Search

Objective: To determine whether the relative measurement of birth weight (BW) and head circumference (HC) in preterm infants is associated with neurological outcomes., Methods: The EPIPAGE-2 Study included 3473 infants born before 32 weeks' gestation, classified based on their Z-score of BW and HC on the Fenton curves as concordant (≤1 SD apart) or discordant (>1 SD difference). We defined four mutually exclusive categories: discordant smaller BW (sBW) with BW-1SD and concordant small measurement (CsM) with BW and HC concordant and both ≤-1SD. Neurological outcomes at 5.5 years were evaluated with standard tests., Results: 2592 (74.8%) preterm neonates were categorised as CM, 258 (7.4%) CsM, 378 (10.9%) sHC and 239 (6.9%) sBW. Compared with the CM children, those born with CsM had significantly higher risks of cognitive deficiency (adjusted OR (aOR) 1.3, 95% CI (1.0 to 2.0)), developmental coordination disorders (aOR 2.6 (1.5 to 4.4)) and need for special school services (aOR 2.3 (1.5 to 3.7)). Those born with sBW had significantly lower risk of cognitive deficiency (aOR 0.6 (0.4 to 0.9)) and the sHC group significantly higher risk of developmental coordination disorders (aOR 1.8 (1.0 to 3.2))., Conclusions: The relative discordance of these preterm infants' BW and HC was associated with their neurological outcomes. It merits further exploration as an indirect indicator of development., Trial Registration Number: NCT03078439., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: This study assessed the prevalence of small for gestational age (SGA) among very preterm (VPT) infants using national and European intrauterine references., Methods: We generated country-specific and common European intrauterine growth references for 11 European countries, according to Gardosi's approach and Hadlock's foetal growth model, using national data on birthweights by sex. These references were applied to the Effective Perinatal Intensive Care in Europe (EPICE) cohort, which comprised 7766 live VPT births without severe congenital anomalies under 32 weeks of gestation in 2011-2012, to estimate the prevalence of infants with SGA birthweights, namely those below the 10th percentile., Results: The SGA prevalence was 31.8% with country-specific references and 34.0% with common European references. The European references yielded a 10-point difference in the SGA prevalence between countries with lower term birthweights (39.9%) - Portugal, Italy and France - and higher term birthweights, namely Denmark, the Netherlands, Sweden (28.9%; p < 0.001). This was not observed with country-specific references, where the respective figures were 32.4% and 33.9% (p = 0.34), respectively., Conclusion: One-third of VPT infants were SGA according to intrauterine references. Common European references showed significant differences in SGA prevalence between countries with high and low-term birthweights., (©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Objective: Extrauterine growth restriction (EUGR) among very preterm infants is related to poor neurodevelopment, but lack of consensus on EUGR measurement constrains international research. Our aim was to compare EUGR prevalence in a European very preterm cohort using commonly used measures.Design: Population-based observational study.Setting: 19 regions in 11 European countries.Patients: 6792 very preterm infants born before 32 weeks' gestational age (GA) surviving to discharge.Main Outcome Measures: We investigated two measures based on discharge-weight percentiles with (1) Fenton and (2) Intergrowth (IG) charts and two based on growth velocity (1) birth weight and discharge-weight Z-score differences using Fenton charts and (2) weight-gain velocity using Patel's model. We estimated country-level relative risks of EUGR adjusting for maternal and neonatal characteristics and associations with population differences in healthy newborn size, measured by mean national birth weight at 40 weeks' GA.Results: About twofold differences in EUGR prevalence were observed between countries for all indicators and these persisted after case-mix adjustment. Discharge weight <10th percentile using Fenton charts varied from 24% (Sweden) to 60% (Portugal) and using IG from 13% (Sweden) to 43% (Portugal), while low weight-gain velocity ranged from 35% (Germany) to 62% (UK). Mean term birth weight strongly correlated with both percentile-based measures (Spearman's rho=-0.90 Fenton, -0.84 IG, p<0.01), but not Patel's weight-gain velocity (rho: -0.38, p=0.25).Conclusions: Very preterm infants have a high prevalence of EUGR, with wide variations between countries in Europe. Variability associated with mean term birth weight when using common postnatal growth charts complicates international benchmarking. [ABSTRACT FROM AUTHOR]

In France, secondary care hospitals encounter difficulties to adhere to retinopathy of prematurity (ROP) screening guidelines. Our objective was to assess the effectiveness and efficacy of a tele-expertise program for ROP screening in neonatal intensive care units without on-site ophthalmologists. We evaluated the impact of a tele-expertise program funded by the Paris Region Health Authority in a secondary care center general hospital of the Paris Region (CHSF), where there was previously no on-site ophthalmologist. We performed an observational, controlled before-after study, with a university tertiary care center with on-site ophthalmologists (Port-Royal) as the control group. Recruitment and data collection for both periods took place from 1 January 2012 to 31 December 31 2012, and from 1 January 2014 to 31 March 2015. The primary endpoint was the percentage of compliance with screening guidelines, secondary endpoints included pain scores and costs. Over the two periods, at total of 351 infants were recruited in the CHSF. Implementation of the tele-expertise resulted in an absolute +57.3% increase in the proportion of examinations realized in accordance with guidelines (3.8% during the "before" period and 61.1% during the "after" period, p<0.001). As compared with the control group, the proportion of infants appropriately screened improved (57.5% versus 43.1%, p = 0.002); median pain score on the acute pain rating scale for neonates during examination was significantly higher (median score 5.5/10, range [2.5–5.7] versus 2.0/10, range [1.0–3.1], p = 0.002). Screening rates in the control group remained unchanged. The average cost per examination increased from €337 in the "before" period to €353 in the "after period" in the tele-expertise group. The implementation of tele-expertise for ROP screening in the CHSF medical center resulted in a major improvement of access to care with a small cost increase. The issue of pain control during examination with tele-expertise should be further addressed. [ABSTRACT FROM AUTHOR]

Background and objectives: Small for gestational age and preeclampsia have both been described as risk factors for bronchopulmonary dysplasia in preterm neonates, but their respective role in the occurrence of bronchopulmonary dysplasia is debated. We evaluated the relation between small for gestational age and bronchopulmonary dysplasia in neonates born to mothers with preeclampsia. We hypothesized that low birth weight is still associated with bronchopulmonary dysplasia in this homogeneous population. Methods: Retrospective single-center cohort study including 141 neonates born between 24 and 30 weeks’ gestation to mothers with preeclampsia. The main outcome measure was moderate to severe bronchopulmonary dysplasia at 36 weeks’ postmenstrual age. Neonates born small for gestational age (birthweight < 10th percentile on the AUDIPOG curves) were compared to those with appropriate birthweight for gestational age by bivariable analyses and logistic regression models, estimating odds ratios (ORs) and 95% confidence intervals (CIs). Results: Bronchopulmonary dysplasia rates were 61.5% (32/52) and 27.4% (20/73) for small for gestational age and appropriate birthweight for gestational age neonates (p < .001). On adjustment for gestational age and other confounding factors, the risk of moderate to severe bronchopulmonary dysplasia was greater for small for gestational age than appropriate birthweight for gestational age neonates (adjusted OR = 5.9, 95% CI [2.2–15.4]), as was the composite outcome death or moderate to severe bronchopulmonary dysplasia (adjusted OR = 4.7, 95% CI [1.9–11.3]). Conclusions: Small for gestational age was associated with bronchopulmonary dysplasia in very preterm neonates born to mothers with preeclampsia. Registration number: CNIL no. 1747084. [ABSTRACT FROM AUTHOR]

Aim: We evaluated the impact of fetal growth restriction on neurodevelopmental outcomes at 2 years corrected age for infants born before 27 weeks gestational age.Method: Data on infants born before 27 weeks gestational age between 1999 and 2008 (n=463), admitted to a tertiary neonatal unit in Paris, were used to compare neurological outcomes at 2 years for infants with birthweight lower than the 10th centile and birthweight of at least the 10th centile, using intrauterine reference curves. Outcomes were cerebral palsy (CP) and the Brunet-Lézine assessment of cognitive development, which provides age-corrected overall and domain-specific (global and fine motor skills, language and social interaction) developmental quotients. Models were adjusted for perinatal and social factors.Results: Seventy-two percent of infants were discharged alive. Eighty-three percent (n=268) were evaluated at 2 years. Six percent had CP. Fetal growth restriction was not associated with the risk of CP. After adjustment, children with a birthweight lower than the 10th centile had a global developmental quotient 4.7 points lower than those with birthweight of at least the 10th centile (p<0.001); differences were greatest for fine motor and social skills (-4.7, p=0.053 and -7.3, p<0.001 respectively).Interpretation: In extremely preterm children, fetal growth restriction was associated with poorer neurodevelopmental outcomes at 2 years, but not with CP. [ABSTRACT FROM AUTHOR]

Objective: We investigated the impact of antenatal diagnosis of fetal growth restriction (FGR) on the risks of mortality and morbidity for very preterm infants given actual birthweight percentiles.Methods: Data on 4608 live born infants 24-31 weeks of gestational age (GA) in 10 European regions in 2003 were used to compare in-hospital mortality, bronchopulmonary dysplasia (BPD) and severe neurological morbidity by birthweight percentiles and antenatal diagnosis of FGR. Other covariates were GA, sex, multiplicity, maternal complications, antenatal corticosteroids, birth in a level III center and region.Results: Sixteen percent (n = 728) of all infants and 72%, 30% and 6%, respectively, of those with birthweight percentiles <10th, 10th-24th and ≥25th had an antenatal diagnosis of FGR. After adjustment for clinical factors, antenatal diagnosis of FGR was not associated with mortality for infants with a birthweight ≥10th percentile (OR [95% CI]: 0.9 [0.5-1.9] and 1.0 [0.6-1.8] for birthweights between the 10th-24th percentile and ≥25th percentile, respectively), but infants with a birthweight <10th percentile had higher mortality (OR [95% CI]: 2.4 [1.0-5.8]). No association was observed at any birthweight percentile with BPD or severe neurological morbidity.Conclusion: Antenatal diagnosis of FGR did not influence risks of mortality or morbidity when birthweight was ≥10th percentile; however, mortality risk was higher in antenatally detected infants with birthweight below the <10th percentile. [ABSTRACT FROM AUTHOR]

Monitoring CO2 levels in preterm infants receiving mechanical ventilation is designed to avoid the harmful consequences of hypocapnia or hypercapnia. Capnography is of questionable accuracy for monitoring PCO2 in preterm infants. To determine the accuracy of sidestream capnography in ventilated preterm infants by comparing end-tidal carbon dioxide (EtCO2) values to mixed venous carbon dioxide pressure (PvCO2) and to transcutaneous carbon dioxide pressure (TcPCO2). Simultaneous recordings of EtCO2, TcPCO2 and PvCO2 in 37 ventilated preterm infants. The PvCO2–EtCO2 gradient was calculated. The Bland–Altman technique and the intra-class correlation coefficient (ICC) were used to assess agreement between methods. The area under the curve (AUC) was calculated. Ninety-nine EtCO2/PvCO2 pairs were studied from 37 preterm infants with a mean gestational age of 27.7 ± 1.9 weeks and a mean birth weight of 1,003 ± 331 g. The mean PvCO2–EtCO2 gradient was 11.2 ± 8.0 mmHg, and the ICC was 0.28. The mean PvCO2–TcPCO2 gradient was 0 ± 7.8 mmHg, and the ICC was 0.78. AUCs for EtCO2 and TcPCO2 were similar in detecting high or low PvCO2. Despite an insufficient correlation between EtCO2 and PvCO2, capnography was able to detect low and high CO2 warning levels with a similar efficacy to that of TcPCO2, and may therefore be of clinical interest. [ABSTRACT FROM AUTHOR]

Backgound: Alveolarization requires coordinated extracellular matrix remodeling, a process in which matrix metalloproteinases (MMPs) play an important role. We postulated that polymorphisms in MMP genes might affect MMP function in preterm lungs and thus influence the risk of bronchopulmonary dysplasia (BPD). Methods and Findings: Two hundred and eighty-four consecutive neonates with a gestational age of ,28 weeks were included in this prospective study. Forty-five neonates developed BPD. Nine single-nucleotide polymorphisms (SNPs) were sought in the MMP2, MMP14 and MMP16 genes. After adjustment for birth weight and ethnic origin, the TT genotype of MMP16 C/T (rs2664352) and the GG genotype of MMP16 A/G (rs2664349) were found to protect from BPD. These genotypes were also associated with a smaller active fraction of MMP2 and with a 3-fold-lower MMP16 protein level in tracheal aspirates collected within 3 days after birth. Further evaluation of MMP16 expression during the course of normal human and rat lung development showed relatively low expression during the canalicular and saccular stages and a clear increase in both mRNA and protein levels during the alveolar stage. In two newborn rat models of arrested alveolarization the lung MMP16 mRNA level was less than 50% of normal. Conclusions: MMP16 may be involved in the development of lung alveoli. MMP16 polymorphisms appear to influence not only the pulmonary expression and function of MMP16 but also the risk of BPD in premature infants. [ABSTRACT FROM AUTHOR]