Determinants of developmental outcomes in a very preterm Canadian cohort

Synnes, Anne; Luu, Thuy Mai; Moddemann, Diane; Church, Paige; Lee, David; Vincer, Michael; Ballantyne, Marilyn; Majnemer, Annette; Creighton, Dianne; Yang, Junmin; Sauve, Reginald S.; Saigal, Saroj; Shah, Prakesh S.; Lee, Shoo K.

doi:10.1136/archdischild-2016-311228

Cited by 204 publications

(177 citation statements)

References 28 publications

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“…2,10,207,211 Data from Canada and Sweden show that 73-83% of survivors after extremely preterm birth have no severe neurodevelopmental impairment. 212,213 NEC, however, significantly increases the risk. [212][213][214] Stricture of the bowel may occur after medical NEC, sometimes even in not confirmed cases, 12 but is more common after surgical NEC.…”

Section: Outcomementioning

confidence: 90%

“…212,213 NEC, however, significantly increases the risk. [212][213][214] Stricture of the bowel may occur after medical NEC, sometimes even in not confirmed cases, 12 but is more common after surgical NEC. In a Chinese study of 464 neonates with NEC, post-NEC strictures were predicted by a pronounced inflammatory response in the acute phase, expressed as a prolonged and accentuated elevation of C-reactive protein, thrombocytopenia, and clinical signs of peritonitis.…”

Section: Outcomementioning

confidence: 90%

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Necrotising Enterocolitis - epidemiology and imaging

Ahle¹

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Section: Outcomementioning

confidence: 90%

Section: Outcomementioning

confidence: 90%

Necrotising Enterocolitis - epidemiology and imaging

Ahle¹

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“…BPD, the most frequent major neonatal morbidity associated with very preterm birth, was defined as supplemental oxygen requirements at 36 weeks of postmenstrual age 20. For full‐term controls, we used medical charts, their immunization booklet (which contains birth information), or maternal recall in cases where no records were available.…”

Section: Methodsmentioning

confidence: 99%

Endothelial Colony‐Forming Cells in Young Adults Born Preterm: A Novel Link Between Neonatal Complications and Adult Risks for Cardiovascular Disease

Bertagnolli

Xie

Paquette

et al. 2018

JAHA

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BackgroundPreterm birth is linked to cardiovascular risks and diseases. Endothelial progenitor cells play a critical role in vascular development and repair. Cord blood endothelial progenitor cells of preterm‐born infants, especially endothelial colony‐forming cells (ECFC), show enhanced susceptibility to prematurity‐related pro‐oxidant stress. Whether ECFC dysfunction is present in adulthood following preterm birth is unknown.Methods and ResultsThis cross‐sectional observational study includes 55 preterm‐born (≤29 gestational weeks) young adults (18–29 years old, 38% male) and 55 sex‐ and age‐matched full‐term controls. ECFC were isolated from peripheral blood; cell proliferative and vascular cord formation capacities were assessed in vitro. Daytime systolic blood pressure was higher, whereas glucose tolerance and body mass index were lower in preterm‐born subjects. ECFC colonies grew in culture for 62% of full‐term‐ and 58% of preterm‐born participants. Preterm‐born participants have formed ECFC colonies later in culture and have reduced proliferation compared with controls. Only in preterm‐born individuals, we observed that the later the ECFC colony grows in culture, the worse was overall ECFC function. In addition, in preterms, elevated systolic blood pressure significantly correlated with reduced ECFC proliferation (rS=−0.463; P=0.030) and numbers of branches formed on matrigel (rS=−0.443; P=0.039). In preterm‐born subjects, bronchopulmonary dysplasia was associated with impaired ECFC function, whereas exposure to antenatal steroids related to better ECFC function.ConclusionsThis study is the first to examine ECFC in preterm‐born adults and to demonstrate ECFC dysfunction compared with full‐term controls. In the preterm‐born group, ECFC dysfunction was associated with bronchopulmonary dysplasia, the major prematurity‐related neonatal morbidity, and with increased systolic blood pressure into adulthood.

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“…This was a retrospective analysis of data collected as part of an observational cohort study conducted by the Canadian Neonatal Network (CNN) and the Canadian Neonatal Follow-up Network (CNFUN) [12]. The research ethics board at each site approved data collection, and infants’ caregivers provided written consent for the 18-month assessment.…”

Section: Methodsmentioning

confidence: 99%

Very Preterm Infants with Technological Dependence at Home: Impact on Resource Use and Family

Nassel¹,

Chartrand

Doré-Bergeron

et al. 2019

Neonatology

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Objective: To examine the impact of medical complexity among very preterm infants on health care resource use, family, and neurodevelopmental outcomes at 18 months’ corrected age. Methods: This observational cohort study of Canadian infants born < 29 weeks’ gestational age in 2009–2011 compared infants with and those without medical complexity defined as discharged home with assistive medical technology. Health care resource use and family outcomes were collected. Children were assessed for cerebral palsy, deafness, blindness, and developmental delay at 18 months. Logistic regression analysis was performed for group comparisons. Results: Overall, 466/2,337 infants (20%) needed assistive medical technology at home including oxygen (79%), gavage feeding (21%), gastrostomy or ileostomy (20%), CPAP (5%), and tracheostomy (3%). Children with medical complexity were more likely to be re-hospitalized (OR 3.6, 95% CI 3.0–4.5) and to require ≥2 outpatient services (OR 4.4, 95% CI 3.5–5.6). Employment of both parents at 18 months was also less frequent in those with medical complexity compared to those without medical complexity (52 vs. 60%, p < 0.01). Thirty percent of children with medical complexity had significant neurodevelopmental impairment compared to 13% of those without medical complexity (p < 0.01). Lower gestational age, lower birth weight, bronchopulmonary dysplasia, sepsis, and surgical necrotizing enterocolitis were associated with a risk of medical complexity. Conclusion: Medical complexity is common following very preterm birth and has a significant impact on health care use as well as family employment and is more often associated with neurodevelopmental disabilities. Efforts should be deployed to facilitate care coordination upon hospital discharge and to support families of preterm children with medical complexity.

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Determinants of developmental outcomes in a very preterm Canadian cohort

Abstract: Most preterm survivors are free of sNDI. The risk factors, including site, associated with neurodevelopmental status suggest opportunities for improving outcomes.

Cited by 204 publications

References 28 publications

Necrotising Enterocolitis - epidemiology and imaging

Necrotising Enterocolitis - epidemiology and imaging

Endothelial Colony‐Forming Cells in Young Adults Born Preterm: A Novel Link Between Neonatal Complications and Adult Risks for Cardiovascular Disease

Very Preterm Infants with Technological Dependence at Home: Impact on Resource Use and Family

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