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Abstract Background Foramen ovale (FO) is an obligate fetal shunt that typically resolves after birth, although patency throughout life is not uncommon. The natural history of patent FO (PFO) is known in term infants, but less is known about its course in extremely preterm infants. We describe the echocardiographic changes in FO size from birth to discharge in extremely low birth weight (ELBW) infants in this retrospective study. Methods Cohort was divided based on size of FO at birth. Size of FO at discharge was measured and evaluated relative to postnatal weight gain. Demographics and clinical outcomes were compared between the two groups. Results Of the 54 ELBW infants, 50 were born with FO less than 3 mm in diameter (small), and 4 were born with FO greater than 3 mm (large). Of small defects, the majority (44/50, 88%) did not increase in size with weight gain, and minority (6/50, 12%) increased in size, and three of these 6 patients, FO grew to be slightly larger than 3 mm. In contrast, all large defects (4 of 4, 100%) nearly doubled in size with postnatal growth. These 4 ELBW infants with enlargement of FO had a flap valve evident on echocardiogram obtained prior to discharge, and subsequently closed on outpatient follow-up echocardiograms, although time to resolution was variable (6 months – 3 years). One infant had presumptive resolution because of the presence of flap valve. Conclusion No maternal or neonatal demographic characteristics were predictive of FO enlargement, although, demonstrable flap valve on discharge echocardiogram correlated with resolution of FO on outpatient follow-up echocardiogram. Therefore, based on our data, we recommend that ELBW infants born with large FO should have echocardiographic re-evaluation of the atrial septal opening prior to discharge, to specify the presence of a flap valve or lack thereof, which is an important detail that can help a neonatologist determine the need for outpatient cardiac follow-up.

Abstract Background Preterm birth and low birthweight have been associated with increased risk of heart failure and cardiovascular disease in young adulthood. However, results from clinical studies of myocardial function are not consistent. Echocardiographic strain analyses allow detection of early stages of cardiac dysfunction, and non-invasive estimates of myocardial work can provide additional information on cardiac function. We aimed to evaluate left ventricular (LV) myocardial function including measures of myocardial work in young adults born very preterm (gestational age -16%, but 22% had borderline impaired GLS between − 16% and − 18%. Mean GLS in PB/ELBW (-19.4% (95% confidence interval (CI) -20.0, -18.9)) was impaired compared to controls (-20.6% (95% CI -21.1, -20.1)), p = 0.003. Lower birthweight was associated to more impaired GLS (Pearson correlation coefficient − 0.2). Means of EF, measures of diastolic function including left atrial reservoir strain, global constructive and wasted work, global work index and global work efficiency was similar in PB/ELBW and controls. Conclusion The young adults born very preterm or with extremely low birthweight had impaired LV-GLS compared to controls, although systolic function mainly within normal range. Lower birthweight was associated with more impaired LV-GLS. These findings could indicate an elevated lifetime risk of developing heart failure in preterm born individuals. Measures of diastolic function and myocardial work were similar compared to controls.

Background: Foramen ovale (FO) is an obligate fetal shunt that typically resolves after birth, although patency throughout life is not uncommon. The natural history of patent FO (PFO) is known in term infants, but less is known about its course in extremely preterm infants. We describe the echocardiographic changes in FO size from birth to discharge in extremely low birth weight (ELBW) infants in this retrospective study. Methods: Cohort was divided based on size of FO at birth. Size of FO at discharge was measured and evaluated relative to postnatal weight gain. Demographics and clinical outcomes were compared between the two groups. Results: Of the 54 ELBW infants, 50 were born with FO less than 3 mm in diameter (small), and 4 were born with FO greater than 3 mm (large). Of small defects, the majority (44/50, 88%) did not increase in size with weight gain, and minority (6/50, 12%) increased in size, and three of these 6 patients, FO grew to be slightly larger than 3 mm. In contrast, all large defects (4 of 4, 100%) nearly doubled in size with postnatal growth. These 4 ELBW infants with enlargement of FO had a flap valve evident on echocardiogram obtained prior to discharge, and subsequently closed on outpatient follow-up echocardiograms, although time to resolution was variable (6 months – 3 years). One infant had presumptive resolution because of the presence of flap valve. Conclusion: No maternal or neonatal demographic characteristics were predictive of FO enlargement, although, demonstrable flap valve on discharge echocardiogram correlated with resolution of FO on outpatient follow-up echocardiogram. Therefore, based on our data, we recommend that ELBW infants born with large FO should have echocardiographic re-evaluation of the atrial septal opening prior to discharge, to specify the presence of a flap valve or lack thereof, which is an important detail that can help a neonatologist determine the need for outpatient cardiac follow-up. [ABSTRACT FROM AUTHOR]

Background: Preterm birth and low birthweight have been associated with increased risk of heart failure and cardiovascular disease in young adulthood. However, results from clinical studies of myocardial function are not consistent. Echocardiographic strain analyses allow detection of early stages of cardiac dysfunction, and non-invasive estimates of myocardial work can provide additional information on cardiac function. We aimed to evaluate left ventricular (LV) myocardial function including measures of myocardial work in young adults born very preterm (gestational age < 29 weeks) or with extremely low birthweight (< 1000 g) (PB/ELBW), compared with term-born age- and sex matched controls. Methods: 63 PB/ELBW and 64 controls born in Norway in the periods 1982–1985, 1991–1992, and 1999–2000 were examined with echocardiography. LV ejection fraction (EF) and LV global longitudinal strain (GLS) were measured. Myocardial work was estimated from LV pressure-strain loops after determination of GLS and construction of a LV pressure curve. Diastolic function was evaluated by determination of the presence or absence of elevated LV filling pressure, including measures of left atrial longitudinal strain. Results: The PB/ELBW with mean birthweight 945 (standard deviation (SD) 217) grams, mean gestational age 27 (SD 2) weeks, and mean age 27 (SD 6) years had LV systolic function mainly within normal range. Only 6% had EF < 50% or impaired GLS >-16%, but 22% had borderline impaired GLS between − 16% and − 18%. Mean GLS in PB/ELBW (-19.4% (95% confidence interval (CI) -20.0, -18.9)) was impaired compared to controls (-20.6% (95% CI -21.1, -20.1)), p = 0.003. Lower birthweight was associated to more impaired GLS (Pearson correlation coefficient − 0.2). Means of EF, measures of diastolic function including left atrial reservoir strain, global constructive and wasted work, global work index and global work efficiency was similar in PB/ELBW and controls. Conclusion: The young adults born very preterm or with extremely low birthweight had impaired LV-GLS compared to controls, although systolic function mainly within normal range. Lower birthweight was associated with more impaired LV-GLS. These findings could indicate an elevated lifetime risk of developing heart failure in preterm born individuals. Measures of diastolic function and myocardial work were similar compared to controls. [ABSTRACT FROM AUTHOR]

Summary: Background: It is unclear if expiratory airflow in survivors born extremely low birth weight (ELBW; 500–999 g) has improved after the introduction of exogenous surfactant into clinical practice in 1991. The primary aim of this study was to describe the changes in airflow at 7–8 years of age of survivors born ELBW in five discrete cohorts from 14 years before to 14 years after the introduction of exogenous surfactant into clinical practice. Methods: The cohorts comprised consecutive survivors born ELBW in 1977–82 and 1985–87 at the Royal Women's Hospital, Melbourne, and in 1991–92, 1997 and 2005 in the state of Victoria, Australia. Survival rates to 2-years of age for infants born ELBW in the state of Victoria rose from approximately 1-in-4 to 3-in-4 over the time of this study. Expiratory airflow measurements at 7–8 years included the forced expired volume in 1 s (FEV1), converted to z-scores for age, height, sex, and race. Findings: There were 596 ELBW participants with expiratory flow data, 280 (47%) of whom had bronchopulmonary dysplasia (BPD). Overall, there was little change in zFEV1 over the 28-year period (mean change per year; 0.003, 95% CI −0.010, 0.015, P = 0.67). There was, however, evidence of an interaction between BPD and year; zFEV1 in those who had BPD fell over time (mean change per year −0.019, 95% CI −0.037, −0.009, P = 0.035), whereas zFEV1 improved in those who did not have BPD (mean change per year 0.021, 95% CI 0.006, 0.037, P = 0.007). Interpretation: Contrary to recent evidence, expiratory airflow of children born ELBW has not improved with the introduction of surfactant, and may be deteriorating in those who had BPD. Funding: National Health and Medical Research Council (Australia); Victorian Government’s Operational Infrastructure Support Program.

Background: In infants born weighing ≤500 g, little has been studied about the association between neurodevelopmental prognosis and growth. This study aimed to evaluate the association between neurodevelopmental impairment (NDI) and z‐scores of physical measurements in infants born weighing ≤500 g. Methods: A single‐center, retrospective cohort study in a level IV neonatal intensive care unit in Japan. Infants born weighing ≤500 g between 2010 and 2019 were eligible. Z‐scores in weight, length/height, and head circumference at birth, due date (or discharge), 6 and 18 months of corrected age, and 3 years of age were compared between infants with and without NDI at 3 years of age. Three infants with severe intraventricular hemorrhage or periventricular leukomalacia were excluded from the comparison analyses. NDI was defined as having a developmental quotient of ≤70, cerebral palsy, visual impairment, or hearing impairment. Results: Of 22 eligible infants, the incidence of NDI at 3 years of age was 54.5%. The z‐score was significantly smaller in the NDI group (n = 10) than that in the non‐NDI group (n = 9) in head circumference at birth (median, −1.94 vs. −0.75; Z = 0.54; p = 0.020), and in height at 18 months of corrected age (median, −2.84 vs. −1.79; Z = 0.58; p = 0.013) and 3 years of age (median, −2.02 vs. −1.21; Z = 0.47; p = 0.046). Conclusions: NDI at 3 years of age was associated with a small head circumference z‐score at birth, height at 18 months of corrected age, and height at 3 years of age in infants born weighing ≤500 g. [ABSTRACT FROM AUTHOR]

IntroductionGlucocorticoids are currently used for the co-therapeutic management of autoimmune hepatitis and some cholestatic diseases. Thus far, we do not know the efficacy of glucocorticoids in the treatment of parenteral nutrition-associated cholestasis. We aimed to analyze whether the administration of late postnatal dexamethasone for treating bronchopulmonary dysplasia influence the occurrence of parenteral nutrition-associated cholestasis in preterm neonates.MethodsA retrospective study was conducted for 78 preterm neonates without major anomalies (gestational age was

Background: Although outcomes for infants born extremely low birthweight (ELBW; <1000 g birthweight) have improved over time, it is important to document survival and morbidity changes following the advent of modern neonatal intensive care in the 1990s. Objective: To describe trends in survival, perinatal outcomes and neurodevelopment to 2 years' corrected age over time across six discrete geographic cohorts born ELBW between 1979 and 2017. Methods: Analysis of data from discrete population‐based prospective cohort studies of all live births free of lethal anomalies with birthweight 500–999 g in the state of Victoria, Australia, over 6 eras: 1979–80, 1985–87, 1991–92, 1997, 2005 and 2016–17. Perinatal data collected included survival, duration and type of respiratory support, neonatal morbidities and two‐year neurodevelopmental outcomes. Results: More ELBW live births were inborn (born in a maternity hospital with a neonatal intensive care unit) over time (1979–80, 70%; 2016–17, 84%), and more were offered active care (1979–80, 58%; 2016–17, 90%). Survival to 2 years rose substantially, from 25% in 1979–80 to 80% in 2016–17. In survivors, rates of any assisted ventilation rose from 75% in 1979–80 to 99% in 2016–17. Cystic periventricular leukomalacia, severe retinopathy of prematurity and blindness improved across eras. Two‐year data were available for 95% (1054/1109) of survivors. Rates of cerebral palsy, deafness and major neurodevelopmental disability changed little over time. The annual numbers with major neurodevelopmental disability increased from 12.5 in 1979–80 to 30 in 2016–17, but annual numbers free of major disability increased much more, from 31 in 1979–80 to 147 in 2016–17. Conclusions: Active care and survival rates in ELBW children have increased dramatically since 1979 without large changes in neonatal morbidities. The numbers of survivors free of major neurodevelopmental disability have increased more over time than those with major disability. [ABSTRACT FROM AUTHOR]

Aims. The aim of the present study was to evaluate the general and oral health status of a group of preterm one-year-old very low (VLBW) and extremely low birthweight (ELBW) infants and make a comparison with full-term one-year-old normal birthweight infants (NBW). Methods. A cross-sectional study was conducted in 102 one-year-old preterm VLBW and ELBW infants, and the data obtained were compared to 87 one-year-old full-term NBW infants. The infants' medical histories were obtained from hospital records and interviews with the mothers. The oral cavities of all infants were examined under the same conditions. The chi-square test, Pearson's chi-square test of independence and Mann-Whitney test were used for the statistical evaluation, with P < 0.05 considered statistically significant. Relative risk (RR) and 95% confidence interval (CI) estimates for variables significantly associated with oral findings were calculated. Results. Both perinatal variables (gestational age, mode of delivery, birthweight, Apgar score, resuscitation, orotracheal intubation and presence of intraoral pathology) and neonatal variables (antibiotic treatment and infections) had a significant association with prematurity, VLBW and ELBW. The one-year-old preterm VLBW and ELBW infants frequently suffered from general diseases, frequently received regular medication and had fewer erupted primary teeth; they also had a higher prevalence of developmental defects of the enamel and deformations of the hard palate. Conclusion. This study confirmed anamnestic, medical and oral differences between one-year-old preterm VLBW and ELBW and full-term NBW infants.

Aim: To assess the causal effect of being born extremely preterm (EP; <28 weeks' gestation) or extremely low birthweight (ELBW; <1000 g), compared with being born at term, on neurodevelopment and social‐emotional development at 2 years' corrected age. Methods: Prospective geographical cohort study of children born EP/ELBW over 12 months in 2016 from Victoria, Australia, and term‐born controls. Children were assessed at 2 years' corrected age with the Bayley Scales of Infant and Toddler Development–3rd edition and the Infant‐Toddler Social and Emotional Assessment. Delay was defined as <−1 standard deviation relative to the mean of controls. The estimand of interest was the mean difference/odds ratio (OR) between the EP/ELBW and control groups estimated using linear/logistic regression, adjusted for multiple pregnancy and social risk. Results: A total of 205 EP/ELBW and 201 controls were assessed at 2 years. Delay/concerns were more common in the EP/ELBW group compared with controls, for cognitive (OR 3.7 [95% confidence interval 2.3, 6.0]), language (5.3 [3.1, 9.0]) and motor (3.9 [2.3, 6.3]) development, and social‐emotional competence (4.1 [1.6, 10.2]). Conclusion: Being born EP/ELBW has an adverse effect on cognitive, language and motor development, and social‐emotional competence at 2 years' corrected age. Close developmental surveillance, including social‐emotional development, is recommended. [ABSTRACT FROM AUTHOR]

Background: Preterm birth and low birthweight have been associated with increased risk of cardiovascular disease in young adults. Endothelial dysfunction is established as an early marker for development of atherosclerotic cardiovascular disease. Previous studies of endothelial function in young adults born very preterm or with extremely low birthweight have, however, shown diverging results.Objective: We aimed to evaluate the risk of cardiovascular disease as measured by vascular endothelial function in young adults born very preterm (

Background: Children born small for gestational age (SGA), particularly when associated with an extremely low birthweight (ELBW), have a higher risk of renal dysfunction. Growth hormone (GH) treatment is used to treat short‐statured children born SGA; however, its effects on renal function remain elusive, especially in those born SGA with ELBW. Methods: Short‐statured children born SGA (N = 42) were included. Subjects were subdivided into two groups based on their birthweight: the ELBW group (N = 15) with a birthweight of <1,000 g, and the non‐ELBW group (N = 27) with birthweights ranging between 1,000 and 2,500 g. The creatinine‐based estimated glomerular filtration rates (eGFR) before (pre‐eGFR) and 5 years after GH treatment (post‐eGFR) were compared. Correlations between eGFR, anthropometric, or birth parameters, and cumulative GH dose were evaluated using Spearman's rank correlation coefficient. Results: The ELBW group had a lower pre‐ and post‐eGFR than the non‐ELBW group. Five‐year GH treatment did not significantly reduce eGFR in either group. Post‐eGFR was positively associated with gestational week and birthweight. However, the cumulative GH dose was not correlated with pre‐eGFR, post‐eGFR, or percentage change in eGFR (%ΔeGFR). The change in bodyweight standard deviation score during GH treatment was positively correlated with %ΔeGFR in the ELBW group. Conclusions: The current results indicated that GH treatment was unlikely a risk for the reduction in eGFR in short‐statured children born SGA. However, eGFR should be carefully monitored, especially in those born SGA with ELBW because these subjects had lower eGFR than non‐ELBW subjects. [ABSTRACT FROM AUTHOR]

Aims. The aim of the present study was to evaluate the general and oral health status of a group of preterm one-yearold very low (VLBW) and extremely low birthweight (ELBW) infants and make a comparison with full-term one-year-old normal birthweight infants (NBW). Methods. A cross-sectional study was conducted in 102 one-year-old preterm VLBW and ELBW infants, and the data obtained were compared to 87 one-year-old full-term NBW infants. The infants' medical histories were obtained from hospital records and interviews with the mothers. The oral cavities of all infants were examined under the same conditions. The chi-square test, Pearson's chi-square test of independence and Mann-Whitney test were used for the statistical evaluation, with P < 0.05 considered statistically significant. Relative risk (RR) and 95% confidence interval (CI) estimates for variables significantly associated with oral findings were calculated. Results. Both perinatal variables (gestational age, mode of delivery, birthweight, Apgar score, resuscitation, orotracheal intubation and presence of intraoral pathology) and neonatal variables (antibiotic treatment and infections) had a significant association with prematurity, VLBW and ELBW. The one-year-old preterm VLBW and ELBW infants frequently suffered from general diseases, frequently received regular medication and had fewer erupted primary teeth; they also had a higher prevalence of developmental defects of the enamel and deformations of the hard palate. Conclusion. This study confirmed anamnestic, medical and oral differences between one-year-old preterm VLBW and ELBW and full-term NBW infants. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of growth hormone (GH) treatment for height gain in short‐stature children born small for gestational age (SGA) with extremely low birthweight (ELBW; birthweight <1,000 g) remains largely unknown. Methods: In study 1, 35 prepubertal Japanese children born SGA with ELBW were categorized into three groups based on the presence or absence of catch‐up growth by age 3 (CU(+) and CU(−), respectively) and GH treatment (GH(+) and GH(−), respectively). Height standard deviation (SD) scores (HT‐SDS) in the CU−/GH+ group (n = 19) were compared with those in the age‐matched CU+/GH− (n = 9) and CU−/GH‐ groups (n = 7). In study 2, 66 prepubertal Japanese SGA children treated with GH were divided into three groups by birthweight: <1,000 g (n = 19), 1,000–2,000 g (n = 20), and >2,000 g (n = 27). Changes in HT‐SDS during the initial 3 years of GH treatment were compared among the three groups. Results: In study 1, the mean HT‐SDS in the CU−/GH+ group (−1.15 SD) was similar to that in the CU+/GH‐ group (−1.39 SD) but higher than that in the CU−/GH− group (−2.24 SD). In study 2, GH achieved a height gain of +1.62 SD in the ELBW group, which was similar to that in the other groups (1,000–2,000 g: +1.46 SD, >2,000 g: +1.53 SD). Conclusions: Growth hormone treatment in short‐stature children born SGA with ELBW increased HT‐SDS, which was similar to that in SGA children born with a birthweight ≥1,000 g. These results indicate that GH treatment may be an effective approach to promote adequate growth recovery for short‐stature children born SGA with ELBW. [ABSTRACT FROM AUTHOR]

Introduction: Preterm birth and low birthweight are mostly connected with delay of development and eruption of primary and permanent teeth. The presence of natal and neonatal teeth or premature eruption of deciduous teeth (dentitio praecox) is extremely rare situation in prematurely delivered infants and aetiology of this disturbance is still not clearly established. Aim: The aim of the case report is to present history, clinical symptoms, complications and management of preterm extremely low birthweight infant with prematurely erupted tooth and to add review of the relevant literature. Case report: A caucasian five weeks old extremely preterm delivered boy (gestational age 24 weeks and six days) with extremely low birthweight (620 g) and polymorbidity was examined due to presence of eruption cyst in frontal region of mandible and one week later due to partial eruption of tooth in the same localization. The crown size and form resembled to primary lower central incisor. The partially erupted tooth was characterized by developmental defects of enamel, inflammation of surrounding gingival tissue and hypermobility. The erupted tooth was extracted due to its serious mobility with sterile forceps and hemorrhage was stopped with digital compression with the help of sterile gauze. The healing after extraction was without complications. Conclusion: The premature eruption of teeth in preterm infant is a very rare situation. Only ten case reports and two retrospective studies focusing on the presence of natal or neonatal teeth in preterm infants were published. The management of preterm infants with prematurely erupted teeth requires the cooperation of dentist with neonatologists. The knowledge of this problem is important for diagnosis, management, parental counseling and elimination of the possible association with various ecto-mezenchymal syndromes.

Background: There are limited data available on the survival and early complications of preterm infants with less than 500 g birthweight. To estimate the outcomes for these infants, it is important for caregivers to be aware of perinatal factors that may affect survival.Objectives: We assessed the mortality and certain early complications of preterm infants born with less than 500 g in Hungary between 2006 and 2015.Methods: We reviewed data of 486 infants from the database of the Hungarian Central Statistical Office and in parallel of 407 infants from the "NICU database." The study period was divided into two epochs: 2006-2010 and 2011-2015.Results: The survival was 27.1% in the first epoch and 39.1% in the second epoch, and the incidence of early complications was slightly higher in the second epoch. In the surviving group (first and second epoch combined), gestational age (25.1 vs 23.7 weeks), birthweight (458 vs 447 g) antenatal steroid treatment (66.3% vs 52.3%), surfactant therapy (95.1% vs 84.3%), median Apgar scores (6 vs 3 and 8 vs 5 at 1 and 5 minutes, respectively) and proportion of caesarean delivery (89.3% versus 68.5%) were higher than in the non-surviving group (first and second epoch combined). The proportion of multiple births was lower in the surviving group (15.7% vs 33.4%).Conclusions: Survival of infants with less than 500 g improved between 2006-2010 and 2011-2015 in Hungary. The slightly higher occurrence of early complications might be associated with improving survival. [ABSTRACT FROM AUTHOR]

Background: Appropriate management of the endotracheal tube (ETT) insertion depth is important. The depth calculated using Tochen's formula is overestimated in extremely‐low‐ birthweight infants, particularly those with a birthweight <750 g. Gestational age has been shown to be particularly useful in the Neonatal Resuscitation Program, 7th edition.5 However, a randomized trial for estimating the ETT insertion depth failed to show the advantage of using gestational age over birthweight.6 Therefore, we aimed to estimate the appropriate ETT insertion depth in neonates weighing <750 g. Methods: This was a single‐center, retrospective observational study including neonates weighing <750 g who required intubation. The appropriate depth was determined by adjusting the distance between the actual ETT position and the area from the first to the second thoracic vertebra on the radiograph. Correlations between gestational age and physique were investigated using Pearson's correlation coefficient. We examined small‐for‐ gestational‐age (SGA) infants and non‐SGA infants separately. Results: Forty neonates were enrolled in this study. The mean gestational age and birthweight were 26.3 weeks and 620 g respectively. Twenty infants were SGA. The ETT position was deep in 35 of 40 cases, with the strongest correlation between weight and ETT insertion depth. The correlation with gestational age was not observed in this study. Conclusions: Our study showed that the ideal ETT insertion depth at birth correlates with birthweight in neonates weighing <750 g. Therefore, determination by gestational age may not be feasible in populations with a high proportion of SGA infants. [ABSTRACT FROM AUTHOR]

Objectives: To examine associations between parent-reported child sleep walking or talking, nightmares, and trouble sleeping at age eight and psychiatric problems in adulthood (age 30-35) in extremely low birth weight (ELBW; <1000 g) survivors and matched normal birth weight (NBW; >2500 g) control participants.Methods: At age eight, parents of ELBW survivors and NBW control participants completed sleep items on the Child Behavior Checklist assessing the presence of sleep walking/talking, nightmares, or trouble sleeping. At age 30-35, 98 ELBW and 94 NBW individuals completed the Mini International Neuropsychiatric Interview (MINI), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI). Analyses were conducted in each birth weight group independently.Results: In NBW participants, sleep walking/talking in childhood predicted higher BAI and BDI scores, as well as more than three times the odds of having a mood or anxiety disorder (OR = 3.48; 95% CI, 1.26-9.60) at age 30-35. Sex and childhood sleep problem interactions revealed that females who manifested sleep walking/talking as children had higher BAI scores than males. Nightmares in children born at NBW predicted higher BAI scores. These associations persisted despite adjustment for child mental health, sex, socioeconomic status, sexual or physical abuse, and family functioning. Trouble sleeping in childhood did not predict adult mental health problems. Childhood sleep problems did not predict psychopathology in ELBW adults.Conclusions: Children born at NBW who manifest sleep walking or talking appear to be at increased risk for developing mood or anxiety disorders in adulthood. No associations between child sleep and adult mental illness were noted in those with ELBW surviviors. Childhood sleep walking/talking may be a unique risk factor for mental health problems later in life. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study was to examine postnatal growth outcomes and predictors of growth failure at 18–24 months corrected age among extremely low birth weight (ELBW) survivors of necrotizing enterocolitis (NEC) compared to survivors without NEC. Methods Data were collected prospectively on ELBW (22–27 weeks gestation or 401–1000 g birth weight) infants born 2000–2013 at 46 centers participating in the Vermont Oxford Network follow-up project. Severe growth failure was defined as < 3rd percentile weight-for-age. Results There were 9171 evaluated infants without NEC, 416 with medical NEC, and 462 with surgical NEC. Rates of severe growth failure at discharge were higher among infants with medical NEC (56%) and surgical NEC (61%), compared to those without NEC (36%). At 18–24 months follow-up, rates of severe growth failure decreased and were similar between without NEC (24%), medical NEC (24%), and surgical NEC (28%). On multivariable analysis, small for gestational age, chronic lung disease, severe intraventricular hemorrhage or cystic periventricular leukomalacia, severe growth failure at discharge, and postdischarge tube feeding predicted < 3rd percentile weight-for-age at follow-up. Conclusions ELBW survivors of NEC have higher rates of severe growth failure at discharge. While NEC is not associated with severe growth failure at follow-up, one quarter of ELBW infants have severe growth failure at 18–24 months. Type of study Prognosis study. Level of evidence II [ABSTRACT FROM AUTHOR]

Aim: To determine whether high intake of intralipid (IL) in extremely low birthweight (ELBW) neonates is associated with higher rates of neuroimpairment and Bayley III scores at two years of corrected age.Methods: Quartiles of IL received by 389 ELBW infants were linked to neurodevelopmental outcomes. Logistic regression analyses, adjusted for confounders, were performed to determine the association between IL dose and neuroimpairment. Linear regression analyses were performed to predict Bayley III scores.Results: No association was found between IL dose and neuroimpairment A significant association was found between higher IL intake and lower Bayley Cognitive, motor and language scores. Adding breast milk intake to the linear regression eliminated the associations.Conclusion: Higher IL intake was associated with lower cognitive, motor and language scores. Breast milk intake eliminated the latter associations, which underscores the important role of breast milk in developmental outcome. [ABSTRACT FROM AUTHOR]

We need to understand the outcomes into adulthood for survivors born either extremely low birthweight (ELBW; <1,000 g) or extremely preterm (EP; <28 weeks' gestational age), particularly their blood pressure and cardiovascular metabolic status,respiratory function, growth, psychological and mental health performance, and functional outcomes. Blood pressure is higher in late adolescence and early adulthood in ELBW/EP survivors compared with controls. In some studies, expreterm survivors have higher insulin and blood lipid concentrations than controls, which may also increase their risk for later cardiovascular disease. ELBW/EP survivors have more expiratory airflow obstruction than do controls. Those who had bronchopulmonary dysplasia (BPD) in the newborn period have even worse lung function than those who did not have BPD. As a group, they are unlikely to achieve their full lung growth potential, which means that more of them are likely to develop chronic obstructive airway disease in later life. Although they are smaller than term born controls, their weight gradually rises and ultimately reaches a mean z-score close to zero in late adolescence, and they ultimately attain a height zscore close to their mid-parental height z-score. On average, ex-preterm survivors have intelligence quotient (IQ) scores and performance on tests of academic achievement approximately 2/3 SD lower than do controls, and they also perform less well on tests of attention and executive function. They have similar high rates of anxiety and depression symptoms in late adolescence as do controls. They are, however, over-represented in population registries for rarer disorders such as schizophrenia and Autism Spectrum Disorder. In cohort studies, ex-preterm survivors mostly report good quality of life and participation in daily activities, and they report good levels of self-esteem. In population studies, they require higher levels of economic assistance, such as disability pensions, they do not achieve education levels as high as controls, fewer are married, and their rates of reproduction are lower, at least in early adulthood. Survivors born ELBW/EP will present more and more to health carers in adulthood, as they survive in larger numbers. [ABSTRACT FROM AUTHOR]

Introduction: Preterm birth and low birthweight are mostly connected with delay of development and eruption of primary and permanent teeth. The presence of natal and neonatal teeth or premature eruption of deciduous teeth (dentitio praecox) is extremely rare situation in prematurely delivered infants and aetiology of this disturbance is still not clearly established. Aim: The aim of the case report is to present history, clinical symptoms, complications and management of preterm extremely low birthweight infant with prematurely erupted tooth and to add review of the relevant literature. Case report: A caucasian five weeks old extremely preterm delivered boy (gestational age 24 weeks and six days) with extremely low birthweight (620 g) and polymorbidity was examined due to presence of eruption cyst in frontal region of mandible and one week later due to partial eruption of tooth in the same localization. The crown size and form resembled to primary lower central incisor. The partially erupted tooth was characterized by developmental defects of enamel, inflammation of surrounding gingival tissue and hypermobility. The erupted tooth was extracted due to its serious mobility with sterile forceps and hemorrhage was stopped with digital compression with the help of sterile gauze. The healing after extraction was without complications. Conclusion: The premature eruption of teeth in preterm infant is a very rare situation. Only ten case reports and two retrospective studies focusing on the presence of natal or neonatal teeth in preterm infants were published. The management of preterm infants with prematurely erupted teeth requires the cooperation of dentist with neonatologists. The knowledge of this problem is important for diagnosis, management, parental counseling and elimination of the possible association with various ecto-mezenchymal syndromes. [ABSTRACT FROM AUTHOR]

Eikenella corrodens has been noted as a causative organism in both neonatal and perinatal sepsis. Positivity of blood cultures at birth among preterm infants may be influenced by the maternal use of peripartum antimicrobials and a normal C-reactive protein result within the first 24 hours need not always reflect the absence of fetal invasion by the highly pathogenic organisms. For these reasons, supportive and adjunctive approaches such as appropriately collected placental swabs for culture would be of value in optimizing the antimicrobial choice for sick preterm infants during the early neonatal period. Fetal infection by E. corrodens detected by placental swab culture influencing antimicrobial management of an extremely premature infant with sepsis is described. Management of the youngest premature survivor with the lowest birthweight among the reported cases in English language of neonatal E. corrodens infection is summarized and literature is reviewed. The value of placental swab, which is often underused, is highlighted in this review. [ABSTRACT FROM AUTHOR]

Exposure to early adversity is known to have deleterious effects on brain-behaviour relations across the lifespan and across a range of domains. Here, we tested a cumulative risk hypothesis of adult social functioning and health outcomes in the fourth decade of life, using the oldest known longitudinally followed cohort of survivors of extremely low birthweight ( ELBW; <1,000 g). We investigated the additional impact of peer victimization in youth on social outcomes at age 29-36 years in ELBW survivors and matched normal birthweight ( NBW; >2,500 g) participants. In the combined sample, peer victimization was associated with lower likelihood of having children and household income, poorer family functioning and self-esteem, more loneliness and chronic health conditions, less social support, and increased likelihood for contact with police. Moderation analyses indicated that among ELBW survivors, compared to their NBW counterparts, victimization was more strongly associated with being convicted of a crime and with having chronic health conditions. These findings highlight the negative long-term impact of peer victimization on all children and that some outcomes may be differentially affected by prenatal and early post-natal environments. [ABSTRACT FROM AUTHOR]

Aim A single centre retrospective cohort study was designed to investigate the estimated glomerular filtration rate (eGFR) in school-age children born with extremely low birthweight (ELBW) and to determine risk factors predictive of decreased eGFR. Methods We compared eGFR based on cystatin C (CysC-eGFR) between school-age children born with ELBW (ELBW group, n = 48; median gestational age: 26.9 weeks; median birthweight: 792 g) and children born at term (control group, n = 48). The ELBW group was then further divided into a decreased CysC-eGFR subgroup (eGFR <90 mL/min per 1.73 m2, n = 20) and a normal CysC-eGFR subgroup ( n = 28), and perinatal background factors were compared. Results The ELBW group showed a significantly lower CysC-eGFR compared with the control group ( P < 0.001). Comparison between the decreased and normal CysC-eGFR subgroups in the ELBW group showed that children with lower birthweight, shorter gestational age, lower 5-min Apgar score, longer length of mechanical ventilation, lower weight gain in the first 11 weeks, chronic lung disease, and postnatal corticosteroid administration had significantly decreased CysC-eGFR. Multivariate logistic regression showed that a lower 5-min Apgar score was the only independent risk factor for decreased CysC-eGFR. Conclusions CysC-eGFR might already be decreased at school age in children born with ELBW. Renal assessment in regular follow-up examinations is recommended. [ABSTRACT FROM AUTHOR]

Aim: To investigate whether behaviour problems are independently related to mild motor impairment in 11-13-year-old children born preterm with extremely low birthweight (ELBW).Methods: The cross-sectional study included 48 (27 males) non-disabled, otherwise healthy ELBW children (<1000 g) and 55 (28 males) term-born peers. Parents reported behaviour using the Child Behaviour Checklist (CBCL). Children completed the Movement Assessment Battery for Children (Movement ABC).Results: Extremely low birthweight children had poorer behaviour scores (CBCL Total Problem T score: mean difference = 5.89, 95% confidence interval = 10.29, 1.49, p = 0.009) and Movement ABC Total Motor Impairment Scores (ELBW group median = 17.5, IQR = 12.3; term-born group median = 7.5, IQR = 9, p < 0.01) than term-born peers. Behaviour was related to motor score (regression coefficient 2.16; 95% confidence interval 0.34, 3.97, p = 0.02) independent of gender, socio-economic factors or birthweight. Motor score had the strongest association with attention (ρ = 0.51; p < 0.01) and social behaviours (ρ = 0.50; p < 0.01).Conclusion: Behaviour problems of otherwise healthy 11- to 13-year-old ELBW children are not related to prematurity independent of their motor difficulties. Supporting improved motor competence in ELBW preteen children may support improved behaviour, particularly attention and social behaviours. [ABSTRACT FROM AUTHOR]

Extremely preterm (EPT) infants (≤28 weeks) remain at risk for poor outcomes. Small baby protocols (SBPs) may improve outcomes, but optimal strategies are unknown. This study evaluated whether EPT infants managed using an SBP would have better outcomes compared to a historical control (HC) group. The study compared a HC group of EPT infants 23 0/7 weeks to 28 0/7 weeks GA (2006–2007), to a similar SBP group (2007–2008). Survivors were followed until 13 years of life. The SBP emphasized antenatal steroids, delayed cord clamping, respiratory and hemodynamic minimalism, prophylactic indomethacin, early empiric caffeine, and control of sound and light. There were 35 HC subjects and 35 SBP subjects. The SBP group had less severe IVH-PVH (9 % vs. 40 %, risk ratio 0.7, 95 % CI 0.5–0.9, P = 0.002) mortality (17 % vs. 46 %, risk ratio 0.6, 95 % CI 0.5–0.9, P = 0.004), and acute pulmonary hemorrhage (6 % vs. 23 %, risk ratio 0.8, 95 % CI 0.7–1.0, P = 0.04). Compliance with the SBP protocol was excellent. For the SBP group in the first 72 h, no subjects received inotropes, hydrocortisone, or sodium bicarbonate. Intubation, mechanical ventilation, fluid boluses, sedation, red blood cell transfusions, and insulin use decreased. At 10–13 years, more SBP subjects had survived without NDI (51 % vs. 23 %, risk ratio = 1.6, 95 % CI = 1.1–2.4, P = 0.01). More SBP subjects also survived without NDI and with a Vineland Adaptive Behavior Composite score > 85 (44 % vs. 11 %, risk ratio = 2.0, 95 % CI = 1.2–3.2, P ≤0.001). The SBP group had less visual impairment. An SBP was associated with improved outcomes, including normal neurologic survival after 10 years. • Extremely preterm infants in the neonatal intensive care unit (NICU) are at very high risk. • Small baby protocols try to combine NICU management choices based on the best available evidence. • This study compared infants managed using a small baby protocol to a similar historical cohort and followed long-term outcomes. • The small baby protocol group had less brain and lung bleeding and deaths and better long-term survival with normal development. [ABSTRACT FROM AUTHOR]

Background: It is unclear if expiratory airflow in survivors born extremely low birth weight (ELBW; 500-999 g) has improved after the introduction of exogenous surfactant into clinical practice in 1991. The primary aim of this study was to describe the changes in airflow at 7-8 years of age of survivors born ELBW in five discrete cohorts from 14 years before to 14 years after the introduction of exogenous surfactant into clinical practice., Methods: The cohorts comprised consecutive survivors born ELBW in 1977-82 and 1985-87 at the Royal Women's Hospital, Melbourne, and in 1991-92, 1997 and 2005 in the state of Victoria, Australia. Survival rates to 2-years of age for infants born ELBW in the state of Victoria rose from approximately 1-in-4 to 3-in-4 over the time of this study. Expiratory airflow measurements at 7-8 years included the forced expired volume in 1 s (FEV 1 ), converted to z-scores for age, height, sex, and race., Findings: There were 596 ELBW participants with expiratory flow data, 280 (47%) of whom had bronchopulmonary dysplasia (BPD). Overall, there was little change in zFEV 1 over the 28-year period (mean change per year; 0.003, 95% CI -0.010, 0.015, P = 0.67). There was, however, evidence of an interaction between BPD and year; zFEV 1 in those who had BPD fell over time (mean change per year -0.019, 95% CI -0.037, -0.009, P = 0.035), whereas zFEV 1 improved in those who did not have BPD (mean change per year 0.021, 95% CI 0.006, 0.037, P = 0.007)., Interpretation: Contrary to recent evidence, expiratory airflow of children born ELBW has not improved with the introduction of surfactant, and may be deteriorating in those who had BPD., Funding: National Health and Medical Research Council (Australia); Victorian Government's Operational Infrastructure Support Program., Competing Interests: Dr Cheong reports receiving additional grants from the National Health and Medical Research Council of Australia (Leadership Fellowship #2016390), and non-industry support for airfare and accommodation as an invited speaker. Dr Mainzer reports no conflicts of interest to declare. The funding sources had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication., (© 2023 The Author(s).)

Background: Several research trials have analyzed the impact of prematurity on the prevalence of hypertension (HT). However, prospective long-term studies are lacking. Objectives: The aim of this study was to evaluate the prevalence of HT at the age of 7 and 11 years in a regional cohort of preterm infants with a birth weight of ≤ 1000 g. Patients and Methods: This study included 67 children with a birth weight of ≤ 1000 g who were born in Malopolska between September 2002 and August 2004. The control group consisted of 38 children born at term, matched for age. Each child underwent 24-h ambulatory blood pressure measurement (ABPM) twice, once at the age of 7 and again at 11 years. The presence of HT was estimated according to the mean arterial pressure (MAP) and a number of individual measurements. Results: At aged 7 years, preterm infants had a significantly higher incidence of HT, defined on the basis of MAP (15% vs. 0%; P < 0.02) and on the percent of individual measurements (56% vs. 33%, P < 0.036). After taking into account the group of patients who received anti-HT treatment after the first part of the study, the incidence of HT at the age of 11 years based on MAP was 19% vs. 10%. Based on the individual measurements, it was 36.5% in the preterm infants vs. 24% in the control group. The differences were not statistically significant. At both time points, the preterm group had a higher mean heart rate (HR) than the control group. Conclusions: Children born prematurely are predisposed to HT in later life, in addition to the persistence of an increased HR. [ABSTRACT FROM AUTHOR]

Aim: This study investigated respiratory morbidity and risk factors during the first five years of life after extremely preterm birth.Methods: Paediatric assessments and parental questionnaires were obtained at two and five years of age in this national prospective cohort of 372 Norwegian children born during 1999-2000 at a gestational age of <28 weeks or birthweight <1,000 grams.Results: Paediatric assessments were obtained for 100% and 82% of the children at two and five years of age and completed questionnaires for 71% and 76%, respectively. Total readmission rates decreased from 49 to 14% at one to five years, and readmissions for respiratory causes fell from 31 to 3%. Bronchopulmonary dysplasia (BPD) or gestational age was not associated with readmissions for respiratory causes in multiple logistic regression models. However, both BPD and gestational age ≤ 25 weeks was associated with wheezing during the first year and the use of asthma medication during the first two years. BPD was associated with asthma medication between three and five years but not significantly at five years.Conclusion: Respiratory morbidity decreased during the first five years of life but was still more common than expected. It was unrelated to BPD and gestational age at five years of age. [ABSTRACT FROM AUTHOR]

Aim: Methods to improve the mental development of extremely low birthweight (ELBW) children are currently lacking. We assessed the effects of long-term supplementation of alpha-tocopherol on the neurological development of 259 school-aged ELBW children. Methods: Extremely low birthweight participants were divided into three groups: group A with no alpha-tocopherol supplementation (n = 121); group B with the supplementation for <6 months (n = 104) and group C with the supplementation for more than 6 months (n = 34). We analysed the participants’ data at birth and between the ages of one-and-a-half to 8 years and evaluated potential factors associated with intellectual disabilities. Results: Children from group C had the best outcome. The groups’ mean gestational weeks and mean ventilator days were as follows: 27.5 weeks, 16.1 days (group A); 25.7 weeks, 41.7 days (group B); and 25.1 weeks, 75.5 days (group C). Multivariate regression analysis revealed that the odds ratios for impaired mental development at 8 years were 1.5 in group B and 0.19 (p = 0.017) in group C, compared with 1.0 in group A. The association between the duration of alpha-tocopherol administration and performance intelligence quotient (IQ) was dose dependent (p = 0.03). Conclusion: Long-term supplementation of alpha-tocopherol appeared to improve mental development, in particular, performance IQ, in school-aged ELBW children. [ABSTRACT FROM AUTHOR]

Phototherapy is assumed to be both effective and safe for extremely low-birth-weight infants. Our objective was to critically assess the relevant evidence from randomized trials. In the decades-old Collaborative Phototherapy Trial, phototherapy reduced serum bilirubin but not neurodevelopmental impairments. In the recent and larger Neonatal Network Trial, aggressive phototherapy compared to conservative phototherapy reduced both peak serum bilirubin (7.0 vs. 9.8 mg/dL) and profound impairment at 18–22 months adjusted age (relative risk = 0.68). However, both trials suggested that phototherapy increased deaths among the smallest infants. Conservative Bayesian analyses of ventilator-treated infants under 751 g birth weight in the Network trial identified a 99% probability of increased deaths and 99% probability of reduced profound impairment with aggressive phototherapy. Potential strategies to optimize the risk/benefit ratio in achieving low serum bilirubin levels, e.g., use of lowered irradiance levels, light-emitting diode phototherapy units, cycled phototherapy, and/or porphyrin compounds, deserve rigorous evaluation. [ABSTRACT FROM AUTHOR]

Aim Extremely premature infants experience long hospitalisation and high readmission rates within 30 days of discharge. This quality control investigation retrospectively explored the impact of the Creating Opportunities for Parent Empowerment ( COPE©) programme on these rates in an all referral, Level- IV small baby intensive care unit setting. Methods The parents of 303 extremely premature infants participated in the study. Of those, 135 were admitted before the implementation of COPE© and served as baseline historical controls, and the remaining 168 neonates received the intervention. Length of stay and readmission rates were analysed using parametric and nonparametric tests. Additional analyses were used to compare the two groups in terms of gestational age, birthweight and other acuity measures. Results Neonates who received COPE© required significantly reduced lengths of stay than the control neonates ( COPE© 127.1 ± 55.8 days vs. control 139.6 ± 61.9 days, p < 0.05) and significantly lower readmission rates ( COPE© 23.9% vs. control 13.2%, p = 0.05). Conclusion The COPE© programme promoted active parental engagement in the unit and significantly reduced hospital stays and readmission rates. Future interventions should identify the specific components of the programme that support the parents of extremely premature infants during the various phases of hospitalisation. [ABSTRACT FROM AUTHOR]

Background: The limits of viability in extremely premature infants are challenging for any neonatologists in developed countries. The neurological development and growth of extremely preterm infants have come to be the emerging issue following the management in the neonatal intensive care unit. Objective: To assess potential associations between changes in practice and survival/neurodevelopmental outcome, and clinical outcomes of extremely preterm infants born at the limit of viability studied in a tertiary center. Study Design: A retrospective study enrolled 51 infants who had no congenital disorders, and were born at 22-24 weeks of gestational age (GA) in 2000-2009 in our institution. Clinical variables and interventions were studied with regard to one-year survival and developmental quotient (DQ) at 3 years of age. Results: The one-year survival rate of 24 preterm infants born in 2005-2009 (79%) was higher than that of the 27 infants born in 2000-2004 (52%, p = 0.04). Infants born after 2005 underwent less tocolysis (54 vs. 94%, p < 0.01) and more frequently antenatal steroid therapy (32 vs. 6%, p = 0.01) than those born before 2004. The post-2005 survivors (n = 19) received more frequently indomethacin therapy (89 vs. 50%, p = 0.03) and early parenteral nutrition (95 vs. 36%, p < 0.01) than the pre-2004 survivors (n = 14). There were no differences in the proportion of infants who attained a DQ of >50 at 3 years of age between pre-2004 (9/13, 69%) and post-2005 groups (10/17, 59%). Multivariate analysis indicated that extremely premature birth at GA <24 weeks was the sole critical factor for a DQ of >50 in survivors. Conclusions: The perinatal care after 2005 improved the overall survival rate, but not the neurological outcome of preterm survivors at the limit of viability. Neurodevelopmental impairments were associated with extremely premature birth at GA <24 weeks. © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Introduction: Glucocorticoids are currently used for the co-therapeutic management of autoimmune hepatitis and some cholestatic diseases. Thus far, we do not know the efficacy of glucocorticoids in the treatment of parenteral nutrition-associated cholestasis. We aimed to analyze whether the administration of late postnatal dexamethasone for treating bronchopulmonary dysplasia influence the occurrence of parenteral nutrition-associated cholestasis in preterm neonates., Methods: A retrospective study was conducted for 78 preterm neonates without major anomalies (gestational age was <30 weeks, and birthweight was ≤1000 g) hospitalized in a neonatal unit. Total and direct serum bilirubin levels were measured about every two weeks for all neonates. Data including the administration of dexamethasone, intravenous nutrition, and enteral feeding were collected by at least three audits., Results: A total of 15 preterm neonates were diagnosed with parenteral nutrition-associated cholestasis, and after stopping parenteral nutrition, the direct bilirubin value decreased to the normal level for no longer than 150 days. The prolonged duration of parenteral nutrition was a risk factor, and late postnatal dexamethasone treatment was a protective factor in reducing the incidence of parenteral nutrition-associated cholestasis., Conclusion: Dexamethasone treatment may reduce the occurrence of parenteral nutrition-associated cholestasis in preterm neonates., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2022 Jiang, Hu and Zhang.)

Background Early-onset hyperkalemia often occurs in extremely preterm infants during a few days after birth. While there are several treatments for hyperkalemia, calcium infusion to reduce plasma potassium concentrations remains controversial. The purpose of this study is to investigate whether a high dosage of calcium reduces early-onset hyperkalemia. Methods Extremely low-birthweight neonates born at 22-25 weeks' gestation were enrolled. We analyzed data using multivariate regression analysis and performed a retrospective cohort study with patients divided into two groups according to the dosage of calcium in their initial infusion. Results A total of 103 patients were eligible. Early-onset hyperkalemia was observed in 27 patients. The dosage of calcium gluconate during 24 h after birth was the only independent factor affecting early-onset hyperkalemia. The maximum plasma potassium concentration during 72 h after birth was negatively correlated with the dosage of calcium. High-dose calcium reduced occurrences of hyperkalemia and hypoglycemia caused by insulin infusion given for treatment of hyperkalemia, without increasing the risk of any other complications. Conclusions Infusion of calcium gluconate may reduce early-onset hyperkalemia in a dose-dependent manner. [ABSTRACT FROM AUTHOR]

The objective of this study was to compare mental health at 5 years in children born extremely preterm with a reference group, and assess associations between functional abilities and mental health within the preterm group. In a national Norwegian cohort with gestational age 22-27 weeks or birthweight 500-999 g, mental health was assessed with the Strengths and Difficulties Questionnaire (SDQ), cognitive function with the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R), motor function with the Movement Assessment Battery for children (ABC-test) and severity of cerebral palsy (CP) with the Gross Motor Function Classification for CP (GMFCS). Neurodevelopmental disabilities (NDD) were described as mild and moderate/severe. SDQ of the preterm children was compared with that of an unselected reference group. SDQ sub-scores ≥90th percentile of the reference group were defined as a mental health problem and a Total Difficulties Score ≥90th percentile (TDS90) as suggestive of psychiatric disorder. Of 361 eligible preterm children, parents completed SDQ for 255 (71 %). 97 (38 %) had TDS90 compared to 116 (11 %) of the reference group (OR 5.1; 95 % CI 3.7-7.1). For the preterms, the rate of TDS90 was higher for those with moderate/severe NDD (27/37 vs. 27/116, adjusted OR 8.0; 95 % CI 3.2-19, and mild NDD 43/102 [adjusted OR 2.2 (1.2-4.1)]. For preterms with no NDD, TDS90 was more common than for the reference group (27/116 vs. 116/1,089, OR 2.5; 95 % CI 1.6-4.1). Extreme prematurity was associated with increased risk of later mental health problems, particularly if they had other functional impairments. [ABSTRACT FROM AUTHOR]

Abstract: Background: It is unclear whether developmental assessment later or earlier in childhood is the better predictor of intelligence at 8years of age. This is an important distinction as many clinical trials assess their final outcomes only in early childhood, assuming the results are valid for later childhood cognitive functioning. Aims: To compare the ability of developmental assessment at 18months with 24months in predicting general intellectual functioning at 8–9years of age in extremely low birth weight (ELBW, birthweight<1000g) children. Study design: Cohort study. Subjects: 58 ELBW survivors born during 1997 at the Royal Women''s Hospital, Melbourne, Australia. Outcome measures: Cognitive assessments at each of 18months, 24months (Mental Developmental Index [MDI]) and 8–9years (Full Scale IQ) of age, corrected for prematurity were compared by regression analysis and by the κ statistic (agreement beyond chance). Results: Both the 18-month and the 24-month MDI were significantly predictive of Full Scale IQ at 8–9years, but more so for the 24-month MDI, with 38% of variance explained compared with 34% of variance explained by the 18-month MDI. The 24-month MDI, expressed as categories of severe, moderate, mild or no developmental delay, was more predictive of categories of severe, moderate, mild or no intellectual impairment at 8–9years (weighted κ=0.43, P <0.001) than was the 18-month MDI (weighted κ=0.35, P =0.001). Conclusions: Cognitive assessment at 24months is superior to cognitive assessment at 18months in predicting IQ and intellectual impairment at 8–9years of age in ELBW children. [Copyright &y& Elsevier]

Survivors of immaturity of outstanding intelligence include Fortunio Licetus, born in 1577, and Isaac Newton, born in 1643. Reliable descriptions began appearing around 1820, and over a dozen infants were born weighing under 1000 g and before World War II, who developed normally. From 1876 to 2006, the birth weight at which half of the infants survived dropped from 2200 to 600 g. Statistics depended on how abortion, stillbirth and live birth were defined, which differed greatly from country to country. WHO definitions in 1993 required the registration of all infants weighing 500 g (22 complete weeks) or above. This definition was not universally adopted, resulting in considerable underreporting. Many medical societies issued ethical recommendations concerning the obligatory or optional treatment of immature infants. The 'window', at which treatment is optional has been set at 22-23 weeks (Japan, Germany), 23-24 weeks (UK, USA, Canada), or 24-26 weeks (France, Netherlands, Switzerland). Instead of assessing an infant's individual prognosis, and ignoring its gender, co-morbidities, and particular cause of premature delivery, these rules frequently relied on gestational age alone to initiate or withhold life support. [ABSTRACT FROM AUTHOR]

Summary: Although it is generally believed that preterm infants are at greater risk for the development of bilirubin-associated brain damage than term infants, quantification of the magnitude of this risk has proven elusive, as has a consensus among experts on the level of total serum bilirubin at which therapy should be initiated. Two large randomized studies have been performed that shed some light on the risk hyperbilirubinemia poses for preterm neonates and both studies are reviewed. Additional study is needed to further clarify the risk posed by hyperbilirubinemia in premature neonates and to frame guidelines for phototherapy and exchange transfusion that are more evidence-based. [Copyright &y& Elsevier]

Aim: To test the hypothesis that implementing guidelines for the standardized care of the extremely premature infant (<27 weeks) in the first week of life would improve patient outcomes in an all referral NICU. Methods: Data were collected on all infants <27 weeks gestational age and <7 days of age on admission cared for using these small baby guidelines (SBG), as well as on all age-matched infants admitted the year prior (comparison). Results: Thirty-seven patients were cared for utilizing the SBG and 40 patients were in the comparison group. There were no differences between the groups in gestational age, birthweight or age on admission. There was no difference in survival to discharge (73% SBG, 70% comparison). The mean length of stay for survivors was 112 ± 38 days SBG and 145 ± 76 days (p < 0.05) comparison group. Survival without BPD was greater in the SBG group (24%) than in the comparison group (9%; p < 0.05), and survival without severe IVH was greater in the SBG group (65%) than in the comparison group (38%; p < 0.01). Conclusions: These data demonstrate that applying a unified approach to the care of the extremely premature infant in the first week of life resulted in a decrease in the length of hospitalization and improved patient outcomes. [ABSTRACT FROM AUTHOR]

Aim: Intraventricular haemorrhage (IVH) causes some of the most adverse outcomes in infants with birthweight <1000 g. Incomplete antenatal steroids, acidosis, inflammation, postnatal transfer, delayed surfactant administration, hypothermia, hypotension, hypocapnia, persistent ductus arteriosus and pneumothorax are all associated with IVH. We hypothesized that prospective surveillance of these IVH-associated conditions decreases their frequency and thus the frequency of IVH. Methods: Cranial ultrasound was performed on days 1, 3, 7, 30 after birth and at discharge, and was assessed according to Papile. The incidence of IVH and IVH-associated conditions was monitored prospectively in all infants <1000 g born in our perinatal centre in 2005/2006, and obstetricians and neonatologists held monthly interdisciplinary review conferences to discuss the preventability of IVH-associated conditions (IVH surveillance). These data were compared to existing prospective data gathered during routine monitoring in 2004. Results: IVH (all grades) occurred in 29/86 extremely low birthweight (ELBW) infants during routine monitoring and in 12/89 ELBW infants during IVH surveillance (p = 0.007). IVH grades 3–4 dropped from 20% to 3.4% (p = 0.0006). There were significant differences in completeness of antenatal steroids (54% vs. 67%, p = 0.04) and timeliness in initial surfactant substitution (45% vs. 71%, p = 0.01). Most other IVH-associated conditions were reduced during IVH surveillance without reaching significance. Conclusions: IVH is not always an inevitable disaster. Obstetricians and neonatologists can reduce its incidence by joint prospective surveillance of IVH-associated conditions. [ABSTRACT FROM AUTHOR]

Aim: To determine the incidence, timing and clinical significance of acquired postnatal cytomegalovirus (CMV) in extremely low-birthweight (ELBW) infants.Methods: Prospective, longitudinal surveillance study. ELBW infants were recruited in the first week of life. Maternal blood was tested for CMV-specific IgG antibodies. Weekly urine samples were obtained from infants for CMV culture and rapid antigen testing. Data were collected regarding clinical course and breast milk intake.Results: Of 181 eligible infants, 119 infants, born to 101 mothers, were enrolled. Eighty of the 101 mothers had their serum checked for CMV status. Seventy percent of those tested were seropositive for CMV. Of the 65 infants born to seropositive mothers, 94% received breast milk during their hospital stay. Complete urine collection was obtained in 92 infants. CMV was cultured from the urine of only four infants, all of whom were born to seropositive mothers. Only one of these four infants was symptomatic. The range at which CMV was first detected was between 48 and 72 postnatal days of age.Conclusions: Despite a very high CMV seropositivity rate in mothers of ELBW infants, and the previously reported high rate of CMV excretion into breast milk, the incidence of postnatal CMV transmission was extremely low in our study. [ABSTRACT FROM AUTHOR]