Aim:To determine the type and rate of disability at 2 years of age in infants born in the geographically defined population of East Anglia with a birthweight less than 1500 g and to assess the risk factors for disabil...Aim:To determine the type and rate of disability at 2 years of age in infants born in the geographically defined population of East Anglia with a birthweight less than 1500 g and to assess the risk factors for disability.Study design:A prospective cohort analysis from all eight neonatal units in East Anglia from 1 993—1997 using a single database.Methods:Local paediatricians assessed childr en at 2 years using the Health Status Questionnaire and data collection was cent rally coordinated.Results:Outcomes for 947 children,99%of survivors,were av ailable,74(7.8%)had severe disability and this was significantly associated with gestational age(p < 0.0005),birthweight(p < 0.0005)and sex(p = 0.046).Major congenital abnormality contributed 27%of all severe disability.The over all cerebral palsy rate was 6.2%,nine children were blind and five had sensori neural hearing loss requiring aids.These children had a high level of use of co mmunity services with 19%of the cohort being referred to one or more community service.ELBW infants or those born < 30 weeks gestation were 1.5 times and twic e as likely to have moderate or severe disability and 2.3 and 5.4 times as likel y to have cerebral palsy as those weighing 1000 to 1500 g or > 30 weeks gestatio n.Boys were at higher risk of adverse outcome.Conclusions:The study was able to define the increased risk associated with being born at lower gestational age or lower birthweight and demonstrates successful ascertainment of outcomes for large local populations at a reasonable cost.展开更多
Background: Inhaled nitric oxide (iNO) is used widely in newborn infants with hypoxic respiratory failure, despite the known and the oretical toxicity of iNO, and a relative lack of information about appropriate doses...Background: Inhaled nitric oxide (iNO) is used widely in newborn infants with hypoxic respiratory failure, despite the known and the oretical toxicity of iNO, and a relative lack of information about appropriate doses. Aim: To determine whether adose-response relationship existed for iNO in preterm infants.Design: A four-period, four-dose, cross-over design was used with iNO given for 15 min in a randomised sequence in concentrations of 5, 10, 20 and 40 parts per million (ppm), with a minimum 5 min wash-out period. Data on ventilatory, bloodgas and other physiological measurements were recorded before and at the end of each period. The relationship of clinical response with iNO dose and period was analysed using multivariate regression. Subjects: Infants with gestational age < 34 weeks and < 28 days postnatal age with hypoxic respiratory failure were recruited. Outcome measure: A clinically significant dose-response was defined as a rise in the post-ductalarterial oxygen tension (PaO2) of at least 3 kPa. Results:Thirteen infants were recruited. At trial entry, ten were < 3 days of age; 11 were being treated with high frequency oscillatory ventilation; median (inter-quartile range) gestational age 27 (25-29) weeks; birthweight 983 (765-1120) g; oxygenation index 27.1 (21.8-28.8). Six infants (46%) showed a clinically significant response. After adjusting for period and patient effect, no evidence for an overall dose effect was identified(likelihood ratio test, p = 0.34). Conclusion: No evidence of a dose-response relationship with iNO was found in this study of very preterm infants with respiratory failure.展开更多
文摘Aim:To determine the type and rate of disability at 2 years of age in infants born in the geographically defined population of East Anglia with a birthweight less than 1500 g and to assess the risk factors for disability.Study design:A prospective cohort analysis from all eight neonatal units in East Anglia from 1 993—1997 using a single database.Methods:Local paediatricians assessed childr en at 2 years using the Health Status Questionnaire and data collection was cent rally coordinated.Results:Outcomes for 947 children,99%of survivors,were av ailable,74(7.8%)had severe disability and this was significantly associated with gestational age(p < 0.0005),birthweight(p < 0.0005)and sex(p = 0.046).Major congenital abnormality contributed 27%of all severe disability.The over all cerebral palsy rate was 6.2%,nine children were blind and five had sensori neural hearing loss requiring aids.These children had a high level of use of co mmunity services with 19%of the cohort being referred to one or more community service.ELBW infants or those born < 30 weeks gestation were 1.5 times and twic e as likely to have moderate or severe disability and 2.3 and 5.4 times as likel y to have cerebral palsy as those weighing 1000 to 1500 g or > 30 weeks gestatio n.Boys were at higher risk of adverse outcome.Conclusions:The study was able to define the increased risk associated with being born at lower gestational age or lower birthweight and demonstrates successful ascertainment of outcomes for large local populations at a reasonable cost.
文摘Background: Inhaled nitric oxide (iNO) is used widely in newborn infants with hypoxic respiratory failure, despite the known and the oretical toxicity of iNO, and a relative lack of information about appropriate doses. Aim: To determine whether adose-response relationship existed for iNO in preterm infants.Design: A four-period, four-dose, cross-over design was used with iNO given for 15 min in a randomised sequence in concentrations of 5, 10, 20 and 40 parts per million (ppm), with a minimum 5 min wash-out period. Data on ventilatory, bloodgas and other physiological measurements were recorded before and at the end of each period. The relationship of clinical response with iNO dose and period was analysed using multivariate regression. Subjects: Infants with gestational age < 34 weeks and < 28 days postnatal age with hypoxic respiratory failure were recruited. Outcome measure: A clinically significant dose-response was defined as a rise in the post-ductalarterial oxygen tension (PaO2) of at least 3 kPa. Results:Thirteen infants were recruited. At trial entry, ten were < 3 days of age; 11 were being treated with high frequency oscillatory ventilation; median (inter-quartile range) gestational age 27 (25-29) weeks; birthweight 983 (765-1120) g; oxygenation index 27.1 (21.8-28.8). Six infants (46%) showed a clinically significant response. After adjusting for period and patient effect, no evidence for an overall dose effect was identified(likelihood ratio test, p = 0.34). Conclusion: No evidence of a dose-response relationship with iNO was found in this study of very preterm infants with respiratory failure.
