[Show abstract][Hide abstract] ABSTRACT: The impact of endotoxemia on cerebral endothelium and cerebral blood flow (CBF) regulation was studied in conscious newborn lambs. Bacterial endotoxin [LPS, 2 microg/kg iv] was infused on 3 consecutive days. Cerebrovascular function was assessed by monitoring CBF and cerebral vascular resistance (CVR) over 12 h each day and by the endothelium-dependent vasodilator bradykinin (BK) (n = 10). Inflammatory responses were assessed by plasma tumor necrosis factor-alpha (TNF-alpha, n = 5). Acutely, LPS disrupted the cerebral circulation within 1 h, with peak cerebral vasoconstriction at 3 h (CBF -28 and CVR +118%, P < 0.05) followed by recovery to baseline by 12 h. TNF-alpha and body temperature peaked approximately 1 h post-LPS. BK-induced vasodilatation (CVR -20%, P < 0.05) declined with each LPS infusion, was abolished after 3 days, and remained absent for at least the subsequent 5 days. Histological evidence of brain injury was found in four of five LPS-treated newborns. We conclude that endotoxin impairs cerebral perfusion in newborn lambs via two mechanisms: 1) acute vasoconstriction (over several hours); and 2) persistent endothelial dysfunction (over several days). Endotoxin-induced circulatory impairments may place the newborn brain at prolonged risk of CBF dysregulation and injury as a legacy of endotoxin exposure.
[Show abstract][Hide abstract] ABSTRACT: After reading this chapter and answering the discussion questions that follow, you should be able to
Present an overview of perinatal mortality rates, stillbirth rates, and neonatal mortality rates in different geographical
and economic regions of the world.
Identify and discuss factors that influence perinatal survival from a global perspective.
Identify and evaluate the evidence base of specific low-cost interventions to improve perinatal health.
[Show abstract][Hide abstract] ABSTRACT: We studied the impact of endotoxemia on cerebral blood flow (CBF), cerebral vascular resistance (CVR), and cerebral oxygen transport (O(2) transport) in fetal sheep. We hypothesized that endotoxemia impairs CBF regulation and O(2) transport, exposing the brain to hypoxic-ischemic injury. Responses to lipopolysaccharide (LPS; 1 microg/kg iv on 3 consecutive days, n = 9) or normal saline (n = 5) were studied. Of LPS-treated fetuses, five survived and four died; in surviving fetuses, transient cerebral vasoconstriction at 0.5 h (DeltaCVR approximately +50%) was followed by vasodilatation maximal at 5-6 h (DeltaCVR approximately -50%) when CBF had increased (approximately +60%) despite reduced ABP (approximately -20%). Decreased CVR and increased CBF persisted 24 h post-LPS and the two subsequent LPS infusions. Cerebral O(2) transport was sustained, although arterial O(2) saturation was reduced (P < 0.05). Histological evidence of neuronal injury was found in all surviving LPS-treated fetuses; one experienced grade IV intracranial hemorrhage. Bradykinin-induced cerebral vasodilatation (DeltaCVR approximately -20%, P < 0.05) was abolished after LPS. Fetuses that died post-LPS (n = 4) differed from survivors in three respects: CVR did not fall, CBF did not rise, and O(2) transport fell progressively. In conclusion, endotoxin disrupts the cerebral circulation in two phases: 1) acute vasoconstriction (1 h) and 2) prolonged vasodilatation despite impaired endothelial dilatation (24 h). In surviving fetuses, LPS causes brain injury despite cerebral O(2) transport being maintained by elevated cerebral perfusion; thus sustained O(2) transport does not prevent brain injury in endotoxemia. In contrast, cerebral hypoperfusion and reduced O(2) transport occur in fetuses destined to die, emphasizing the importance of sustaining O(2) transport for survival.
[Show abstract][Hide abstract] ABSTRACT: The developmental outcome of 61 very low-birthweight infants was studied prospectively by means of the Bayley Scales of Infant Development at one and two years of age, corrected for prematurity. Preliminary analysis revealed that the mean scores for mental and psychomotor development were within the normal limits at both testing occasions. However, further analysis showed that there was a significant decrease in mental development scores from one to two years of age, due primarily to an increase in the numbers of low-scoring children with ‘hyperactive’ behaviour at two years. Separate subgroups of children with suboptimal mental and psychomotor development scores were characterised at both testing occasions by the presence of ‘hyperactive’ behaviour and disability, usually of a minor degree. The presence of hyperactivity, disability and lowered mental performance may help in the early identification of children at increased developmental risk.
Les déterminants des performances de développement chez les survivants de très faible poids de naissance à Iàge de un et deux ans
Le devenir dévelopmental de 61 nourrissons de très faible poids de naissance a étéétudié prospectivement à l'aide de la Bailey Scale of Infant Development aux âges de un et deux ans, après correction pour prématurité. Une analyse préliminaire révéla que les scores moyens de développement mental et psychomoteur étaient dans les limites de la normale aux deux âges. En fait, des études ultérieures montrérent une diminution significative des scores de développement mental entre lâge de un et deux ans avant tout en raison d'un accroissement du nombre des enfants avec faible performance et un comportement instable à làge de deux ans. Des sous-groupes séparés d'enfants avec des scores de développement mental et psycho-moteur sous-optimaux sont apparus caractérisés aux deux examens successifs par un comportement instable et une incapacité, généralement mineure. La présence d'instabilité, d'incapacité et de performances mentales basses peut aider à l'dentification précoce des enfants exposés à un risque accru de troubles du développement.
Maßstäbe für die Entwicklung von ein-und zweijährigen Kindern, die ein sehr niedriges Geburtsgewicht hatten
Die voraussichtliche Entwicklung von 61 Kindern mit sehr niedrigem Geburtsgewicht wurde im Alter von ein und zwei Jahren unter Verwendung der Bayley Scales of Infant Development unter Berücksichtigung der Unreife untersucht. Eine vorläufige Analyse ergab, daß die Mittelwerte für die geistige und psychomotorische Entwicklung bei beiden Untersuchungen innerhalb der Norm lagen. Weitere Analysen jedoch zeigten, daß die Parameter für die geistige Entwicklung im Alter von zwei Jahren deutlich schlechter waren, was primär durch eine Zunahme der Anzahl der Kinder mit schlechten Testergebnissen durch ‘hyperaktives' Verhalten im Alter von zwei Jahren bedingt war. Andere Untergruppen von Kindern mit niedrigen geistigen und psychomotorischen Entwicklungsscores fielen bei beiden Untersuchungen durch hyperaktives Verhalten und Unfähigkeit, gewöhnlich geringeren Grades, auf. Das Vorhandensein von Hyperaktivität, Unfähigkeit und Verminderter geistigen Leistung kann eine Hilfe sein, Kinder mit erhöhtem Entwicklungsrisiko frühzeitig zu erkennen.
Determinantes del desarrollo en niños con un peso al nacer muy bajo, supervivientes al año y dos años de edad
El nivel de desarrollo de 61 niños con muy bajo peso al nacer fue estudiado prospectivamente utilizando las Escalas Bayley de Desarrollo infantil a las edades de uno y dos años, corregidas por prematuridad. Los análisis prelininares mostraron que el puntaje promedio para el desarrollo psicomotor estaba dentro de los limites normales, ambas veces en que se pasó el test. Sin embargo, análisis posteriore mostraron que habia un significativo decrecimiento en los puntajes de desarrollo mental desde el años a los dos años de edad, debido fundamentalmente a un aumento en las cifras de los niños con bajo puntaje con comportamiento hiperactivo a los dos años. Subgrupos separados de niños con desarrollo mental y psicomotor subóptimo estaban caracterizados, en las dos ocasiones en que se pasó el test, por la presencia de una conducta hiperactiva y dishabilidad generalmente en un grado menor. La presencia de hiperactividad, dishabilidad y realización mental baja pueden ayudar en la identificaión precoz de niños con riesgo aumentado en su desarrollo.
[Show abstract][Hide abstract] ABSTRACT: Three hundred and seventy-seven consecutive liveborn infants with a birthweight between 500g and 1500g born at two perinatal centres in the calendar years 1977 and 1978 and 40 outborn infants in the same weight group admitted to one of the hospitals during the same period were studied. Although the survival rates in individual 100g weight groups vary between 14.3% and 97.4%, overall survival rates for inborn and outborn infants in both hospitals were similar, ranging from 69.0% to 71.5%. Twenty-two perinatal factors were found to have a significant effect on survival, of which 15 were common to the inborn populations in both hospitals. Eight of these 22 factors were indicators of intrapartum asphyxia. Multiple regression analysis showed that whereas birthweight was the most important variable influencing outcome in one hospital, the infant's condition at birth is the most important in the other. This difference may be related to the aggressive approach to perinatal intensive care of extremely preterm infants in the latter hospital.
Journal of Paediatrics and Child Health 03/2008; 17(4):277 - 280. DOI:10.1111/j.1440-1754.1981.tb01958.x · 1.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study of extremely low birth-weight (ELBW, birth-weight 500–999 g) infants born in Victoria was to determine the changes between 3 distinct eras; 1979-80, 1985-87, and 1991-92, in the proportions who were born outside level 3 perinatal centres (outbom), the proportions of outborn infants who were transferred after birth to a level 3 neonatal unit, the survival rate for outborn infants, and sensorineural impairment and disability rates in outborn survivors. The proportion of ELBW livebirths who were outborn fell significantly over successive eras, from 30.2% (106 of 351) in 1979-80, to 23.0% (129 of 560) in 1985-87, and to 15.6% (67 of 429) in 1991-92. Between 1979-80 and 1985-87, die proportions who were outborn fell predominantly in those of birth-weight from 800–999 g, whereas between 1985-87 and 1991-92 the proportions who were outborn fell predominandy in those of birth-weight 500–799 g. The proportions of outborn infants who were transferred after birth to a level 3 neonatal unit were similar in die 3 eras, at 49.1%, 38.0% and 41.2%, respectively. The survival rates for outborn infants were lower in each era dian for infants born in a level 3 perinatal centre. Only 1 outborn infant not transferred after birth to a level-3 unit survived in any era. The survival rates for infants transferred after birth were similar in the first 2 eras, but rose significantly in 1991-92 (34.6%, 36.7% and 60.7%, respectively). The rates of sensorineural impairments and disabilities in survivors fell significantly between die first 2 eras, and remained low in the last era. It is pleasing that the proportion of tiny babies who were outborn fell significantly over time, reflecting increased referral of high-risk mothers to level 3 perinatal centres before birth. For ELBW outborn infants, survival prospects free of substantial disability are reasonable, but not as good as for those born in level 3 perinatal centres.
Australian and New Zealand Journal of Obstetrics and Gynaecology 02/2008; 37(3):253 - 257. DOI:10.1111/j.1479-828X.1997.tb02403.x · 1.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND
We previously reported the results of a randomized, controlled trial showing that repeat doses of antenatal corticosteroids reduced the risk of respiratory distress syndrome and serious neonatal morbidity. However, data have not been available regarding longer-term effects of this treatment.
Women who had received an initial course of corticosteroid treatment 7 or more days previously were randomly assigned to receive an intramuscular injection of corticosteroid (11.4 mg of betamethasone) or saline placebo; the dose was repeated weekly if the mother was still considered to be at risk for preterm delivery and the duration of gestation was less than 32 weeks. We assessed survival free of major neurosensory disability and body size of the children at 2 years of corrected age.
Of the 1085 children who were alive at 2 years of age, 1047 (96.5%) were seen for assessment (521 exposed to repeat-corticosteroid treatment and 526 exposed to placebo). The rate of survival free of major disability was similar in the repeat corticosteroid and placebo groups (84.4% and 81.0%, respectively; adjusted relative risk, 1.04, 95% confidence interval, 0.98 to 1.10; adjusted P = 0.20). There were no
significant differences between the groups in body size, blood pressure, use of health services, respiratory morbidity, or child behavior scores, although children exposed to repeat doses of corticosteroids were more likely than those exposed to placebo to warrant assessment for attention problems (P = 0.04).
Administration of repeat doses of antenatal corticosteroids reduces neonatal morbidity without changing either survival free of major neurosensory disability or body size at 2 years of age. (Current Controlled Trials number, ISRCTN48656428.)
New England Journal of Medicine 09/2007; 357:1179‐89. · 55.87 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background The effi cacy and safety of repeat doses of prenatal corticosteroids remains uncertain. Our aim was to establish whether repeat prenatal corticosteroids given to women at risk of preterm birth can reduce neonatal morbidity without harm.
The Lancet 06/2006; 367:1913‐1919. DOI:10.1016/s0140‐6736(06)68846‐6 · 45.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Extrauterine growth restriction in preterm infants secondary to suboptimal nutrition is a major problem in neonatal intensive care units. Evidence is emerging that early growth deficits have long-term adverse effects, including short stature and poor neurodevelopmental outcomes. The parenteral route of feeding is essential to maintain nutritional integrity before successful transition to the enteral route of feeding is achieved. Nevertheless, early initiation of enteral feeding in sub-nutritional trophic quantity is vital for promoting gut motility and bile secretion, inducing lactase activity, and reducing sepsis and cholestatic jaundice. Results emerging from over sixty randomized clinical trials are available for providing a template on which feeding protocols can be based. Preterm breast milk expressed from the infant's own mother is the milk of choice. Supplementation with a human milk fortifier is necessary to optimize nutritional intake. Preterm formulas are an appropriate substitute for preterm human milk when the latter is unavailable. There are over ten systematic reviews of randomized controlled trials published by the Cochrane Library that addressed feeding strategies, but most do not address long-term outcome measures of clinical importance. There is an urgent need for large-scale, long-term randomized controlled trials to help evaluate metabolic, growth, and neurodevelopmental responses of preterm infants to earlier and more aggressive nutritional management.
Croatian Medical Journal 11/2005; 46(5):737-43. · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A proactive policy of resuscitation at birth and prompt initiation of intensive care have been shown to be associated with an improvement in the survival of very preterm infants in both institution-based and population-based studies. As a greater percentage of live births were offered intensive care, the survival rate rose progressively in all birth weight and gestation subgroups among extremely low birth weight infants, including those who were born at borderline viability between 23 weeks and 25 weeks of gestational age. Their quality-adjusted survival rate also rose progressively, since the large gains in survival over time had not been offset by significant increases in survival with disability. Cost-effectiveness and cost-utility ratios remained stable overall, with efficiency gains in the smaller infants over time, as more such infants were being born in Level III perinatal centers with the regionalization of perinatal-neonatal healthcare programs. National and international surveys of obstetricians and neonatologists on their perception of viability and their management decisions in extremely preterm infants have shown significant variations on the application use of intensive care in those born extremely preterm. If doctors believe that such infants have little prospect for intact survival, their management would be suboptimal or delayed, thus creating a self-fulfilling prophecy. Both developed and developing countries need to develop appropriate policies for initiating and withdrawing intensive care, taking into consideration their own cultural, social, and economic factors.
Croatian Medical Journal 11/2005; 46(5):744-50. · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To characterize parent perceptions and satisfaction with physician counseling and delivery-room resuscitation of very low birth weight infants in countries with neonatal intensive care capacity.
Convenience sample of 327 parents of 379 inborn very low birth weight infants (<1501 g) who had received resuscitation and neonatal intensive care in 9 neonatal intensive care units (NICUs) in 6 Pacific Rim countries and in 2 California hospitals. The sample comprised mostly parents whose infants survived, because in some centers interviews of parents of nonsurviving infants were culturally inappropriate. Of 359 survivors for whom outcome data were asked of parents, 29% were reported to have long-term sequelae. Half-hour structured interviews were performed, using trained interpreters as necessary, at an interval of 13.7 months after the infant's birth. We compared responses to interview questions that detailed counseling patterns, factors taken into consideration in decisions, and acceptance of parental decision-making.
Parents' recall of perinatal counseling differed among centers. The majority of parents assessed physician counseling on morbidity and mortality as adequate in most, but not all, centers. They less commonly perceived discussions of other issues as adequate to their needs. The majority (>65%) of parents in all centers felt that they understood their infant's prognosis after physician counseling. The proportion of parents who expected long-term sequelae in their infant varied from 15% (in Kuala Lumpur, Malaysia) to 64% (in Singapore). The majority (>70%) of parents in all centers, however, perceived their infant's outcome to be better than they expected from physician counseling. A majority of parents across all centers feared that their infant would die in the NICU, and approximately one third continued to fear that their infant might die at home after nursery discharge. The parents' regard for physicians' and, to a lesser extent, partners' opinions was important in decision-making. Less than one quarter of parents perceived that physicians had made actual life-support decisions on their own except in Melbourne, Australia, and Tokyo, Japan (where 74% and 45% of parents, respectively, reported sole physician decision-making). Parents would have preferred to play a more active, but not autonomous, role in decisions made for their infants. Counseling may heighten parents' anxiety during and after their infant's hospitalization, but that does not diminish their recalled satisfaction with counseling and the decision-making process.
Counseling differs by center among these centers in Australasia and California. Given that parents desire to play an active role in decision-making for their premature infant, physicians should strive to provide parents the medical information critical for informed decision-making. Given that parents do not seek sole decision-making capacity, physicians should foster parental involvement in life-support decisions to the extent appropriate for local cultural norms.
[Show abstract][Hide abstract] ABSTRACT: This study was undertaken to evaluate physician counselling practices and resuscitation decisions for extremely preterm infants in countries of the Pacific Rim. We sought to determine the degree to which physician beliefs, parents' opinion and medical resources influence decision-making for infants at the margin of viability.
A survey was administered to neonatologists and paediatricians who attend deliveries of preterm infants in Australia, Hong Kong, Japan, Malaysia, Taiwan and Singapore. Questions were asked regarding physician counselling practices, decision-making for extremely preterm infants and demographic information.
Physicians counsel parents antenatally with increasing frequency as gestational age increases. Most physicians discuss infant mortality and morbidity with parents prior to delivery. Physicians less frequently discuss the option of no resuscitation of an extremely preterm infant, withdrawal of support at a later time, or financial costs to parents. Severe congenital malformations, perception of a poor future quality of life, parental wishes and a high probability of death for the infant are influential in limiting resuscitation in very preterm infants for a majority of physicians. Less influential factors are parent socioeconomic status, language barriers, financial costs for the family, allocation of national resources, moral or religious considerations, or fear of litigation. Physician thresholds for resuscitation of infants ranged between 22 and 25 weeks gestation and between 400 and 700 g birthweight.
We report physician beliefs and practices regarding resuscitation and the counselling of parents of extremely preterm infants in Pacific Rim countries. While we find variation among countries, physician practices appear to be determined by ethical decision-making and medical factors rather than social or economic factors in each country.
Journal of Paediatrics and Child Health 05/2005; 41(4):209-14. DOI:10.1111/j.1440-1754.2005.00589.x · 1.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Close collaboration between obstetricians and neonatologists is essential for proper care of the growth-restricted fetus. A joint decision on the appropriate timing of delivery is made, based on the risk of fetal compromise compared with that of neonatal morbidity. A neonatal resuscitative team should be available at delivery. Gestational assessment, anthropological measurements and physical examination are necessary to confirm the diagnosis of intra-uterine growth retardation and establish the symmetric, asymmetric, combined or dysmorphic classification. Neonatal management requires special attention to a number of significant morbidities that growth-restricted infants are more prone to develop compared with normally grown infants, including asphyxia, meconium aspiration syndrome, respiratory distress syndrome, massive pulmonary haemorrhage, chronic lung disease, hypothermia, hypoglycaemia, hypocalcaemia, polycythaemia-hyperviscosity, intraventricular haemorrhage, sepsis, necrotizing enterocolitis, coagulation abnormalities, and congenital anatomical and genetic abnormalities. Intra-uterine growth retardation is associated with a higher stillbirth rate and infant mortality rate in preterm, term and post-term infants.
Seminars in Fetal and Neonatal Medicine 11/2004; 9(5):403-9. DOI:10.1016/j.siny.2004.03.004 · 3.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Regionalized perinatal care was first advocated in Canada 35 years ago. Its development in the United States of America (from 1971), United Kingdom (from 1972) and Australia (from 1978), has been described. In all instances, the efforts and perseverance of visionary individuals were crucial in introducing the concepts to the medical profession, and in bringing the principles to national consciousness at a governmental level. Official endorsement of regionalized perinatal care by both the national professional bodies and the central and regional governments was necessary. An important milestone along the path of regionalized perinatal care was the establishment of national training programmes, and the recognition of maternal-fetal medicine and neonatal-perinatal medicine as respective subspecialties for obstetricians and paediatricians. The developmental process requires close collaboration among all three groups (individuals, professional bodies and government) to improve both the quality and availability of perinatal services to a geographically defined region.
Seminars in Neonatology 05/2004; 9(2):89-97. DOI:10.1016/j.siny.2003.08.011
[Show abstract][Hide abstract] ABSTRACT: The importance of population-based long-term follow-up studies of geographically determined cohorts to evaluate the effectiveness, efficiency and availability of a regionalized perinatal-neonatal care programme is demonstrated by the Victorian Infant Collaborative Study Group. The survival and quality of survival of consecutively born extremely-low-birthweight infants below 1000 g or extremely preterm infants below 28 weeks' gestation in the state of Victoria were assessed up to 14 years of age over four distinctive eras: 1979-1989, 1985-1987, 1991-1992 and 1997. Both survival and quality-adjusted survival rates rose progressively in all birth weight and gestation subgroups, associated with progressively more such infants being born in level III perinatal centres. Cost-effectiveness and cost-utility ratios remained stable overall, with efficiency gains in the smaller infants over time. Regionalized long-term follow-up provides unique information that is not available from institution-based studies, which is vital to the regional organization of perinatal-neonatal care.
Seminars in Neonatology 05/2004; 9(2):135-44. DOI:10.1016/j.siny.2003.08.008
[Show abstract][Hide abstract] ABSTRACT: Globally, the perinatal mortality rate (PMR) is 53/1000 (7.5 million annual perinatal deaths) and the neonatal mortality rate (NMR) is 36/1000 (5.1 million annual neonatal deaths). Of the 141 million annual livebirths, 127 million (90%) are born in developing countries, which, compared to developed countries, have a higher PMR (57/1000 vs 11/1000, 5.2x) and NMR (39/1000 vs 7/1000, 5.6x). Five million annual neonatal deaths (98% of the world's total) occur in developing countries. Regional annual livebirths figures are: Asia-Oceania 76 million, Africa 31 million, Central and South America 12 million, Europe 8 million, and North America 4 million. Regional annual neonatal death figures are: Asia-Oceania 3.3 million, Africa 1.3 million, Central and South America 0.3 million, Europe 0.07 million, North America 0.03 million. The Asia-Oceania region has a PMR of 53/1000 and a NMR of 41/1000. It has half of the world's livebirths and two-thirds of the world's neonatal deaths. The PMR and NMR have often been used as an indicator of the standard of a country's social, educational and healthcare systems. Strategies, which address inequalities both within a country and between countries, are necessary if there is going to be further improvement in global perinatal health.
Journal of Perinatal Medicine 02/2003; 31(5):376-9. DOI:10.1515/JPM.2003.057 · 1.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The present review examines the role of dietary nucleotides in infants, and the scientific rationale and benefits of nucleotide supplementation of infant formula. The immunoprotective benefits of human milk, the biology of human milk nucleotides, and the immunological and gastrointestinal effects of dietary nucleotides in animal studies and in vitro experiments are examined. Clinical studies are reviewed, especially those examining the efficacy of nucleotide-supplemented infant formula in enhancing immunity and reducing the risk of sepsis. The presence of human milk cells, and a variety of immunoactive and trophic components of human milk, can explain the reduced incidence of sepsis in breastfed term and preterm infants. Nucleotides, believed to play an immunomodulatory role, are found in lower concentrations in infant formula. Animal studies have shown that dietary nucleotides enhance a number of immune responses and the growth, differentiation and repair of the gut. Several clinical studies have reported beneficial effects of nucleotide supplementation on gut microflora, diarrhoea and immune function, and one study has reported better catch-up growth in term infants with severe intrauterine growth retardation. More basic research studying the metabolism of nucleotides in neonates is encouraged. Additional randomized controlled trials are necessary to demonstrate the clinical benefits of nucleotide supplementation of infant formula, as it cannot be presumed that nucleotides produce the same benefits for the infant as human milk. Studies are especially necessary in high-risk neonatal situations, such as extreme prematurity, significant suboptimal nutrient intake before and after birth, and recovery from gut injury.
Journal of Paediatrics and Child Health 01/2003; 38(6):543-9. DOI:10.1046/j.1440-1754.2002.00056.x · 1.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A network of neonatal intensive care units in Pacific Rim countries was formed to compare infant risk factors, clinical practices, and outcomes for very low birthweight infants.
A multicentre, prospective study compared outcomes for infants born smaller than 1501 g or at less than 31 weeks gestation.
Gestational age-specific survival and incidence of intracranial haemorrhage varied for infants born in these nurseries. We found differences in infant risk factors among the nurseries. There were also significant differences in the use of antenatal steroids, but similar rates for Caesarean section and surfactant treatment. The factor most predictive of neonatal death and severe intracranial abnormality was an elevated Clinical Risk Index for Babies (CRIB) score. Antenatal steroid treatment (>24 h prior to delivery) was associated with improved survival and decreased incidence of severe intracranial abnormalities. Antenatal steroid treatment for less than 24 h prior to delivery was not associated with improved survival. Caesarean delivery was associated with improved survival, but showed no benefit regarding the incidence of severe intracranial abnormality.
Our Pacific Rim nursery network found differences in neonatal outcomes that correlated best with measures of neonatal risk at birth, antenatal steroid treatment, and Caesarean delivery. These data emphasize the importance of obstetric care to improve postnatal outcomes in premature infants, and highlight the usefulness of CRIB scores in these patients.
Journal of Paediatrics and Child Health 06/2002; 38(3):235-40. DOI:10.1046/j.1440-1754.2002.00779.x · 1.15 Impact Factor