Superior vena cava flow and intraventricular haemorrhage in extremely preterm infants

Objective: To evaluate the relationship between superior vena cava flow (SVCF) measurements within the first 24?h of life, and development of intraventricular haemorrhage (IVH) in extremely preterm infants.

Study design: Single centre retrospective cohort study of 108 preterm infants born less than 28 weeks’ gestation. Main outcome measure was degree of IVH at day 7 postnatal age.

Results: The mean GA of the study group was 25.4 weeks. Mean SVCF was lower (75?ml/kg/min) in infants later diagnosed with IVH (n?=?46) compared to infants, who did not develop IVH (87.7?ml/kg/min, p?=?0.055). PDA diameter was inversely associated with SVCF (p?=?0.024) and reversal of flow in the descending aorta (p?=?0.001). Sensitivity analysis did not confirm an independent association of SVCF with development of IVH [OR 0.990 (0.978–1.002), p?=?0.115].

Conclusion: Our study describes early SVCF in extremely preterm infants is associated with the extent of ductal shunting, but insensitive in predicting IVH.     

The effect of histological chorioamnionitis on the short-term outcome of preterm infants ≤32 weeks: a single-center study

Abstract

Background and objectives: Chorioamnionitis (CA) is an acute inflammation of the membranes and chorion of the placenta. The aim of this study was to determine the effect of histological CA on the short-term outcome of preterm infants.

Subjects and methods: The clinical characteristics and outcomes of the preterm infant including respiratory distress syndrome, duration of mechanical ventilation, patent ductus arteriosus (PDA) requiring medical treatment or ligation, necrotizing enterocolitis, bronchopulmonary dysplasia, death and intraventricular hemorrhage (IVH; grade III–IV) were analyzed.

Results: Two hundred and eighty-one infants born at ≤32 weeks gestational ages were included. Infants were divided into two groups: one with histological CA (n?=?145) and without histological CA (n?=?136). Mean gestational age was 28.8?±?2.6 weeks and 29.1?±?2.5 weeks, and mean birth weight was 1138?±?350?g and 1210?±?299?g, respectively. There were no differences in gestational age and birth weight among the groups. Compared with the group, histological CA was associated with early onset sepsis (p?=?0.007), PDA (p?=?0.003), IVH (p?=?0.03), and death (p?=?0.04).

Conclusion: Maternal histological CA is an important risk factor for preterm deliveries and associated with serious morbidities such as early onset sepsis, IVH, PDA and increased mortality.     

Cord blood erythropoietin and interleukin-6 for prediction of intraventricular hemorrhage in the preterm neonate

Objective.?To evaluate cord blood erythropoietin (EPO) and interleukin-6 (IL-6) levels to predict preterm infants at risk of developing intraventricular hemorrhage (IVH).

Methods.?Levels of umbilical cord EPO, acid–base status and IL-6 were analyzed in 116 consecutive, preterm newborns (GA at delivery: 29 [23–34 ] weeks) born to mothers who had a clinically indicated amniocentesis to rule out infection. Early-onset neonatal sepsis (EONS) was diagnosed using symptoms, hematological criteria and blood cultures.

Results.?IVH was diagnosed by cranial ultrasounds. The prevalence of IVH in our population was 25% (29/116). There was a direct relationship between cord blood EPO and cord blood IL-6 concentration (r?=?0.225, p?=?0.014), independent of GA at birth. Elevated cord blood EPO levels (r?=?0.182, p?=?0.016) and GA at birth (r?=??0.236, p?=?0.004) remained significant independent factors associated with the risk of IVH, when evaluated with stepwise logistic regression analyses. Cord blood IL-6, pH, and EONS were not associated with IVH. These relationships remained following correction for GA at birth (p?=?0.027).

Conclusions.?Our results suggest that elevation in cord blood EPO may predict newborns at risk for IVH, independent of fetal inflammatory status. Further studies are warranted to confirm this association.     

Homocysteine levels and its association with intraventricular hemorrhage in preterm infants born to preeclamptic mothers

Abstract

Objective: To investigate the relation between serum homocysteine levels and intraventricular hemorrhage (IVH) in preterm infants born to preeclamptic mothers.

Method: This study included 84 preterm infants (42 born to preeclamptic mothers and 42 born to normotensive healthy mothers) who were admitted to Izmir Tepecik Training and Research Hospital Neonatology Clinic on the postnatal first day. The measurement of homocysteine levels in all samples were performed with an Immulite 2000 analyzer, using the chemiluminescence method. Cranial ultrasounds were performed on the fourth day and in the 1 month of age.

Results: The mean plasma levels of homocysteine in infants born to preeclamptic mothers and in the control group were 8.2?±?5.9?μmol/L and 5.3?±?2.7?μmol/L, respectively. The plasma levels of homocysteine were significantly higher in the study group (p?=?0.006). There was no association between the plasma homocysteine levels and IVH or other neonatal complications including necrotizing enterocolitis, retinopathy of prematurity, bronchopulmonary dysplasia and mortality.

Conclusion: Our data suggest that plasma levels of homocysteine are higher among infants born to preeclamptic mothers, but these high levels are not associated with IVH and other neonatal complications in preterm infants.     

Platelet indices in late preterm newborns

Background: The current study objective was to compare blood platelet indices in late preterm newborns (LPN) and full term newborns (FTN).

Materials and methods: We recruited 58 LPN and 71 FTN. Platelet indices were estimated in blood samples collected from the umbilical artery.

Results: LPN demonstrated a decreased count of blood platelets (249?×?10³/μL) as compared to FTN (295?×?10³/μL), p?p?p?=?0.02. Large platelet count (LP) was lower in LPN (4.0%) in comparison with FTN (6.0%), (p?=?0.01).

Conclusions: The obtained results may indicate immaturity of thrombopoiesis in newborns born late preterm. Decrease in platelet count, platelet hematocrit and large platelets can cause disturbances in the hemostatic system and lead to bleeding complications and can increase the risk of infections. Morphological parameters of blood platelets in infants born late preterm differ from those of term neonates as in other preterm infants. This reflects the immaturity of this newborn and shows the need to pay special diagnostic and therapeutic care to them.     

Method of delivery and intraventricular haemorrhage in extremely preterm infants

Objectives.?It has been reported that caesarean delivery (CD) protects against intraventricular haemorrhage (IVH) in the extremely preterm infant, but it is not known whether this effect involve the more severe grades of IVH. Thus, our aim was to confirm the correlation between the occurrence of IVH and the mode of delivery, and to evaluate this correlation for each grade of IVH.

Methods.?All infants with gestational age (GA)?≤?28 weeks admitted to the neonatal intensive care unit of a tertiary hospital were studied for each grade IVH and major complications rate.

Results.?We found that vaginally born infants had a higher rate of each grade of IVH, but the increase was statistically significant only for grade 3 IVH (18% vs. 2%, p?<?0.0001) and all grades IVH (45% vs. 20%, p?<?0.0001). Multivariate analysis demonstrated that CD (RR: 0.42, 95% CI 0.28–0.63), birth weight?≥?800?g (RR: 0.48, 95% CI 0.32–0.73), 27–28 weeks of GA (RR: 0.38, 95% CI 0.25–0.60) and antenatal steroids (0.66, 95% CI 0.22–0.46) decrease independently the risk of developing IVH.

Conclusions.?Our study demonstrates that CD decreases the risk of developing IVH in extremely preterm infants including the most severe grades of IVH.     

Impact of chorioamnionitis on short- and long-term outcomes in very low birth weight preterm infants: the Neonatal Research Network Japan

Objective: To evaluate the short- and long-term outcomes among very low birth weight (VLBW) preterm infants after histologic chorioamnionitis (HCA).

Methods: We performed a retrospective analysis of 5849 single infants (birth weight <1500?g) born at a gestational age between 22?+?0 and 33?+?6 weeks. Clinical data were obtained from the Neonatal Research Network Japan between 2003 and 2007. Multivariable logistic regression analyses were performed to assess the effect of HCA on short- and long-term outcome.

Results: According to logistic regression analysis, HCA was associated with lower incidence of respiratory distress syndrome (odds ratio [OR]?=?0.54; p?<?0.001), increased chronic lung disease (OR?=?1.68; p?<?0.001) and sepsis (OR?=?1.71; p?<?0.001) and as a short-term outcomes. There was no significant association with intraventricular hemorrhage (OR?=?1.11; p?=?0.33), periventricular leukomalacia (OR?=?1.07; p?=?.070) and death before discharge (OR?=?0.97; p?=?0.084). HCA was associated with increased home oxygen therapy (OR?=?3.09; p?<?0.001), but not with cerebral palsy (CP; OR?=?0.91; p?=?0.63), develop quotient?<?70 (OR?=?1.27; p?=?0.17), visual impairment (OR?=?1.08; p?=?0.77), severe hearing impairment (OR?=?1.28; p?=?0.62) and death (OR?=?0.98; p?=?0.91) before three years of age.

Conclusions: In this retrospective population-based study in Japan, HCA was not a risk factor for death, neurodevelopmental impairment and CP in VLBW three-year-old preterm infants.     

Long-term refractive status of preterm infants from singleton and multiple pregnancies*

Objective: To study the effect of plurality on refractive status in former preterm infants at age 8–12 years.

Methods: Refraction was compared in singletons and multiples, in very low birth weight infants (VLBW, <1500?g) at age 6 months and 8–12 years. Preterm infants were compared with a group of term infants.

Results: Thirty-seven of 104 (36%) VLBW infants were multiples. Comparison of refraction between singletons and multiples revealed no difference at age 6 months, while at age 8–12 years, multiples had significantly more refractive errors (singletons 28% versus multiples 54% p?=?0.01), particularly myopia. In preterms, refractive status at age 6 months and multiple birth were significant predictors of refraction at 8–12 years, while birth weight (BW) and retinopathy of prematurity (ROP) were not predictive. Refractive errors were significantly more common in preterms (37%) than in term-born children (14%) (p?=?0.0002). Overall, refraction moved from predominantly hyperopic at 6 months to normal or myopic at age 8–12 years in preterm.

Conclusions: Multiple gestation in preterms is associated with increased risk for refractive errors, particularly myopia in childhood. Refraction in preterms during childhood progresses from hyperopia to myopia. Former preterms have more refractive errors than children born at term-born children.     

Comparison of non-synchronized nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure as post-extubation respiratory support in preterm infants with respiratory distress syndrome: a randomized controlled trial

Objective: To determine whether post-extubation respiratory support via nsNIPPV decreases the need for mechanical ventilation (MV) compared to nasal continuous positive airway pressure (NCPAP) in preterm infants with respiratory distress syndrome (RDS).

Methods: In this randomized, controlled, open, prospective, single-center clinical trial, we randomly assigned preterm ventilated infants with RDS to either nsNIPPV or NCPAP after extubation. The primary outcome, extubation failure, was defined by pre-specified failure criteria in the 72 hours after extubation.

Results: A total of 63 preterm ventilated infants were randomized to receive either nsNIPPV (n?=?31) or NCPAP (n?=?32). Extubation failure occurred in six (19.3%) of nsNIPPV group compared with nine (28.12%) of NCPAP group and was statistically not significant (p?=?0.55). The duration of NIV was significantly lower in nsNIPPV group as compared to NCPAP group (40.4?±?39.3 hours versus 111.8?±?116.4 hours, p?=?0.003). The duration of supplementary oxygen was significantly lower in nsNIPPV versus NCPAP group (84.9?±?92.1 hours versus 190.1?±?140.5 hours, p?=?0.002). The rates of BPD in nsNIPPV group (2/29, 6.9%) were significantly lower than in NCPAP group (9/28, 32.14%) (p?=?0.02).

Conclusions: Compared to NCPAP, nsNIPPV appears to be a feasible mode of extubation in preterm infants with significant beneficial effects of reduced duration of NIV support, supplementary oxygen and decreased rates of BPD.     

Correlation between fetal heart rate reactivity and mortality and severe neurological morbidity in extremely low birth weight infants

Objective: To determine the correlation between specific fetal heart rate (FHR) abnormalities and the incidence of death, severe (grade 3–4) intraventricular hemorrhage (IVH) and periventricular echogenicity (PVE) in extremely low birth weight infants (ELBW) within the first 4 days after birth. Methods: The study included live-born ELBW infants ≤ 30 weeks’ gestation who were born in 2000–2007 at Kaplan Medical Center, Rehovot, Israel, and, who had FHR monitoring during the 24?h before delivery and cranial ultrasound during the first 4 days of life. FHR pattern was analyzed for the presence of baseline rate, reactivity, variability and decelerations. Results: 96 infants with mean birth weight 757?±?150?g and mean gestational age 25.8?±?1.5 weeks were included. By 4 days of life, 23/96 (24%) died, 17/96 (18%) developed severe IVH and 31/96 (32%) had PVE. Absence of reactivity was significantly associated with increase in both death (p?=?0.02, OR 3.45, 95% CI: 1.22–9.47 and severe IVH (p?=?0.029, OR 3.33, 95% CI: 1.25–10) but not with PVE. Other FHR parameters were not associated with adverse outcome. Conclusion: These results suggest that FHR reactivity may be of value in predicting short-term outcome in ELBW infants. This may be helpful in counseling parents with imminent extremely preterm birth.     

Preterm at birth is not associated with greater cardiovascular risk in adolescence

Objective: To determine the effects of preterm birth and gender on subsequent cardiovascular risk factors among urban adolescents in a capital in the Brazilian northeast and to compare them with a group of adolescents term at birth.

Methods: In a retrospective double cohort, data of birth weight were extracted from hospital registers of children born in a same day of birth, between 1992 and 2002. We classified the preterm as a unique group born before 37 weeks of gestation. A total of 134 adolescents, aged 10–20 years were found and investigated. We measured anthropometric and clinical data, blood lipid profile and glucose after overnight fasting.

Results: Preterm subjects had less years of scholar education, especially between females (p?=?0.01). Preterm females also had lower height (p?=?0.00) and waist-hip circumference ratio (p?=?0.01). Preterm males had lower cesarean delivery (p?=?0.05) and greater family history of cardiovascular disease (p?=?0.05). Although the differences on clinical or laboratorial measurements were small and non-significant for cardiovascular risk factors, systolic blood pressure (SBP) and diastolic blood pressure (DBP) tended to be higher in preterm groups, especially for females (SBP?=?4.1?mmHg and DBP?=?1.6?mmHg, p?=?0.12 and p?=?0.38, respectively).

Conclusion: Premature did not increase cardiovascular risk adolescents in this sample. The lower association between premature and poor health outcomes among adolescents in a low average socioeconomic status population from a capital in the Brazilian northeast corroborates previous findings in other countries.     

Risk factors for periventricular echodensities and outcomes in preterm infants

Objectives: To determine the incidence, risk factors and outcomes associated with transient and/or persistent periventricular echodensities (PVED) among preterm infants.

Methods: Medical records of preterm infants born at?≤ 32 weeks gestational age (GA) with PVED and no other brain pathology were reviewed and compared to matched control infants in a case-controlled retrospective study. Neurodevelopmental outcomes at 8–24 months corrected age were documented.

Results: A 17.8% incidence of PVED was recorded, with the highest incidence of 30–40% recorded at 29–31 weeks GA. Study and control groups were similar for all maternal parameters and neonatal morbidities, except for a higher incidence of respiratory distress syndrome among the study group. PVED at one month of age was predicted by 5?min Apgar score?p?=?0.005)]. PVED was not associated with long-term neurodevelopmental disability.

Conclusions: No risk factors or specific associated morbidities were identified among preterm infants with transient PVED. PVED at one month of age was predicted by low 5?min Apgar scores, possibly suggesting different pathogenesis or timing between the groups. Long-term outcome studies are needed to determine PVED impact.     

First trimester maternal serum pregnancy-associated plasma protein-A is a predictive factor for early preterm delivery in normotensive pregnancies

Abstract

In this study, we investigated whether the concentrations of pregnancy-associated plasma protein-A (PAPP-A) or free β-hCG (fβhCG) in the first trimester can identify women at increased risk of subsequent preterm delivery in the absence of hypertensive disorders. Preterm and early preterm deliveries are defined as those deliveries before completing 37 and 34 weeks, respectively. A total of 868 women were enrolled into this study. According to the level of the markers, the patients were evaluated in three groups: 1 – maternal serum level ≤5th percentile, 2 – between 5th and 95th percentiles, 3 – ≥95th percentile. In the group of patients with a PAPP-A level ≤5th percentile [≤0.35 multiples of the median (MoM)], mean gestational age (GA) at delivery, mean birth weight and the number of the cases with early preterm delivery were significantly lower than the others. Mean level of PAPP-A was significantly lower in cases with early preterm than term deliveries (0.58?±?0.32 versus1.09?±?0.69; p?=?0.01). Maternal serum level of fβhCG did not show significant difference between these groups (0.84?±?0.45 versus 1.17?±?0.77; p?=?0.15). Low levels of maternal serum PAPP-A (≤0.35 MoM) (Odds ratio?=?7; 95% confidence interval 1.8–27.7; p?=?0.0048) significantly predicted early preterm delivery in normotensive pregnancies. Women with low levels of PAPP-A at first trimester have a higher risk of early preterm delivery even in the absence of hypertensive disorders.     

Brain growth in preterm infants is affected by the degree of growth restriction at birth

Abstract

Objective: Documentation of examination of brain structural development by magnetic resonance imaging (MRI) beyond the neonatal period is scarce for both preterm and small for gestational age (SGA) infants.

Aim: To investigate structural brain development during infancy in preterm children born SGA by MRI.

Methods: A total of 205 preterm infants, 139 appropriate for gestational age (AGA) and 66 SGA, of which 33 had birth weight (BW)?<?3rd percentile and 33 had BW 3rd–10th percentile, were examined prospectively by brain MRI at the corrected age of 5 months. The total volume of the brain, ventricles and cerebellum, the area of vermis and corpus callosum, and the height of the pituitary, mesencephalon and pons were estimated on MRI.

Results: Brain volume was smaller in the SGA?<?3rd percentile infants, independent of other perinatal factors. Chronic lung disease was an independent predictor of low brain volume. Pituitary height was greater in SGA?<?3rd percentile than in AGA infants. The corpus callosum area was less in SGA?<?3rd percentile than in SGA of 3rd–10th percentile infants.

Conclusions: Preterm infants born SGA with BW?<?3rd percentile had differences in brain structural measurements at the corrected age of 5 months, compared with preterm AGA infants, which could have implications for their neurocognitive development.     

Measurement of interleukin-6 (IL-6) and erythropoietin (EPO) in umbilical cords of preterm infants with intraventricular hemorrhage in two hospitals in Tehran

Background: Intraventricular hemorrhage (IVH) is an important cause of death in premature infants. This study aimed to assess the association of the umbilical cord plasma levels of interleukin-6 (IL-6) and erythropoietin (EPO) with the occurrence and severity of IVH in premature infants.

Methods: Fifty premature newborns of mothers with chorioamnionitis risk factor were selected via nonprobability sampling. The concentration of the cord plasma’s IL-6 and erythropoietin were measured by enzyme-linked immunosorbent assay (ELISA) for 3 days. Finally, all samples underwent sonography for the diagnosis of IVH. Results analyzed statistically.

Results: Among the samples, 68.98% of them were diagnosed with IVH grade 1. The most severe IVH cases were detected on the second day. The mean and standard deviation of IL-6 level was 74.71?±?50.53 in the case group and 24.10?±?46.10 in the control group. There was a correlation between IL-6 levels and IVH (p?=?0.0005). The mean and standard deviation of EPO level was 18.38?±?15.23 in the IVH group and 6.45?±?13.48 in samples without IVH. A correlation was detected between EPO level and IVH (p?=?0.005).

Conclusion: The concentration of IL-6 and EPO levels of the cord plasma was higher in the premature newborns with IVH.     

Does the presence of polycystic ovary syndrome increase the risk of obstetrical complications in women with gestational diabetes?

Objective.?To determine whether women with both polycystic ovary syndrome (PCOS) and gestational diabetes mellitus (GDM) have an increased risk of obstetric complications compared with women with GDM alone.

Methods.?A retrospective cohort study of maternal/fetal outcomes in women with GDM and PCOS was compared with women with GDM alone. Outcomes were compared using Fisher's exact test for categorical variables and t-test for continuous variables. Logistic regression models allowed for the calculation of odds ratios and 95% confidence intervals (CIs) for each outcome, adjusted for confounding.

Results.?One hundred seventy one women were included in the study. Significantly more women with both GDM and PCOS had pregnancy-induced hypertension/preeclampsia (15.9% vs. 3.9%, p?=?0.019, OR?=?4.62, 95% CI?=?1.38–15.41). Multiple logistic regression revealed that this increase persisted after controlling for body mass index (p?=?0.028, OR?=?4.43, 95% CI?=?1.17–16.72) and parity (p?=?0.050, OR?=?3.45, 95% CI?=?1.00–11.92). Women with GDM and PCOS tended to have more preterm deliveries (25.0% vs. 11.8%, p?=?0.063). More infants of women with GDM and PCOS required phototherapy treatment for hyperbilirubinemia (25.0% vs. 7.9%, p?=?0.0066, OR?=?3.90, 95% CI?=?1.52–9.98). Logistic regression revealed that this association persisted after controlling for preterm delivery (OR?=?3.18, 95% CI?=?1.14–8.82, p?=?0.026).

Conclusions.?Mothers with both disorders should be monitored more carefully and counseled regarding their increased risk of both maternal and fetal complications.     

Sustained versus intermittent lung inflation for resuscitation of preterm infants: a randomized controlled trial

Aim: To evaluate efficacy and safety of delivery room (DR) sustained lung inflation (SLI) in resuscitation of preterm neonates.

Methods: Randomized Controlled Trial including 112 preterm infants randomized to either SLI (n?=?57) using T-piece resuscitator [maximum three inflations with maximum pressure of 30?cmH₂O for 15?s followed by continuous positive airway pressure (CPAP) of 5–7 cmH₂O] or conventional bag/mask inflation (CBMI) (n?=?55) using traditional self-inflating bag (maximum pressure of 40?cmH₂O at a rate of 40–60 per min). Failure was defined as the need for DR or first 72?h intubation. Cord and 2-h post-resuscitation blood samples were collected to measure interleukin (IL)-1β and tumor necrosis factor-α levels before and after intervention.

Results: SLI was associated with significantly higher success rate compared to CBMI [75.4 versus 54.5%; p?=?0.017], lower need for DR intubation [5.3% versus 23.6%; (X^2?=^?7.7; p?=?0.005)], higher 5-min-Apgar score (median 8 versus 7; p?=?0.018), shorter duration on nasal-CPAP (p?=?0.017), and non-significantly different air leak (7% versus 11%; p?=?0.3) and bronchopulmonary dysplasia rates among survivors (2% versus 11%; p?=?0.09). Post-resuscitation IL-1β plasma levels increased significantly in CBMI (p?=?0.009) and not in SLI group.

Conclusion: Delivery room SLI is more effective than intermittent bag and mask inflation for improving short-term respiratory outcome in preterm infants, without significant adverse effects.     

Total energy intake accounts for postnatal anthropometric growth in moderately/late preterm infants

Objective: Moderately preterm (MP) (32–33 weeks) and late preterm (LP) (34–36 weeks) infants have higher risks of mortality and growth and developmental problems. We, herein present a new concept of nutritional assessment, total energy intake (TEI), which is the sum total of kilocalories administered in all nutrient forms.

Methods: Fifty-two preterm infants were classified as MP (n?=?12), LP/appropriate for gestational age (LP/AGA) (n?=?33), or LP/small for gestational age (LP/SGA) (n?=?7). All groups received nutrient therapy by the same protocol. The sum of the daily energy intake at 14 and 28 days after birth was determined.

Results: TEI was 2822.1?±?162.1?kcal/kg/28 days in the MP group, 3187.2?±?265.0?kcal/kg/28 days in the LP/AGA group and 3424.6?±?210.4?kcal/kg/28 days in the LP/SGA group. In all groups, TEI for 28 days was significantly correlated with body weight gain (r?=?0.465, p?=?0.006). TEI for 14 days after birth was inversely correlated with the body weight loss rate after birth (r?=??0.491, p?=?0.0002).

Conclusion: TEI was well correlated with anthropometric changes after birth. TEI may be used to effectively assess preterm infants’ nutritional needs.     

Early caffeine therapy for prevention of bronchopulmonary dysplasia in preterm infants

Abstract

Objective: To determine if an early commencement of caffeine is associated with improved survival without bronchopulmonary dysplasia (BPD) in preterm infants.

Methods: Retrospective data analysis from the Alere Neonatal Database for infants weighing ≤1250?g, and treated with caffeine within the first 10 days of life. The neonatal outcomes were compared between the infants who received early caffeine (0–2 days) with the infants who received delayed caffeine (3–10 days).

Results: A total of 2951 infants met the inclusion criteria (early caffeine 1986, late caffeine 965). The early use of caffeine was associated with reduction in BPD (OR 0.69, 95%?CI 0.58–0.82, p?<?0.001) and BPD or death (OR 0.77, 95%?CI 0.63–0.94, p?=?0.01). Other respiratory outcomes also improved with the early commencement of caffeine. The frequency of severe intraventricular hemorrhage and patent ductus arteriosus was lower and the length of hospitalization was shorter in infants receiving early caffeine therapy. However, early use of caffeine was associated with an increase in the risk of nectrotizing enterocolits (NEC) (OR 1.41, 95%?CI 1.04–1.91, p?=?0.027).

Conclusion: Early commencement of caffeine was associated with improvement in survival without BPD in preterm infants. The risk of NEC with early caffeine use requires further investigation.     

Delayed cord clamping and inotrope use in preterm infants

Objective: To evaluate the impact of delayed cord clamping (DCC) on need for inotropic support and mean arterial blood pressure (MABP).

Methods: This is a single-center, prospective case-control study of premature infants, born <32 weeks gestation, who underwent DCC in comparison to a matched control group who underwent immediate cord clamping (ICC). The primary outcomes were the differences in MABP and inotropic medication used over the first week of life. Secondary outcomes included the admission hemoglobin, need for blood transfusion, and rates of intraventricular hemorrhage (IVH). Infants were matched on EGA, birth weight, sex, antenatal corticosteroid and magnesium exposure, and presence of chorioamnionitis.

Results: Hundred and fifty-eight infants (DCC n?=?79, ICC n?=?79) were included. Demographic factors were similar between groups. DCC infants had a higher admission hemoglobin (p?p?=?.03), fewer median transfusions (p?=?.03), and were discharged at an earlier post-menstrual age (p?=?.04). When controlling for other factors, DCC was not associated with a reduction in inotrope use (p?=?.22) but was associated with a reduction in high-grade IVH (p?=?.01). There was no difference in MABP between the groups.

Conclusions: DCC is not associated with a reduction in the use of inotropes or a difference in MABP.