The myocardial function during and after whole-body therapeutic hypothermia for hypoxic–ischemic encephalopathy,a cohort study

Background

Therapeutic hypothermia has become standard treatment for moderate and severe neonatal hypoxic–ischemic encephalopathy (HIE) to reduce cerebral morbidity and mortality. The effect on the heart is incompletely explored.

Aim

To assess the myocardial function during and after whole-body therapeutic hypothermia for HIE.

Study design

Observational cohort study.

Subjects

Forty-four infants with HIE cooled for 72 hours were compared with 48 healthy term infants and 20 normothermic infants with HIE.

Outcome measures

Tissue Doppler deformation indices of myocardial function (peak systolic strain, peak systolic strain-rate, early diastole strain-rate and strain-rate in atrial systole) during (days 1 and 3) and after (day 4) therapeutic hypothermia.

Results

On days one and three all indices in both HIE groups were lower than the corresponding indices in the healthy infants. The two HIE groups had similar indices, except peak systolic strain-rate on days 1 and 3 and strain-rate in atrial systole on day 1. All strain-rate indices improved from day 3 to 4 (after rewarming) in the cooled group and achieved similar values to those in healthy infants on day 3. All indices were higher in the cooling-group after rewarming than in the normothermic infants with HIE on day 3, except early diastolic strain-rate.

Conclusions

Infants with HIE had similarly impaired myocardial function during days 1–3 whether normothermic or hypothermic. The myocardial function improved significantly at day 4 (after rewarming), approaching the day 3 levels in the healthy neonates.     

Early exposure to maternal voice: Effects on preterm infants development

Background

Preterm infants complete their development in Neonatal Intensive Care Unit being exposed to environmental stimuli that lead to the early maturation of the sensory systems. It is known that the fetus perceives sounds and reacts to them with movements since the 26th–28th week of gestational age. Maternal voice represents a source of sensory stimulation for the fetus.

Aims

To investigate the effect of the exposure to maternal voice, administered by bone conduction, on preterm infants autonomic and neurobehavioral development.

Study design

Longitudinal, explorative, case control study.

Subjects

71 preterm infants with birth weight < 1500 g, born adequate for gestational age Outcome measures: vital and neurobehavioral parameters at term, neurofunctional assessment at 3 and 6 months of corrected age.

Results

Infants in the treatment group had lower heart rate values and a higher proportion of stable skin color at each study point as compared to the control group. The scores in the visual attention performance and in the quality of the general movements at term were better in the treatment group than in the control one. Neurofunctional assessment score at 3 months of corrected age was higher in the treatment group whereas no difference between the two groups was detected at 6 months of corrected age.

Conclusions

Early exposure to maternal voice exerts a beneficial effect on preterm infants autonomic and neurobehavioral development.     

Arousal from sleep pathways are affected by the prone sleeping position and preterm birth: Preterm birth,prone sleeping and arousal from sleep

Objectives

Preterm infants exhibit depressed arousability from sleep when compared with term infants. As the final cortical element of the arousal process may be the most critical for survival, we hypothesized that the increased vulnerability of preterm infants to the Sudden Infant Death Syndrome (SIDS) could be explained by depressed cortical arousal (CA) responses. We evaluated the effects of preterm birth on stimulus-induced arousal processes in both the prone and supine sleeping positions.

Study design

10 healthy preterm infants were studied with daytime polysomnography, in both supine and prone sleeping positions, at 36 weeks gestational age, 2–4 weeks, 2–3 months and 5–6 months post-term corrected age. Sub-cortical activations and cortical arousals (CA) were expressed as proportions of total arousal responses. Preterm data were compared with data from 13 healthy term infants studied at the same corrected ages.

Results

In preterm infants increased CAs were observed in the prone position at all ages studied. Compared to term infants, preterm infants had significantly fewer CAs in QS when prone at 2–3 months of age and more CAs when prone at 2–4 weeks in AS. There were no differences in either sleep state when infants slept supine.

Conclusions

Prone sleeping promoted CA responses in healthy preterm infants throughout the first six months of post-term age. We have previously suggested that in term infants enhanced CA represents a critical protection against a potentially harmful situation; we speculate that for preterm-born infants the need for this protection is greater than in term infants.     

Sex and gestational age effects on auditory brainstem responses in preterm and term infants

Background

Some studies find delayed development of the auditory brainstem in preterm infants, but others do not.

Aim

To compare auditory brainstem responses (ABRs) in healthy preterm and term infants depending on sex and gestational age (GA).

Methods

Participants were 111 preterm (27–36 weeks GA) and 92 term (37–41 weeks GA) infants. ABR tests were conducted at 6 weeks (corrected age if preterm).

Results

There were no overall differences between term and preterm groups in ABRs. However, males showed longer latencies for waves III, V, and I–III, III–V, and I–V intervals and smaller amplitudes for wave III and V than females in both preterm and term groups (all p values ≤ .01). A 3-way interaction between group, sex, and GA (p < .05) showed that preterm males with later GA had longer wave I–V interval, whereas term females with later GA showed shorter wave I-V interval. Growth velocity predicted wave I–V interval in preterm infants, controlling for other factors (male: p = .07, female: p < .05).

Conclusion

ABRs in preterm and term infants were similar at 6 weeks (corrected age if preterm), but males had less advanced ABRs than females. More rapid growth predicted less mature ABR in later GA preterm infants in this setting where they were unlikely to receive extra iron. The roles of GA, growth, and iron balance in ABR development warrant further study.     

The development of autonomic cardiovascular control is altered by preterm birth

Objectives

Autonomic dysfunction, either sympathetic or parasympathetic, may explain the increased incidence of Sudden Infant Death Syndrome (SIDS) among preterm infants, as well as their subsequent heightened risk of hypertension in adulthood. As little is known about the development of autonomic function in preterm infants, we contrasted autonomic cardiovascular control across the first 6 months after term-corrected age (CA) in preterm and term infants.

Study design

Preterm (n = 25) and age matched term infants (n = 31) were studied at 2–4 weeks, 2–3 months and 5–6 months CA using daytime polysomnography. Blood pressure and heart rate were measured during quiet (QS) and active (AS) sleep. Autonomic control was assessed using spectral indices of blood pressure and heart rate variability (BPV and HRV) in ranges of low frequency (LF, reflecting sympathetic + parasympathetic activity), high frequency (HF, respiratory-mediated changes + parasympathetic activity), and LF/HF ratio (sympatho-vagal balance).

Results

In preterm infants, HF HRV increased, LF/HF HRV decreased and LF BPV decreased with age (p < 0.05); these changes were most evident in AS. Compared to term infants, preterm infants in QS exhibited lower LF, HF and total HRV at 5–6 months; higher HF BPV at all ages; and lower LF BPV at 2–4 weeks (p < 0.05).

Conclusions

With maturation, in preterm infants, parasympathetic modulation of the heart increases while sympathetic modulation of blood pressure decreases. Compared to term infants, preterm infants exhibit lesser parasympathetic modulation of the heart along with greater respiratory-mediated changes and lower sympathetic modulation of blood pressure. Impaired autonomic control in preterm infants may increase their risk of cardiovascular dysfunction later in life.     

Postural complexity differs between infant born full term and preterm during the development of early behaviors

Background and aims

Postural control differs between infants born preterm and full term at 1–3 weeks of age. It is unclear if differences persist or alter the development of early behaviors. The aim of this longitudinal study was to compare changes in postural control variability during development of head control and reaching in infants born preterm and full term.

Methods

Eighteen infants born preterm (mean gestational age 28.3 ± 3.1 weeks) were included in this study and compared to existing data from 22 infants born full term. Postural variability was assessed longitudinally using root mean squared displacement and approximate entropy of the center of pressure displacement from birth to 6 months as measures of the magnitude of the variability and complexity of postural control. Behavioral coding was used to quantify development of head control and reaching.

Results

Group differences were identified in postural complexity during the development of head control and reaching. Infants born preterm used more repetitive and less adaptive postural control strategies than infants born full term. Both groups changed their postural complexity utilized during the development of head control and reaching.

Discussion

Early postural complexity was decreased in infants born preterm, compared to infants born full term. Commonly used clinical assessments did not identify these early differences in postural control. Altered postural control in infants born preterm influenced ongoing skill development in the first six months of life.     

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

Background

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

Aim

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

Subjects

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

Outcome measures

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

Results

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

Conclusions

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

Jerky spontaneous movements at term age in preterm infants who later developed cerebral palsy

Background

Assessment of spontaneous movements in infants has been a powerful predictor of cerebral palsy (CP). Recent advancements on computer-based video analysis can provide detailed information about the properties of spontaneous movements.

Aims

The aim of this study was to investigate the relationship between spontaneous movements of the 4 limbs at term age and the development of CP at 3 years of age by using a computer-based video analysis system.

Study design and subjects

We analyzed video recordings of spontaneous movements at 36–44 weeks postmenstrual age (PMA) for 145 preterm infants who were born preterm (22–36 weeks PMA with birthweights of 460–1498 g). Sixteen of the infants developed CP by 3 years of age, while 129 developed normally. We compared 6 movement indices calculated from 2-dimensional trajectories of all limbs between the 2 groups.

Results

We found that the indices of jerkiness were higher in the CP group than in the normal group (p < 0.1 for arms and p < 0.01 for legs). No decline was observed in the average velocity and number of movement units in the CP group compared with to the normal group.

Conclusions

Jerkiness of spontaneous movements at term age provides additional information for predicting CP in infants born preterm.     

Is maternal obesity associated with sustained inflammation in extremely low gestational age newborns?

Background

The offspring of obese women are at increased risk for systemic inflammation. Blood concentrations of inflammatory proteins in preterm newborns of obese women have not been reported.

Aim

To compare blood concentrations in the highest quartile for gestational age of inflammatory proteins and day of blood specimen collection on two days at least one week apart of newborns of overweight (i.e., BMI 25–29) and obese women (i.e., BMI ≥ 30) with newborns of women with lower BMIs. Because deliveries for spontaneous indications are more likely than those for other indications to be associated with inflammation, we evaluated spontaneous indication deliveries separately from maternal or fetal indications.

Study design

Prospective cohort study.

Subjects and outcome measures

We measured from 939 children born before the 28th week of gestation 25 inflammation-related proteins in blood obtained on postnatal day 1 (range 1–3), day 7 (range 5–8) and day 14 (range 12–15).

Results

Among infants delivered for spontaneous indications, maternal BMI was not related to elevated concentrations of any protein. Among infants delivered for maternal (i.e., preeclampsia) or fetal indications, those whose mother was overweight or obese were more likely than others to have elevated concentrations of inflammation proteins.

Conclusions

Maternal pre-pregnancy overweight and obesity appear to contribute to a pro-inflammatory state in very preterm newborns delivered for maternal or fetal indications. Our failure to see a similar pattern among newborns delivered for spontaneous indications, which often have inflammatory characteristics, might reflect competing risks.     

Prevalence of head deformities in preterm infants at term equivalent age

Introduction

Due to a rising number of head deformities in healthy newborns, there has been an increasing interest in nonsynostotic head deformities in children over recent years. Although preterm infants are more likely to have anomalous head shapes than term newborns, there is limited data available on early prevalence of head deformities in preterm infants.

Aims

The purposes of the present study were to acquire quantitative data on head shape of preterm infants at Term Equivalent Age (TEA), to determine the prevalence of symmetrical and asymmetrical head deformities and to identify possible risk factors.

Methods

In a cross-sectional study design, Cranial Vault Asymmetry Index (CVAI) and Cranial Index (CI) calculated from routine head-scans with a non-invasive laser shape digitizer were recorded and categorized in type and severity of deformation for three different groups of gestational age. Perinatal and postnatal patient data was tested for possible associations.

Results

Scans of 195 infants were included in the study. CVAI at TEA was higher in very preterm (4.1%) compared to term and late preterm infants. Prevalence of deformational plagiocephaly was 38% in very preterm infants. CI was lower in very (71.4%) and late (77.2%) preterm infants compared to term infants (80.0%). Compared to term babies (11%), a large number of very (73%) and late (28%) preterm infants exhibited dolichocephaly at TEA.

Discussion

Prevalence of symmetrical and asymmetrical head deformities in preterm infants is high at TEA. Interventions are required to prevent head deformities in preterm infants during the initial hospital stay.     

Visual function assessment in late-preterm newborns

Aim

To describe the development of visual functions in a population of low-risk late preterm infants.

Subjects and methods

Eighty low-risk late preterm with a gestational age between 34.0 and 36.9 weeks were assessed at birth and at term equivalent age (TEA) using a structured visual assessment battery. The results were compared to those previously obtained in term born infants using the same battery.

Results

For 5 items (spontaneous ocular motility, ocular motility with target, fixation, horizontal tracking and color tracking) the results were similar both at birth and TEA; for the other 4 (vertical and arc tracking, ability to discriminate striped black/white targets and attention at distance) visual findings at TEA were more mature than at birth. Comparing the responses in late preterm at TEA and term-born infants at 48 h of life, only 2 items (attention at distance, ability to discriminate black/white stripes) were different, with more mature findings in late preterm infants.

Conclusions

Our results show that in late preterm some aspects of visual functions have a progressive maturation infants between birth and TEA, confirming that the time between birth and term age appears to be crucial for the development of these abilities.     

Neonatal neurological examination of late preterm babies

Backgrounds

Healthy late-preterm (LP) infants examined at term equivalent age showed wider median and range of neurological scores than full-term infants; differences between infants born at 34 and those born at 35–36 weeks were also observed.

Aims

The aim of this study is to establish the range and frequency distribution of neonatal neurological scores in a cohort of low risk LP infants assessed during the first 3 days from birth.

Study design and subjects

118 low-risk infants born between 34 and 36 weeks of gestational age (GA) were assessed between 48 and 72 h from birth.

Outcome measures

The full version of the Hammersmith Neonatal Neurologic Assessment and the screening proforma were used to assess all the infants. The raw scores obtained were compared to those of full-term infants using the same examination.

Results

The distribution of neurological scores was similar among the 3 GAs for 26 items, with different median scores among LP infants born at 36 weeks and those born at 34 and 35 in only 2 items.LP infants showed a wider range of findings for each item than that of full term infants assessed soon after birth. Using the screening proforma, in our cohort, for each item the findings falling outside the 90% level were identical to those found in term-born and very preterm infants assessed at term age.

Conclusions

The neurological scores obtained in our cohort could help as reference data when examining LP infants at birth compared to age matched low risk infants.     

The effect of postnatal age on the early tactile manual abilities of preterm infants

Background

Although preterm infants possess early tactile manual abilities, the influence of the postnatal experience has not yet been systematically examined.

Aims

To investigate whether early tactile manual habituation, discrimination and recognition (following interference) of shape in preterm infants are modified by postnatal age.

Study design

Prospective study.

Subjects

Forty preterm infants were assessed from the post-conceptional age (PCA) of 34 weeks. Two groups were made up according to postnatal age (PNA): low PNA (PNA ≤ 10 days of life) and high PNA (PNA ≥ 12 days of life).

Outcome measures

An object (prism or cylinder) was presented repeatedly in the left hand, and holding times of the object were recorded during each trial.

Results

Holding time was shorter for all preterm infants following successive presentation of the same object irrespective of postnatal age range. In the discrimination phase, the mean holding time for the novel object was longer than holding times in the last two habituation trials, in both PNA groups. Finally, the mean holding time of the familiar object presented in the recognition phase was shorter than the holding time of the novel object presented previously, but only in the low PNA group.

Conclusions

Tactile manual habituation and discrimination of shape information is present in preterm infants at a post-conceptional age of 34 weeks, independently of postnatal age. However, tactile manual recognition of familiar shapes following interference is affected by length of postnatal experience. The significance of this last result is discussed in detail.     

Circulating hematopoietic and endothelial progenitor cells in newborn infants: Effects of gestational age,postnatal age and clinical stress in the first 3 weeks of life

Introduction

Circulating endothelial progenitor cells (EPC) are bone marrow derived progenitors that can be mobilized by erythropoietin or in response to tissue injury, and participate in vascular repair. EPC are understudied in human neonates. Whether EPC frequency in newborn infants may be influenced by gestational age or postnatal stress is unknown.

Methods

Blood samples were collected on day 1 of life and weekly for 3 weeks from hospitalized neonates for plasma erythropoietin and flow cytometry analysis for CD34 +, CD34+CD45 −, CD34+VEGFR2 + and CD34+CD45 − VEGFR2 + cells (EPC). Associations between CD34 + cell subsets and clinical parameters were studied.

Results

Forty five patients were enrolled. An inverse correlation with gestational age was observed for CD34 + and CD34 + VEGFR2 + cell frequencies in whole blood (WB) on day 1 (p < 0.05). In preterm infants, CD34 + cell frequency decreased with increased postnatal age (p = 0.0001) and CD34+VEGFR2 + cell frequency was higher at week 3 than on day 1 in WB (p = 0.0002). On day one, CD34 + and CD34+CD45 − cell frequencies in the mononuclear cell fraction (MNC) were higher in preterm than term infants (p = 0.035 and p = 0.049, respectively) but CD34+CD45 − VEGFR2 + cell frequency (median 2.2/million MNC versus 3.8/million MNC) and erythropoietin levels were not significantly different. Transient increases in EPC were observed in five infants with infection. Four preterm infants who developed bronchopulmonary dysplasia had undetectable or low EPC through the first 3 weeks of life.

Conclusions

Gestational age and postnatal age influenced circulating CD34 + and CD34+VEGFR2 + but not CD34+CD45 − VEGFR2 + (EPC) cell frequencies. Circulating EPC in neonates may be influenced by clinical stress.     

Parenting stress in mothers of very preterm infants — Influence of development,temperament and maternal depression

Objective

To measure levels of parenting stress and postnatal depression in mothers of very preterm infants in comparison with mothers of infants born at term is the objective of this study. The study also aimed to explore factors associated with parenting stress in the mothers of the preterm infants.

Methods

One hundred and five mothers who delivered 124 babies at ≤ 30 weeks gestation were enrolled together with 105 term mothers who delivered 120 babies. At one year of age (corrected for prematurity for the preterm cohort), the mothers completed the Parenting Stress Index Short Form (PSI), the Edinburgh Postnatal Depression Scale (EPDS) and the Short Temperament Scale for Toddlers. The infants had neurodevelopmental assessment. The preterm and term groups were compared.

Results

Questionnaires were completed by 101 of the preterm mothers and 98 of the term mothers. The mean PSI Total Stress score was significantly higher for the preterm mothers (70.28 vs 64.52, p = 0.022), with 19% of the preterm group and 9% of the term group having high scores (p = 0.038).There was no group difference on the EPDS or measures of temperament, with disability being greater in the preterm infants. For the preterm group, maternal depression and infant temperament were independent predictors of Total Stress scores on multivariate analysis.

Conclusions

Parenting stress in mothers of preterm infants at one year of age is significantly greater than that found in mothers of term infants. For preterm mothers, symptoms of depression and infant temperament are independent risk factors for higher levels of parenting stress.     

The effect of in-hospital developmental care on neonatal morbidity,growth and development of preterm Taiwanese infants: A randomized controlled trial

Introduction

Intervention studies of developmental care for preterm infants in Western societies have shown early but unsustainable effects on child outcomes, however only a limited of studies have examined if developmental care interventions produce similar effects in Eastern cultural contexts.

Aims

To examine the effectiveness of in-hospital developmental care on neonatal morbidity, growth and development of preterm infants with very low birth weight (VLBW; birth weight < 1500 g) in Taiwan.

Methods

One hundred and seventy-eight VLBW preterm infants were randomly assigned to the clinical trial during hospitalization at three hospitals in Taiwan; the control group received five sessions of standard child-focused developmental care and the intervention group received five sessions of child- and parent-focused developmental care. Sixty-two normal term infants were also included as a comparison group. Infants were examined for morbidity, growth and developmental outcomes at term age.

Results

At study entry, more infants in the intervention group were twins or multiples than those in the control group (29% vs. 16%, p = 0.05). After adjusting for birth set, the intervention group had lower incidences of stage II–III retinopathy (odds ratio [OR] = 0.34 [95% confidence interval (CI): 0.15–0.79]; p = 0.01) and feeding desaturation (OR = 0.32 [95% CI: 0.10–1.00]; p = 0.05) and had greater daily weight gains (difference = 2.0 g/day [95% CI: 0–4.0 g/day]; p = 0.05) as compared with the control group. However, the intervention and control groups did not differ in any of the neurodevelopmental measures.

Conclusions

In-hospital developmental care has short-term benefits for Taiwanese VLBW preterm infants in reducing the risk of retinopathy and feeding desaturation as well as in enhancing weight gains at term age.     

Serial changes in myocardial function in preterm infants over a four week period: the effect of gestational age at birth

Background

Myocardial performance is impaired in the first days of life in preterm infants but improves by day 5. Tissue Doppler imaging (TDI) is a novel and reliable means of assessing myocardial performance.

Objective

To investigate myocardial performance using TDI and shortening fraction (SF) in preterm infants of different gestational age groups and serial changes in these parameters in first four weeks of life.Study designInfants less than 36 weeks of gestation were divided into group 1 (24–27 weeks, n = 8), group 2 (28–31 weeks, n = 12) and group 3 (32–35 weeks, n = 13). Infants with severe congenital malformations, a hypoxic insult at birth, and those on inotropic support were excluded. Echocardiograms were performed at 36–48 hours, 2 weeks and 4 weeks of life. Left ventricular (LV) SF, systolic (S′), early diastolic (E′) and late diastolic (A′) TDI velocities were assessed. We analyzed the data using a repeated-measures ANOVA.

Results

Thirty three infants underwent serial TDI and SF measurements. There was an increase in LV S′ (p = .02) and E′ (.01) velocities in group 2 , and in group 3 (p = .03 for S′ and p = .04 for E′), but no significant increase in group 1 (p = .48 for S′ and .32 for E′). At each study point, there was significant difference in myocardial performance between group 1 and 3 for each of the parameters (p < .05). There was no significant increase in SF over time in any of the groups.

Conclusion

We describe a serial increase in myocardial performance in infants of 28 weeks gestation and above. While there was no change in myocardial performance among the most extremely preterm infants, this may have been the result of small sample size of the group.     

Is term newborn body composition being achieved postnatally in preterm infants?

Background

The American Academy of Pediatrics (AAP) recommends that preterm infants' growth duplicates fetal growth rates and that body composition replicates in utero body composition.

Aims

To compare the total body fat mass between preterm infants assessed at term corrected age and full-term newborns, and to investigate the effects of gestational age, gender, weight increase, being breast fed on total adiposity.

Study design

Prospective observational study.

Subjects

One hundred and ten preterm infants [mean (SD) gestational age: 29.9 (2.3) weeks; birth weight: 1118 (274) g], and 87 full term [mean (SD) 38.6 (1.21) weeks, 3203 (385) g], breastfed infants.

Outcome measures

Growth and body composition by means of a pediatric air displacement system were assessed at term corrected age in preterm infants and on day 3 of life in full term infants.

Results

Weight, length and head circumference were smaller in the preterm group as compared to the term group. Mean (SD) percentage of fat mass in preterm infants was significantly higher as compared to term infants [14.8 (4.4) vs 8.59 (3.71), P < 0.0001]. Fat mass was negatively correlated with gestational age (P < 0.001), and positively associated with weight increase (P < 0.05).

Conclusions

Our data suggest that body composition, in terms of fat mass, in preterm infants at term corrected age is different from that of full term newborns.     

Maternal preeclampsia is associated with increased risk of necrotizing enterocolitis in preterm infants

Background

Necrotizing enterocolitis (NEC) is an important cause of mortality and morbidity in preterm infants.

Aims

To evaluate the effect of maternal preeclampsia on the development and severity of NEC in premature infants.

Study design

Prospective observational study in a tertiary neonatal intensive care unit.

Subjects

The preterm infants of ≤ 37 gestational age who were consecutively hospitalized were enrolled. The study group contained preterm infants born to a preeclamptic mother and the comparison group contained preterm infants born to a normotensive mother.

Outcome measures

The primary outcome was to determine the association between preeclampsia and NEC.

Results

A total of 88 infants had NEC diagnosis. The incidence of NEC in infants born to preeclamptic mothers (22.9%) was significantly higher compared with those born to normotensive mothers (14.6%). According to NEC stages, NEC was more advanced in preeclamptic mother infants. NEC developed significantly earlier in infants with NEC in the study group. The duration of NEC was also significantly longer in infants born to preeclamptic mothers. In multiple logistic regression model, preeclampsia was found to be predictive of NEC with an odds ratio of 1.74 (95% confidence interval 0.64–0.92).

Conclusions

Maternal preeclampsia may be an important risk factor for the development of NEC in premature infants as NEC incidence and severity of NEC were found to be significantly higher in premature infants born to preeclamptic mothers. The onset of NEC was significantly earlier and duration of NEC was longer in these infants.