Journal of Perinatology最新文献

Objective: To characterize long-term feeding outcomes in infants who underwent tracheostomy prior to their first birthday.

Study design: Retrospective review of feeding outcomes at initial hospital discharge and age 5 in a cohort of infants who underwent tracheostomy at a children's hospital over a 16-year period.

Results: 145 infants met inclusion criteria. In this cohort, 117 were feeding tube dependent at time of initial hospital discharge and 71 were feeding tube dependent age 5. Cardiovascular comorbidities (p = 0.009), long-term tracheostomy dependence (p < 0.001), higher birth weight (p = 0.011), older age at tracheostomy decannulation (p < 0.001) and older gestational age (p = 0.007) were factors associated with feeding tube dependence at age 5.

Conclusion: The long-term feeding outcomes of infants who require tracheostomy demonstrate high levels of feeding impairment at age 5.

Objective: To evaluate the effect of age correction up to 36 months of age for growth assessments of extremely preterm (<28 weeks) and very preterm (28 to <32 weeks) infants.

Study design: This longitudinal analysis used data from the Preterm Infant Multicenter Growth Study (2001-2014).

Results: 1,416 children were included (Median gestational age = 27 weeks). Chronological age-based weight, height, and head circumference z-scores were consistently lower than those based on corrected age for all ages (0, 4, 8, 21 and 36 months) by up to -5.2 (95% confidence interval -5.4, -5.1) z-scores for length at term. Using chronological age, higher proportions of children were misclassified as having suboptimal growth (up to 72.9% misdiagnosed as stunted and 89.8% misdiagnosed as underweight at term).

Conclusion: For extremely and very preterm children, age correction is required for all growth measures through 36 months of corrected age.

Objective: The aim of this study was to examine the predictive value of the lung ultrasound score (LUS) for successful extubation in preterm infants born at ≤25⁺⁶ weeks.

Methods: This was a single-center, prospective cohort study. Preterm infants with gestational age (GA) ≤ 25⁺⁶ weeks who received invasive mechanical ventilation (IMV) for ≥72 h were included. Lung ultrasound was performed every day. Multivariate logistic regression analysis was used to evaluate factors that predict extubation outcomes.

Results: Ninety-three infants with GA ≤ 25⁺⁶ weeks were included. The mean GA was 24.5 ± 1.2 weeks. Extubation failure occurred in 55 (59.1%) neonates, and success occurred in 38 (40.9%) neonates. The LUS was significantly lower in the successful group than in the failed group (24.0 ± 2.5 vs. 32.1 ± 3.1 p < 0.001). Logistic regression analysis showed that LUS was an independent predictor of successful extubation (odd ratio 0.15 [95% CI 0.045-0.508], P = 0.002). The area under the receiver operating characteristic curve was 0.98 (p < 0.001) for LUS, and a cutoff value of ≥ 28 had 94.6% sensitivity and 92.7% specificity in detecting extubation failure.

Conclusion: The LUS has good accuracy for predicting successful extubation in extremely preterm infants with GA ≤ 25⁺⁶ weeks.

Objective: This study aims to investigate the correlation between exposure to disinfection byproducts of chlorination and preterm birth (PTB) through evidence-based medicine Meta-analysis and Mendelian randomization (MR) analysis.

Study design: Meta-analysis was conducted on 17 studies involving 1,251,426 neonates, revealing a higher risk of PTB with exposure to total trihalomethanes (TTHMs) and chloroform. Mendelian randomization (MR) analysis confirmed a causal relationship between chlorides and PTB.

Results: TTHMs and chloroform were associated with increased PTB risk, while haloacetic acids showed no significant association. TTHMs were linked to small gestational age. Ethnicity and study design influenced heterogeneity.

Conclusions: Exposure to chlorination byproducts, particularly TTHMs and chloroform, poses a significant risk for PTB. MR analysis supports a causal relationship between chlorides and PTB, highlighting the importance of water disinfection byproduct control in preventing PTB.

Objective: Acetaminophen and indomethacin are used for medical management of a patent ductus arteriosus. This study compared the efficacy of these agents in ELBW infants.

Study design: This was a retrospective study of all courses of indomethacin and acetaminophen. Baseline characteristics, details of pharmacologic therapy, toxicity, and acetaminophen serum concentrations were collected. The primary analysis compared rates of ductus closure with indomethacin versus acetaminophen using Pearson's Chi-squared test.

Results: Ductus closure after a single course of therapy was similar between acetaminophen and indomethacin 16% vs. 18%, (p = 0.79). No differences were found in gestational age, birth weight, patient acuity, toxicity, or acetaminophen concentrations between those courses that resulted in closure compared to those that did not. When comparing single-agent exposure, indomethacin was initiated earlier (9.0 vs. 13.5 days, p = 0.022) but PDA closure rates were similar between groups.

Conclusion: Acetaminophen and indomethacin produced similar rates of ductus closure in this population.

Objective: To compare the efficacy of nebulized salbutamol in reducing respiratory distress in late preterm and term neonates with transient tachypnea of newborn (TTN).

Study design: Double-blind, placebo-controlled randomized trial.

Methods: Neonates with TTN (n = 134) were allocated to nebulized salbutamol (n = 67) versus placebo (normal saline) (n = 67). The primary outcome was the duration of tachypnea (respiratory rate >60/min). Secondary outcomes were maximum Downes score and fraction of inspired oxygen (FiO₂) after nebulization, duration of respiratory support, and adverse effects of salbutamol nebulization.

Results: Median duration of tachypnea was 12.5 (10-16) vs. 12 (10.4-14) hours in salbutamol and placebo groups, respectively; p = 0.489. Almost all neonates received positive-pressure respiratory support at delivery room and subsequently. Maximum Downe's score, FiO₂ requirement, and duration of respiratory support were similar. No adverse effect of salbutamol was documented.

Conclusion: There was no difference in the duration of tachypnea with nebulized salbutamol compared to placebo in late preterm and term neonates with TTN.

Clinical trial registration: Clinical trial registry of India, Registration no: CTRI/2023/05/052441, Registered prospectively on 10/05/2023, https://ctri.icmr.org.in/.

Objective: To evaluate the therapeutic dose and safety of bemiparin in neonatal thrombosis treatment.

Study design: A retrospective review was conducted on infants treated with bemiparin between 2018 and 2023 at a tertiary hospital.

Results: 72 neonates with a mean gestational age of 37 weeks were included. Twenty were preterm, with a median gestational age of 33.5 weeks and a median birth weight of 1847.5 grams. The mean (SD) initial and therapeutic bemiparin doses were 170.5 (31) and 200 (37.2) IU/kg/day, respectively. Only 32% of patients reached the therapeutic target range (TTR) with the initial dose. Preterm infants required higher doses to reach TTR (215 vs 194.7 IU/kg/day, p = 0.05). Adverse events were minimal (1.4%) and unrelated to the starting dose or prematurity.

Conclusion: Bemiparin appears to be a potential therapeutic option for anticoagulation in neonates; however, targeted anti-Xa levels were rarely achieved with the initial dose and most patients required uptitration.

Objective: Decrease: 1) time from tracheostomy or gastrostomy tube placement to discharge home, and 2) avoidable readmissions within 7 days post-discharge, for medically complex infants.

Study design: Five neonatology units and representatives from Medicaid and Managed Care Organizations participated. Measures included length of stay (LOS) from surgery to discharge, readmissions, and time from surgery to identifying home nursing. We used statistical process control (SPC) methods and bivariate tests for post-hoc before-after comparisons.

Result: Among 421 infants, no avoidable readmissions occurred in the final 25 months. LOS and all-cause readmissions were unchanged (SPC). LOS changes were variable, ranging from -39.5 days (tracheostomy and ventilator) to +30.8 days (tracheostomy without ventilator) and not significant. Median time to identify home nursing was 70.1 days (range 2-428).

Conclusion: Although lack of skilled home nursing precluded improving transitions from NICU to home in medically complex infants, all avoidable readmissions were eliminated for 25 months.