Two-year outcome of infants weighing 600 grams or less at birth and born 1994 through 1998

Sweet, Matthew P.; Hodgman, Joan E.; Peña, Ivette; Barton, Lorayne; Pavlova, Zdena; Ramanathan, Rangasamy

doi:10.1016/s0029-7844(02)02451-1

Cited by 44 publications

(20 citation statements)

References 21 publications

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“…Preterm infants have a much higher burden of neurologic impairment (2). Although the etiology of preterm injury is multifactorial, exposure to hypoxia as shown by metabolic acidosis, active labor, abnormal heart rate traces in labor, and subsequent low Apgar scores is an important factor associated with adverse outcomes (3)(4)(5)(6), raising the possibility that some preterm infants might be candidates for treatment (7).…”

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confidence: 99%

Effect of Cerebral Hypothermia on Cortisol and Adrenocorticotropic Hormone Responses after Umbilical Cord Occlusion in Preterm Fetal Sheep

et al. 2008

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ABSTRACT:The hypothalamic-pituitary-adrenal (HPA) axis is essential for adaptation to stress. In the present study, we examined the hypothesis that head cooling with mild systemic hypothermia would adversely affect fetal adrenocorticotropic hormone (ACTH) and cortisol responses to an asphyxial insult. Chronically instrumented preterm fetal sheep (104 d of gestation, term is 147 d) were allocated to sham occlusion (n ϭ 7), 25 min of complete umbilical cord occlusion (n ϭ 7), or occlusion and head cooling with mild systemic hypothermia (n ϭ 7, mean Ϯ SEM esophageal temperature 37.6 Ϯ 0.3°C vs 39.0 Ϯ 0.2°C; p Ͻ 0.05) from 90 min to 70 h after occlusion, followed by spontaneous rewarming. During umbilical cord occlusion, there was a rapid rise in ACTH and cortisol levels, with further increases after release of cord occlusion. ACTH levels returned to sham control values after 10 h in both occlusion groups. In contrast, plasma cortisol levels remained elevated after 48 h in both occlusion groups and were still significantly elevated in the hypothermia-occlusion group 2 h after rewarming, at 72 h, compared with the normothermia-occlusion and sham groups. In conclusion, hypothermia does not affect the overall HPA responses to severe asphyxia in the preterm fetus but does prolong the cortisol response. (Pediatr Res 63: 51-55, 2008)

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Effect of Cerebral Hypothermia on Cortisol and Adrenocorticotropic Hormone Responses after Umbilical Cord Occlusion in Preterm Fetal Sheep

et al. 2008

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“…[1][2][3][4][5] Unfortunately, many of the surviving infants have been afflicted by serious developmental and/or long-term health problems. [2][3][4][5][6][7][8][9][10] The issue of survival versus quality of survival has engendered ethical debate. [11][12][13] It has prompted professional societies to express interest and make recommendations to health care providers regarding appropriate care of mothers and infants at this threshold of viability.…”

mentioning

confidence: 99%

Attitudes of Obstetric and Pediatric Health Care Providers Toward Resuscitation of Infants Who Are Born at the Margins of Viability

Lavin¹,

Kantak²,

Ohlinger³

et al. 2006

Pediatrics

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OBJECTIVES. The objective of this study was to determine the attitudes of a variety of health care providers toward the recommendations that should be made to parents regarding the resuscitation of infants who are born at the margins of viability. METHODS.A written questionnaire was distributed to the medical and nursing staff at 4 tertiary perinatal centers. For each of 5 weekly gestational age intervals from 22 weeks to 26 weeks, 6 days, the health care providers were asked to describe on a scale from 1 to 5 whether they would strongly discourage through strongly encourage resuscitation. They also were queried regarding their comfort with counseling regarding these issues. The attitudes of various groups of providers were compared across weekly intervals.RESULTS. A total of 204 physicians and 539 nurses completed the survey. The majority would strongly discourage, either discourage or strongly discourage, be neutral or recommend, recommend or strongly recommend, and strongly recommend resuscitation during the 23rd, 24th, 25th, 26th, and 27th weeks of gestation, respectively. Obstetric caregivers were slightly less likely than pediatric caregivers to strongly discourage resuscitation from 22 weeks to 22 weeks, 6 days and 23 weeks to 23 weeks, 6 days. There were no significant differences in the recommendations of obstetricians and pediatricians. Pediatric nurses were more likely to strongly recommend resuscitation from 26 weeks to 26 weeks, 6 days and more likely either to discourage or to strongly discourage resuscitation from 23 weeks to 23 weeks, 6 days and to strongly discourage resuscitation from the 22 weeks to 22 weeks, 6 days than their obstetric counterparts. Obstetric nurses were slightly less likely than obstetricians to strongly recommend resuscitation at 26 weeks to 26 www.pediatrics.org/cgi

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“…In 1999, the emphasis in decision making shifted to concerns of complications and long-term morbidity in these VLBW infants after a very poor 2-year outcome in these infants was observed. 11 It was then decided that there would be no routine resuscitation for infants <500 g or <23 weeks gestation. Infants of 500-600 g or >23 1/7th to 23 6/7th weeks gestation are resuscitated at the parents' request.…”

Section: Discussionmentioning

confidence: 99%

Decreasing trend in postneonatal mortality

2008

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Objective: The objective was to evaluate the postneonatal mortality rate at our institution from 1999 to 2006 as a follow-up to a previous report from our hospital covering 1993 to 1998 and to investigate the causes of death in infants dying in the postneonatal period.Study Design: We identified all infant deaths before discharge from the nursery aged X28 days. Clinical data for all cases and autopsy records where available were reviewed and the cause of death was determined for each infant.Result: Total nursery deaths for the 7 years were 211, of which 14 (6.6%) occurred after the neonatal period. This represents a decreasing trend from the 12% reported in 1993 to 1998. Causes of death were the complications of prematurity and congenital defects. The five infants whose cause of death was the complications of prematurity had chronic lung disease, four had abdominal surgery for perforation and resection and two had intraventricular hemorrhage (IVH) Gr IV. All infants had multiple organ failure by the time of death and the final event was infection and/or renal failure. The nine congenital defects included two trisomy 21 with complications, one CHARGE association with heart defects, one hypertrophic cardiomyopathy and two others with multiple congenital heart defects. Of the three remaining infants, the anomalies included one with hydranencephaly, one with caudal regression and one with multiple vascular liver tumors. Conclusion:Along with the general decrease in infant mortality, postneonatal mortality is decreasing as a percentage of nursery deaths. The causes of death include complications of prematurity and congenital defects.

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Two-year outcome of infants weighing 600 grams or less at birth and born 1994 through 1998

Cited by 44 publications

References 21 publications

Effect of Cerebral Hypothermia on Cortisol and Adrenocorticotropic Hormone Responses after Umbilical Cord Occlusion in Preterm Fetal Sheep

Effect of Cerebral Hypothermia on Cortisol and Adrenocorticotropic Hormone Responses after Umbilical Cord Occlusion in Preterm Fetal Sheep

Attitudes of Obstetric and Pediatric Health Care Providers Toward Resuscitation of Infants Who Are Born at the Margins of Viability

Decreasing trend in postneonatal mortality

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