Impact of Delivery Mode on Morbidity in Preterm Infants with Very Low Birth Weights (<1500 Grams)

The mode of delivery and gestational age for very-low-birth-weight (VLBW) preterm infants are not yet well established and are constant topics of debate. Objective: To analyze the impact of delivery mode on morbidity in preterm infants weighing less than 1500 g. Results: Among 21,957 births, 81 were analyzed;53 were delivered vaginally, and 28 were delivered by cesarean section. The median maternal age, gestational age and body mass index among those delivered vaginally and by cesarean section were 20 years and 22.5 years, 27.6 weeks and 30.1 weeks, and 26.0 kg/m2 and 27.8 kg/m2, respectively. With respect to neonatal blood gas parameters, for those born vaginally and by cesarean section, the median pH was 7.32 and 7.24, the pCO2 was 41.5 mmHg and 51.1 mmHg, and the pO2 was 22.3 mmHg and 16 mmHg. The median fetal weight among those born by cesarean section and vaginally were 1180 g and 955 g, respectively. The median Apgar scores at the first and fifth minutes among those born by cesarean section and vaginally were 5.00 and 8.00 and 4.50 and 7.00, respectively. Conclusion: There was no significant difference between the results of vaginal and cesarean delivery for VLBW infants. Thus, further studies on this subject are needed.

Neurodevelopmental Outcomes of Extremely Premature Infants with Extremely Low and Very Low Birth Weight at Three Years of Age: A Retrospective Study

Introduction: The purpose of this retrospective study is to identify medical conditions impacting neurodevelopmental outcomes of extremely low birth weight and very low birth weight preterm infants at three years of age. Methods: Infants born in Banner Diamond Children’s University Medical Center, receiving services in the Newborn Intensive Care Unit, and attending Neonatal Developmental Follow-Up Clinic were identified. Participants received developmental assessment and follow-up from August 2012 through December 2018. Relevant clinical conditions during initial hospital stay and up to three years of age were obtained by reviewing medical and developmental records. Bayley Scales of Infant Toddler Development (Bayley III) was used to evaluate skill development at 6, 9, 12, 18, 24, 30, 36 months. Results: Data analysis did not reveal significant p-values;it did demonstrate that some predictor variables impact neurodevelopmental outcomes in cognitive, language and motor skill development. Conclusion: This retrospective study reports significant association between birth weight and low cognitive scores. Correlations were also found between gestational age and Total Language, and the longer an infant stayed in the NICU, the poorer the Total Language Scaled Scores at 8 to 12 months, 15 to 18 months, and 24 to 36 months. Birth weight was found to be the greatest predictor of poor motor scores.

Application of prolonging small feeding volumes early in life to prevent of necrotizing enterocolitis in very low birth weight preterm infants

Objective:To study the effects of prolonging small feeding volumes early in life on the incidence of necrotizing enterocolitis(NEC)in very low birth weight(VLBW)preterm infants.Methods:A total of 128 VLBW infants who could not be breastfed were assigned into the experimental group(63 cases)and the control group(65 cases)using a random number table.The experiment group was fed 12 mL/(kg·d)on day 1 which was increased to 24 mL/(kg·d)for the first 10 study days.The control group was fed 12 mL/(kg·d)for the first 14e48 hours.Then,the feeding volume increased by 24-36 mL/(kg·d)up to 140e160 mL/(kg·d)and maintained until the 10th day after birth.The incidence of feeding intolerance and NEC,duration of hospitalization,time to full enteral feedings,incidence of intrahepatic cholestasis,and the levels of gastrin and motilin in serum were assessed.Results:The incidence of feeding intolerance was significantly lower in the experimental group compared with the control group(15.87% vs.33.84%).There was a significant reduction in the incidence of NEC between the experimental and control groups(7.9% vs.16% in the control group).Conclusion:A protocol that prolongs small feeding volumes early in life can reduce the incidence and severity of NEC,but still warrants further study.

Study on the Relationship between Nursing Staffing and Nosocomial Infection in Very Low Birth Weight Infants

Background: At present, there is no domestic research on the relationship between nurse staffing and hospital infection in very low birth weight infants. In this paper, we will explore the relationship between nurses of very low birth weight (VLBW) infants in neonatal intensive care unit (NICU) and nosocomial infections. Methods: The clinical data of 280 very low birth weight infants born in our hospital from January 2010 to January 2020 were collected, and the chi-square test and multiple logistic regression analysis were used to study the nursing staff of each very low birth weight infant who was admitted to the NICU The relationship between the number of infections and hospital infections. Results: On average, each nurse needs to care for 4.3 very low birth weight infants (lowest to highest: 2.50 - 8.42). In the univariate analysis, the higher the incidence of urinary tract infection (P < 0.05), the multivariate logistic regression analysis of neonatal nosocomial infection showed that nurse staffing was significantly related to the incidence of urinary tract infection (OR = 1.78;95% confidence interval, 1.17 - 2.35, P < 0.05). However, there was no significant correlation between nurse staffing and bloodstream infection (OR = 0.91;95% confidence interval, 0.74 - 1.06, P > 0.05) or Ventilator associated pneumonia (VAP) infection (OR = 1.17;95% confidence interval, 0.94 - 1.47, P > 0.05). Conclusion: Our research shows that in the neonatal intensive care unit, the reasonable deployment of nursing staff is an important factor in preventing urinary tract infections in very low birth weight infants. It is important for improving the survival rate of very low birth weight infants and reducing the occurrence of sequelae.

Bronchopulmonary Dysplasia in Premature Infants with Very Low Birth Weight: A Single Centre Retrospective Study in China

To investigate bronchopulmonary dysplasia (BPD) and its treatment with dexamethasone (DEX) in premature infants with birth weight (BW) < 1500 g. We retrospectively reviewed the records of preterm infants admitted to the Division of Neonatology, the Second Xiangya Hospital, Central South University between September 2011 and December 2014. Patients were excluded if they needed oxygen therapy but were lost to follow-up at ≤36 weeks post-menstrual age (PMA) or <56 days after birth, or they had severe congenital anomalies. The incidence of BPD was 18% (37/212). Gestational age (GA) was <32 weeks in all BPD patients. GA, BW, and Apgar scores were lower and hospitalization duration and pulmonary surfactant (PS) use were higher in the BPD group than in the non-BPD group (P < 0.05). Risk factors for BPD included neonatal respiratory distress syndrome, neonatal pneumonia, positive sputum culture, pulmonary hemorrhage, respiratory failure. Multivariate logistic regression revealed that GA (odds ratio [OR]: 0.479, P = 0.004) and neonatal respiratory distress syndrome (OR: 6.146, P = 0.043) were independent risk factors for BPD. DEX was administered to 26 patients after the diagnosis of BPD. After one and two weeks of DEX treatment, the oxygen requirement had significantly reduced compared to the week prior to treatment (P < 0.05), while during treatment, the weight gain rate and weight gain efficiency slower significantly than that during either of the two preceding weeks (P < 0.001). These results suggest that low GA was the most important risk factor for BPD, DEX reduced oxygen dependency but decreased weight gain.

A Clinical Analysis of Physical and Neurological Development in very Low Birth Weight Infants with MEIR(Massage,Exercises,Intelligence training,and Rehabilitation training)

Objective:This study aimed to investigate the application of MEIR(Massage,Exercises,Intelligence training,and Rehabilitation training)in Chinese VLBW infants and to observe its effects on infants’growth and deve1opment.Methods:Clinical data of 92 VLBW infants who were treated at the neonatal intensive care unit(NICU)of Loudi Centra1 Hospital were retrospectively analyzed.The patients were grouped as the MEIRgroup(n=47)and controls(n=45).Physical and neurodevelopment deve1opment were compared between the two groups.Results:There were differences in height and weight and head circumference between the two groups at all corrected ages(all P<0.05).Abnormal motions,reflexes,muscular tension,audio-visual reactions,and posture,and the total numbers of abnormalities of 3-,6-,9-and 12-corrected month-old infants in the MElRgroup were 1ower than in the control group(all P<0.05).The mental development index and psychomotor development index of 6-and 12-corrected month infants in the MEIR group were higher than in the control group(all P<0.05).Conclusion:MEIR could improve the physical and neurological developments of VLBW infants,reduce the incidence of adverse events,and improve their growth and development.

Neonatal Nutrition and Later Outcomes of Very Low Birth Weight and Preterm Infants <32 Gestational Age at a Tertiary Care Hospital of Portugal

Premature infants, especially those born with less than 1500 g, often exhibit slow overall growth. Lack of early nutritional support is an important element. The present authors describe parenteral nutritional practices in a tertiary hospital and evaluate postnatal growth of preterm infants under 32 weeks of gestational age or with a birth weight < 1500 g. For population study, we examined 431 newborn files. Their median gestational age was 29.7 weeks. Of them, 25.4% were small for gestational age (SGA). 77.5% received parenteral nutrition (PN), 54.5% of which was provided on the first day. The average time was 14.7 days. The average weight gain by the 30th day was 425 g. At discharge, 37% were rd month 20% had their weight under P3, decreasing to 10% by the 12th month. Children who initiated PN in the first 24 hours of life had significantly better weight on the 30th day of their life (p th month of corrected age (p = 0.038). And they had better Body Mass Index (BMI) in the 3rd (p = 0.012) and 12th (p = 0.023) months. Despite better feeding practices, there is still significant failure in post natal growth. Early introduction of PN was associated with an improved weight gain, which suggests that nutrition that included amino acids may be critical during the first 24 hours of life.

Fish oil-containing lipid emulsions prevention on parenteral nutrition-associated cholestasis in very low birth weight infants:a meta-analysis

Background The effect of fish oil-containing lipid emulsions on preventing parenteral nutrition-associated cholestasis(PNAC)in very low birth weight(VLBW)infants is not known.Thus,we conducted a meta-analysis to identify any preven-tion effect.Methods PubMed,EMBASE,and CENTRAL were searched up to 26 January 2021 for studies related to the preventive effect of fish oil-containing lipid emulsions and fish oil-free lipid emulsions on cholestasis in VLBW infants.Revman 5.3 was used to synthesize the results.A fixed-effect model was used to summarize the data when the heterogeneity was non-significant(I2<50%),and a random-effects model was used when the heterogeneity was significant(I2>50%).Results Of 728 articles,11 randomized controlled trials met the inclusion criteria.The meta-analysis indicated that fish oil-containing lipid emulsion reduced the occurrence of PNAC significantly with risk ratio(RR)=0.53,95%confidence interval(CI)0.36-0.80,P=0.002.The heterogeneity was non-significant with I2=23%.Subgroup analysis based on par-enteral nutrition duration and median birth weight was performed.The synthesis results for patients with parenteral nutri-tion duration exceeding 14 days revealed I2=35%(P=0.15)and pooled RR=0.47,95%CI 0.30-0.73,P=0.0008;and for patients with duration less than 14 days revealed I2=0%(P=0.72)and pooled RR=1.14,95%CI 0.39-3.35,P=0.81.The synthesis for patients with birth weight more than 1000 g revealed I2=0%(P=0.41)and pooled RR=0.55,95%CI 0.26-1.18,P=0.12;and for patients with birth weight below 1000 g revealed I2=44%(P=0.11)and pooled RR=0.53,95%CI 0.33-0.85,P=0.009.Conclusions The fish oil-containing lipid emulsion can reduce the occurrence of PNAC in VLBW infants based on the avail-able original randomized controlled trial studies,especially for patients with parenteral nutrition duration exceeding 14 days and extremely low birth weight infants.Future studies should be performed before a definitive conclusion can be established.

No relationship between mode of delivery and neonatal mortality and neurodevelopment in very low birth weight infants aged two years

Background:To compare neonatal mortality and neurodevelopmental outcomes at two years of age in very low birth weight infants(≤1500 g)born by cesarean with those by vaginal delivery.Methods:In this retrospective,case-control study,we evaluated neonatal mortality,medical conditions and neurodevelopmental outcomes at two years of corrected age in 710 very low birth weight(VLBW)infants born between January 2005 and December 2010.Of the 710 infants,351 were born by the cesarean and 359/710 by vaginal route.Results:There were no significant differences in neonatal mortality between the cesarean delivery group and vaginal delivery group[56/351(15.9%)vs.71/359(19.8%),P=0.20].VLBW infants delivered by the cesarean procedure had a higher incidence of respiratory distress syndrome than those born by the vaginal route[221/351(63.0%)vs.178/359(49.6%),P<0.001].There were no differences in other neonatal morbidities,including intraventricular hemorrhage[126/351(35.9%)vs.134/359(37.3%),P=0.69],bronchopulmonary dysplasia[39/351(11%)vs.31/359(8.6%),P=0.38]and necrotising enterocolitis[40/351(11.4%)vs.32/359(8.9%),P=0.32]between the two groups.The incidence of poor neurodevelopment after cesarean delivery was similar to that after vaginal delivery[105/351(29.9)vs.104/359(29.0%),P=0.78].Conclusions:In neither neurodevelopment nor neonatal mortality did cesarean birth offered significant advantages to VLBW infants.Moreover,the operation might be associated with an increased risk of respiratory distress syndrome for VLBW infants.The mode of delivery of VLBW infants should be largely based on obstetric indications and maternal considerations rather than perceived better outcomes for the neonate.

Prevention of peripherally inserted central catheter-related infections in very low-birthweight infants by using a central line bundle guideline with a standard checklist

Objective:To investigate the effectiveness and feasibility of using a central line bundle(CLB)guideline with a standard checklist in the prevention of peripherally inserted central catheter(PICC)-related infections(CRIs)in very low-birth-weight infants(VLBWIs).Methods:Fifty-seven VLBWIs who underwent PICC insertion at a hospital in Qingdao,China,between November 2012 and June 2013,were monitored with the CLB guideline and a standard checklist.Fifty-three VLBWIs who underwent PICC insertion were monitored by standard hospital procedures.The incidence of CRIs was compared between the two groups.Results:The incidence of infection significantly decreased from 10.0%catheter days in the control group to 2.2%catheter days in the study group(p<0.05).The indwelling catheter time significantly increased in the study group compared to the control group(31.9±15.0days vs.24.8±7.4 days,respectively,p<0.05).Colonization infections also decreased from 6.9% catheter days in the control group to 2.2%catheter days in the study group(p<0.05).The incidence of catheter-related bloodstream infections decreased from 3.1%catheter days in the control group to 0%catheter days in the study group.Conclusion:The use of a CLB guideline with a standard checklist could be an effective and feasible protocol for preventing CRIs and prolonging indwelling catheter timein VLBWIs.

Improving health care usage in a very low birth weight population

Background:Prematurity is the biggest contributor to admissions in the neonatal intensive care unit(NICU).The period following hospital discharge is a vital continuum for the very low birth weight(VLBW)infant The objective of this study was to assess the impact of a unique discharge and follow-up process on the outcomes of VLBW infants leaving the NICU.Methods:All outpatient health care usage by VLBW infants born in the study year(cases)was retrospectively tracked through 12 months of age.A cohort of healthy newborn infants were matched by birthdate to each VLBW infant(controls)and similarly tracked.Results:In this study,there were 85 cases and 85 controls.The mean gestational age at birth for the cases was 29.1±2.7 weeks with a mean birth weight of 1079±263 g.That of the controls was 38.9±13 weeks and 3202±447 g.Over 90%of both populations had Medicaid coverage.All VLBW infants received care at the Special Care Developmental Follow-Up Clinic.When compared with the controls,VLBW infants discharged from the NICU made fewer acute,unscheduled visits to the Emergency Department or Urgent Care Clinic(2.3±2.5 vs.3.7±3.5;P=0.007)despite their high-risk medical and social status.Their growth pattern showed significant"catch-up"and was similar to the matched controls at the last scheduled visit for each group.Conclusions:Outcomes including health care utilization in high-risk infants can be improved through meticulous discharge planning and follow-up measures that utilize existing hospital infrastructure to provide affordable comprehensive care.

Gut microbiota in preterm infants receiving breast milk or mixed feeding

BACKGROUND Preterm birth is the leading cause of mortality in newborns,with very-low-birthweight infants usually experiencing several complications.Breast milk is considered the gold standard of nutrition,especially for preterm infants with delayed gut colonization,because it contains beneficial microorganisms,such as Lactobacilli and Bifidobacteria.AIM To analyze the gut microbiota of breastfed preterm infants with a birth weight of 1500 g or less.METHODS An observational study was performed on preterm infants with up to 36.6 wk of gestation and a birth weight of 1500 g or less,born at the University Hospital Dr.JoséEleuterio González at Monterrey,Mexico.A total of 40 preterm neonates were classified into breast milk feeding(BM)and mixed feeding(MF)groups(21 in the BM group and 19 in the MF group),from October 2017 to June 2019.Fecal samples were collected before they were introduced to any feeding type.After full enteral feeding was achieved,the composition of the gut microbiota was analyzed using 16S rRNA gene sequencing.Numerical variables were compared using Student’s t-test or using the Mann–Whitney U test for nonparametric variables.Dominance,evenness,equitability,Margalef’s index,Fisher’s alpha,Chao-1 index,and Shannon’s diversity index were also calculated.RESULTS No significant differences were observed at the genus level between the groups.Class comparison indicated higher counts of Alphaproteobacteria and Betaproteobacteria in the initial compared to the final sample of the BM group(P<0.011).In addition,higher counts of Gammaproteobacteria were detected in the final than in the initial sample(P=0.040).According to the Margalef index,Fisher’s alpha,and Chao-1 index,a decrease in species richness from the initial to the final sample,regardless of the feeding type,was observed(P<0.050).The four predominant phyla were Bacteroidetes,Actinobacteria,Firmicutes,and Proteobacteria,with Proteobacteria being the most abundant.However,no significant differences were observed between the initial and final samples at the phylum level.CONCLUSION Breastfeeding is associated with a decrease in Alphaproteobacteria and Betaproteobacteria and an increase of Gammaproteobacteria,contributing to the literature of the gut microbiota structure of very low-birth-weight,preterm.

Portal venous gas resulting from umbilical vein catheterization in a very-low-birth-weight infant with no interruption in early feeding

Introduction Portal venous gas(PVG)is common in necrotizing enterocolitis and occasionally occurs in neonates after umbilical vein catheterization(UVC).Therefore,determining the cause of PVG requires further clinical evaluation in these cases.Case presentation We report the case of a very-low-birth-weight infant who underwent UVC after birth.PVG was an unexpected finding on ultrasound following catheterization.The UVC was immediately removed and replaced with a peripherally inserted central catheter.The infant’s physical examination was unremarkable.Bedside X-ray revealed neither PVG nor pneumatosis intestinalis,which would indicate the onset of necrotizing enterocolitis.After full evaluation,breastfeeding was started on the same day.The infant did not develop feeding intolerance,necrotizing enterocolitis,or other disorders.Conclusion PVG occasionally occurs in neonates who undergo UVC and is considered to be caused by exogenous gases.PVG is more easily detected with ultrasound than with X-ray and does not affect early feeding in premature infants.

Prevalence of retinopathy of prematurity in Brunei Darussalam

AIM: To identify the prevalence of retinopathy of prematurity (ROP) among preterm neonates admitted to Department of Neonatology, RIPAS hospital, Brunei Darussalam. ·METHODS: We studied 67 preterm infants fulfilling the eligibility criteria for ROP screening. All infants studied were admitted to the Department of Neonatology, RIPAS Hospital, within a period of one year. Birth weight (BW), gestational age (GA), corrected age at each review, initial and final diagnoses and number of reviews required was recorded for each infant. Infants were followed up two weekly until they reach a corrected age of 40 weeks or complete vascularization was noted. Prevalence of ROP was identified. Descriptive analysis, regression analysis and independent-sample t-test were used to statistically check for differences between ROP and non -ROP groups. ·RESULTS: A total number of 201 ROP screenings were carried out for 67 preterm infants. Males outnumbered females (56.7%). The mean number of reviews per child was (3.19 ±1.1) times (range: 1 -6 times), the mean GA among the preterm babies examined was (29.5 ±2.6) weeks (range: 23 -36 weeks), and the mean BW was 1300 ±500g (range: 660 -3600g). The prevalence of ROP among the examined infants was 34.8% . Prevalence of threshold disease that required laser treatment was 25.4% . Prevalence of ROP among those with extremely low BW was 86.7% compared to 27.8% in those with very low BW. Respiratory distress and congenital heart diseases were significantly associated with higher incidence of ROP. ·CONCLUSION: Lower BW, lower GA and female gender are associated with higher risk of developing ROP among preterm infants in Brunei Darussalam.

Development of necrotizing enterocolitis after blood transfusion in very premature neonates

Background Prior studies report conflicting evidence on the association between packed red blood cell(PRBC)transfu-sions and necrotizing enterocolitis(NEC),especially in early weeks of life where transfusions are frequent and spontaneous intestinal perforation can mimic NEC.The primary objective of this study was to evaluate the association between PRBC transfusions and NEC after day of life(DOL)14 in very premature neonates.Methods A retrospective cohort analysis of very premature neonates was conducted to investigate association between PRBC transfusions and NEC after DOL 14.Primary endpoints were PRBC transfusions after DOL 14 until the date of NEC diagnosis,discharge,or death.Wilcoxon ranked-sum and Fisher's exact tests,Cox proportional hazards regression,and Kaplan-Meier curves were used to analyze data.Results Of 549 premature neonates,186(34%)received transfusions after DOL 14 and nine(2%)developed NEC(median DOL=38;interquartile range=32-46).Of the nine with NEC after DOL 14,all were previously transfused(P<0.001);therefore,hazard of NEC could not be estimated.Post hoc analysis of patients from DOL 10 onward included five additional patients who developed NEC between DOL 10 and DOL 14,and the hazard of NEC increased by a factor of nearly six after PRBC transfusion(hazard ratio=5.76,95%confidence interval=1.02-32.7;P=0.048).Conclusions Transfusions were strongly associated with NEC after DOL 14.Prospective studies are needed to determine if restrictive transfusion practices can decrease incidence of NEC after DOL 14.

Factors affecting length of stay according to bronchopulmonary dysplasia severity:a nationwide cohort study in Korea

Background Longer hospitalizations for preterm infants with bronchopulmonary dysplasia(BPD)delay developmental outcomes,increase the risk for hospital-acquired complications,and exert a substantial socioeconomic burden.This study aimed to identify factors associated with an extended length of stay(LOS)at different levels of severity of BPD.Methods A cohort study was conducted using the Korean Neonatal Network registry of very low birth weight infants with BPD between 2013 and 2017 through retrospective analysis.Results A total of 4263 infants were diagnosed with BPD.For mild BPD,infants requiring surgical treatment for patent ductus arteriosus needed a longer LOS[eadjustedβcoefficients(adjβ)1.041;95%confidence interval(CI):0.01–0.08]and hydrocephalus(eadjβ1.094;95%CI 0.01–0.17).In moderate BPD,infants administered steroids or with intraventricular hemorrhage required a longer LOS(eadjβ1.041;95%CI 0.00–0.07 and eadjβ1.271;95%CI 0.11–0.38,respectively).In severe BPD,infants with comorbidities required a longer LOS:pulmonary hypertension(eadjβ1.174;95%CI 0.09–0.23),administrated steroid for BPD(eadjβ1.116;95%CI 0.07–0.14),sepsis(eadjβ1.062;95%CI 0.01–0.11),patent ductus arteriosus requiring surgical ligation(eadjβ1.041;95%CI 0.00–0.08),and intraventricular hemorrhage(eadjβ1.016;95%CI 0.05–0.26).Additionally,the higher the clinical risk index score,the longer the LOS needed for infants in all groups.Conclusions The factors affecting LOS differed according to the severity of BPD.Individualized approaches to reducing LOS may be devised using knowledge of the various risk factors affecting LOS by BPD severity.