Postdischarge Infant Mortality Among Very Low Birth Weight Infants: A Population-Based Study

Kugelman, Amir; Reichman, Brian; Chistyakov, Irena; Boyko, Valentina; Levitski, Orna; Lerner‐Geva, Liat; Riskin, Arieh; Bader, David A.

doi:10.1542/peds.2006-3765

Cited by 39 publications

(28 citation statements)

References 38 publications

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“…The diagnosis of respiratory distress syndrome was made based on the need for oxygen therapy or assisted ventilation and confirmed by a thoracic radiograph. 18 Sepsis was diagnosed based on clinical signs and confirmed by a positive microbial growth on at least 2 blood cultures. Necrotizing enterocolitis was diagnosed in agreement with Bell criteria.…”

Section: Methodsmentioning

confidence: 99%

Mortality Risk After Neonatal Seizures in Very Preterm Newborns

et al. 2012

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We analyzed clinical and instrumental data of 403 consecutive newborns with gestational age from 24 to 32 weeks, admitted to the University-Hospital of Parma between January 2000 and December 2007, to evaluate the possible relationship between neonatal mortality and occurrence of neonatal seizures in very preterm newborns. Seventy-four subjects died during hospital stay. Seizures were present in 35 neonates, in whom the mortality rate was 37.1%. Multivariate analysis revealed that birth-weight

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Section: Methodsmentioning

confidence: 99%

Mortality Risk After Neonatal Seizures in Very Preterm Newborns

et al. 2012

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“…Infants with BPD have worse long-term outcomes than those without chronic lung disease. They are more than twice as likely to be readmitted to hospital in their first year of life and, having survived their primary hospitalizations, they are more likely to die than very preterm infants without chronic lung disease [3,4] . Survivors with BPD have an increased risk of neurodevelopmental impairment [5] and their respiratory function remains compromised well into adolescence [6,7] .…”

Section: Introductionmentioning

confidence: 99%

Inhalation or Instillation of Steroids for the Prevention of Bronchopulmonary Dysplasia

Bassler

2015

Neonatology

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Survival of extremely preterm infants has increased over recent years, but bronchopulmonary dysplasia (BPD) remains a major cause of morbidity. In the USA, BPD is the most common chronic respiratory disorder of infancy and affects the pulmonary and overall health of 10,000 preterm infants annually [1]. Preclinical and clinical studies suggest a crucial role for lung inflammation and host immune response in the pathogenesis of BPD [2]. Inflammation may result from, amongst others, chorioamnionitis, postnatal infection, ventilation, and the administration of oxygen [2]. Infants with BPD have worse long-term outcomes than those without chronic lung disease. They are more than twice as likely to be readmitted to hospital in their first year of life and, having survived their primary hospitalizations, they are more likely to die than very preterm infants without chronic lung disease [3,4]. Survivors with BPD have an increased risk of neurodevelopmental impairment [5] and their respiratory function remains compromised well into adolescence [6,7]. As the first generations of extremely low birth weight (ELBW) survivors have not yet reached retirement age, there are currently no reliable data addressing the association between BPD and pulmonary diseases of the elderly such as chronic obstructive pulmonary disease. Although BPD is quite common in ELBW infants, there are infants who do not develop BPD, which supports the argument that BPD is a preventable disease, emphasizing the need for high-quality safety and efficacy prevention studies. However, according to an Institute of Medicine statement regarding pediatric drug studies, the therapeutic area that has the fewest drugs indicated for neonates is BPD [8]. As inflammation seems to be a primary mediator of injury in the pathogenesis of BPD, anti-inflammatory agents such as steroids have long been the focus of preventive research activities. However, systemic steroids, although reducing BPD, have frequently been linked to adverse neurodevelopmental outcomes and these considerations may have contributed to the recently reported widespread use of inhaled corticosteroids in neonatal units in North America and Europe. Inhaled corticosteroids were prescribed to 25% of infants born at <29 weeks of gestation with birth weights <1,500 g in neonatal units of 35 children's hospitals in the USA [9]. According to a survey across all neonatal units in Germany, 46% administered inhaled corticosteroids to preterm infants either as prophylaxis or treatment for BPD [10]. Pediatricians and neonatologists should ask themselves whether the off-label use of inhaled corticosteroids in preterm infants is justifiable in view of the available evidence. The authors of the pertinent review from the Cochrane Collaboration, including 7 studies and 492 infants, conclude that there is currently no evidence to support the routine use of inhaled steroids for the prevention of BPD [11]. Recently, the primary outcome results of the Neonatal European Study of Inhaled Steroids (NEUROSIS), including 863 very ...

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“…1,3 Infants with bronchopulmonary dysplasia who survive have increased risks of neurodevelopmental impairment 4 and respiratory problems later in life. 5,6 Bronchopulmonary dysplasia results from ongoing lung injury and simultaneous repair 7,8 ; inflammation related to chorioamnionitis, postnatal infections, or iatrogenic causes (such as the use of ventilation or oxygen) contributes to lung fibrosis and arrested lung development.…”

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confidence: 99%

Early Inhaled Budesonide for the Prevention of Bronchopulmonary Dysplasia

et al. 2015

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BACKGROUND Systemic glucocorticoids reduce the incidence of bronchopulmonary dysplasia among extremely preterm infants, but they may compromise brain development. The effects of inhaled glucocorticoids on outcomes in these infants are unclear. METHODS We randomly assigned 863 infants (gestational age, 23 weeks 0 days to 27 weeks 6 days) to early (within 24 hours after birth) inhaled budesonide or placebo until they no longer required oxygen and positive-pressure support or until they reached a postmenstrual age of 32 weeks 0 days. The primary outcome was death or bronchopulmonary dysplasia, confirmed by means of standardized oxygen-saturation monitoring, at a postmenstrual age of 36 weeks. RESULTS A total of 175 of 437 infants assigned to budesonide for whom adequate data were available (40.0%), as compared with 194 of 419 infants assigned to placebo for whom adequate data were available (46.3%), died or had bronchopulmonary dysplasia (relative risk, stratified according to gestational age, 0.86; 95% confidence interval [CI], 0.75 to 1.00; P=0.05). The incidence of bronchopulmonary dysplasia was 27.8% in the budesonide group versus 38.0% in the placebo group (relative risk, stratified according to gestational age, 0.74; 95% CI, 0.60 to 0.91; P=0.004); death occurred in 16.9% and 13.6% of the patients, respectively (relative risk, stratified according to gestational age, 1.24; 95% CI, 0.91 to 1.69; P=0.17). The proportion of infants who required surgical closure of a patent ductus arteriosus was lower in the budesonide group than in the placebo group (relative risk, stratified according to gestational age, 0.55; 95% CI, 0.36 to 0.83; P=0.004), as was the proportion of infants who required reintubation (relative risk, stratified according to gestational age, 0.58; 95% CI, 0.35 to 0.96; P=0.03). Rates of other neonatal illnesses and adverse events were similar in the two groups. CONCLUSIONS Among extremely preterm infants, the incidence of bronchopulmonary dysplasia was lower among those who received early inhaled budesonide than among those who received placebo, but the advantage may have been gained at the expense of increased mortality. (Funded by the European Union and Chiesi Farmaceutici; ClinicalTrials.gov number, NCT01035190.).

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Postdischarge Infant Mortality Among Very Low Birth Weight Infants: A Population-Based Study

Abstract: Although the postdischarge death rate was relatively low in our cohort of very low birth weight infants, attention should be focused on the subgroups of infants who are at higher risk to decrease their mortality further.

Cited by 39 publications

References 38 publications

Mortality Risk After Neonatal Seizures in Very Preterm Newborns

Mortality Risk After Neonatal Seizures in Very Preterm Newborns

Inhalation or Instillation of Steroids for the Prevention of Bronchopulmonary Dysplasia

Early Inhaled Budesonide for the Prevention of Bronchopulmonary Dysplasia

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