Trends in Perinatal Practices and Neonatal Outcomes of Very Low Birth Weight Infants during a 16-year Period at NEOCOSUR Centers

D’Apremont, Ivonne; Marshall, Guillermo; Musalem, Claudia; Mariani, Gonzalo; Musante, Gabriel; Bancalari, Aldo; Fabres, Jorge; Mena, Patrícia; Zegarra, Jaime; Tavosnanska, Jorge; Lacarrubba, José; Solana, Claudio; Ferreira, Catalina Vaz; Herrera, Tamara; Villarroel, Luís; Tapia, José Luís

doi:10.1016/j.jpeds.2020.05.040

Cited by 45 publications

(38 citation statements)

References 43 publications

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“…[1][2][3][4] Our highest eCPAP rate in 2018 (58.4%) was still lower than that (64.8%) reported by the South American multinational network. 18 Our highest LSCS rate by 2018 was comparable with most HICs networks. [1][2][3][4][5] During the first 8 years of this study period, only data on admission temperature was collected to monitor AH.…”

Section: Discussionmentioning

confidence: 60%

Ten-year trend of care practices, morbidities and survival of very preterm neonates in the Malaysian National Neonatal Registry: a retrospective cohort study

Chee

Neoh

et al. 2021

bmjpo

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ObjectivesTo determine a 10-year trend of survival, morbidities and care practices, and predictors of in-hospital mortality in very preterm neonates (VPTN, gestation 22 to <32 weeks) in the Malaysian National Neonatal Registry.DesignRetrospective cohort study.Setting43 Malaysian neonatal intensive care units.Patients29 010 VPTN (without major malformations) admitted between 1 January 2009 and 31 December 2018.Main outcome measuresCare practices, survival, admission hypothermia (AH, <36.5°C), late-onset sepsis (LOS), pneumothorax, necrotising enterocolitis grade 2 or 3 (NEC), severe intraventricular haemorrhage (sIVH, grade 3 or 4) and bronchopulmonary dysplasia (BPD).ResultsDuring this 10-year period, there was increased use of antenatal steroid (ANS), lower segment caesarean section (LSCS) and early continuous positive airway pressure (eCPAP); but decreased use of surfactant therapy. Survival had increased from 72% to -83.9%. The following morbidities had decreased: LOS (from 27.9% to 7.1%), pneumothorax (from 6.0% to 2.7%), NEC (from 8.1% to 4.7%) and sIVH (from 12.2% to 7.5%). However, moderately severe AH (32.0°C–35.9°C) and BPD had increased. Multiple logistic regression analyses showed that lower birth weight, no ANS, no LSCS, admission to neonatal intensive care unit with <100 VPTN admissions/year, no surfactant therapy, no eCPAP, moderate and severe AH, LOS, pneumothorax, NEC and sIVH were significant predictors of mortality.ConclusionSurvival and major morbidities had improved modestly. Failure to use ANS, LSCS, eCPAP and surfactant therapy, and failure to prevent AH and LOS increased risk of mortality.

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Section: Discussionmentioning

confidence: 60%

Ten-year trend of care practices, morbidities and survival of very preterm neonates in the Malaysian National Neonatal Registry: a retrospective cohort study

Chee

Neoh

et al. 2021

bmjpo

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“…Historically, cystic periventricular WMI or leukomalacia (cPVL), characterized by large cystic lesions in the deep periventricular white matter, was the most common type of white matter injury in preterm babies. Fortunately, this type of white matter injury has become much less common [ 2 ], presumptively due to improved obstetric and neonatal healthcare [ 3 ]. However, more diffuse types of white matter injuries are increasingly recognized [ 1 , 4 ].…”

Section: Patterns Of Preterm Brain Injurymentioning

confidence: 99%

Preterm Brain Injury, Antenatal Triggers, and Therapeutics: Timing Is Key

Ophelders

Gussenhoven

Klein

et al. 2020

Cells

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With a worldwide incidence of 15 million cases, preterm birth is a major contributor to neonatal mortality and morbidity, and concomitant social and economic burden Preterm infants are predisposed to life-long neurological disorders due to the immaturity of the brain. The risks are inversely proportional to maturity at birth. In the majority of extremely preterm infants (<28 weeks’ gestation), perinatal brain injury is associated with exposure to multiple inflammatory perinatal triggers that include antenatal infection (i.e., chorioamnionitis), hypoxia-ischemia, and various postnatal injurious triggers (i.e., oxidative stress, sepsis, mechanical ventilation, hemodynamic instability). These perinatal insults cause a self-perpetuating cascade of peripheral and cerebral inflammation that plays a critical role in the etiology of diffuse white and grey matter injuries that underlies a spectrum of connectivity deficits in survivors from extremely preterm birth. This review focuses on chorioamnionitis and hypoxia-ischemia, which are two important antenatal risk factors for preterm brain injury, and highlights the latest insights on its pathophysiology, potential treatment, and future perspectives to narrow the translational gap between preclinical research and clinical applications.

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“…Most relevant morbidities, associated with a higher risk of mortality in extremely PTNB include severe germinal matrix-intraventricular hemorrhage (GM-IVH), respiratory distress syndrome and necrotizing enterocolitis [19]. Also, a recent study on PTNB with a gestational age of 28.8 ± 2.9 weeks reports that despite the advances in modern neonatology the incidence of severe IVH, necrotizing enterocolitis and periventricular leukomalacia remained stable between 2001 and 20116 [20]. Interestingly, perinatal and, most relevantly, environmental factors, including from maternal education and occupation, whether they kids are taken care by the parents, stress exposure during neonatal intensive care unit stay or malnutrition among others, might have the greatest influence on future neurodevelopmental delay [3,16].…”

Section: Etiology and Consequences Of Prematuritymentioning

confidence: 99%

Germinal Matrix-Intraventricular Hemorrhage of the Preterm Newborn and Preclinical Models: Inflammatory Considerations

Atienza-Navarro

Alves-Martínez

Lubián‐López

et al. 2020

IJMS

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The germinal matrix-intraventricular hemorrhage (GM-IVH) is one of the most important complications of the preterm newborn. Since these children are born at a critical time in brain development, they can develop short and long term neurological, sensory, cognitive and motor disabilities depending on the severity of the GM-IVH. In addition, hemorrhage triggers a microglia-mediated inflammatory response that damages the tissue adjacent to the injury. Nevertheless, a neuroprotective and neuroreparative role of the microglia has also been described, suggesting that neonatal microglia may have unique functions. While the implication of the inflammatory process in GM-IVH is well established, the difficulty to access a very delicate population has lead to the development of animal models that resemble the pathological features of GM-IVH. Genetically modified models and lesions induced by local administration of glycerol, collagenase or blood have been used to study associated inflammatory mechanisms as well as therapeutic targets. In the present study we review the GM-IVH complications, with special interest in inflammatory response and the role of microglia, both in patients and animal models, and we analyze specific proteins and cytokines that are currently under study as feasible predictors of GM-IVH evolution and prognosis.

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Trends in Perinatal Practices and Neonatal Outcomes of Very Low Birth Weight Infants during a 16-year Period at NEOCOSUR Centers

Cited by 45 publications

References 43 publications

Ten-year trend of care practices, morbidities and survival of very preterm neonates in the Malaysian National Neonatal Registry: a retrospective cohort study

Ten-year trend of care practices, morbidities and survival of very preterm neonates in the Malaysian National Neonatal Registry: a retrospective cohort study

Preterm Brain Injury, Antenatal Triggers, and Therapeutics: Timing Is Key

Germinal Matrix-Intraventricular Hemorrhage of the Preterm Newborn and Preclinical Models: Inflammatory Considerations

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