Pulmonary and Neurological Follow-Up of Extremely Preterm Infants

Doyle, Lex W.; Anderson, Peter J.

doi:10.1159/000297771

Cited by 45 publications

(36 citation statements)

References 124 publications

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“…The findings implicate that event counts exert more direct effect than GA on the causal pathways related to neurodevelopmental outcomes, and are also compatible with epidemiological observations that extremely preterm infants may survive without major neurological problems if free of serious morbidities [25]. The GA effect on CP risk by event counts was tested in two categories in this study.…”

Section: Discussionsupporting

confidence: 85%

Hypoxic/Ischemic and Infectious Events Have Cumulative Effects on the Risk of Cerebral Palsy in Very-Low-Birth-Weight Preterm Infants

Wang

Lin²,

Wang³

et al. 2014

Neonatology

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Background: Hypoxia/ischemia and inflammation are two major mechanisms for cerebral palsy (CP) in preterm infants. Objective: To investigate whether hypoxia/ischemia- and infection-related events in the perinatal and neonatal periods had cumulative effects on CP risk in very-low-birth-weight (VLBW) premature infants. Methods: From 1995 to 2005, 5,807 VLBW preterm infants admitted to Taiwan hospitals were enrolled.The cumulative effects of hypoxic/ischemic and infectious events during the perinatal and neonatal periods on CP risk at corrected age 24 months were analyzed. Results: Of the 4,355 infants with 24-month follow-up, 457 (10.5%) had CP. The CP group had significantly higher incidences of hypoxia/ischemia-related events in the perinatal and neonatal periods, and sepsis in the neonatal period than the normal group. Three hypoxic/ischemic events, including birth cardiopulmonary resuscitation (OR 2.25; 95% CI 1.81-2.82), patent ductus arteriosus (PDA) ligation (2.94; 1.35-5.75) and chronic lung disease (3.14; 2.61-3.85) had the most significant contribution to CP. Relative to CP risk for infants with neither the three hypoxic/ischemic events nor sepsis, the CP odds increased 1.98-, 2.26- and 2.15-fold for infants with birth cardiopulmonary resuscitation, PDA ligation and chronic lung disease, respectively; while the combination with sepsis further increased the odds to 3.18-, 3.83- and 3.25-fold, respectively. Using the three hypoxic/ischemic events plus sepsis, CP rates were 10.0, 16.7, 26.7, 40.0 and 54.7% for infants with none, one, two, three and four events, respectively. Conclusions: Hypoxic/ischemic and infectious events across the perinatal and neonatal periods exerted cumulative effects on CP risk in VLBW premature infants.

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Section: Discussionsupporting

confidence: 85%

Hypoxic/Ischemic and Infectious Events Have Cumulative Effects on the Risk of Cerebral Palsy in Very-Low-Birth-Weight Preterm Infants

Wang

Lin²,

Wang³

et al. 2014

Neonatology

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“…Despite this, the incidence of BPD remains stable or even higher [2] probably due to the improved survival of extremely premature infants. The impact of BPD on later life is significant and multi-systemic: surviving infants with BPD have more frequent neurodevelopmental [3], cardiovascular [4] and respiratory [5] sequelae compared to those without BPD [6]. Furthermore, BPD is associated with prolonged hospitalisation and increased mortality and morbidity lasting well into childhood [7].…”

Section: Introductionmentioning

confidence: 99%

Using Measurements of Shunt and Ventilation-to-Perfusion Ratio to Quantify the Severity of Bronchopulmonary Dysplasia

et al. 2015

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Background: Classifying the severity of bronchopulmonary dysplasia (BPD) by continuous numerical variables would facilitate follow-up of disease progression and quantified analysis of disease determinants. Objectives: To non-invasively measure oxygenation impairment in BPD by the degree of right-to-left shunt, right shift of the oxyhaemoglobin dissociation curve and ventilation/perfusion (V_A/Q) inequality and to explore their relation with clinical parameters. Methods: Prospective cohort study of 24 infants with a median (interquartile range, IQR) gestation of 25 weeks (24-27) and a birth weight of 0.70 kg (0.63-0.93), studied at 36 days (30-66), at a postmenstrual age (PMA) of 33 weeks (29-36). Inspired oxygen (F_IO₂) was varied to obtain three to five transcutaneous oxygen saturation (SpO₂) values between 85 and 96%. Values of shunt, shift and V_A/Q were obtained by plotting the paired data of SpO₂ against F_IO₂ for each infant using a unique program. Right-to-left shunt, right shift of the oxyhaemoglobin dissociation curve and V_A/Q were measured in infants born <32 weeks PMA receiving oxygen at 28 days. Results: The median (IQR) shunt was 8% (0.3-16.5), shift 14.5 kPa (10.9-19.4) and V_A/Q 0.40 (0.30-0.48). Shunt, shift and V_A/Q were significantly related to gestational age (GA) at birth, PMA at study, weight at study and weight gain per week. Conclusions: Severity of pulmonary oxygenation impairment in BPD can be quantified at the cot-side by non-invasive measurement of shunt, shift and V_A/Q. Low GA at birth, low weight at birth and at the time of study and impaired weight gain are significantly associated with the severity of oxygen-exchange impairment in infants with BPD.

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“…BPD is a syndrome of persistent respiratory insufficiency in which preterm infants continue to require supplemental oxygen and/or mechanical ventilatory support beyond the gestational age of 36 weeks [3] , and it is associated with poor long-term outcomes [4,5] . BPD is more common in extremely premature infants [3] , which is mostly due to differences in lung maturation, antenatal corticosteroid exposure, surfactant administration and insults from mechanical ventilation, infection and hyperoxia [3,6] .…”

Section: Introductionmentioning

confidence: 99%

Early Postnatal Surge of Serum Clara Cell Secretory Protein in Newborn Infants

Loughran‐Fowlds

Lin²,

Oei³

et al. 2011

Neonatology

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Background: Clara cell secretory protein (CCSP) is an anti-inflammatory mediator, but its role in neonatal lung adaptation and diseases is uncertain. Objective: To characterize postnatal changes in serum CCSP in relation to gestation, respiratory disease (RDS) and bronchopulmonary dysplasia (BPD) in comparison with other anti-inflammatory cytokines (IL-4, -10 and -13). Methods: Blood was collected from 76 infants (26 of 23–29 weeks’ gestation, 33 of 30–36 weeks’ gestation and 17 term infants) at birth (preterm cord blood); on admission; at 12, 24 and 48 h; and on days 3–4 and 7 of life. CCSP was assayed by ELISA and cytokines by Bio-Plex. Results: Median serum CCSP in extremely and moderately preterm infants rose from a baseline of 13.6 and 15.9 to 33.4 ng/ml (p = 0.04) and 59.8 ng/ml (p = 0.03) at 12 h of age, respectively. CCSP levels were highest in term infants (80.7 ng/ml at 12 h). CCSP then decreased to 22.5 ng/ml on days 3–4 (p = 0.001). CCSP of 37 RDS infants fell to a lower baseline on days 4 and 7 than that of the 22 non-RDS preterms. The 8 infants who developed BPD had persistently low serum CCSP (12.7 ng/ml at 12 h). In contrast, early postnatal changes were not seen in IL-4, -10 and -13 levels, but low IL-10 and -13 levels were found on day 7 in BPD infants. Conclusions: Serum CCSP levels were characterized by an early postnatal surge. This apparent gestation-influenced surge may represent an initiation of a protective cascade against postnatal lung injury during extrauterine adaptation.

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Pulmonary and Neurological Follow-Up of Extremely Preterm Infants

Cited by 45 publications

References 124 publications

Hypoxic/Ischemic and Infectious Events Have Cumulative Effects on the Risk of Cerebral Palsy in Very-Low-Birth-Weight Preterm Infants

Hypoxic/Ischemic and Infectious Events Have Cumulative Effects on the Risk of Cerebral Palsy in Very-Low-Birth-Weight Preterm Infants

Using Measurements of Shunt and Ventilation-to-Perfusion Ratio to Quantify the Severity of Bronchopulmonary Dysplasia

Early Postnatal Surge of Serum Clara Cell Secretory Protein in Newborn Infants

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