Low Birth Weight Preterm Infants

Objective

Mortality of very low birth weight premature infants is of great public health concern. To better guide local intervention program, it is essential that current and reliable statistics be collected to understand the factors associated with mortality of these infants.

Methods

Data of very low birth weight premature infants admitted to a neonatal unit during 2002-2009 was retrospectively collected. Changes in perinatal care between two halves of the study period (2002-2005 and 2006-2009) were identified. Factors associated with in-hospital mortality were found by logistic regression and a predictive score model was established.

Findings

A total of 475 cases were enrolled. In-hospital mortality decreased from 29.8% in 2002-2005 to 28.1% in 2006-2009 (P>0.05). More infants born <28 gestational weeks survived to discharge in the latter epoch (38.1% vs 8.3%, P<0.05). Persistent pulmonary hypertension of newborn, pulmonary hemorrhage, birth weight <000 grams, gestational age <33 weeks, feeding before 3 postnatal days and enteral feeding were found predictors of in-hospital mortality by logistic regression. The discriminating ability of the predictive model was 82.4% and the cutoff point was -0.56.

Conclusion

Survival of very low birth weight premature neonates was not significantly improved in 2006-2009 than 2002-2005. Infants with a score higher than -0.56 were assessed to be at high risk of in-hospital mortality. Multi-center studies of planned follow-up are needed to develop a comprehensive and applicable score system.     

The Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) study of neonatal group B streptococcal infections in Canada

OBJECTIVES:

To determine the presentation and medical outcomes of neonatal group B streptococcus (GBS) disease in Canada, and describe maternal and obstetrical risk factors.

DESIGN:

Retrospective review of health records and laboratory databases using standardized data collection forms.

SETTING:

All neonates diagnosed with GBS infections in 1992 at 13 Canadian paediatric centres.

RESULTS:

A total of 105 infants meeting the criteria for neonatal GBS disease were identified. The majority of cases (78 or 74.3%) had early-onset disease (EOD); 78.9% (60 of 76) of these cases presented within 24 h of delivery. Rates of EOD (less than seven days) varied from 0.44/1000 live births to 2.1/1000 live births, with an overall rate of 1.2/1000 live births. Pneumonia was the most common clinical illness (43.8%), followed by bacteremia without focus (23.8%) and meningitis (16.2%). At least one maternal risk factor for neonatal GBS disease was noted in 46 of 78 (59%) infants with EOD. A median of one dose (range one to 23 doses) of intrapartum antibiotics was given in 18 of 75 (24%) of the pregnancies. Overall, the mean gestational age at birth was 36.2±4.7 weeks, with 38 of 96 (39.6%) infants having a gestational age at birth younger than 37 weeks (31 of 73 [42.5%] EOD cases were born with a gestational age younger than 37 weeks). The median birth weight was 3099 g (range 610 g to 4830 g). Thirty of 94 (31.9%) infants had a birth weight less than 2500 g. Seventeen (16.2%) infants died.

CONCLUSIONS:

In 1992, neonatal GBS disease was a significant cause of morbidity and mortality in Canadian infants. More than half of the cases identified in this study could have been potentially preventable by the use of intrapartum antibiotics for women with known risk factors. There is a need for prospective studies to better define risk factors and preventative measures for neonatal GBS infections in Canada.     

Population-based reference for birth weight for gestational age in northern China

Background

Localized birth weight references for gestational age serve as an essential tool in accurate evaluation of atypical birth outcomes (e.g. small for gestational age) in clinical diagnosis and region-specific epidemiological studies. Such standards are currently not available in Mainland China.

Aims

To construct up-to-date, sex- and parity-specific birth weight references based on 231,937 births in Taiyuan, China during years 2005–2011.

Study design

Population-based, cross-sectional.

Subjects

Hospital-registered, healthy infants with births dated between 11/01/2005 and 12/31/2011 within Taiyuan area.

Outcome measures

Birth weight in grams, and gestational age in complete weeks were calculated using a combination of last-menstrual-date-based estimation and ultrasound examination.

Results

Separate birth weight references are constructed for male and female infants born from primiparous and multiparous mothers. Male infants are found to weigh more than female infants in later gestational ages (appr. weeks 33–42), and infants born to multiparous mother are found to weigh more than infants born to primiparous mothers in later gestational ages (appr. weeks 36–42).

Conclusions

The Taiyuan birth weight reference curves display similar trends of growth as reference curves from other countries worldwide (Netherlands, Scotland, Australia, Canada, Hong Kong, Korea and Kuwait). However, growth of birth weight for Taiyuan infants tends to be slower compared to European and North American infants regardless of gender, but similar to infants from other Asian countries.     

Hypoglycemia in term newborns with a birth weight below the 10th percentile

BACKGROUND:

Current recommendations suggest that routine screening for hypoglycemia should be performed in all term newborns with a birth weight (BW) below the 10th percentile. The impact of updated growth curves on the incidence of hypoglycemia in small-for-gestational-age (SGA) newborns has not been evaluated.

OBJECTIVES:

To evaluate the occurrence and severity of hypoglycemia in term newborns with a BW between the 10th and fifth percentile, and below the fifth percentile, using recently updated growth curves.

DESIGN:

A one-year prospective cohort study.

METHODS:

Inclusion criteria were gestational age of 37 weeks or greater and BW below the 10th percentile. Neonatal hypoglycemia was defined as a blood glucose level of less than 2.6 mmol/L measured after 2 h of life. Blood glucose was measured routinely for all SGA infants during the first 36 h of life.

RESULTS:

A total of 187 SGA infants met the study criteria: 85 infants with a BW between the 10th and fifth percentile, and 102 infants with a BW below the fifth percentile. The characteristics of the study cohort were similar between BW groups. Twenty-six per cent of the infants screened had at least one episode of hypoglycemia: 22% of infants in the 10th to fifth percentile group and 28% in the less than fifth percentile group. Hypoglycemia was symptomatic in four infants, all of whom were below the fifth percentile for BW. The mean (± SD) lowest blood glucose level was 2.1±0.4 mmol/L (range 0.6 mmol/L to 2.5 mmol/L) in the 10th to fifth percentile group and 2.0±0.5 mmol/L (range 0.8 mmol/L to 2.5 mmol/L) in the less than fifth percentile group (P=0.05).

CONCLUSION:

The present study demonstrates a high incidence of hypoglycemia among SGA infants with a BW below the 10th percentile using updated growth curves. There was no difference in the incidence of hypoglycemia among SGA infants with a BW below the fifth percentile versus those with a BW between the 10th and fifth percentile.     

Resting heart rate does not predict growth in preterm infants

Background

Previous reports indicate that preterm infants with higher baseline heart rate (HR) have greater weight gain than preterm infants with lower baseline HR. To verify this correlation and the potential utility of resting HR as a bench mark for risk of extrauterine growth restriction (EUGR), we studied preterm infants born between 32 and 36 weeks gestation. Earlier gestation infants (27 to 31 weeks) were included.

Methods

In retrospective chart review we collected heart rate (HR) and growth data on 156 infants between 27.0 and 34.0 weeks gestation from birth to hospital discharge.

Results

There was a significant increase in weight gain from day 10 of life in infants with higher resting HR compared to infants with lower resting HR. However, upon controlling for birth weight and gestational age, there was no significant relationship between HR and weight gain for any gestational age group of premature infants.

Conclusions

Contrary to previous reports, there was no significant relationship between HR and growth at any gestational age after controlling for birth weight and gestational age. It is important to continue to search for a clinical marker of risk for poor growth in preterm infants and to give an opportunity for nutritional interventions which may support better growth and developmental outcomes.     

Heparin is not required for peripheral intravenous locks in neonates

OBJECTIVE:

To determine the relative efficacy and safety of peripheral intravenous locks maintained with heparin saline solutions compared with those maintained with normal saline.

DESIGN:

Randomized, controlled trial comparing the two methods of maintaining peripheral intravenous locks.

SETTING:

Infants in the neonatal intensive care unit (NICU) at Foothills Hospital, Calgary, Alberta.

PATIENTS:

Neonates requiring the maintenance of intravenous locks for medications, primarily antibiotics, were randomly placed in either a heparin saline (n=93) or normal saline (n=93) group.

INTERVENTIONS:

Patients were chosen to receive either heparinized saline (5 units/mL) or normal saline, 0.3 mL in the intravenous catheter every 6 h, administered by nursing staff in a blinded manner.

RESULTS:

There was no difference in catheter lifespan (39±24 h for the heparinized saline group; 34±22 h for the normal saline group) and no difference in the number of intravenous catheters per patient (1.9 heparinized group, 1.6 normal saline group). There were no differences in the reasons for catheter removal, complications at the skin site or systemic bleeding including intracranial hemorrhage between the two groups. The risk of catheter occlusion was inversely correlated with gestational age and the administration of vancomycin and cefotaxime versus ampicillin and gentamicin.

CONCLUSIONS:

Heparin is not required for the maintenance of peripheral intravenous locks in neonates regardless of the solution used. Catheter occlusion is more likely to be associated with a low gestational age and the administration of vancomycin and cefotaxime versus ampicillin and gentamicin.     

The Effects of Non-Nutritive Sucking and Pre-Feeding Oral Stimulation on Time to Achieve Independent Oral Feeding for Preterm Infants

Background:

The survival rates of preterm infants has increased over the last years, but oral feeding difficulties are the most common problems encountered by them

Objectives:

This study aimed at comparing the effects of non-nutritive sucking (NNS) and pre-feeding oral stimulation on feeding skills, length of hospital stay and weight gain of 26-32 weeks gestational age preterm infants in NICU, to determine the more effective intervention.

Patients and Methods:

Thirty-two preterm infants were assigned randomly into three groups. One intervention group received pre-feeding oral stimulation program and the other received non-nutritive sucking stimulation, while the control group received a sham intervention. Gestational age of infants was calculated during 1, 4 and 8 oral feeding and discharge time from NICU. The infants’ weights were measured weekly from birth and at discharge time.

Results:

Mean gestational age on 8 time oral feeding per day, in 3 groups was not significant (P = 0.282). Although NNS and pre-feeding oral stimulation groups has fulfilled this criterion 7.55 and 6.07 days sooner than the control group, respectively (a result which is of great clinical and economic importance), but the difference did not reach statistical significance. Weight gaining at discharge time in NNS group was significantly higher than control and pre-feeding oral stimulation groups (P < 0.05).

Conclusions:

This study revealed that pre-feeding oral stimulation and NNS programs both were effective on oral feeding skills and weight gaining of the immature newborns. Yet, it seems that NNS program was more effective than pre-feeding oral stimulation on weight gaining.