Neurodevelopmental and Growth Impairment Among Extremely Low-Birth-Weight Infants With Neonatal Infection

Stoll, Barbara J.; Hansen, Nellie I.; Adams‐Chapman, Ira; Fanaroff, Avroy A.; Hintz, Susan R.; Vohr, Betty R.; Higgins, Rosemary D.

doi:10.1001/jama.292.19.2357

Cited by 1,358 publications

(1,051 citation statements)

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“…3,[7][8][9][10] Preterm infants, known to exhibit a markedly increased risk for the development of severe infections, may critically depend on their innate immune response, as the presence of early-onset and nosocomial infections mainly determines acute and long-term morbidity and mortality in this population, especially regarding the development of neurological and pulmonary impairment. [17][18][19] Especially, the development of chronic lung disease in preterm infants is known to be triggered by infectious complications and ongoing inflammatory processes. 18,[20][21][22] The aim of the present study therefore was to investigate whether genetic variation within the MBL gene is associated with alterations of acute and long-term pulmonary morbidity in preterm infants.…”

Section: Discussionmentioning

confidence: 99%

“…The ability to respond effectively to infectious hazards clearly determines acute and long-term outcome especially in preterm infants. [17][18][19] Thus, several studies revealed pre-and postnatal infections to contribute to the development of chronic lung disease in preterm infants, 18,[20][21][22] which mainly determines morbidity and mortality during the first year of life in this patient cohort. Bronchopulmonary dysplasia (BPD) is histologically characterized by decreased alveolar septation resulting in large saccular airspaces, representing a rupture of pulmonary development from the saccular to the alveolar stage.…”

Section: Introductionmentioning

confidence: 99%

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Association of polymorphisms in the mannose-binding lectin gene and pulmonary morbidity in preterm infants

et al. 2007

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Deficiency in the collectin mannose-binding lectin (MBL) increases the risk for pulmonary and systemic infections and its complications in children and adults. The aim of this prospective cohort study was to determine the genetic association of sequence variations within the MBL gene with systemic infections and pulmonary short-and long-term complications in preterm infants below 32 weeks gestational age (GA). Three single-nucleotide polymorphisms (SNPs) in the coding region and one SNP in the promotor region of MBL2 were genotyped by direct sequencing and with sequence-specific probes in 284 newborn infants o32 weeks GA. Clinical variables were comprehensively monitored. An association was found between two SNPs and the development of bronchopulmonary dysplasia (BPD), defined as persistent oxygen requirement at 36 weeks postmenstrual age, adjusting for covariates GA, grade of respiratory distress syndrome and days on mechanical ventilation (rs1800450 (exon 1 at codon 54, B variant): odds ratio dominant model (OR) ¼ 3.59, 95% confidence interval (CI) ¼ 1.62-7.98; rs7096206 (À221, X variant): OR ¼ 2.40, 95% CI ¼ 1. 16-4.96). Haplotype analyses confirmed the association to BPD, and a single haplotype (frequency 56%) including all SNPs in their wild-type form showed a negative association with the development of BPD. We detected no association between the MBL gene variations and the development of early-onset infections or further pulmonary complications. Frequent variants of the MBL gene, leading to low MBL concentrations, are associated with the diagnosis of BPD in preterm infants. This provides a basis for potential therapeutic options and further genetic and proteomic analysis of the function of MBL in the resistance against pulmonary long-term complications in preterm infants.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association of polymorphisms in the mannose-binding lectin gene and pulmonary morbidity in preterm infants

et al. 2007

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“…Neonatal variables possibly related to the outcome were: bronchopulmonary dysplasia (BPD), small for gestational age (SGA), abnormal cranial ultrasound (periintraventricular or parenchymatous hemorrhage or leukomalacia), male gender, use of mechanical ventilation, patent ductus arteriosus (PDA), septicemia with positive blood culture, and gestational age categorized as less than versus greater than or equal to 28 weeks, birth weight less than 750g, necrotizing enterocolitis, head circumference at birth below the 10 th percentile 15,16 .…”

Section: Methodsmentioning

confidence: 99%

“…Stoll et al 15 reported a 20% loss-to-follow-up rate in very low birth weight premature children at 18 to 22 months corrected age. The children we studied belong to a low-income population, and many of the families live on the outskirts of the city of Rio de Janeiro and have difficulty paying for transportation to the hospital.…”

Section: Study Limitationsmentioning

confidence: 99%

Predictive factors for neuromotor abnormalities at the corrected age of 12 months in very low birth weight premature infants

Mello

Silva

Rodrigues

et al. 2009

Arq. Neuro-Psiquiatr.

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-Background: The increase in survival of premature newborns has sparked growing interest in the prediction of their long-term neurodevelopment. Objective: To estimate the incidence of neuromotor abnormalities at the corrected age of 12 months and to identify the predictive factors associated with altered neuromotor development in very low birth weight premature infants. Method: Cohort study. The sample included 100 premature infants. The outcome was neuromotor development at 12 months classified by Bayley Scale (PDI) and neurological assessment (tonus, reflexes, posture). A multivariate logistic regression model was constructed. Neonatal variables and neuromotor abnormalities up to 6 months of corrected age were selected by bivariate analysis. Results: Mean birth weight was 1126g (SD: 240). Abnormal neuromotor development was presented in 60 children at 12 months corrected age. Conclusion: According to the model, patients with a diagnosis including bronchopulmonary dysplasia, hypertonia of lower extremities, truncal hypotonia showed a 94.0% probability of neuromotor involvement at 12 months.KEY WORDS: infant, premature, child development, psychomotor performance, risk factors.Fatores preditivos para anormalidades neuromotoras aos 12 meses de idade corrigida em prematuros de muito baixo peso resumo -Introdução: O aumento na sobrevida de recém-nascidos prematuros tem suscitado interesse crescente na predição do seu neurodesenvolvimento a longo prazo. Objetivo: Estimar a incidência de anormalidades neuromotoras aos 12 meses de idade corrigida e identificar os fatores associados ao desenvolvimento neuromotor alterado em prematuros de muito baixo peso. Método: Estudo de coorte. A amostra incluiu 100 crianças prematuras.O desfecho foi o desenvolvimento neuromotor aos 12 meses. Modelo de regressão logística multivariado foi construído. Variáveis neonatais e anormalidades neuromotoras até os 6 meses de idade corrigida foram selecionadas por análise bivariada. Resultados: O peso de nascimento médio foi 1126g (DP:240). Aos 12 meses 60% das crianças apresentaram desenvolvimento neuromotor alterado. Conclusão: De acordo com o modelo, pacientes com diagnóstico incluindo displasia broncopulmonar, hipertonia de membros inferiores e hipotonia de tronco tinham 94% de probabilidade de comprometimento neuromotor aos 12 meses. PAlAVRAS-ChAVE: desenvolvimento infantil, desempenho psicomotor, criança, prematuro, fatores de risco.

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“…11 Late-onset neonatal sepsis is a significant risk factor for increased mortality and prolonged hospital stays, 12 although mortality is variable and related to the implicated pathogen. 13 In those who survive, there is poorer long-term growth and developmental outcomes, 14,15 with associated increased morbidity and increasing healthcare costs. 16 Prevention of CLABSI is a key objective for improvement of patient safety and reduction of mortality, hospital stay, and costs.…”

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confidence: 99%

Impact of a Central Line Infection Prevention Bundle in Newborn Infants

McMullan

Gordon

2016

Infect. Control Hosp. Epidemiol.

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OBJECTIVETo compare central line use and central line–associated bloodstream infection in newborn infants before and after the introduction of a central line infection prevention bundle in order to determine the effectiveness of the bundle and to identify areas for further improvement.DESIGNRetrospective cohort analysis of prospectively collected data.SETTINGLevel 5 neonatal intensive care unit in Sydney, Australia.PATIENTSNewborn infants admitted to the Royal Prince Alfred Hospital Neonatal Intensive Care Unit who had a central venous catheter (CVC) inserted.METHODSData regarding clinical characteristics, CVC use, and infection were collected before and after the introduction of a bundle of interventions. The bundles encompassed (1) insertion of CVC, (2) maintenance of CVC, (3) an education program, and (4) ongoing surveillance and feedback.RESULTSBaseline and intervention groups were comparable in clinical characteristics. The number of CVCs inserted was reduced in the intervention group (central line utilization rate, 0.16 vs 0.2, P<.0001). Overall CVC dwell time was reduced, resulting from significant reduction in peripherally inserted CVC dwell time (6 days [95% CI, 5.0–11.8 days] vs 7.3 days [4.0–10.4 days], P=.0004). Central line–associated bloodstream infections were significantly reduced, predominantly secondary to decreased peripherally inserted CVC–related bloodstream infections (1.2/1,000 central line–days vs 11.5/1,000 central line–days, P<.0001).CONCLUSIONThis central line infection bundle was effective in reducing CVC use, dwell time, and central line–associated bloodstream infections.Infect Control Hosp Epidemiol 2016;37:1029–1036

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Neurodevelopmental and Growth Impairment Among Extremely Low-Birth-Weight Infants With Neonatal Infection

Cited by 1,358 publications

References 57 publications

Association of polymorphisms in the mannose-binding lectin gene and pulmonary morbidity in preterm infants

Association of polymorphisms in the mannose-binding lectin gene and pulmonary morbidity in preterm infants

Predictive factors for neuromotor abnormalities at the corrected age of 12 months in very low birth weight premature infants

Impact of a Central Line Infection Prevention Bundle in Newborn Infants

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