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Maureen Hack - One of the best experts on this subject based on the ideXlab platform.
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improved neurodevelopmental outcomes for extremely Low Birth Weight infants in 2000 2002
Pediatrics, 2007Co-Authors: Deanne Wilsoncostello, Harriet Friedman, Nori Minich, Bonnie S Siner, Gerry H Taylor, Mark D. Schluchter, Maureen HackAbstract:BACKGROUND. Neurodevelopmental impairment of extremely Low Birth Weight infants increased in the 1990s. Modern therapeutic changes may have influenced more recent neonatal outcomes. OBJECTIVE. We sought to compare neonatal therapies and outcomes among all extremely Low Birth Weight infants born in 2000-2002 (period III) to 2 previous periods: 1982-1989 (period I) and 1990-1999 (period II). METHODS. The population included 496 extremely Low Birth Weight infants born at our perinatal center during period I, 749 during period II, and 233 during period III. Therapies, rates of death, and survival with and without impairment at 20 months' corrected age were compared. RESULTS. Between periods I and II, survival increased from 49% to 68% as did neonatal morbidity. This resulted in increased survival without impairment but also increased survival with impairment. Changes in therapy during period III included an increase in antenatal steroid use and a decrease in postnatal steroid use, although the rate of chronic lung disease did not change. Sepsis decreased, as did severe intraventricular hemorrhage. On folLow-up, the rate of cerebral palsy decreased from 13% to 5%, resulting in a decrease in neurodevelopmental impairment from 35% to 23%. As a result, during period III versus II, survival without impairment increased, whereas survival with impairment decreased. CONCLUSION. Since 2000, neurodevelopmental impairment has decreased among extremely Low Birth Weight infants. A variety of perinatal and neonatal factors were associated with the improved outcomes including increased antenatal steroid use and cesarean section delivery, as well as decreased sepsis, severe cranial ultrasound abnormalities, and postnatal steroid use despite no change in the rate of chronic lung disease.
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improved neurodevelopmental outcomes for extremely Low Birth Weight infants in 2000 2002
Pediatrics, 2007Co-Authors: Deanne Wilsoncostello, Harriet Friedman, Nori Minich, Bonnie S Siner, Gerry H Taylor, Mark D. Schluchter, Maureen HackAbstract:BACKGROUND. Neurodevelopmental impairment of extremely Low Birth Weight infants increased in the 1990s. Modern therapeutic changes may have influenced more recent neonatal outcomes. OBJECTIVE. We sought to compare neonatal therapies and outcomes among all extremely Low Birth Weight infants born in 2000-2002 (period III) to 2 previous periods: 1982-1989 (period I) and 1990-1999 (period II). METHODS. The population included 496 extremely Low Birth Weight infants born at our perinatal center during period I, 749 during period II, and 233 during period III. Therapies, rates of death, and survival with and without impairment at 20 months' corrected age were compared. RESULTS. Between periods I and II, survival increased from 49% to 68% as did neonatal morbidity. This resulted in increased survival without impairment but also increased survival with impairment. Changes in therapy during period III included an increase in antenatal steroid use and a decrease in postnatal steroid use, although the rate of chronic lung disease did not change. Sepsis decreased, as did severe intraventricular hemorrhage. On folLow-up, the rate of cerebral palsy decreased from 13% to 5%, resulting in a decrease in neurodevelopmental impairment from 35% to 23%. As a result, during period III versus II, survival without impairment increased, whereas survival with impairment decreased. CONCLUSION. Since 2000, neurodevelopmental impairment has decreased among extremely Low Birth Weight infants. A variety of perinatal and neonatal factors were associated with the improved outcomes including increased antenatal steroid use and cesarean section delivery, as well as decreased sepsis, severe cranial ultrasound abnormalities, and postnatal steroid use despite no change in the rate of chronic lung disease.
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outcomes in young adulthood for very Low Birth Weight infants
The New England Journal of Medicine, 2002Co-Authors: Maureen Hack, Mark D. Schluchter, Daniel J Flannery, Lydia Cartar, Elaine A Borawski, Nancy KleinAbstract:Background Very-Low-Birth-Weight infants (those weighing less than 1500 g) born during the initial years of neonatal intensive care have now reached young adulthood. Methods We compared a cohort of 242 survivors among very-Low-Birth-Weight infants born between 1977 and 1979 (mean Birth Weight, 1179 g; mean gestational age at Birth, 29.7 weeks) with 233 controls from the same population in Cleveland who had normal Birth Weights. We assessed the level of education, cognitive and academic achievement, and rates of chronic illness and risk-taking behavior at 20 years of age. Outcomes were adjusted for sex and sociodemographic status. Results Fewer very-Low-Birth-Weight young adults than normal-Birth-Weight young adults had graduated from high school (74 percent vs. 83 percent, P=0.04). Very-Low-Birth-Weight men, but not women, were significantly less likely than normal-Birth-Weight controls to be enrolled in postsecondary study (30 percent vs. 53 percent, P=0.002). Very-Low-Birth-Weight participants had a Low...
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long term developmental outcomes of Low Birth Weight infants
The Future of Children, 1995Co-Authors: Maureen Hack, Nancy Klein, H G TaylorAbstract:Advances in neonatal medicine have resulted in the increased survival of infants at Lower and Lower Birth Weight. While these medical success stories highlight the power of medical technology to save many of the tiniest infants at Birth, serious questions remain about how these infants will develop and whether they will have normal, productive lives. Low Birth Weight children can be born at term or before term and have varying degrees of social and medical risk. Because Low Birth Weight children are not a homogeneous group, they have a broad spectrum of growth, health, and developmental outcomes. While the vast majority of Low Birth Weight children have normal outcomes, as a group they generally have higher rates of subnormal growth, illnesses, and neurodevelopmental problems. These problems increase as the child's Birth Weight decreases. With the exception of a small minority of Low Birth Weight children with mental retardation and/or cerebral palsy, the developmental sequelae for most Low Birth Weight infants include mild problems in cognition, attention, and neuromotor functioning. Long-term folLow-up studies conducted on children born in the 1960s indicated that the adverse consequences of being born Low Birth Weight were still apparent in adolescence. Adverse sociodemographic factors negatively affect developmental outcomes across the continuum of Low Birth Weight and appear to have far greater effects on long-term cognitive outcomes than most of the biological risk factors. In addition, the cognitive defects associated with social or environmental risks become more pronounced as the child ages. Enrichment programs for Low Birth Weight children seem to be most effective for the moderately Low Birth Weight child who comes from a Lower socioeconomic group. Continued research and attempts to decrease the rate of Low Birth Weight and associated perinatal medical sequelae are of primary importance. Ongoing documentation of the long-term outcome of Low Birth Weight children needs to be mandated, as does the implementation of environmental enrichment programs to help ameliorate the long-term consequences for infants who are born Low Birth Weight.
Maria Quigley - One of the best experts on this subject based on the ideXlab platform.
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Formula versus donor breast milk for feeding preterm or Low Birth Weight infants
Cochrane Database of Systematic Reviews, 2014Co-Authors: Maria QuigleyAbstract:BACKGROUND When sufficient maternal breast milk is not available, alternative sources of enteral nutrition for preterm or Low Birth Weight infants are donor breast milk or artificial formula. Donor breast milk may retain some of the non-nutritive benefits of maternal breast milk for preterm or Low Birth Weight infants. However, feeding with artificial formula may ensure more consistent delivery of optimal levels of nutrients. Uncertainty exists about the balance of risks and benefits of feeding formula versus donor breast milk for preterm or Low Birth Weight infants. OBJECTIVES To determine the effect of feeding with formula compared with donor breast milk on growth and development in preterm or Low Birth Weight infants. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2014, Issue 3), MEDLINE (1966 to March 2014), EMBASE (1980 to March 2014), CINAHL (1982 to March 2014), conference proceedings and previous reviews. SELECTION CRITERIA Randomised or quasi-randomised controlled trials comparing feeding with formula versus donor breast milk in preterm or Low Birth Weight infants. DATA COLLECTION AND ANALYSIS We extracted data using the standard methods of the Cochrane Neonatal Group, with separate evaluation of trial quality and data extraction by two review authors. MAIN RESULTS Nine trials, in which 1070 infants participated, fulfilled the inclusion criteria. Four trials compared standard term formula versus donor breast milk and five compared nutrient-enriched preterm formula versus donor breast milk. Only the two most recent trials used nutrient-fortified donor breast milk. The trials contain various methodological quality weaknesses, specifically uncertainty about adequate allocation concealment methods in three trials and lack of blinding in most of the trials.Formula-fed infants had higher in hospital rates of increase in Weight [mean difference (MD): 2.58 (95% confidence interval (CI) 1.98 to 3.71) g/kg/day], length [MD 1.93 (95% CI 1.23 to 2.62) mm/week] and head circumference [MD 1.59 (95% CI 0.95 to 2.24) mm/week]. We did not find evidence of an effect on post-discharge growth rates or neurodevelopmental outcomes. Formula feeding increased the risk of necrotising enterocolitis: typical risk ratio 2.77 (95% CI 1.40 to 5.46); risk difference 0.04 (95% CI 0.02 to 0.07). AUTHORS' CONCLUSIONS In preterm and Low Birth Weight infants, feeding with formula compared with donor breast milk results in a higher rate of short-term growth but also a higher risk of developing necrotising enterocolitis. Limited data on the comparison of feeding with formula versus nutrient-fortified donor breast milk are available. This limits the applicability of the findings of this review as nutrient fortification of breast milk is now a common practice in neonatal care. Future trials may compare growth, development and adverse outcomes in infants who receive formula milk versus nutrient-fortified donor breast milk given as a supplement to maternal expressed breast milk or as a sole diet.
Mary Y Anthony - One of the best experts on this subject based on the ideXlab platform.
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formula milk versus donor breast milk for feeding preterm or Low Birth Weight infants
Cochrane Database of Systematic Reviews, 2007Co-Authors: Maria A Quigley, Ginny Henderson, Mary Y AnthonyAbstract:Background Maternal breast milk may contain less nutrients than artificial formula milk but may confer important non-nutrient advantages for preterm or Low Birth Weight infants. Objectives To determine the effect of feeding with formula milk compared with maternal breast milk on rate of growth and developmental outcomes in preterm or Low Birth Weight infants. Search methods The standard search strategy of the Cochrane Neonatal Review Group was used. This included electronic searches of the Cochrane Central Register of Controlled Trials Register (CENTRAL, The Cochrane Library, Issue 3, 2007), MEDLINE (1966 - June 2007) and EMBASE (1980 - June 2007) and CINAHL (1982 to June 2007) (all accessed via OVID) and previous reviews including cross references. Selection criteria Randomised controlled trials comparing feeding with formula milk versus preterm human milk in preterm or Low Birth Weight infants. Data collection and analysis The standard methods of the Cochrane Neonatal Review Group were used, with separate evaluation of trial quality and data extraction by two authors. Main results No eligible trials were identified. Authors' conclusions There are no data from randomised trials of formula milk versus maternal breast milk for feeding preterm or Low Birth Weight infants. This may relate to a perceived difficulty of allocating an alternative feed to an infant whose mother wishes to feed with her own breast milk. Maternal breast milk remains the default choice of enteral nutrition because observational studies, and meta-analyses of trials comparing feeding with formula milk versus donor breast milk, suggest that feeding with breast milk has major non-nutrient advantages for preterm or Low Birth Weight infants.
Waldemar A Carlo - One of the best experts on this subject based on the ideXlab platform.
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plastic bags for prevention of hypothermia in preterm and Low Birth Weight infants
Pediatrics, 2013Co-Authors: Alicia E Leadford, Jamie B Warren, Albert Manasyan, Elwyn Chomba, Ariel A Salas, Robert Schelonka, Waldemar A CarloAbstract:BACKGROUND AND OBJECTIVES: Hypothermia contributes to neonatal mortality and morbidity, especially in preterm and Low Birth Weight infants in developing countries. Plastic bags covering the trunk and extremities of very Low Birth Weight infants reduces hypothermia. This technique has not been studied in larger infants or in many resource-limited settings. The objective was to determine if placing preterm and Low Birth Weight infants inside a plastic bag at Birth maintains normothermia. METHODS: Infants at 26 to 36 weeks’ gestational age and/or with a Birth Weight of 1000 to 2500 g born at the University Teaching Hospital in Lusaka, Zambia, were randomized by using a 1:1 allocation and parallel design to standard thermoregulation (blanket or radiant warmer) care or to standard thermoregulation care plus placement inside a plastic bag at Birth. The primary outcome measure was axillary temperature in the World Health Organization–defined normal range (36.5–37.5°C) at 1 hour after Birth. RESULTS: A total of 104 infants were randomized. At 1 hour after Birth, infants randomized to plastic bag ( n = 49) were more likely to have a temperature in the normal range as compared with infants in the standard thermoregulation care group ( n = 55; 59.2% vs 32.7%; relative risk 1.81; 95% confidence interval 1.16–2.81; P = .007). The temperature at 1 hour after Birth in the infants randomized to plastic bag was 36.5 ± 0.5°C compared with 36.1 ± 0.6°C in standard care infants ( P 38.0°C) did not occur in any infant. CONCLUSIONS: Placement of preterm/Low Birth Weight infants inside a plastic bag at Birth compared with standard thermoregulation care reduced hypothermia without resulting in hyperthermia, and is a Low-cost, Low-technology tool for resource-limited settings. * Abbreviations: WHO — : World Health Organization
Richard A Ehrenkranz - One of the best experts on this subject based on the ideXlab platform.
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changes in pathogens causing early onset sepsis in very Low Birth Weight infants
The New England Journal of Medicine, 2002Co-Authors: Arbara J Stoll, Avroy A Fanaroff, Richard A Ehrenkranz, Nellie I Hanse, Linda L Wrigh, Waldema A Carlo, James A Lemons, Edward F Donova, A R Stark, Jo E TysoAbstract:Background It is uncertain whether the rates and causes of early-onset sepsis (that occurring within 72 hours after Birth) among very-Low-Birth-Weight infants have changed in recent years, since antibiotics have begun to be used more widely during labor and delivery. Methods We studied 5447 very-Low-Birth-Weight infants (those weighing between 401 and 1500 g) born at centers of the Neonatal Research Network of the National Institute of Child Health and Human Development between 1998 and 2000 who had at least one blood culture in the first three days of life and compared them with 7606 very-Low-Birth-Weight infants born at centers in the network between 1991 and 1993. Results Early-onset sepsis (as confirmed by positive blood cultures) was present in 84 infants in the more recent Birth cohort (1.5 percent). As compared with the earlier Birth cohort, there was a marked reduction in group B streptococcal sepsis (from 5.9 to 1.7 per 1000 live Births of infants weighing 401 to 1500 g, P<0.001) and an increase ...
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growth outcomes of very Low Birth Weight infants in the newborn intensive care unit
Clinics in Perinatology, 2000Co-Authors: Richard A EhrenkranzAbstract:The American Academy of Pediatrics Committee on Nutrition advocates that the goal of nutritional management of very Low-Birth Weight infants be to achieve postnatal growth at a rate that approximates the growth of a normal fetus at the same postconceptional age. Although optimal nutrition for very Low-Birth Weight infants has not been defined, reports of longitudinal growth of hospitalized infants have demonstrated that current nutritional practices permit growth at rates that approximate the intrauterine growth rate once Birth Weight is regained. Unless growth exceeds the intrauterine rate, however, most very Low-Birth Weight infants fail to achieve catch-up growth, and are beLow the 10th percentile body Weight of the reference fetus at the same postconceptional age. This article discusses this seeming paradox and concludes with a challenge to identify ways to improve the growth of very Low-Birth Weight infants.
