Neonatology最新文献

Introduction: The SafeBoosC-III trial investigated the effect of cerebral oximetry-guided treatment in the first 72 h after birth on mortality and severe brain injury diagnosed by cranial ultrasound in extremely preterm infants (EPIs). This ancillary study evaluated the effect of cerebral oximetry on global brain injury as assessed by magnetic resonance imaging (MRI) at term equivalent age (TEA).

Methods: MRI scans were obtained between 36 and 44.9 weeks PMA. The Kidokoro score was independently evaluated by two blinded assessors. The intervention effect was assessed using the nonparametric Wilcoxon rank sum test for median difference and 95% Hodges-Lehmann (HL) confidence intervals (CIs). The intraclass correlation coefficient (ICC) was used to assess the agreement between the assessors.

Results: A total of 210 patients from 8 centers were included, of whom 121 underwent MRI at TEA (75.6% of alive patients): 57 in the cerebral oximetry group and 64 in the usual care group. There was an excellent correlation between the assessors for the Kidokoro score (ICC agreement: 0.93, 95% CI: 0.91-0.95). The results showed no significant differences between the cerebral oximetry group (median 2, interquartile range [IQR]: 1-4) and the usual care group (median 3, IQR: 1-4; median difference -1 to 0, 95% HLCI: -1 to 0; p value 0.1196).

Conclusions: In EPI, the use of cerebral oximetry-guided treatment did not lead to significant alterations in brain injury, as determined by MRI at TEA. The strong correlation between the assessors highlights the potential of the Kidokoro score in multicenter trials.

Necrotizing enterocolitis (NEC) is a severe intestinal condition primarily affecting preterm neonates. It has a high mortality rate, particularly in infants with a birthweight of below 1,500 g or for those requiring surgical intervention. The European Reference Network for Inherited and Congenital Anomalies (ERNICA) has developed a clinical practice guideline to aid clinical decision-making pertaining to the surgical treatment and management of NEC in preterm neonates. This guideline was developed in accordance with the Guidelines 2.0 checklist and GRADE methodology. A multidisciplinary group of Europe's top experts collaborated with patient representatives to develop this guideline. After selecting critical points in care for which recommendations are required, a systematic review of the literature and critical appraisal of the evidence was performed. The Evidence to Decision framework was used as a guide to structure the consensus meetings and draft the recommendations. The panel developed seven recommendations and three good practice statements on the following topics: indications for surgery, peritoneal drainage, surgical technique, management of extensive NEC, enteral feeding, and neurodevelopmental outcomes in premature neonates with NEC. The certainty of evidence was graded as (very) low for most recommendations. However, the panel weighed up the benefits and harms in light of all relevant arguments and expert opinion. This guideline provides recommendations on caring for premature neonates with NEC. These recommendations can assist clinicians in their care decisions and can inform families on treatment options and relevant considerations. This guideline will be revised every 5 years to ensure it remains up to date.

Introduction: Restricted fetal and neonatal growth is a known risk factor for bronchopulmonary dysplasia (BPD) in premature infants. However, the impact of nutrition and infant growth specifically on lung growth in BPD is unknown. Moreover, whether all lung growth in BPD is beneficial is unclear. We hypothesized that lung growth and development and severity of BPD directly relate to caloric and protein intake, weight gain, and linear growth of premature neonates.

Methods: In this retrospective study, caloric and protein intake for the first 4 weeks of life, growth parameters along with lung volume, mass, density, and BPD severity obtained by ultrashort echo time (UTE) MRI, were analyzed.

Results: The cohort included 95 neonates with mean GA 26.1 weeks and BW 790 g. Infants with grade 2 and 3 BPD had less caloric and protein intake during first 4 weeks of life vs. grade 1 BPD (96/98 vs. 106 kcal/kg/day; 3.79/3.75 vs. 3.99 g protein/kg/day; p < 0.05). UTE MRI showed that lung mass per body surface area increased with increasing BPD severity (237, 311, 384 g/m2 for grade 1, 2, and 3, respectively, p < 0.05). Increased caloric intake was associated with decreased lung mass (p = 0.02) and improved BPD score on MRI (p = 0.04).

Conclusion: Decreased nutritional intake during the first 4 weeks of life appears to be associated with more severe BPD, increased lung mass and more severe lung disease on MRI.

Introduction: Ideal early postnatal weight loss (PWL) and its association with mortality and morbidity in preterm infants are not well known. This review explored the association between early PWL and outcomes in very premature infants (<32 weeks).

Methods: This is a systematic review and meta-analyses of the observational studies. PubMed, Medline, EMBASE, Cochrane Library, EMCARE, and MedNar databases were searched in April 2024. Outcomes of interest were mortality and morbidities such as intraventricular haemorrhage (IVH), chronic lung disease (CLD), patent ductus arteriosus, necrotising enterocolitis (NEC), retinopathy of prematurity, and long-term neurodevelopmental outcomes. Data were pooled separately for adjusted and unadjusted odds ratios (ORs) using random-effects model. Separate analyses were conducted for case-control and cohort studies. Data were pooled separately for the excess weight loss (EWL) group (>15% from birth weight) and inadequate weight loss (IWL) group (<5% from birth weight).

Results: Eighteen studies (25,158 infants) were included. Pooling of adjusted ORs in EWL group from cohort studies found significant association with mortality (OR 1.39 confidence interval [CI; 1.10-1.75]), severe IVH (OR 1.37 CI [1.18-1.59]), NEC (OR 2.05 CI [1.05-4.03]), and "Mortality or IVH" (OR 1.40 CI [1.10-1.78]). Pooling adjusted ORs from case-control studies showed a significant association between EWL and CLD and between IWL and mortality or CLD. Certainty of evidence was "Low" or "Very-low."

Conclusion: EWL or IWL in very preterm infants may be associated with higher odds of mortality and morbidity. However, cofactors of severity of associated disease, insufficient nutrition, and treatments could not be assessed.

Introduction: The objective of this study was to determine the impact of nasal high flow (nHF) implementation on lung growth at 6 months corrected age (CA) in preterm infants.

Methods: This single-center retrospective cohort study included preterm infants born <30 weeks' gestation and surviving to 6 months CA at the neonatal intensive care unit of the Amsterdam University Medical Centers. In the nCPAP cohort (2009-2012), continuous distending pressure (CDP) was applied solely with nasal continuous positive airway pressure support. In the nHF cohort (2015-2018), nCPAP was used and followed by nHF therapy to deliver CDP. Bodyweight and length at 6 months CA were used as a proxy for lung growth. We also assessed the impact on respiratory management and neonatal morbidity. Multivariate analysis was performed after multiple imputation, using a linear regression adjusting for confounding variables.

Results: Of the 598 eligible infants, 313 infants were included in the nCPAP cohort and 285 infants in the nHF cohort. The analyses showed no differences between the nCPAP and nHF cohort in body weight (7.29 vs. 7.31 kilogram, 95% CI -0.14 to 0.20, p = 0.71) and length (66.6 vs. 66.8 centimeters, 95% CI -0.30 to 0.81, p = 0.26) at 6 months CA. No differences in moderate/severe bronchopulmonary dysplasia (BPD) were reported, but nHF implementation was associated with longer CDP duration, a trend toward more days on supplemental oxygen, and a shift from moderate to severe BPD.

Conclusions: Implementation of nHF did not impact body growth, which is associated with lung growth, at 6 months CA in preterm infants born <30 weeks.

Introduction: We aimed to evaluate whether the incidence of pneumothorax is associated with adverse neonatal outcomes in very preterm infants.

Methods: This multicenter cohort study included all infants with a gestational age of 24-31 weeks, admitted to the tertiary neonatal intensive care units of the Chinese Neonatal Network, from 2019 to 2022. Pneumothorax was diagnosed via chest X-ray or lung computed tomography. The primary outcome was a composite measure of mortality and/or any severe neonatal morbidity. Multivariable logistic or linear regression analyses were performed to assess the association between pneumothorax and neonatal outcomes. Propensity score matching was used to ensure the robustness of the results.

Results: Among the 37,917 infants in the study, 465 (1.2%) developed pneumothorax. Pneumothorax was significantly associated with a higher risk of mortality and/or severe neonatal morbidity (adjusted odds ratio = 3.15, 95% confidence interval: 2.36, 4.20). Pneumothorax exposure was also independently associated with increased mortality, severe intraventricular hemorrhage, moderate or severe bronchopulmonary dysplasia, and the need for invasive ventilation and its duration. Additionally, pneumothorax was associated with an increased length of hospital stay among survivors (adjusted odds ratio = 7.62, 95% confidence interval: 4.33, 10.91). The usage of high-frequency invasive mechanical ventilation before pneumothorax and pneumothorax treated with an intercostal chest drain seemed to have the most significant harmful effect (adjusted odds ratios were 3.34 and 3.27, respectively).

Conclusion: Our study underscores the significant impact of pneumothorax on increasing mortality and severe morbidities in very preterm infants.

Introduction: We aimed to investigate international variation in gestational age (GA) specific severe intraventricular hemorrhage (IVH) rates, among infants of <30 weeks' GA from the neonatal networks of 11 high-income countries/region.

Methods: Retrospective cohort study of outcomes of grade 3/4 IVH rates and composite of g3/4 IVH or death in GA groups of 22-23, 24-25, 26-27, and 28-29 weeks infants admitted to networks of Australia and New Zealand, Canada, Finland, Israel, Italy (Tuscany), Japan, Spain, Sweden, Switzerland, and the UK. Their risk adjusted trends across 3 epochs (2007-11, 2012-15, and 2016-19) were also evaluated.

Results: Outcomes of 165,329 infants (median GA 27 weeks, birthweight 950 g) were analyzed. Overall, the lowest grade 3/4 IVH rate was observed in Japan (6.4%) and the highest in Israel (16.1%). The overall gestation-specific rate of IVH grade 3/4 were 25.8%, 18.6%, 9.0%, and 3.8% and composite outcome of grade 3/4 IVH/death rates 52.2%, 33.6%, 15.6%, and 6.7% for the 22-23, 24-25, 26-27, and 28-29 weeks' GA groups, respectively. These inter-network variations were greater at lower GA. In epoch comparisons, almost all networks showed significant decreases in GA specific composite outcome rates, particularly in the 26-27 week' GA group. Japan and Canada demonstrated significant decreases in each GA group while Spain demonstrated significant decreases in each GA group except for 22-23 weeks' gestation.

Conclusions: Rates of grade 3/4 IVH and composite outcome rates varied internationally and have decreased over time. Identification of the driving factors behind variations may allow for opportunities for practice review and improvement.