Neurologic and Developmental Disability after Extremely Preterm Birth

Wood, Nicholas; Marlow, Neil; Costeloe, Kate; Gibson, Alan T.; Wilkinson, A

doi:10.1056/nejm200008103430601

Cited by 1,227 publications

(461 citation statements)

References 22 publications

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“…15 A large-scale study carried out in the United Kingdom and Ireland of extremely premature infants, born between 20 and 25 weeks of gestation, found that 79% were stillborn or died before admittance to a Neonatal Intensive Care Unit (NICU). 16 Of the 811 infants in this study admitted to an NICU, 60% died in hospital. Of those discharged; 2% died, 23% were classified as having severe disability at 30 months (defined as one likely to put the child in need of physical assistance to perform daily activities), 25% had other disabilities at 30 months, and 49% were found to have no disabilities at 30 months.…”

Section: Premature Birthmentioning

confidence: 82%

The Prevention of Preterm Labour - Corticotropin Releasing Hormone Type 1 Receptors as a Target for Drug Design and Development

Keller¹,

Kirkwood

Morgan³

et al. 2003

MRMC

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The role of the corticotropin releasing hormone in the onset of labour and the subsequent medicinal chemistry implications of CRH antagonists for the prevention of premature birth, and identification of the CRH type 1 receptor as the target for this drug design, are reviewed here. Keywords AbstractThe role of the corticotropin releasing hormone in the onset of labour and the subsequent medicinal chemistry implications of CRH antagonists for the prevention of premature birth, and identification of the CRH type 1 receptor as the target for this drug design, are reviewed here.

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Section: Premature Birthmentioning

confidence: 82%

The Prevention of Preterm Labour - Corticotropin Releasing Hormone Type 1 Receptors as a Target for Drug Design and Development

Keller¹,

Kirkwood

Morgan³

et al. 2003

MRMC

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“…Rates of disability among surviving VLBW neonates may be higher in developing countries such as South Africa (Ballot, Chirwa & Cooper, 2010) as the setting and resources in these contexts differ markedly to those in developed countries. Factors such as increased length of hospital stay (Mokhachane, Saloojee & Cooper, 2006), and increased risk of the surviving neonate being subjected to a variety of complications while in hospital (Wood et al, 2000) are known to result in a range of problems such as cerebral palsy, cognitive impairment, blindness and hearing impairment (Hack, 2007).…”

mentioning

confidence: 99%

The occurrence of high-risk factors for hearing loss in verylow- birth-weight neonates: A retrospective exploratory study of targeted hearing screening

Kanji

Khoza-Shangase

2012

South African Journal of Communication Disorders

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The current study aimed at determining the type and frequency of high-risk factors for hearing loss in a group of very-low-birth-weight (VLBW) neonates in a tertiary hospital in South Africa with the objective of collating evidence that could be used in arguing for or against revisiting targeted hearing screening in developing countries. Furthermore, the study aimed at investigating the relationship between the identified high-risk factors and hearing screening results. In a retrospective data review design, data were collated from files from the VLBW project; this included hearing screening records, as well as records from participant medical and audiology files. Records of 86 neonates with birth weights ranging between 680 g and 1 500 g were reviewed. Findings indicated that neonatal jaundice, exposure to human immunodeficiency virus (HIV), mechanical or assisted ventilation, and neonatal intensive care unit stay greater than 48 hours were the most frequently occurring high-risk factors for hearing loss in the current sample. These factors are consistent with those listed in the high-risk register of the Health Professions Council of South Africa for the South African context. Findings confirm the complexity of risk factors, and the influence that a variety of factors such as poor follow-up or return rate might have on the implementation of early hearing detection and intervention. The importance of establishing context-specific risk factors for effective implementation of targeted screening protocols where universal newborn hearing screening is not yet a reality was highlighted by the current study.

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“…Using this method of data collection, we do not know whether or not those completing questionnaires did so with reference to medical records or other knowledge of infants. However, very similar questionnaires have been used in previous authoritative cohort studies 78 and incorporation of such health professional data into analyses in this trial did not affect outcomes.…”

Section: Infant Outcomes At 2 Yearsmentioning

confidence: 99%

The SNAP trial: a randomised placebo-controlled trial of nicotine replacement therapy in pregnancy – clinical effectiveness and safety until 2 years after delivery, with economic evaluation

Cooper

Lewis

Thornton

et al. 2014

Health Technology Assessment

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BackgroundSmoking during pregnancy causes many adverse pregnancy and birth outcomes. Nicotine replacement therapy (NRT) is effective for cessation outside pregnancy but efficacy and safety in pregnancy are unknown. We hypothesised that NRT would increase smoking cessation in pregnancy without adversely affecting infants.ObjectivesTo compare (1) at delivery, the clinical effectiveness and cost-effectiveness for achieving biochemically validated smoking cessation of NRT patches with placebo patches in pregnancy and (2) in infants at 2 years of age, the effects of maternal NRT patch use with placebo patch use in pregnancy on behaviour, development and disability.DesignRandomised, placebo-controlled, parallel-group trial and economic evaluation with follow-up at 4 weeks after randomisation, delivery and until infants were 2 years old. Randomisation was stratified by centre and a computer-generated sequence was used to allocate participants using a 1 : 1 ratio. Participants, site pharmacies and all study staff were blind to treatment allocation.SettingSeven antenatal hospitals in the Midlands and north-west England.ParticipantsWomen between 12 and 24 weeks’ gestation who smoked ≥ 10 cigarettes a day before and ≥ 5 during pregnancy, with an exhaled carbon monoxide (CO) reading of ≥ 8 parts per million (p.p.m.).InterventionsNRT patches (15 mg per 16 hours) or matched placebo as an 8-week course issued in two equal batches. A second batch was dispensed at 4 weeks to those abstinent from smoking.Main outcome measuresParticipants: self-reported, prolonged abstinence from smoking between a quit date and childbirth, validated at delivery by CO measurement and/or salivary cotinine (COT) (primary outcome). Infants, at 2 years: absence of impairment, defined as no disability or problems with behaviour and development. Economic: cost per ‘quitter’.ResultsOne thousand and fifty women enrolled (521 NRT, 529 placebo). There were 1010 live singleton births and 12 participants had live twins, while there were 14 fetal deaths and no birth data for 14 participants. Numbers of adverse pregnancy and birth outcomes were similar in trial groups, except for a greater number of caesarean deliveries in the NRT group. Smoking: all participants were included in the intention-to-treat (ITT) analyses; those lost to follow-up (7% for primary outcome) were assumed to be smoking. At 1 month after randomisation, the validated cessation rate was higher in the NRT group {21.3% vs. 11.7%, odds ratio [OR], [95% confidence interval (CI)] for cessation with NRT, 2.05 [1.46 to 2.88]}. At delivery, there was no difference between groups’ smoking cessation rates: 9.4% in the NRT and 7.6% in the placebo group [OR (95% CI), 1.26 (0.82 to 1.96)]. Infants: at 2 years, analyses were based on data from 888 out of 1010 (87.9%) singleton infants (including four postnatal infant deaths) [445/503 (88.5%) NRT, 443/507 (87.4%) placebo] and used multiple imputation. In the NRT group, 72.6% (323/445) had no impairment compared with 65.5% (290/443) in placebo (OR 1.40, 95% CI 1.05 to 1.86). The incremental cost-effectiveness ratio for NRT use was £4156 per quitter (£4926 including twins), but there was substantial uncertainty around these estimates.ConclusionsNicotine replacement therapy patches had no enduring, significant effect on smoking in pregnancy; however, 2-year-olds born to women who used NRT were more likely to have survived without any developmental impairment. Further studies should investigate the clinical effectiveness and safety of higher doses of NRT.Trial registrationCurrent Controlled Trials ISRCTN07249128.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 18, No. 54. See the NIHR Journals Library programme website for further project information.

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Neurologic and Developmental Disability after Extremely Preterm Birth

Abstract: Severe disability is common among children born as extremely preterm infants.

Cited by 1,227 publications

References 22 publications

The Prevention of Preterm Labour - Corticotropin Releasing Hormone Type 1 Receptors as a Target for Drug Design and Development

The Prevention of Preterm Labour - Corticotropin Releasing Hormone Type 1 Receptors as a Target for Drug Design and Development

The occurrence of high-risk factors for hearing loss in verylow- birth-weight neonates: A retrospective exploratory study of targeted hearing screening

The SNAP trial: a randomised placebo-controlled trial of nicotine replacement therapy in pregnancy – clinical effectiveness and safety until 2 years after delivery, with economic evaluation

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