Predicting neurosensory disabilities at two years of age in a national cohort of extremely premature infants

Leversen, Katrine Tyborg; Sommerfelt, Kristian; Rønnestad, Arild; Kaaresen, Per Ivar; Farstad, T; Skranes, J; Støen, Ragnhild; Elgen, Irene Bircow; Rettedal, Siren; Eide, Geir Egil; Irgens, Lorentz M.; Markestad, Trond

doi:10.1016/j.earlhumdev.2010.07.009

Cited by 32 publications

(34 citation statements)

References 39 publications

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“…Combined outcomes are problematic since each morbidity may be influenced by several factors. We had prespecified this secondary outcome since it is the most predictive factor for a life without disability 22,23 Survival without major complications was part of the analytical statistical plan, but this was analyzed only in an exploratory manner and was not adjusted for multiple comparison. This lack of adjustment is a limitation of the study.…”

Section: Discussionmentioning

confidence: 99%

Nonintubated Surfactant Application vs Conventional Therapy in Extremely Preterm Infants

et al. 2015

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Treatment of respiratory distress syndrome in premature infants with continuous positive airway pressure (CPAP) preserves surfactant and keeps the lung open but is insufficient in severe surfactant deficiency. Traditional surfactant administration is related to short periods of positive pressure ventilation and implies the risk of lung injury. CPAP with surfactant but without any positive pressure ventilation may work synergistically. This randomized trial investigated a less invasive surfactant application protocol (LISA).OBJECTIVE To test the hypothesis that LISA increases survival without bronchopulmonary dysplasia (BPD) at 36 weeks' gestational age in extremely preterm infants. DESIGN, SETTING, AND PARTICIPANTSThe Nonintubated Surfactant Application trial was a multicenter, randomized, clinical, parallel-group study conducted between April 15, 2009, and March 25, 2012, in 13 level III neonatal intensive care units in Germany. The final follow-up date was June 21, 2012. Participants included 211 of 558 eligible (37.8%) spontaneously breathing preterm infants born between 23.0 and 26.8 weeks' gestational age with signs of respiratory distress syndrome. In an intention-to-treat design, infants were randomly assigned to receive surfactant either via a thin endotracheal catheter during CPAP-assisted spontaneous breathing (intervention group) or after conventional endotracheal intubation during mechanical ventilation (control group). Analysis was conducted from September 6, 2012, to June 20, 2013.INTERVENTION LISA via a thin catheter. MAIN OUTCOMES AND MEASURESSurvival without BPD at 36 weeks' gestational age. RESULTSOf 211 infants who were randomized, 104 were randomized to the control group and 107 to the LISA group. Of the infants who received LISA, 72 (67.3%) survived without BPD compared with 61 (58.7%) of those in the control group. The reduction in absolute risk was 8.6% (95% CI, −5.0% to 21.9%; P = .20). Intervention group infants were less frequently intubated (80 infants [74.8%] vs 103 [99.0%]; P < .001) and required fewer days of mechanical ventilation. Significant reductions were seen in pneumothorax (5 of 105 intervention group infants [4.8%] vs 13 of 103 12.6%]; P = .04) and severe intraventricular hemorrhage (11 infants [10.3%] vs 23 [22.1%]; P = .02), and the combined survival without severe adverse events was increased in the intervention group (54 infants [50.5%] vs 37 [35.6%]; P = .02; absolute risk reduction, 14.9; 95% CI, 1.4 to 28.2).CONCLUSIONS AND RELEVANCE LISA did not increase survival without BPD but was associated with increased survival without major complications. Because major complications are related to lifelong disabilities, LISA may be a promising therapy for extremely preterm infants.

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Section: Discussionmentioning

confidence: 99%

Nonintubated Surfactant Application vs Conventional Therapy in Extremely Preterm Infants

et al. 2015

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“…[34][35][36] Although studies have suggested that administration of antenatal corticosteroids to the mother have improved some early-childhood neurosensory and developmental outcomes over the last decade for some group of preterm infants, 1,37,38 evidence is lacking whether this trend applies to the most extremely preterm infants born at Ͻ25 weeks' gestation. [39][40][41] Furthermore, the temporal trends have shown a relatively constant gap in neuropsychological skills between preterm and term children. 26,27,42,43 Our outcome data can be compared with recent reports in showing similar estimates of risks associated with either ultrasonographic evidence of brain injury or severe ROP in children born extremely preterm or with extremely low birth weight.…”

Section: Discussionmentioning

confidence: 99%

Impact at Age 11 Years of Major Neonatal Morbidities in Children Born Extremely Preterm

Farooqi¹,

Hägglöf²,

Sedin

et al. 2011

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT: Children born extremely preterm are at risk for neurosensory, cognitive, behavioral, and academic impairments. Severe retinopathy of prematurity, brain injury, and bronchopulmonary dysplasia are associated with poorer outcomes at early ages. WHAT THIS STUDY ADDS:Extremely preterm children, especially those with brain injury and severe retinopathy, have shown increased risk for poor outcome and increased needs for educational support services. This is the first study to examine the combined effect of the 3 most serious neonatal morbidities at 11 years in extremely preterm-born children.abstract BACKGROUND: Uncertainty continues regarding the extent to which neonatal morbidities predict poor long-term outcome and functional abilities in extremely preterm infants. OBJECTIVE:The goal of this study was to determine the impact of bronchopulmonary dysplasia (BPD), ultrasonographic signs of brain injury, and severe retinopathy of prematurity (ROP) on 11-year outcomes in infants born at Ͻ26 weeks' gestation. METHODS:A total of 247 infants were born alive before 26 completed weeks of gestation from 1990 through 1992 in all of Sweden, and 98 (40%) survived to a postmenstrual age of 36 weeks. Main outcome measures were (1) poor outcome, defined as combined end point of death after 36 weeks' postmenstrual age or survival with at least 1 major disability at 11 years, and (2) consequences of chronic conditions in the survivors according to a validated instrument administered to parents. RESULTS:Brain injury and severe ROP but not BPD correlated independently with poor outcome at 11 years of age. Among children who were free from BPD, brain injury, and severe ROP, 10% had a poor outcome. Corresponding rates with any 1, any 2, and all 3 neonatal morbidities were 19%, 58%, and 80%, respectively. Multivariate analysis revealed that brain injury and severe ROP were associated with high rates of consequences of chronic conditions. CONCLUSIONS:In infants born extremely preterm who survive to a postmenstrual age of 36 weeks, severe ROP and brain injury separately predict the risk of death or major disability at 11 years of age. Thus, continued research to determine how to prevent these complications of prematurity is critical. Pediatrics 2011;127:e1247-e1257

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“…For children who did not participate at 5 but did at 11 (n = 35), results regarding NDDs were obtained from the 2-year follow-up. 33 None of these children had CP or were blind or deaf. An experienced pediatrician (KS) contacted the parents of 17 children by phone because we could not exclude that the children had ID from the questionnaires.…”

Section: Ep/elbw Groupmentioning

confidence: 97%

Mental Health in Children Born Extremely Preterm Without Severe Neurodevelopmental Disabilities

et al. 2016

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Predicting neurosensory disabilities at two years of age in a national cohort of extremely premature infants

Cited by 32 publications

References 39 publications

Nonintubated Surfactant Application vs Conventional Therapy in Extremely Preterm Infants

Nonintubated Surfactant Application vs Conventional Therapy in Extremely Preterm Infants

Impact at Age 11 Years of Major Neonatal Morbidities in Children Born Extremely Preterm

Mental Health in Children Born Extremely Preterm Without Severe Neurodevelopmental Disabilities

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