Prospective evaluation of perinatal risk factors for cerebral palsy and delayed development in high risk infants
Jeong Nyun KimRan NamgungWook ChangChang Hee OhJi Cheol ShinEun Sook ParkChang Il ParkMin Soo ParkKook In ParkChul LeeDong Han
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Prematurity, intrauterine infection and perinatal brain injury have been reported to be significant risk factors of cerebral palsy (CP). We examined the perinatal predictors of cerebral palsy and delayed development (DD) in 184 high risk infants. Thirty-five infants were diagnosed as cerebral palsy and delayed development at 12 months corrected age. Antenatal, intrapartum, and neonatal factors were prospectively evaluated in 2 groups of high risk infants compared with controls; Group A (n = 79), infants weighing less than 2,000 g; Group B (n = 43), infants weighing 2,000 g or more. In univariate analysis, there were no significant antenatal and intrapartum factors associated with cerebral palsy and delayed development in either group. We found that significant postnatal risk factors of CP in group A included sepsis (p = 0.008), BPD (bronchopulmonary dysplasia) (p = 0.028), IVH (intraventricular hemorrhage) (p = 0.042), ventriculomegaly (VM) (p = 0.001) and a longer duration of mechanical ventilation (p = 0.001); while in group B, sepsis (p = 0.047) and neonatal seizure (p = 0.027) were significant risk factors. In multivariate analysis, sepsis in group B was a moderate risk factor of CP (OR (odds ratio) 1.47; 95% CI (confidence interval) 1.02-2.13). In conclusion, neonatal sepsis may contribute to the development of cerebral palsy and delayed development. We suggest that high risk infants who have sepsis should be carefully followed for cerebral palsy and delayed development. The prevention of cerebral palsy may be feasible by decreasing neonatal risk factors such as sepsis during the neonatal period.Keywords:
Bronchopulmonary Dysplasia
Neonatal Sepsis
Univariate analysis
Aim Echocardiographic evaluation of left ventricular function in preterm infants with and without bronchopulmonary dysplasia. Methods In 82 preterm infants (32 in no‐bronchopulmonary‐dysplasia group, 35 in mild‐bronchopulmonary‐dysplasia group, and 15 in severe‐bronchopulmonary‐dysplasia group), echocardiography was performed on the first day of life, at 28 days of life, and at 36 weeks postconceptional age. Results The mean E/A ratio at 36 PCA was 0.94±0.31 and 0.73±0.12 in the mild‐ and severe‐bronchopulmonary‐dysplasia groups, respectively ( P =.037). The mean E′‐wave velocity was 5.62±1.61 cm/s vs 4.32±1.11 cm/s at 1 day of life ( P =.006) and 6.40±1.39 cm/s vs 5.34±1.37 cm/s at 28 days of life ( P =.030) in the no‐bronchopulmonary‐dysplasia and mild‐bronchopulmonary‐dysplasia groups, respectively. This measure tended to be lower in the severe‐bronchopulmonary‐dysplasia group compared to the no‐bronchopulmonary‐dysplasia group (5.25±1.29 cm/s at 28 days of life; P =.081). The E/E′ ratio differed between the no‐bronchopulmonary‐dysplasia (7.21±1.85) and mild‐bronchopulmonary‐dysplasia groups (9.03±2.56; P =.019) at 1 day of life. The left ventricle myocardial performance index decreased between 1 day of life and 36 postconceptional age in infants without bronchopulmonary dysplasia and those with mild bronchopulmonary dysplasia, but not in those with severe bronchopulmonary dysplasia. Conclusion E/A and E/E′ ratios are the most sensitive indicators of impaired left ventricle diastolic function in preterm infants with bronchopulmonary dysplasia.
Bronchopulmonary Dysplasia
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Bronchopulmonary dysplasia in premature neonates leads to physical and mental developmental disorders and behavioral problems and associated with frequent rehospitalizations and long hospital stay. Study objective: to study the predictors of bronchopulmonary dysplasia development in premature neonates in structure of intensive care. Study design: A retrospective cohort analysis was performed in 127 children recruited from two NICU of Dnipro between January 2016 to March 2020. Inclusion criteria: preterm neonates 28-32 gestation weeks with respiratory distress syndrome (RDS). Results demonstrated that every day of mechanical ventilation, supplemental oxygen with FiO2 more than 30% and cardiac drugs usage increased risk of bronchopulmonary dysplasia development by 15-20%. In conclusion, finding out predictors of bronchopulmonary dysplasia helps to improve and prudently use usual treatment regimens in premature neonates and decrease the frequency of moderate and severe bronchopulmonary dysplasia.
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Aims: We determined the association between short-term neonatal morbidities, such as bronchopulmonary dysplasia (BPD) and intraventricular hemorrhage (IVH), and Ureaplasma spp. in amniotic fluid, placental and amniotic mem-brane of preterm infants.
Bronchopulmonary Dysplasia
Ureaplasma urealyticum
Ureaplasma
Periventricular leukomalacia
Neonatology
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Bronchopulmonary Dysplasia in Post-Surfactant Era: Results of an Objective Assessment of the Disease
Modern methods of respiratory support have led to the transformation of the course of bronchopulmonary dysplasia. A significant role is played by the use of surfactant preparations for the prevention of respiratory distress syndrome and subsequent formation of bronchopulmonary dysplasia in premature infants. In this connection, an objective assessment of the efficacy of surfactant replacement therapy is required. The article presents the results of studying the patterns of development of bronchopulmonary dysplasia in premature infants (n =121) of different gestational age. It was shown that a new form of moderate or mild bronchopulmonary dysplasia prevailed in extremely premature infants in the course of surfactant replacement therapy. Children of a gestational age greater than 32 weeks who do not require surfactant therapy usually have typical bronchopulmonary dysplasia.
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Surfactant therapy
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To verify if preterm neonates transferred between tertiary referral centers have worse outcomes than matched untransferred infants.Cohort study with a historically matched control group.Two tertiary-level neonatal ICUs.Seventy-five neonates per group.Transfer between tertiary-level neonatal ICUs carried out by a fully equipped transportation team.We measured in-hospital mortality, frequency of intraventricular hemorrhage greater than 2nd grade, periventricular leukomalacia, necrotizing enterocolitis greater than or equal to grade 2, bronchopulmonary dysplasia, composite outcomes (in-hospital mortality/bronchopulmonary dysplasia, in-hospital mortality/intraventricular hemorrhage > 2nd grade, and bronchopulmonary dysplasia/periventricular leukomalacia/intraventricular hemorrhage > 2nd grade), length of neonatal ICU stay, weight at discharge, and time spent on ventilatory support. Seventy-five similar (except for antenatal steroids administration) neonates were enrolled in each cohort. Cohorts did not differ in mortality, bronchopulmonary dysplasia, intraventricular hemorrhage greater than 2nd grade, periventricular leukomalacia, necrotizing enterocolitis greater than or equal to grade 2, any composite outcomes, neonatal ICU stay, weight at discharge, and duration of respiratory support. Results were unchanged adjusting for antenatal steroids.Neonatal transfer between tertiary-level centers does not impact on clinical outcomes, if performed under optimal conditions.
Bronchopulmonary Dysplasia
Periventricular leukomalacia
Necrotizing Enterocolitis
Pulmonary hemorrhage
Tertiary referral hospital
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Introduction. Despite the increase in the specific weight of bronchopulmonary dysplasia among children, its true incidence is unknown. The ratio of the incidence of bronchopulmonary dysplasia and associated prematurity remains unexplored. The aim of the study was to analyze the ratio of the incidence of bronchopulmonary dysplasia and prematurity and to predict their dynamics. Material and methods. According to official data, 469 cases of bronchopulmonary dysplasia and the frequency of prematurity in 2012-2017 were studied with the use of a continuous retrospective method. The Brown method’s calculation of the absolute growth, growth rate, growth rate, and forecasting was carried out. The results of the study. An increase in the incidence of bronchopulmonary dysplasia in children occurs simultaneously with an increase in the frequency of prematurity. However, the indices of the growth rate and growth rate of prematurity outstrip those of the incidence of bronchopulmonary dysplasia and the absolute increase in bronchopulmonary dysplasia is significantly higher than for the frequency of prematurity. Short-term prognosis indicates an increase in the incidence of bronchopulmonary dysplasia and the frequency of prematurity. Conclusion. Indices of the dynamics and prognostic estimates of the incidence of children with bronchopulmonary dysplasia and prematurity should be taken into account when managing specialized medical care.
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Bronchopulmonary dysplasia is the most common pulmonary complication of preterm infants. The incidence of bronchopulmonary dysplasia is increasing due to improved survival of preterm infants at lower gestational ages. Bronchopulmonary dysplasia is associated with serious respiratory and neurodevelopmental problems during childhood. Advances in our understanding of its pathogenesis and recognition that the 'new' bronchopulmonary dysplasia is secondary to developmental arrest during canalicular stages of lung development, have made it possible to explore avenues for its prevention and management. This review examines the evidence for various preventative strategies and provides current information on potential future therapies including cytokine targeted and gene therapy, angiogenic therapy and other molecular agents for the prevention of bronchopulmonary dysplasia.
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