Impact of Bronchopulmonary Dysplasia, Brain Injury, and Severe Retinopathy on the Outcome of Extremely Low-Birth-Weight Infants at 18 Months: Results From the Trial of Indomethacin Prophylaxis in Preterms

Schmidt, Barbara; Asztalos, Elizabeth; Roberts, Robin S.; Robertson, Charlene M.T.; Sauve, Reginald S.; Whitfield, Michael F.

doi:10.1097/01.ogx.0000079648.61092.0e

Cited by 201 publications

(297 citation statements)

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“…6, 21 We have not observed any differences in the incidence of severe ROP between study and control groups and more importantly, the occurrence of severe ROP is similar to that noted in populations of infants of comparable age. 5,20 -21 The potential selection bias inherent to retrospective studies had been partially minimized in our investigation by the case-control nature of the design.…”

Section: Discussionsupporting

confidence: 69%

Indomethacin prophylaxis or expectant treatment of patent ductus arteriosus in extremely low birth weight infants?

et al. 2007

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Background: Indomethacin prophylaxis or expectant treatment are common strategies for the prevention or management of symptomatic patent ductus arteriosus (sPDA). Objective:To compare the clinical responses of extremely low birth weight (ELBW) infants to indomethacin prophylaxis with hat of other infants who were managed expectantly by being treated with indomethacin or surgically only after an sPDA was detected.Methods: Retrospective cohort investigation of 167 ELBW infants who received indomethacin prophylaxis (study) and 167 ELBW infants (control) treated expectantly who were matched by year of birth (1999 to 2006), birth weight, gestational age (GA) and gender.Results: Mothers of the two groups of infants were comparable demographically and on the history of preterm labor, pre-eclampsia, antepartum steroids and cesarean delivery. Study and control infants were similar in birth weight, GA, low 5 min Apgar scores, surfactant administration, the need for arterial blood pressure control, bronchopulmonary dysplasia and neonatal mortality. Necrotizing enterocolitis, spontaneous intestinal perforations, intraventricular hemorrhage grade III to IV, periventricular leukomalacia and stage 3 to 5 retinopathy of prematurity occurred also with similar frequency in both groups of infants. In the indomethacin prophylaxis group, 29% of the infants developed sPDA, and of them 38% responded to indomethacin treatment. In the expectantly treated group, 37% developed sPDA, and of them 59% responded to indomethacin treatment. Overall, surgical ligation rate for sPDA was similar between both groups of patients.Conclusion: In our experience, indomethacin prophylaxis does not show any advantages over expectant early treatment on the management of sPDA in ELBW infants. Although no deleterious effects were observed, prophylaxis exposed a significant number of infants who may have never developed sPDA, to potential indomethacin-related complications.

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Section: Discussionsupporting

confidence: 69%

Indomethacin prophylaxis or expectant treatment of patent ductus arteriosus in extremely low birth weight infants?

et al. 2007

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“…This is consistent with other studies linking BPD with poor neurodevelopmental outcome. 28,29 We have shown that infants with BPD in the current era have improved growth and can demonstrate catch-up growth for weight and HC compared with 10 years ago. We speculate that the use of early parenteral amino acids and caloric-dense feeding strategies had a significant role.…”

Section: Discussionmentioning

confidence: 99%

Nutritional strategies and growth in extremely low birth weight infants with bronchopulmonary dysplasia over the past 10 years

et al. 2011

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Objective: Changes in nutritional strategies over the past decade have been shown to improve postnatal growth in extremely low birth weight (ELBW) infants. We showed 10 years ago that the majority of these ELBW infants with bronchopulmonary dysplasia (BPD) suffer postnatal growth failure. We theorized that recent changes in nutritional support strategies would positively affect growth outcomes in ELBW infants with BPD.Study Design: A retrospective study of 88 ELBW infants with BPD. Nutritional data, postnatal growth and BPD severity were compared across three cohorts: (1) weight gain p14 g kg À1 per day, (2) 14.1 to 16 g kg À1 per day and (3) X16 g kg À1 per day from return to birth weight through discharge. We also compared these to a historical cohort.Result: In all, 73% of current subjects grew at or above fetal rates. There was less extrauterine growth restriction (EUGR) by weight and head circumference for those ELBW infants with BPD receiving higher amounts of protein. Aggressive early TPN and receipt of caloric-dense milk seemed to be the 'new' nutritional strategies improving growth for current ELBW infants with BPD compared with those 10 years ago.Conclusion: Despite a diagnosis of BPD, improved nutritional strategies have enhanced postnatal growth in infants at high risk for EUGR.

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“…Preterm birth presents a substantial challenge for the neurodevelopment of the postural control systems, because the infants are born with an immature and more vulnerable motor and sensory system, and because the infants commonly suffer brain injuries such as periventricular hemorrhage and leukomalacia or ventricular enlargement (Schmidt et al 2003; Fallang and Hadders-Algra 2005). As a result, preterm birth commonly causes dysfunctional postural control with delayed onset and poor quality of early walking.…”

Section: Discussionmentioning

confidence: 99%

“…Postural control issues and neurological disorders ELBW and low gestational age has been associated with three common morbidities: bronchopulmonary dysplasia, brain injury identified via ultrasound (periventricular leukomalacia or ventricular enlargement) and severe retinopathy (Schmidt et al 2003). However, even in the absence of identifiable CNS events, preterm birth is characterized by a potential disruption in the typical temporal and spatial progression of development of brain structures.…”

Section: Elbw and Visionmentioning

confidence: 99%

Decreased postural control in adolescents born with extremely low birth weight

et al. 2015

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The survival rates of infants born preterm with extremely low birth weight (ELBW ≤ 1000 g) have gradually improved over the last decades. However, these infants risk to sustain long-term disorders related to poor neurodevelopment. The objective was to determine whether adolescents born with ELBW have decreased postural control and stability adaptation. Twenty-nine ELBW subjects performed posturography with eyes open and closed under unperturbed and perturbed standing by repeated calf vibration. Their results were compared with twenty-one age-and gender-matched controls born after full-term pregnancy. The ELBW group had significantly decreased stability compared with controls in anteroposterior direction, both during the easier quiet stance posturography (p = 0.007) and during balance perturbations (p = 0.007). The ELBW group had similar stability decrease in lateral direction during balance perturbations (p = 0.013). Statistically, the stability decreases were similar with eyes closed and open, but proportionally larger with eyes open in both directions. Both groups manifested significant adaptation (p ≤ 0.023) to the balance perturbations in anteroposterior direction, though this adaptation process could not compensate for the general stability deficits caused by ELBW on postural control. Hence, adolescent survivors of ELBW commonly suffer long-term deficits in postural control, manifested as use of substantially more recorded energy on performing stability regulating high-frequency movements and declined stability with closed and open eyes both in anteroposterior and lateral direction. The determined relationship between premature birth and long-term functional deficits advocates that interventions should be developed to provide preventive care in neonatal care units and later on in life.

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Impact of Bronchopulmonary Dysplasia, Brain Injury, and Severe Retinopathy on the Outcome of Extremely Low-Birth-Weight Infants at 18 Months: Results From the Trial of Indomethacin Prophylaxis in Preterms

Cited by 201 publications

References 0 publications

Indomethacin prophylaxis or expectant treatment of patent ductus arteriosus in extremely low birth weight infants?

Indomethacin prophylaxis or expectant treatment of patent ductus arteriosus in extremely low birth weight infants?

Nutritional strategies and growth in extremely low birth weight infants with bronchopulmonary dysplasia over the past 10 years

Decreased postural control in adolescents born with extremely low birth weight

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