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Erratum. 勘误。
Pub Date : 2024-04-22 DOI: 10.1159/000538725
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引用次数: 0
Erratum. 勘误。
Pub Date : 2024-04-22 DOI: 10.1159/000538838
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引用次数: 0
Severe Bronchopulmonary Dysplasia Adversely Affects Brain Growth in Preterm Infants. 严重支气管肺发育不良对早产儿脑部发育有不利影响
Pub Date : 2024-04-22 DOI: 10.1159/000538527
Taiki Shimotsuma, Seiichi Tomotaki, Mitsuyo Akita, Ryosuke Araki, Hiroko Tomotaki, Kougoro Iwanaga, Akira Kobayashi, Akihiko Saitoh, Yasutaka Fushimi, Junko Takita, Masahiko Kawai
INTRODUCTIONBronchopulmonary dysplasia (BPD) is associated with neurodevelopmental outcomes of preterm infants, but its effect on brain growth in preterm infants after the neonatal period is unknown. This study aimed to evaluate the effect of severe BPD on brain growth of preterm infants from term to 18 months of corrected age (CA).METHODSSixty-three preterm infants (42 with severe BPD and 21 without severe BPD) who underwent magnetic resonance imaging at term equivalent age (TEA) and 18 months of CA were studied by using the Infant Brain Extraction and Analysis Toolbox (iBEAT). We measured segmented brain volumes and compared brain volume and brain growth velocity between the severe BPD group and the non-severe BPD group.RESULTSThere was no significant difference in brain volumes at TEA between the groups. However, the brain volumes of the total brain and cerebral white matter in the severe BPD group were significantly smaller than those in the non-severe BPD group at 18 months of CA. The brain growth velocities from TEA to 18 months of CA in the total brain, cerebral cortex, and cerebral white matter in the severe BPD group were lower than those in the non-severe BPD group.CONCLUSIONBrain growth in preterm infants with severe BPD from TEA age to 18 months of CA is less than that in preterm infants without severe BPD.
简介支气管肺发育不良(BPD)与早产儿的神经发育结局有关,但它对早产儿新生儿期后脑发育的影响尚不清楚。本研究旨在评估严重 BPD 对足月儿到 18 个月矫正年龄(CA)早产儿脑部发育的影响。方法使用婴儿脑提取和分析工具箱(iBEAT)对在足月等效年龄(TEA)和 18 个月矫正年龄(CA)接受磁共振成像的 63 名早产儿(42 名患有严重 BPD,21 名未患有严重 BPD)进行研究。我们测量了分段脑容量,并比较了严重 BPD 组和非严重 BPD 组的脑容量和脑生长速度。但是,重度 BPD 组在 CA 18 个月时的全脑和脑白质体积明显小于非重度 BPD 组。从TEA到18个月CA期间,重度BPD组的全脑、大脑皮层和脑白质的脑生长速度均低于非重度BPD组。
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引用次数: 0
Erratum. 勘误。
Pub Date : 2024-04-18 DOI: 10.1159/000538869
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引用次数: 0
Relationship between Neonatal Cerebral Fuels and Neurosensory Outcomes at 3 Years in Well Babies: Follow-Up of the Glucose in Well Babies (GLOW) Study. 健康婴儿 3 岁时新生儿脑燃料与神经感觉结果之间的关系:健康婴儿葡萄糖(GLOW)研究的后续研究。
Pub Date : 2024-04-17 DOI: 10.1159/000538377
Deborah L Harris, Philip J Weston, G. Gamble, Jane E Harding
INTRODUCTIONWe sought to investigate if the availability of cerebral fuels soon after birth in healthy term babies was associated with developmental progress at 3 years of age.METHODSHealthy term babies had plasma glucose, lactate, and beta-hydroxybutyrate concentrations measured over the first 5 days. At 3 years, parents completed Ages and Stages (ASQ-3) questionnaires between December 2018 and August 2022. Developmental progress, analysed using structural equation modelling, was compared between children whose median fuel concentrations were above and below the mean neonatal concentrations of glucose (3.3 mmol/L) and total ATP-equivalents (140 mmol/L) in the first 48 h and over the first 5 days.RESULTSSixty-four (96%) families returned completed questionnaires. We found no differences between developmental progress in children who had median neonatal plasma glucose concentrations <3.3 or ≥3.3 mmol/L in the first 48 h (estimated mean difference in ASQ scores -1.0, 95% confidence interval: -5.8, 3.7, p = 0.66) or 120 h (-3.7, -12.0, 4.6, p = 0.39]). There were also no differences for any other measures of cerebral fuels including total ATP above and below the median over 48 and 120 h, any plasma or interstitial glucose concentration <2.6 mmol/L, or cumulative duration of interstitial glucose concentration <2.6 mmol/L.CONCLUSIONSThere was no detectable relationship between plasma concentrations of glucose, lactate, and beta-hydroxybutyrate soon after birth in healthy term babies and developmental progress at 3 years of age.
导言我们试图研究健康足月儿出生后不久获得脑燃料是否与3岁时的发育进展有关。方法健康足月儿在出生后最初5天测量血浆葡萄糖、乳酸和β-羟基丁酸浓度。3岁时,父母在2018年12月至2022年8月期间填写了年龄与阶段(ASQ-3)问卷。使用结构方程模型分析,比较了在最初 48 小时和最初 5 天内燃料浓度中位数高于和低于新生儿葡萄糖(3.3 mmol/L)和总 ATP 当量(140 mmol/L)平均浓度的儿童的发育进展情况。我们发现,在最初 48 小时内,新生儿血浆葡萄糖浓度中位数<3.3 或≥3.3 mmol/L(ASQ 评分的估计平均差异为-1.0,95% 置信区间:-5.8,3.7,p = 0.66)或 120 小时内(-3.7,-12.0,4.6,p = 0.39]),儿童的发育进展没有差异。结论健康足月儿出生后不久的血浆葡萄糖、乳酸和β-羟丁酸浓度与3岁时的发育进展之间没有可检测到的关系。
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引用次数: 0
Mortality Risk in US Neonatal Intensive Care Unit Infants by Birth Size Classifications Comparing Three Growth Curves. 美国新生儿重症监护室婴儿按出生体型分类的死亡率风险,比较三种生长曲线。
Pub Date : 2024-04-15 DOI: 10.1159/000536180
A. N. Ferguson, Marion Granger, I. Olsen, Reese H Clark, Jessica G Woo
INTRODUCTIONThree widely referenced growth curves classify infant birth anthropometric measurements as small (SGA), appropriate (AGA), or large (LGA) for gestational age (GA) differently. We assessed how these differences in assignment affect the identification and prediction of neonatal intensive care unit (NICU) mortality risk in US preterm infants.METHODSBirth data of infants admitted to NICUs from the Pediatrix Clinical Data Warehouse (2013-2018) were analyzed. Birth weight, length, and head circumference of 46,724 singleton infants (24-32 weeks GA) were classified as SGA, AGA, or LGA using the Olsen, Fenton, and INTERGROWTH-21st curves. NICU mortality risk based on birth size classification was analyzed using unadjusted and adjusted logistic regression stratified by GA.RESULTSOdds of mortality were increased with SGA classification at all GAs, size measurements, and curve sets, compared with AGA infants. LGA classification for weight was associated with lower mortality risk at 24 weeks GA and higher risk at 30 weeks GA. Odds of mortality did not differ significantly across curve sets. Classification of size at birth alone had relatively low predictive ability to identify mortality risk, with unadjusted AUCs near 0.5 for all analyses.CONCLUSIONThere were no significant differences across curve sets in predicting mortality. Classification of size at birth is a relatively imprecise method to identify infants at risk for NICU mortality.
引言三条广泛引用的生长曲线将婴儿出生时的人体测量值分为小胎龄(SGA)、适龄(AGA)或大胎龄(LGA),但它们的分类方法各不相同。我们评估了这些分类差异对美国早产儿新生儿重症监护室(NICU)死亡风险的识别和预测有何影响。方法分析了Pediatrix临床数据仓库(2013-2018年)中新生儿重症监护室收治的婴儿出生数据。采用Olsen、Fenton和INTERGROWTH-21st曲线将46724名单胎婴儿(体重24-32周)的出生体重、身长和头围分为SGA、AGA或LGA。结果与 AGA 婴儿相比,在所有 GA、体型测量和曲线组中,SGA 分类婴儿的死亡率均有所增加。体重为 LGA 的婴儿在孕期 24 周时死亡风险较低,而在孕期 30 周时死亡风险较高。不同曲线组的死亡几率差异不大。结论不同曲线组在预测死亡率方面没有显著差异。出生时体型分类是一种相对不精确的方法,用于识别新生儿重症监护室死亡风险婴儿。
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引用次数: 0
LISA Eligibility and LISA Success in Extremely Preterm Infants: A Single-Center Experience. 极早产儿的 LISA 资格和 LISA 成功率:单中心经验
Pub Date : 2024-04-10 DOI: 10.1159/000537904
Ruth Klein, Laura Fastnacht, Angela Kribs, Benjamin Kuehne, K. Mehler
INTRODUCTIONLess invasive surfactant application (LISA) is associated with improved short-term outcomes in preterm infants. Data on LISA eligibility and success for infants <28 weeks of gestation are lacking.METHODSPreterm infants <28 weeks of gestation who were born and actively treated in our tertiary care center in 2018 were included in the retrospective study. We assessed baseline characteristics, delivery room (DR) management, LISA success and complications, and short-term outcome.RESULTSIn total, 57 infants received LISA in the DR. LISA eligibility was 73% at 22 weeks, 88% at 23 weeks, and >90% at gestational ages >24 weeks. LISA was successful in 63% of infants. LISA failure was associated with increased risk for high-grade IVH (OR 17.88), death (OR 10.94), and a reduced chance for survival without complications (OR 8.75).CONCLUSIONOur report justifies LISA as a mode for surfactant application in preterm infants. It contributes to the call for studies to define risk factors for LISA failure.
引言 无创表面活化剂应用(LISA)可改善早产儿的短期预后。有关 90% 胎龄大于 24 周的早产儿接受 LISA 的资格和成功率的数据。63%的婴儿 LISA 成功。LISA 失败与高级别 IVH 风险增加(OR 17.88)、死亡(OR 10.94)和无并发症存活机会减少(OR 8.75)有关。我们的报告证明了 LISA 作为早产儿表面活性物质应用模式的合理性,并呼吁开展研究以确定 LISA 失败的风险因素。
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引用次数: 0
Proactive Diagnosis and Tailor-Made Treatment of Patent Ductus Arteriosus in Very Preterm Infants with Routine Echocardiography in Japan: A post hoc Analysis of the PLASE Study. 日本常规超声心动图对早产儿动脉导管未闭的主动诊断和定制治疗:PLASE 研究的事后分析。
Pub Date : 2024-04-09 DOI: 10.1159/000538363
Seiichi Tomotaki, Tetsuya Isayama, Tohru Kobayashi, Satoshi Masutani, Hidenori Kawasaki, Atsushi Nakayama, Toshifumi Ikeda, K. Toyoshima
INTRODUCTIONA feature of the management of extremely preterm infants in Japan is proactive circulatory management using early routine echocardiography performed by neonatologists.METHODSThis study was a post hoc analysis of the Patent ductus arteriosus and Left Atrial Size Evaluation in preterm infants (PLASE) study, which is a prospective cohort study including preterm infants admitted to 34 tertiary neonatal intensive care units in Japan between October 2015 and December 2016. We described the details of the treatment strategy of patent ductus arteriosus (PDA) based on early routine echocardiography.RESULTSIn total, 613 preterm infants were included into the analysis. Twenty percent of infants with prophylactic indomethacin were switched to therapeutic cyclooxygenase inhibitor (COX-I) before the completion of the full prophylactic indomethacin course. Therapeutic COX-I was mostly administered based on echocardiographic findings before PDA became symptomatic or hemodynamically significant. Therapeutic COX-I was frequently discontinued after one or two doses before the full course (three doses) was completed. The proportion of infants requiring additional treatment (additional therapeutic COX-I course or surgical PDA closure) after discontinued COX-I courses (<3 doses) compared to infants after completed 3 doses course was significantly lower (after the first therapeutic COX-I course 46% vs. 68%, p < 0.001) or without a significant difference (after the second or third course).CONCLUSIONSThe clinical management of PDA in Japan featured (1) COX-I administration based on echocardiographic findings before symptomatic or hemodynamically significant PDA appeared and (2) frequent discontinuation of therapeutic COX-I before completing the standard three doses course.
简介在日本,极早产儿管理的一个特点是由新生儿科医生使用早期常规超声心动图进行积极的循环管理。方法本研究是对早产儿动脉导管未闭和左心房大小评估(PLASE)研究的一项事后分析,该研究是一项前瞻性队列研究,包括 2015 年 10 月至 2016 年 12 月期间在日本 34 家三级新生儿重症监护病房收治的早产儿。我们描述了基于早期常规超声心动图的动脉导管未闭(PDA)治疗策略的细节。结果共有613名早产儿纳入分析。20%使用预防性吲哚美辛的早产儿在完成整个预防性吲哚美辛疗程前改用治疗性环氧化酶抑制剂(COX-I)。治疗性 COX-I 大多是在 PDA 出现症状或血流动力学显著变化之前根据超声心动图结果使用的。在完成整个疗程(三剂)之前,治疗性 COX-I 经常在服用一到两剂后停止。与完成 3 个疗程的婴儿相比,停用 COX-I 疗程(<3 个疗程)后需要额外治疗(额外的 COX-I 疗程或手术关闭 PDA)的婴儿比例明显降低(第一个 COX-I 疗程后 46% 对 68%,P < 0.结论日本 PDA 临床治疗的特点是:(1) 在出现症状或血流动力学显著的 PDA 之前,根据超声心动图结果服用 COX-I;(2) 在完成标准的 3 个剂量疗程之前,频繁停用治疗性 COX-I。
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引用次数: 0
Coupling between Regional Oxygen Saturation of the Brain and Vital Signs during Immediate Transition after Birth. 出生后即刻过渡期间大脑区域氧饱和度与生命体征之间的耦合。
Pub Date : 2024-04-08 DOI: 10.1159/000534524
Dries Hendrikx, Alexander Caicedo Dorado, Sabine Van Huffel, Gunnar Naulaers, C. Wolfsberger, B. Urlesberger, G. Pichler
INTRODUCTIONThe primary aim was to analyze any coupling of heart rate (HR)/arterial oxygen saturation (SpO2) and regional cerebral oxygen saturation (rScO2) and regional cerebral fractional tissue oxygen extraction (cFTOE) during immediate transition after birth in term and preterm neonates to gain more insight into interactions.METHODSThe present study is a post hoc analysis of data from 106 neonates, obtained from a prospective, observational study. Measurements of HR, SpO2, rScO2, and cFTOE were performed during the first 15 min after birth. The linear and nonlinear correlation were computed between these parameters in a sliding window. The resulting coupling curves were clustered. After clustering, demographic data of the clusters were de-blinded and compared.RESULTSDue to missing data, 58 out of 106 eligible patients were excluded. Two clusters were obtained: cluster 1 (N = 39) and cluster 2 (N = 9). SpO2 had linear and nonlinear correlations with rScO2 and cFTOE, whereby the correlations with rScO2 were more pronounced in cluster 2. HR-rScO2 and HR-cFTOE demonstrated a nonlinear correlation in both clusters, again being more pronounced in cluster 2, whereby linear correlations were mainly absent. After de-blinding, the demographic data revealed that the neonates in cluster 2 had significantly lower gestational age (mainly preterm) compared to cluster 1 (mainly term).DISCUSSIONBesides SpO2, also HR demonstrated a nonlinear correlation with rScO2 and cFTOE in term and preterm neonates during immediate transition after birth. In addition, the coupling of SpO2 and HR with cerebral oxygenation was more pronounced in neonates with a lower gestational age.
简介:本研究的主要目的是分析足月儿和早产儿出生后立即过渡期间心率(HR)/动脉血氧饱和度(SpO2)与区域脑氧饱和度(rScO2)和区域脑组织氧萃取分数(cFTOE)之间的任何耦合关系,以深入了解其相互作用。在新生儿出生后 15 分钟内测量了 HR、SpO2、rScO2 和 cFTOE。在滑动窗口中计算了这些参数之间的线性和非线性相关性。由此得出的耦合曲线被聚类。结果由于数据缺失,106 名符合条件的患者中有 58 人被排除在外。得出两个聚类:聚类 1(39 人)和聚类 2(9 人)。SpO2 与 rScO2 和 cFTOE 存在线性和非线性相关性,其中第 2 组与 rScO2 的相关性更为明显。HR-rScO2 和 HR-cFTOE 在两个群组中都显示出非线性相关性,同样在群组 2 中更为明显,而在群组 2 中主要没有线性相关。去盲后,人口统计学数据显示,与第 1 组(主要是足月儿)相比,第 2 组新生儿的胎龄明显较低(主要是早产儿)。此外,胎龄越小的新生儿 SpO2 和 HR 与脑氧合的耦合关系越明显。
{"title":"Coupling between Regional Oxygen Saturation of the Brain and Vital Signs during Immediate Transition after Birth.","authors":"Dries Hendrikx, Alexander Caicedo Dorado, Sabine Van Huffel, Gunnar Naulaers, C. Wolfsberger, B. Urlesberger, G. Pichler","doi":"10.1159/000534524","DOIUrl":"https://doi.org/10.1159/000534524","url":null,"abstract":"INTRODUCTION\u0000The primary aim was to analyze any coupling of heart rate (HR)/arterial oxygen saturation (SpO2) and regional cerebral oxygen saturation (rScO2) and regional cerebral fractional tissue oxygen extraction (cFTOE) during immediate transition after birth in term and preterm neonates to gain more insight into interactions.\u0000\u0000\u0000METHODS\u0000The present study is a post hoc analysis of data from 106 neonates, obtained from a prospective, observational study. Measurements of HR, SpO2, rScO2, and cFTOE were performed during the first 15 min after birth. The linear and nonlinear correlation were computed between these parameters in a sliding window. The resulting coupling curves were clustered. After clustering, demographic data of the clusters were de-blinded and compared.\u0000\u0000\u0000RESULTS\u0000Due to missing data, 58 out of 106 eligible patients were excluded. Two clusters were obtained: cluster 1 (N = 39) and cluster 2 (N = 9). SpO2 had linear and nonlinear correlations with rScO2 and cFTOE, whereby the correlations with rScO2 were more pronounced in cluster 2. HR-rScO2 and HR-cFTOE demonstrated a nonlinear correlation in both clusters, again being more pronounced in cluster 2, whereby linear correlations were mainly absent. After de-blinding, the demographic data revealed that the neonates in cluster 2 had significantly lower gestational age (mainly preterm) compared to cluster 1 (mainly term).\u0000\u0000\u0000DISCUSSION\u0000Besides SpO2, also HR demonstrated a nonlinear correlation with rScO2 and cFTOE in term and preterm neonates during immediate transition after birth. In addition, the coupling of SpO2 and HR with cerebral oxygenation was more pronounced in neonates with a lower gestational age.","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":"16 9","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140728579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Endothelial-to-Mesenchymal Transition in Human and Murine Models of Congenital Diaphragmatic Hernia. 人类和小鼠先天性膈疝模型中的内皮细胞向间质转化
Pub Date : 2024-04-08 DOI: 10.1159/000537802
Jamie Gilley, Sandra K Hanneman, M. Ottosen, B. Shivanna, Sundeep Keswani
INTRODUCTIONCongenital diaphragmatic hernia (CDH) is a complex congenital disorder, characterized by pulmonary hypertension (PH) and hypoplasia. PH secondary to CDH (CDH-PH) features devastating morbidity and mortality (25-30%) among neonates. An unmet need is determining mechanisms triggering CDH-PH to save infants. Prior data suggest abnormal remodeling of the pulmonary vascular extracellular matrix (ECM), presumed to be driven by endothelial-to-mesenchymal transition (EndoMT), hinders postnatal vasodilation and limits anti-PH therapy in CDH. There are limited data on the role of EndoMT in CDH-PH.METHODSThe purpose of the study was to investigate how EndoMT contributes to CDH-PH by identifying cells undergoing EndoMT noted by alpha smooth muscle actin (α-SMA) expression in human umbilical vein endothelial cells (HUVECs) and lung tissue obtained from murine pups using the nitrofen model. N = 8 CDH, N = 8 control HUVECs were stained for α-SMA and CD31 after being exposed for 24 h to TGFB, a known EndoMT promoter. N = 8 nitrofen, N = 8 control murine pup lungs were also stained for α-SMA and CD31. α-SMA and CD31 expression was quantified in HUVECs and murine tissue using Fiji imaging software and normalized to the total number of cells per slide noted by DAPI staining.RESULTSCDH HUVECs demonstrated a 1.1-fold increase in α-SMA expression (p = 0.02). The murine model did not show statistical significance between nitrofen and control pup lungs; however, there was a 0.4-fold increase in α-SMA expression with a 0.8-fold decrease in CD31 expression in the nitrofen pup lungs when compared to controls.CONCLUSIONThese results suggest that EndoMT could potentially play a role in the ECM remodeling seen in CDH-PH.
简介先天性膈疝(CDH)是一种复杂的先天性疾病,以肺动脉高压(PH)和肺发育不良为特征。继发于 CDH 的 PH(CDH-PH)在新生儿中具有毁灭性的发病率和死亡率(25-30%)。确定引发 CDH-PH 的机制以挽救婴儿是一项尚未满足的需求。先前的数据表明,肺血管细胞外基质(ECM)的异常重塑(推测由内皮细胞向间质转化(EndoMT)驱动)阻碍了出生后的血管扩张,并限制了 CDH 的抗肺动脉高压治疗。本研究的目的是通过鉴定人脐静脉内皮细胞(HUVECs)中α平滑肌肌动蛋白(α-SMA)的表达和使用硝基呋喃模型从幼鼠肺组织中获得的内皮细胞,研究内皮细胞间充质转化是如何导致CDH-PH的。将 N = 8 个 CDH、N = 8 个对照组 HUVEC 暴露于 TGFB(已知的 EndoMT 促进剂)24 小时后,对其进行 α-SMA 和 CD31 染色。结果CDH HUVECs 的 α-SMA 表达增加了 1.1 倍(p = 0.02)。小鼠模型在硝基芬和对照组幼鼠肺之间未显示出统计学意义;但是,与对照组相比,硝基芬幼鼠肺中 α-SMA 表达增加了 0.4 倍,CD31 表达减少了 0.8 倍。
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引用次数: 0
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Neonatology
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