The Leboyer birth method requires that the newborn infant is placed on the mothers abdomen and the cord is clamped when it stops pulsating. Since late cord-clamping may result in marked hypervolemia and polycythemia of the neonate, we studied right and left ventricular systolic time intervals by means of pulsed-Doppler echocardiography. Left and right ventricular preejection periods (LPEP, RPEP), right time peak velocity (RTPV), left and right ventricular ejection times (LVET, RVET), and ratio of RTPV/RVET(c) corrected for heart rate were studied in 15 fullterm neonates with early (< 10s) cord clamping and in 15 fullterm neonates delivered according to Leboyer (cord clamping after 3 min) on day 1 (2-4 h after birth) and day 5. After Leboyer birth hematocrit was significantly increased on day 1 (0.61 +/- 0.06 vs. 0.53 +/- 0.07) and on day 5 (0.57 +/- 0.02 vs. 0.50 +/- 0.07). Blood pressure was similar in both groups and increased by about 10% from day 1 to day 5. LVET and RVET were not affected by the mode of placental transfusion, thereby suggesting normal left and right ventricular function after Leboyer birth. The LPEP/LVET (0.36 +/- 0.09 vs. 0.30 +/- 0.08) and RPEP/RVET ratio (0.41 +/- 0.11 vs. 0.33 +/- 0.08) were significantly higher in the Leboyer group (p < 0.05) compared to the early cord clamped group suggesting higher systemic and pulmonary resistance. RPEP decreased significantly by 17% in the control group from day 1 to day 5 (p < 0.05), but did not change in the Leboyer group. In the Leboyer group RPEP/RVET ratio decreased significantly from day 1 to day 5, whereas the control values did not change during the first five days. RTPV:RVET(c) is inversely related to pulmonary artery pressure. A normal ratio is > 0.35, or greater. Mean ratio of RTPV : RVET(c) was significantly lower in the Leboyer group (0.31 +/- 0.08) on day 1 compared to the control group (0.41 +/- 0.09; p < 0.05), but did not differ on day 5. The results suggest that Leboyer delivery was associated with transiently increased pulmonary and systemic resistance, whereas right and left ventricular functions were not affected. This may be explained by increased blood viscosity due to increased hematocrit.
There are few programs available aimed at preventing short- and long-term negative consequences after preterm birth and covering the entire care continuum. The “Transition to Home (TtH)” model is such a program, offering structured, individual support for families with preterm infants before and after hospital discharge. This study gathers and examines the parents’ views of receiving support from an interprofessional team under the TtH model of care during hospitalization and after discharge. Using a qualitative explorative design, 39 semi-structured interviews with parents were analyzed thematically. From this analysis, three main themes were identified: (1) TtH and the relevance of continuity of care; (2) Enhancement of parents’ autonomy and self-confidence; (3) Perception of interprofessional collaboration. Within these themes, the most relevant aspects identified were continuity of care and the appointment of a designated health care professional to anchor the entire care continuum. Emotional support complemented by non-medical approaches, along with strength-based and family resource-oriented communication, also emerged as key aspects. Continuous, family-centered care and well-organized interprofessional collaboration promote the well-being of the family after a premature birth. If the aspects identified in this study are applied, the transition from hospital to home will be smoothened for the benefit of affected families.
Compromised intrauterine fetal growth leading to low birth weight (<2500 g) is associated with adulthood renal and cardiovascular disease. The aim of this study was to assess the effect of salt intake on blood pressure (salt sensitivity) in children with low birth weight. White children (n=50; mean age: 11.3+/-2.1 years) born with low (n=35) or normal (n=15) birth weight and being either small or appropriate for gestational age (n=25 in each group) were investigated. The glomerular filtration rate was calculated using the Schwartz formula, and renal size was measured by ultrasound. Salt sensitivity was assigned if mean 24-hour blood pressure increased by >or=3 mm Hg on a high-salt diet as compared with a controlled-salt diet. Baseline office blood pressure was higher and glomerular filtration rate lower in children born with low birth weight as compared with children born at term with appropriate weight (P<0.05). Salt sensitivity was present in 37% and 47% of all of the low birth weight and small for gestational age children, respectively, higher even than healthy young adults from the same region. Kidney length and volume (both P<0.0001) were reduced in low birth weight children. Salt sensitivity inversely correlated with kidney length (r(2)=0.31; P=0.005) but not with glomerular filtration rate. We conclude that a reduced renal mass in growth-restricted children poses a risk for a lower renal function and for increased salt sensitivity. Whether the changes in renal growth are causative or are the consequence of the same abnormal "fetal programming" awaits clarification.
This study was done to compare postnatal alterations in blood viscosity (capillary viscometer) and its determinants: hematocrit, plasma viscosity (capillary viscometer), red cell aggregation (Myrenne aggregometer) and red cell deformability (rheoscope) in the first five days of postnatal life in full‐term neonates with early (< 10 s) and late (3 min) cord‐clamping. The fetal blood volume of the placenta (“residual placental blood volume”) decreased from 52±8 ml/kg of neonatal body weight after early cord‐clamping to 15±4 ml/kg after later cord‐clamping. Neonatal blood volume, calculated as the difference between an assumed total feto‐placental blood volume of 115 ml/kg and the measured fetal blood volume of the placenta, was 50% higher in the late cord‐clamped infants than in the early cord‐clamped infants. Both groups showed similar viscosity, hematocrit and other rheological parameters in cord blood. In the infants with early cord‐clamping, the hematocrit decreased from 0.48±0.04 1/1 at birth to 0.43±0.61/1 after 24 h ( p < 0.05). Whole blood viscosity did not change significantly with age. After late cord‐clamping, the hematocrit rose from 0.50±0.04% at birth to 0.63±0.051/1 at 2 h of age ( p < 0.005) and dropped to 0.59±0.51/1 ( p < 0.05) at 24 h. Blood viscosity increased by 40% ( p < 0.001) within the first 2 h, but did not change significantly during the following five days. In both groups, plasma viscosity and red cell aggregation increased significantly ( p < 0.05) on day 5 due to significant increases in total plasma protein and fibrinogen concentrations ( p < 0.01). Red cell deformation was not affected by the mode of cord‐clamping and did not change with age. We conclude that late cord‐clamping results in marked rise in blood viscosity due to increasing hematocrit. The postnatal rise in plasma viscosity and red cell aggregation may keep the blood viscosity at a high level despite falling hematocrit.
Neonatal sepsis causes high mortality and morbidity in preterm infants, but less is known regarding the long-term outcome after sepsis. This study aimed to determine the impact of sepsis on neurodevelopment at 2 years' corrected age in extremely preterm infants.This was a multicenter Swiss cohort study on infants born between 2000 and 2007 at 24(0/7) to 27(6/7) weeks' gestational age. Neurodevelopmental outcome was assessed with the Bayley Scales of Infant Development-II. Neurodevelopmental impairment (NDI) was defined as a Mental or Psychomotor Developmental Index lower than 70, cerebral palsy (CP), or visual or auditory impairment.Of 541 infants, 136 (25%) had proven sepsis, 169 (31%) had suspected sepsis, and 236 (44%) had no signs of infection. CP occurred in 14 of 136 (10%) infants with proven sepsis compared with 10 of 236 (4%) uninfected infants (odds ratio [OR]: 2.90 [95% confidence interval (CI): 1.22-6.89]; P = .016). NDI occurred in 46 of 134 (34%) infants with proven sepsis compared with 55 of 235 (23%) uninfected infants (OR: 1.85 [95% CI: 1.12-3.05]; P = .016). Multivariable analysis confirmed that proven sepsis independently increased the risk of CP (OR: 3.23 [95% CI: 1.23-8.48]; P = .017) and NDI (OR: 1.69 [95% CI: 0.96-2.98]; P = .067). In contrast, suspected sepsis was not associated with neurodevelopmental outcome (P > .05). The presence of bronchopulmonary dysplasia, pathologic brain ultrasonography, retinopathy, and sepsis predicted the risk of NDI (P < .0001).Proven sepsis significantly contributes to NDI in extremely preterm infants, independent of other risk factors. Better strategies aimed at reducing the incidence of sepsis in this highly vulnerable population are needed.
Treatment of retinopathy of prematurity (ROP) stage 3 plus with bevacizumab is still very controversial. We report the outcome of 6 eyes of 4 premature infants with ROP stage 3 plus disease treated with ranibizumab monotherapy.Six eyes of 4 premature infants with threshold ROP 3 plus disease in zone II, were treated with one intravitreal injection of 0.03 ml ranibizumab. No prior laser or other intravitreal therapy was done. Fundus examination was performed prior to the intervention and at each follow-up visit. Changes in various mean vital parameters one week post intervention compared to one week pre-intervention were assessed.The gestational age (GA) of patient 1, 2, 3, and 4 at birth was 24 5/7, 24 5/7, 24 4/7, and 26 1/7 weeks, respectively. The birth weight was 500 grams, 450 grams, 665 grams, and 745 grams, respectively. The GA at the date of treatment ranged from 34 3/7 to 38 6/7 weeks. In one infant, upper air way infection was observed 2 days post injection of the second eye. Three eyes required paracentesis to reduce the intraocular pressure after injection and to restore central artery perfusion. After six months, all eyes showed complete retinal vascularisation without any signs of disease recurrence.Treatment of ROP 3 plus disease with intravitreal ranibizumab was effective in all cases and should be considered for treatment. One infant developed an upper air way infection suspicious for nasopharyngitis, which might be a possible side effect of ranibizumab. Another frequent complication was intraocular pressure rise after injection. More patients with longer follow-up duration are mandatory to confirm the safety and efficacy of this treatment.NCT02164604; Date of registration: 13.06.2014.
