Mortality, In-Hospital Morbidity, Care Practices, and 2-Year Outcomes for Extremely Preterm Infants in the US, 2013-2018

Bell, Edward F.; Hintz, Susan R.; Hansen, Nellie I.; Bann, Carla; Wyckoff, Myra H.; DeMauro, Sara B.; Walsh, Michele C.; Vohr, Betty R.; Stoll, Barbara J.; Carlo, Waldemar A.; Meurs, Krisa P. Van; Rysavy, Matthew A.; Patel, Ravi; Merhar, Stephanie L.; Sánchez, Pablo J.; Laptook, Abbot R.; Hibbs, Anna Maria; Cotten, C. Michael; D’Angio, Carl T.; Winter, Sarah; Fuller, Janell; Das, Abhik

doi:10.1001/jama.2021.23580

Cited by 315 publications

(143 citation statements)

References 42 publications

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“…Complications in preterm infants are the leading cause of death in the first month of life and continue to affect the outcome of preterm infants ( He et al, 2017 ; Cao et al, 2021 ; Bell et al, 2022 ). The gut microbiota plays important roles in health and disease.…”

Section: Discussionmentioning

confidence: 99%

Dynamic Changes of the Gut Microbiota in Preterm Infants With Different Gestational Age

Jia

Chang

et al. 2022

Front. Microbiol.

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The gut microbiota plays a key role in the pathogenesis of diseases affecting preterm infants and gestational age is one of the important factors which affect the gut microbiota of infants. To determine the characteristics of the gut microbiota in preterm infants of different gestational ages from birth to 1 year after birth, we collected 622 fecal samples from neonates of different gestational ages at different time points after birth. According to the gestational ages, the samples were divided into four groups, extremely preterm, very preterm, moderate to late preterm, and term group. Meconium and fecal samples at day 14, 28, 120, and 365 after birth were collected. 16S rRNA sequencing was performed and the composition and structure of the gut microbiota in preterm infants of different gestational age was compared with that of term infants. In our study, alpha diversity of meconium in extremely preterm group was higher than very preterm group, moderate to late preterm group and term group and alpha diversity of meconium in preterm group was decreased with increasing of gestational age. At day 14 to day 120 after birth, alpha diversity of term and moderate to late preterm group were significantly higher than other two preterm groups. However, moderate to late preterm group owned the highest alpha diversity which was higher than term group at day 365 after birth. Besides, the results shown the duration of opportunistic pathogen such as Klebsiella and Enterococcus which dominant colonization was different in different gestational age groups. As well as the probiotics, such as Bifidobacterium, which abundance enriched at different time point in different gestational age groups. We profiled the features of dynamic changes of gut microbiome from different gestational ages infants. The results of our research provide new insights for individualized interventions of specific microbes of preterm infants with different gestational ages at different time points after birth.

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Section: Discussionmentioning

confidence: 99%

Dynamic Changes of the Gut Microbiota in Preterm Infants With Different Gestational Age

Jia

Chang

et al. 2022

Front. Microbiol.

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“…1 Despite significant progression of neonatal intensive care treatments, NEC continues to be a devastating disease with an in-hospital mortality rate that can reach 30 to 50%. 2,3 Besides its impact on mortality, NEC is associated with significant morbidity such as short-bowel syndrome or malnutrition as well as with brain injury and impaired neurological development 4 5-7 Early diagnosis of NEC is challenging as initial clinical manifestations like vomiting, feeding intolerance or abdominal distension are frequent and non-specific symptoms in preterm infants. NEC may be clinically indistinguishable from other conditions such as sepsis-associated ileum, food protein induced enterocolitis (FPIEs) or spontaneous intestinal perforation (SIP).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Bedside Ultrasound for Early Diagnosis of Necrotizing Enterocolitis: A Pilot Study

et al. 2022

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Objective: To assess whether bedside ultrasound (BUS) as first imaging modality allows an earlier diagnosis of necrotizing enterocolitis (NEC) compared to abdominal radiography. Study design: Before-after controlled study in preterm infants with suspected NEC. The intervention group (October 2019-October 2021) received BUS as first imaging modality and were managed accordingly to BUS findings. The control group (October 2015-September 2019) received radiography as first imaging modality. The main outcome was NEC confirmation at the time of initial imaging. Secondary outcomes included time to diagnosis, laboratory data and treatment requirements. Results: Thirty-five episodes of suspected NEC with 14 (40%) confirmed NEC cases and 49 episodes of suspected NEC with 22 (44.9%) confirmed NEC cases were included in the intervention and control group respectively. In the intervention group 11 of 14 (78.6%) NEC cases were confirmed at initial evaluation compared to 5 of 22 (22.7%) in the control group (p=0.001). Infants in the intervention group developed thrombocytopenia and coagulopathy less frequently, were exposed to less radiation, and required less days of parenteral nutrition compared to the control group (p<0.05). Conclusion: The use of BUS as first imaging modality allowed an earlier diagnosis and timely treatment of NEC compared to abdominal radiography.

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“…Durch große Fortschritte in der perinatalen Versorgung überleben mehr Kinder, insbesondere extrem Frühgeborene (FG) an der Grenze der Lebensfähigkeit [ 7 ]. Trotz enormer Anstrengungen, das unreife Gehirn zu schützen, persistieren neurologische Einschränkungen wie z.…”

Section: Introductionunclassified

Biomarker und Neuromonitoring zur Entwicklungsprognose nach perinataler Hirnschädigung

Felderhoff-Müser

Hüning

2022

Monatsschr Kinderheilkd

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Das sich entwickelnde Gehirn ist in der Perinatalperiode besonders empfindlich für eine Vielzahl von Insulten, wie z. B. Extremfrühgeburtlichkeit und perinatale Asphyxie. Ihre Komplikationen können zu lebenslangen neurokognitiven, sensorischen und psychosozialen Einschränkungen führen; deren Vorhersage bleibt eine Herausforderung. Eine Schlüsselfunktion kommt der möglichst exakten Identifikation von Hirnläsionen und funktionellen Störungen zu. Die Prädiktion stützt sich auf frühe diagnostische Verfahren und die klinische Erfassung der Meilensteine der Entwicklung. Zur klinischen Diagnostik und zum Neuromonitoring in der Neonatal- und frühen Säuglingsperiode stehen bildgebende Verfahren zur Verfügung. Hierzu zählen zerebrale Sonographie, MRT am errechneten Termin, amplitudenintegriertes (a)EEG und/oder klassisches EEG, Nah-Infrarot-Spektroskopie, General Movements Assessment und die frühe klinische Nachuntersuchung z. B. mithilfe der Hammersmith Neonatal/Infant Neurological Examination. Innovative Biomarker und -muster (Omics) sowie (epi)genetische Prädispositionen sind Gegenstand wissenschaftlicher Untersuchungen. Neben der Erfassung klinischer Risiken kommt psychosozialen Faktoren im Umfeld des Kindes eine entscheidende Rolle zu. Eine möglichst akkurate Prognose ist mit hohem Aufwand verbunden, jedoch zur gezielten Beratung der Familien und der Einleitung von frühen Interventionen, insbesondere vor dem Hintergrund der hohen Plastizität des sich entwickelnden Gehirns, von großer Bedeutung. Diese Übersichtsarbeit fokussiert die Charakterisierung der oben genannten Verfahren und ihrer Kombinationsmöglichkeiten. Zudem wird ein Ausblick gegeben, wie innovative Techniken in Zukunft die Prädiktion der Entwicklung und Nachsorge dieser Kinder vereinfachen können.

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Mortality, In-Hospital Morbidity, Care Practices, and 2-Year Outcomes for Extremely Preterm Infants in the US, 2013-2018

Cited by 315 publications

References 42 publications

Dynamic Changes of the Gut Microbiota in Preterm Infants With Different Gestational Age

Dynamic Changes of the Gut Microbiota in Preterm Infants With Different Gestational Age

Bedside Ultrasound for Early Diagnosis of Necrotizing Enterocolitis: A Pilot Study

Biomarker und Neuromonitoring zur Entwicklungsprognose nach perinataler Hirnschädigung

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