Mortality and major morbidity in premature infants less than 31 weeks gestational age in the decade after introduction of surfactant

Genzel‐Boroviczény, Orsolya; Macwilliams, Sabine; Poblotzki, M. von; Zoppelli, Luciano

doi:10.1080/00016340500290947

Cited by 15 publications

(9 citation statements)

References 17 publications

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“…Validity of Dexamethasone use in advanced and severe ROP seems to be confirmed by hypothesis including the presence of proinflammatory agents in the development of retinal abnormalities. It is proved by the increased level of CRP in the analyzed laser-steroids group (p<0.01), being the highest in the most advanced ROP stages, coexisting with intrauterine infection, enterocolitis necroticans and pneumonia [2][3][4][5]7]. Moreover, in this group the significant increase of transfusion number, prolonged duration of ventilation and anemia was noticed (p<0.01), which is in accordance with data in the literature [45].…”

Section: Discussionsupporting

confidence: 79%

“…Additionally, it has been revealed that the so-called Fetal Inflammatory Response (FIRS) is the result of chorioamnionitis, antenatal intrauterine as well as Candida infections which are important agents in pathogenesis of prematurity complications such as sepsis, Periventricular Leukomalacia (PVL), Intraventricular Hemorrhage (IVH), Necrotizing Enterocolitis (NEC) or bronchopulmonary dysplasia [2,3,5,6]. There are also studies which state that the abovementioned factors intensify frequency and severity of ROP, however neonatal noninfectious inflammation might further increase the inflammatory burden [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Early Experience with Diode Laser Combined with Systemic Steroid Therapy for Severe Stages of Retinopathy of Prematurity

Modrzejewska¹,

Lachowicz²,

D³

et al. 2014

J Steroids Hormon Sci

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Citation: Modrzejewska M, Lachowicz E, Joanna Kot D, Lubiński W, Rudnicki J, et al. (2014) AbstractAims: To study the efficacy of diode laser-systemic steroid therapy in extremely and very-low-birth-weight prematures with severe Retinopathy of Prematurity (ROP).Methods: 36 eyes of 18 prematures, mean gestational age 25.67 weeks (SD ± 1.28) and 811, 83 g birth weight (SD ± 299.08) with aggressive-posterior ROP (AP-ROP) and threshold 3 ROP with plus sign and Extraretinal Fibrovascular Proliferation (EFP) were enrolled. Indirect diode laser combined with intravenous course of Dexamethason was applied. Analyzed risk factors were correlated with the same ones received in cohort treated only with laser. Shapiro-Wilk, t-Student, U Mann-Whitney tests were involved in the statistical analysis (significance levels at p<0.05).Results: Favorable anatomical results after mean 11.29 (SD ± 2.29) days of therapy were noted in 32 eyes (88.88%), ROP 5 developed in four eyes, but this difference was statistically non-significant (p=0.0612). Transient cortisol decreasing, hyperglycemia and partial adrenal fatigue were noted in some babies. During therapy, arterial systolic and diastolic pressures rose (p<0.05; p<0.01), significantly, which were related with severity of ROP, such as, C-reactive protein, erythrocyte and hematocrit, ventilation duration and number of transfusion (p<0.01).

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Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Early Experience with Diode Laser Combined with Systemic Steroid Therapy for Severe Stages of Retinopathy of Prematurity

Modrzejewska¹,

Lachowicz²,

D³

et al. 2014

J Steroids Hormon Sci

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“…It is estimated that worldwide, over 1 million neonates die annually due to overwhelming infections [1]. The incidence of sepsis correlates inversely with the gestational age of the infants, and premature infants, in particular, show a unique susceptibility to (bacterial) pathogens with secondary sepsis rates ranging from 22% to 36% in very low birth-weight neonates and up to 62% in extremely premature infants [2][3][4]. In addition to extrinsic factors, such as invasive procedures and long hospital stays, an immaturity of the immune system is thought to account for the increased rate of neonatal infections [5].…”

Section: Introductionmentioning

confidence: 99%

Neutrophil and endothelial adhesive function during human fetal ontogeny

Nußbaum

Gloning

Pruenster

et al. 2013

Journal of Leukocyte Biology

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Attenuation of the immune response contributes to the high rate of neonatal infections, particularly in premature infants. Whereas our knowledge of innate immune functions in mature neonates is growing, little is known about the ontogeny of neutrophil recruitment. We investigated neutrophils and ECs in the course of gestation with respect to rolling and adhesive functions. With the use of microflow chambers, we demonstrate that the neutrophil's ability to roll and adhere directly correlates with gestational age. These adhesion-related abilities are very rare in extremely premature infants (<30 weeks of gestation), which may correlate with our observation of markedly reduced expression of PSGL-1 and Mac-1 on neutrophils in preterm infants. In parallel, the capacity of HUVECs to mediate neutrophil adhesion under flow increases with gestational age. In addition, HUVECs from extremely premature infants exerting the lowest ability to recruit adult neutrophils show a diminished up-regulation of E-selectin and ICAM-1. Finally, by following neutrophil function postnatally, we show that maturation of PMN recruitment proceeds equivalently during extra- and intrauterine development. Thus, PMN recruitment and EC adhesion-related functions are ontogenetically regulated in the fetus, which might contribute significantly to the high risk of life-threatening infections in premature infants.

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“…Implementation of factors such as regionalization of perinatal care, more widespread use of antenatal steroids, postnatal surfactant, new modalities of mechanical ventilation and therapeutic use of nitric oxide, prevention of streptococcus group B infection, improvement of nutrition and improvement of general care in the NICU have undoubtedly contributed significantly to reducing neonatal mortality in ELBW neonates [18] . However, mortality in the delivery room (DR) has not substantially changed in the last decade and still represents 15% of liveborn and 32% of total deaths of ELBW infants [17,[19][20][21][22] . Interestingly, factors influencing early death in the DR are related with a proactive or a restrictive approach to ante-and perinatal treatment of the most immature infants between 22 and 25 weeks' gestation [23,24] but also to improving resuscitation protocols by implementation of acquired knowledge in everyday practice [25] .…”

Section: Early Neonatal Mortalitymentioning

confidence: 99%

Tailoring Oxygen Needs of Extremely Low Birth Weight Infants in the Delivery Room

Vento¹

2011

Neonatology

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Fetal to neonatal transition poses an extraordinary challenge for the extremely low birth weight (ELBW) neonate. Indeed a significant number of ELBW neonates will need proactive resuscitation to achieve postnatal stabilization. Positive pressure ventilation and oxygenation are the most relevant interventions in the delivery room (DR). Oxygen needs during resuscitation still represent a conundrum for neonatologists. While hyperoxemia favors oxidative stress and subsequent organ injury, hypoxemia is associated with long-term neurodevelopmental impairment. It has been shown that ELBW neonates can be successfully resuscitated with lower concentrations of oxygen as had been done traditionally. Moreover, reducing oxygen load has resulted in achievement of arterial partial pressures of oxygen at admission closer to the physiologic range, less oxidative stress and less inflammation. The availability of reference ranges for arterial oxygen saturation (SpO₂) for ELBW neonates in the first 10 min after birth has been an extraordinary step forward in our ability to individually titrate oxygen needs thus avoiding the risks of both hypo- and hyperoxemia. The optimal fraction of inspired oxygen (FiO₂) to initiate resuscitation and the safest SpO₂ percentiles for ELBW neonates during the first minutes of life are still unknown and will need further research in the future. Until then, optimal ventilation at birth and individually tailoring FiO₂ according to the nomogram seem to be the most reasonable and safe approach.

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Mortality and major morbidity in premature infants less than 31 weeks gestational age in the decade after introduction of surfactant

Cited by 15 publications

References 17 publications

Early Experience with Diode Laser Combined with Systemic Steroid Therapy for Severe Stages of Retinopathy of Prematurity

Early Experience with Diode Laser Combined with Systemic Steroid Therapy for Severe Stages of Retinopathy of Prematurity

Neutrophil and endothelial adhesive function during human fetal ontogeny

Tailoring Oxygen Needs of Extremely Low Birth Weight Infants in the Delivery Room

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