Chronic Physiologic Instability Is Associated With Neurodevelopmental Morbidity at One and Two Years in Extremely Premature Infants

Mattia, Frank R.; deRegnier, Raye‐Ann

doi:10.1542/peds.102.3.e35

Cited by 44 publications

(35 citation statements)

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“…Mattia et al 19,20 reported an association between cumulative illness severity and neurodevelopmental outcome in premature infants p30 weeks gestation at birth. Those in the highest quartile for cumulative SNAP score from their entire newborn hospitalization were more likely to have abnormal gross motor and psychomotor development at 2 to 3 years and 4 to 5 years of age than infants with a less severe hospital course.…”

Section: Discussionmentioning

confidence: 99%

“…16 Cumulative SNAP score for the first 28 days of life (SNAP28) was calculated by addition of daily SNAP scores for each subject, using a modification of the method described by Mattia and deRegnier. 19 Thus, an infant with sequential daily scores of 20, 5, 17, 5 and 23 would have a 5-day cumulative score of 70. As described previously, 19 SNAP points for individual parameters were interpolated for up to 3 days where physiologically appropriate, if new values were not recorded.…”

Section: Data Collectionmentioning

confidence: 99%

“…19 Thus, an infant with sequential daily scores of 20, 5, 17, 5 and 23 would have a 5-day cumulative score of 70. As described previously, 19 SNAP points for individual parameters were interpolated for up to 3 days where physiologically appropriate, if new values were not recorded. Thus, if the subject had a hematocrit meriting a daily SNAP score of 1 point on hospital day 20, was not transfused and no subsequent values were obtained, 1 SNAP point was assigned for hematocrit on hospital days 20, 21 and 22.…”

Section: Data Collectionmentioning

confidence: 99%

“…18 Summation of serial illness severity scores, or cumulative illness severity, a measure of sustained exposure to physiological instability, was used in two studies of premature infants to account for differences in neurodevelopmental and cognitive outcomes. 19,20 No study has explored the relationship between cumulative illness severity and development of severe ROP. Moreover, fluctuation of illness severity scores over time has not been explored as a possible risk factor for ROP.…”

Section: Introductionmentioning

confidence: 99%

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Cumulative illness severity and progression from moderate to severe retinopathy of prematurity

et al. 2007

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Objective: To test cumulative neonatal illness severity (IS) and IS fluctuation as predictors of progression from moderate to severe retinopathy of prematurity (ROP).Study Design: Data from research databases and medical record review were collected for infants from four neonatal intensive care unit (NICUs) admitted between 1995 and 2001 and diagnosed with prethreshold ROP. Cumulative neonatal IS measured using daily Scores for Neonatal Acute Physiology (SNAP) for the first 28 days of life, and IS fluctuation as assessed by summing changes between daily SNAP scores, were tested as predictors of progression to threshold ROP using logistic regression.Result: Infants progressing to threshold (n ¼ 79), compared to those not progressing to threshold (n ¼ 130), had significantly (P<0.05) lower gestational ages (25.2±1.1 versus 25.8±1.4 weeks), higher cumulative neonatal SNAP (255±77 versus 224±63 weeks) and had more severe hospitalizations as indicated by diagnoses and medical management. In regression analysis, gestational age, chronological age and presence of plus disease at first diagnosis of prethreshold were associated with development of threshold. After adjusting for these factors, cumulative neonatal SNAP was significantly associated with progression to threshold. However, addition of cumulative SNAP to the model only increased receiver-operating characteristic curve area from 0.77 to 0.78 (NS). Other factors, including SNAP fluctuation, were not associated with progression to threshold after adjustment using this model. Conclusion:Cumulative neonatal IS, as measured by cumulative SNAP, is an independent risk factor for progression from moderate to severe ROP. However, cumulative IS does not enhance assessment of risk for ROP progression after adjusting for simpler clinical factors.

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Section: Discussionmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cumulative illness severity and progression from moderate to severe retinopathy of prematurity

et al. 2007

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“…High CRIB and SNAPPE-II scores, which indicate increased medical risk and severity factors, are also predictors for neurobehavioral delays. 37,38 It is thus most important to note that these potential confounders were well matched between the three study groups. No differences in gestational age and birth weight between the three iron groups existed.…”

Section: Discussionmentioning

confidence: 99%

Iron Status and Neurobehavioral Development of Premature Infants

et al. 2004

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Growth and Development of Premature Infants Fed Predominantly Human Milk, Predominantly Premature Infant Formula, or a Combination of Human Milk and Premature Formula

O'Connor,

Jacobs,

Hall

et al. 2003

J. pediatr. gastroenterol. nutr.

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BackgroundIn a recent meta‐analysis, human milk feeding of low birth‐weight (LBW) infants was associated with a 5.2 point improvement in IQ tests. However, in the studies in this meta‐analysis, feeding regimens were used (unfortified human milk, term formula) that no longer represent recommended practice.ObjectiveTo compare the growth, in‐hospital feeding tolerance, morbidity, and development (cognitive, motor, visual, and language) of LBW infants fed different amounts of human milk until term chronologic age (CA) with those of LBW infants fed nutrient‐enriched formulas from first enteral feeding.MethodsThe data in this study were collected in a previous randomized controlled trial assessing the benefit of supplementing nutrient‐enriched formulas for LBW infants with arachidonic acid and docosahexaenoic acid. Infants (n = 463, birth weight, 750–1,800 g) were enrolled from nurseries located in Chile, the United Kingdom, and the United States. If human milk was fed before hospital discharge, it was fortified (3,050–3,300 kJ/L, 22–24 kcal/oz). As infants were weaned from human milk, they were fed nutrient‐enriched formula with or without arachidonic and docosahexaenoic acids (3,300 kJ/L before term, 3,050 kJ/L thereafter) until 12 months CA. Formula fed infants were given nutrient‐enriched formula with or without added arachidonic and docosahexaenoic acids (3,300 kJ/L to term, 3,050 kJ/L thereafter) until 12 months CA. For the purposes of this evaluation, infants were categorized into four mutually exclusive feeding groups: 1) predominantly human milk fed until term CA (PHM‐T, n = 43); 2) ≥ 50% energy from human milk before hospital discharge (≥ 50% HM, n = 98); 3) < 50% of energy from human milk before hospital discharge (< 50% HM, n = 203); or 4) predominantly formula fed until term CA (PFF‐T, n = 119).ResultsPFF‐T infants weighed approximately 500 g more at term CA than did PHM‐T infants. This absolute difference persisted until 6 months CA. PFF‐T infants were also longer (1.0–1.5 cm) and had larger head circumferences (0.3–1.1 cm) than both PHM‐T and ≥ 50% HM infants at term CA. There was a positive association between duration of human milk feeding and the Bayley Mental Index at 12 months CA (P = 0.032 full and P = 0.073 reduced, statistical models) after controlling for the confounding variables of home environment and maternal intelligence. Infants with chronic lung disease fed ≥ 50% HM until term CA (n = 22) had a mean Bayley Motor Index about 11 points higher at 12 months CA compared with infants PFF‐T (n = 24, P = 0.033 full model).ConclusionOur data suggest that, despite a slower early growth rate, human milk fed LBW infants have development at least comparable to that of infants fed nutrient‐enriched formula. Exploratory analysis suggests that some subgroups of human milk fed LBW infants may have enhanced development, although this needs to be confirmed in future studies.

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Chronic Physiologic Instability Is Associated With Neurodevelopmental Morbidity at One and Two Years in Extremely Premature Infants

Cited by 44 publications

References 35 publications

Cumulative illness severity and progression from moderate to severe retinopathy of prematurity

Cumulative illness severity and progression from moderate to severe retinopathy of prematurity

Iron Status and Neurobehavioral Development of Premature Infants

Growth and Development of Premature Infants Fed Predominantly Human Milk, Predominantly Premature Infant Formula, or a Combination of Human Milk and Premature Formula

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