Longitudinal follow-up of ventricular performance in healthy neonates

Background

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

Aim

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

Design

This is a longitudinal follow-up study.

Subjects

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

Outcome measures

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

Results

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

Conclusions

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

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

Objective

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

Methods

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

Results

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

Conclusion

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

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

Background

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

Methods

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

Results

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

Conclusions

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

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.     

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

Background

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

Aim

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

Study design

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

Subjects

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

Outcome measures

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

Results

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

Conclusion

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

Developmental trajectories of children with birth asphyxia through 36 months of age in low/low–middle income countries

Background

Resuscitation following birth asphyxia reduces mortality, but may be argued to increase risk for neurodevelopmental disability in survivors.

Aims

To test the hypothesis that development of infants who received resuscitation following birth asphyxia is not significantly different through 36 months of age from infants who had healthy births.

Study design

Prospective observational cohort design comparing infants exposed to birth asphyxia with resuscitation or healthy birth.

Subjects

A random sample of infants with birth asphyxia who received bag-and-mask resuscitation was selected from birth records in selected communities in 3 countries. Exclusion criteria: birth weight < 1500 g, severely abnormal neurological examination at 7 days, mother < 15 years, unable to participate, or not expected to remain in the target area. A random sample of healthy-birth infants (no resuscitation, normal neurological exam) was also selected. Eligible = 438, consented = 407, and ≥ 1 valid developmental assessment during the first 36 months = 376.

Outcome measure(s)

Bayley Scales of Infant Development-II Mental (MDI) and Psychomotor (PDI) Development Index.

Results

Trajectories of MDI (p = .069) and PDI (p = .143) over 3 yearly assessments did not differ between children with birth asphyxia and healthy-birth children. Rather there was a trend for birth asphyxia children to improve more than healthy-birth children.

Conclusions

The large majority of infants who are treated with resuscitation and survived birth asphyxia can be expected to evidence normal development at least until age 3. The risk for neurodevelopmental disability should not justify the restriction of effective therapies for birth asphyxia.     

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

Background

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

Aim

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

Study design and subjects

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

Outcome measures

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

Results

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

Conclusions

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

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

Objectives

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

Methods

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

Results

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

Conclusion

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

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

Background

Perinatal asphyxia influences peripheral oxygenation and perfusion in neonates.

Objectives

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

Methods

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

Results

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

Conclusion

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

Serum neutrophil gelatinase-associated lipocalin as a predictor of the development of bronchopulmonary dysplasia in preterm infants

Background

Bronchopulmonary dysplasia (BPD) is a chronic lung disease mostly occurring in preterm infants. The pathogenesis of BPD involves early inflammation and remodeling of the premature lung.

Aim

To search for the novel predictive marker of BPD development, we studied serum levels of neutrophil gelatinase-associated lipocalin (NGAL), an innate immune mediator, in preterm infants.

Methods

Serum NGAL concentrations at birth were measured by enzyme-linked immunosorbent assay. The reference levels were determined in 52 infants having no anomalies or inherited diseases. The levels and clinical variables were assessed in association with BPD.

Results

Geometric means (95%CI) of serum NGAL levels at birth of infants having no underlying diseases were 32.4 (22.1–47.5), 58.6 (47.9–71.8), and 126.2 (99.0–168.7) ng/mL for < 31, 31–36 and > 36 gestational weeks (GW), respectively (p < 0.001). These levels positively correlated with neutrophil (p < 0.0001) or monocyte counts (p < 0.0001). The median NGAL levels (307.8 ng/mL) and neutrophil counts (4141/μL) at birth of 16 preterm infants (< 31 GW) who developed BPD were higher than those (42.9 ng/mL and 1357/μL) of 20 infants (< 31 GW) who did not (p < 0.0001 and p = 0.012), respectively. In multivariable analysis for 36 infants born less than 31 GW, higher NGAL levels (≥ 82 ng/mL) but not neutrophil counts at birth had a significant association with developing BPD (gestational-age adjusted odds ratio [OR] = 37.45 [3.08–455.49], p < 0.01).

Conclusions

High serum levels of NGAL at birth could be an early sensitive marker for BPD in preterm infants, because their levels were physiologically low.     

Small for gestational age babies are not related to changes in markers of adipose tissue dysfunction during reproductive age

Background

Small for gestational age (SGA) birth has been associated with adipocyte dysfunction during later phases of life. Because SGA women are at a higher risk of developing polycystic ovary syndrome (PCOS), adipocyte dysfunction detected in patients with PCOS may be associated with SGA birth.

Aims

To determine whether SGA birth is related to altered serum markers of adipose tissue dysfunction during the third decade of life in Brazilian women. A secondary objective was to relate the presence of PCOS with serum markers of adipose tissue dysfunction.

Study design

Prospective cohort observational study.

Subjects

A total of 384 women born at 37 to 42 weeks of gestation from June 1, 1978 to May 31, 1979 in Ribeirão Preto, State of São Paulo, Brazil. After exclusion, 165 women participated in the study. Of these women, 43 were in the SGA group and 122 were in the adequate for gestational age group based on birth weight determined from cohort files.

Outcome measures

Body mass index (BMI), arterial systolic and diastolic pressures, abdominal circumference and serum concentrations of total testosterone, fasting glucose and insulin, lipid profile, adiponectin, leptin and necrosis factor alpha tumor (TNFα).

Results

BMI was an independent predictor of lower adiponectin (adjusted coefficient = − 0.02, p = 0.01) and higher leptin (adjusted coefficient = 0.06, p = 0.01) concentrations. The serum insulin concentration was associated with higher leptin (adjusted coefficient = 0.03, p = 0.02) and TNF-α (adjusted coefficient = 0.01, p = 0.03) concentrations. Having PCOS or being born SGA did not predict any markers of adipocyte dysfunction.     

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

Background

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

Aims

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

Study design

A single-blinded randomized clinical trial

Subjects

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

Outcome measures

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

Results

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

Conclusion

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

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

Background

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

Aim

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

Study design

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

Subjects

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

Outcome measures

Bayley Scales of Infant Development-III Language Composite.

Results

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

Conclusions

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

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

Aim

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

Study design

Case–control study

Subjects

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

Outcome measures

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

Results

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

Conclusion

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

Feasibility of using ultrasound to measure preterm body composition and to assess macronutrient influences on tissue accretion rates

Background and aims

To assess ultrasound as a method for (i) measuring body composition (BC) of preterm infants and for (ii) assessing the influence of macronutrient intakes on tissue accretion rates.

Methods

Preterm ultrasound studies of four anatomical sites were performed approximately every three weeks from birth to corrected-term age. Preterm measurements were compared to foetal reference data. Duplicate scans at each site were taken on a subset of infants to test the reproducibility of the method, assessed as the coefficient of variation (CV). The influence of measured macronutrient intakes on preterm BC was assessed by regression analysis.

Results

Median (range) gestation and birth weight of 40 preterm infants were 27 (23–29) weeks and 1022 (480–1475) g, respectively. Accretion rates of adipose and muscle tissues were not uniform across the four sites. Relative to the foetus, preterm adipose tissue thickness was reduced at an equivalent (corrected) gestation, but towards term, a faster accretion rate of subcutaneous abdominal adipose and limb muscle tissue was evident. Timing of fortification (p = 0.012), enteral carbohydrate intake (p = 0.008) and the protein energy ratio of intakes (p = 0.038) moderated the ratio of adipose to muscle tissue accretion over the four sites by − 0.004, − 0.048 and − 0.042, respectively.

Conclusions

Ultrasound provides a non-invasive, portable method of assessing changes in subcutaneous adipose tissue and muscle accretion and appears sufficiently sensitive to detect influences of macronutrient intakes on accretion rates from birth. The method warrants further investigation as a bedside tool for measuring BC of preterm infants.     

Ventral stream sensitivity in “healthy” preterm-born adolescents: Psychophysical and neuropsychological evaluation

Background

Deficits of motion processing have been reported in premature and very low birth-weight subjects during infancy, childhood and adolescence. Less is known about ventral stream functioning in preterms.

Aim

The aim of this study is to investigate ventral stream functioning in a sample of “healthy” adolescents born preterm with normal outcome and without brain damage.

Study design

We enrolled thirty preterm-born adolescents (mean age: 14.2 years, mean gestational age 28.9 weeks, mean birth weight 1097 g), and 34 age-matched term-born controls (mean age: 14.5 years). All subjects were administered a psychophysical test known as “Form Coherence Task” and a comprehensive standardized battery of neuropsychological tests suitable for investigating ventral stream functioning including Street Completion Test, Poppelreuter–Ghent Test and the first part of the Visual Object and Space Perception (VOSP) battery. Dorsal stream visual functioning was investigated by the second part of the VOSP.

Results

Preterm (PT) subjects showed the same results in all “ventral” tasks with respect to full-term controls without any correlation to gestational age or birth weight. We found a significant negative correlation between Form Coherence Task and Letters Task (p = .014) and between Form Coherence and Silhouette Tasks (p = .017). No correlation was observed between Form Coherence Task and Street and Ghent Tests. A statistical difference was instead found between PTs and controls in two tasks of the VOSP battery that mostly involve the dorsal stream.

Conclusions

Preterm birth per se (in absence of evident brain lesions) is not sufficient to compromise the development of ventral pathway.     

Early enteral feeding in very low birth weight infants

Background/aim

Debate exists about when to initiate enteral feeding (EF) in very low birth weight (VLBW) preterm infants. This retrospective study compared the effectiveness of an education-based quality improvement project and the relationship of time of the first EF to necrotizing enterocolitis (NEC) or death incidence and parenteral nutrition (PN) days in VLBW infants.

Study design/subjects

VLBW infants born in 2 epochs were compared for hour of the first feed, PN days, NEC or death incidence, and feeding type. The 2 epochs were temporally divided by a quality improvement initiative to standardize initiation of EF in postnatal hours 6–24.

Results

603 VLBW infants were included. Median time of feed initiation decreased from 33 (Epoch 1) to 14 h (Epoch 2) (p < 0.0001). Median PN days were 14 vs. 12, respectively (p = 0.07). The incidence of NEC or death was 13.4% vs. 9.5%, respectively (p = 0.14). When controlling for birth weight, gestational age, race, gender, and time period, earlier feed initiation was associated with decreased NEC or death (p = 0.003). Evaluation of the relationship of early EF (defined as within the first 24 h) in Epoch 2 alone showed that early EF was significantly associated with decreased NEC or death (6.3 vs 15.1%) (RR, 95% CI = 0.28, 0.13–0.58) and less PN days (p < 0.0001).

Conclusions

In a VLBW infant cohort, an education-based process improvement initiative decreased time of EF initiation to a median of 14 h with no associated increase in NEC or death. In fact, results suggest that earlier feeding is associated with decreased NEC or death.     

Bullying of extremely low birth weight children: Associated risk factors during adolescence

Background

Preterm children have many risk factors which may increase their susceptibility to being bullied.

Aims

To examine the prevalence of bullying among extremely low birth weight (ELBW, < 1 kg) and normal birth weight (NBW) adolescents and the associated sociodemographic, physical, and psychosocial risk factors and correlates among the ELBW children.

Methods

Cohort study of self-reports of bullying among 172 ELBW adolescents born 1992–1995 compared to 115 NBW adolescents of similar age, sex and sociodemographic status. Reports of being bullied were documented using the KIDSCREEN-52 Questionnaire which includes three Likert type questions concerning social acceptance and bullying. Multiple linear regression analyses adjusting for sociodemographic factors were used to examine the correlates of bullying among the ELBW children.

Results

Group differences revealed a non-significant trend of higher mean bullying scores among ELBW vs. NBW children (1.56 vs. 1.16, p = 0.057). ELBW boys had significantly higher bullying scores than NBW boys (1.94 vs. 0.91, p < 0.01), whereas ELBW and NBW girls did not differ (1.34 vs. 1.30, p = 0.58). Bullying of ELBW children was significantly associated with subnormal IQ, functional limitations, anxiety and ADHD, poor school connectedness, less peer connectedness, less satisfaction with health and comfort, and less risk avoidance.

Conclusion

ELBW boys, but not girls, are more likely to be victims of bullying than NBW boys. School and health professionals need to be aware of the risk of bullying among ELBW male adolescents.     

The impact of cesarean section on neonatal outcome of infants born at 23 weeks of gestation

Objective

Determine the impact of cesarean section (CS) on neonatal outcome of infants born at 23 weeks of gestation.

Methods

A retrospective study was performed involving 34 infants born at 23 weeks and 91 infants born at 24–26 weeks. Indications necessitating delivery were severe pregnancy induced hypertension, non-reassuring fetal heart rate patterns (NRFHRs), or intrauterine infection (IUI). Obstetrical indication for CS included NRFHR and breech presentation. Poor outcome included neonatal death or cerebral palsy. Univariate and multiple logistic analyses were performed to determine the effect of CS for obstetrical indications on poor outcome.

Results

The incidence of poor outcome was significantly higher at 23 weeks (number of poor outcomes/total number: 22/34) compared to that (31/91) at 24–26 weeks (p < 0.01). The incidence of a poor outcome was significantly higher at 23 weeks for infants having NRFHR (11/16) compared to those at 24–26 weeks (15/43, p = 0.02). However, the incidence of a poor outcome was similar in infants with IUI (6/10 at 23 weeks versus 5/11 at 24–26 weeks, p = 0.41). Vaginal birth in cases of obstetrical indication for CS at 23 weeks was associated with higher risk of a poor outcome (odds ratio: 8.2). In contrast, the risk at 24–26 weeks was not higher (OR, 0.8). After adjustment using variables of vaginal birth and IUI, vaginal birth significantly affected poor outcome (OR, 13.0).

Conclusion

Poor neonatal outcome was closely related to the mode of delivery, suggesting that CS for obstetrical indication at 23 weeks may improve neonatal outcome.     

Clinical condition and transmission of coinfections with human cytomegalovirus in infants of HIV-1 infected mothers in the era of mother-to-child-transmission prophylaxis

Background and aim

The aim of the study was to evaluate the clinical state and the risk of coinfections in infants of HIV-1-infected women receiving MTCT prophylaxis.

Methods

The study included 35 Polish infants of HIV-1-infected mothers diagnosed for congenital infections. Children were evaluated for HIV-1, HCMV and HCV infection by serological and molecular methods during following visits up to 18th month of life. None of the children received breast milk after birth.

Results

HIV-1 infection was found in one child not receiving MTCT prophylaxis, one HCV infection was detected in another infant. HCMV-DNA in the urine was present in 13/35 children (37.14%) in the 10th day and 24/35 children (68.57%) at 4th week of life. The group of children managed with full and incomplete MTCT regimen did not differ in most clinical parameters. Children receiving MTCT prophylaxis were born more frequently as first children (p = 0.045) and by cesarean section (p = 0.047). HCMV-positive children receiving MTCT prophylaxis were had lower gestational age (p = 0.03) and smaller head circumference (p = 0.02). They were born more frequently as premature (0.02) and with low birth weight (0.02). Maternal cART and the use of protease inhibitors were not significantly associated with perinatal complications. No differences in CD4 + and CD8 + counts were noted between the group receiving full and incomplete MTCT protocol.

Conclusions

ARV used in MTCT preventive protocols is safe for infants although the risk of the transmission of HCMV coinfection is not reduced.