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"Infants (Premature)"
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Higher or Lower Hemoglobin Transfusion Thresholds for Preterm Infants
In this open, randomized, multicenter trial involving extremely-low-birth-weight preterm infants, the use of a higher hemoglobin threshold for red-cell transfusion did not improve survival without neurodevelopmental impairment at 22 to 26 months of age, corrected for prematurity.
Journal Article
Juniper : the girl who was born too soon
\"Juniper French was born four months early, at 23 weeks gestation. She weighed 1 pound, 4 ounces, and her twiggy body was the length of a Barbie doll. Her head was smaller than a tennis ball, her skin was nearly translucent, and through her chest you could see her flickering heart. Babies like Juniper, born at the edge of viability, trigger the question: Which is the greater act of love--to save her, or to let her go? Kelley and Thomas French chose to fight for Juniper's life, and this is their incredible tale. In one exquisite memoir, the authors explore the border between what is possible and what is right. They marvel at the science that conceived and sustained their daughter and the love that made the difference. They probe the bond between a mother and a baby, between a husband and a wife. They trace the journey of their family from its fragile beginning to the miraculous survival of their now thriving daughter.\" -- Dust jacket.
Book
Antenatal Betamethasone for Women at Risk for Late Preterm Delivery
In this multicenter, randomized trial involving women at high risk for late preterm delivery, administration of betamethasone significantly reduced the rate of neonatal respiratory complications.
Antenatal glucocorticoids are widely used in obstetrics for pregnancies at risk for early preterm delivery. Their use increased especially after a consensus conference held by the National Institutes of Health in 1994, which concluded that there was strong evidence that glucocorticoids reduce adverse neonatal outcomes, including death, the respiratory distress syndrome, and other complications, when administered to women who are likely to deliver before 34 weeks of gestation.
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The recommendation was not extended to women at risk for preterm delivery after 34 weeks because of both a lack of data
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,
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and the belief that at a threshold of . . .
Journal Article
Nutritional strategies for the very low birthweight infant
\"The goal of nutritional management in VLBW and ELBW infants is the achievement of postnatal growth at a rate that approximates the intrauterine growth of a normal fetus at the same postconceptional age. In reality, however, growth lags considerably after birth; although non-nutritional factors are involved, nutrient deficiencies are critical in explaining delayed growth. This practical clinically-oriented pocketbook reviews and summarises all available clinical evidence. It enables the reader to implement parenteral or enteral feeding plans, with the goals of reducing postnatal weight loss, earlier return to birthweight, and improved catch-up growth. Both nutrient balance and growth and the impact on neurodevelopment and health outcomes are evaluated. With many tables and algorithms to summarise key data and management strategies, Nutritional Strategies for the Very Low Birthweight Infant is an invaluable guide for all healthcare professionals caring for premature babies\"--Provided by publisher.
Book
Cerebral Oximetry Monitoring in Extremely Preterm Infants
In extremely preterm infants, the use of cerebral oximetry monitoring to guide treatment for the first 72 hours after birth did not reduce the risk of death or severe brain injury at 36 weeks’ postmenstrual age.
Journal Article
Losing Gabriel : a love story
When baby Gabriel's health takes a turn for the worse, the lives of those involved are forever changed.
Book
Randomized Trial of Platelet-Transfusion Thresholds in Neonates
The rate of death or major bleeding was significantly higher among preterm infants with severe thrombocytopenia assigned to transfusions at higher platelet-count thresholds (50,000 per cubic millimeter) than among those assigned to lower thresholds (25,000 per cubic millimeter).
Journal Article
Neurodevelopmental outcome at 2 years for preterm children born at 22 to 34 weeks’ gestation in France in 2011: EPIPAGE-2 cohort study
Objectives To describe neurodevelopmental outcomes at 2 years corrected age for children born alive at 22-26, 27-31, and 32-34 weeks’ gestation in 2011, and to evaluate changes since 1997.Design Population based cohort studies, EPIPAGE and EPIPAGE-2.Setting France.Participants 5567 neonates born alive in 2011 at 22-34 completed weeks’ gestation, with 4199 survivors at 2 years corrected age included in follow-up. Comparison of outcomes reported for 3334 (1997) and 2418 (2011) neonates born alive in the nine regions participating in both studies.Main outcome measures Survival; cerebral palsy (2000 European consensus definition); scores below threshold on the neurodevelopmental Ages and Stages Questionnaire (ASQ; at least one of five domains below threshold) if completed between 22 and 26 months corrected age, in children without cerebral palsy, blindness, or deafness; and survival without severe or moderate neuromotor or sensory disabilities (cerebral palsy with Gross Motor Function Classification System levels 2-5, unilateral or bilateral blindness or deafness). Results are given as percentage of outcome measures with 95% confidence intervals.Results Among 5170 liveborn neonates with parental consent, survival at 2 years corrected age was 51.7% (95% confidence interval 48.6% to 54.7%) at 22-26 weeks’ gestation, 93.1% (92.1% to 94.0%) at 27-31 weeks’ gestation, and 98.6% (97.8% to 99.2%) at 32-34 weeks’ gestation. Only one infant born at 22-23 weeks survived. Data on cerebral palsy were available for 3599 infants (81.0% of the eligible population). The overall rate of cerebral palsy at 24-26, 27-31, and 32-34 weeks’ gestation was 6.9% (4.7% to 9.6%), 4.3% (3.5% to 5.2%), and 1.0% (0.5% to 1.9%), respectively. Responses to the ASQ were analysed for 2506 children (56.4% of the eligible population). The proportion of children with an ASQ result below threshold at 24-26, 27-31, and 32-34 weeks’ gestation were 50.2% (44.5% to 55.8%), 40.7% (38.3% to 43.2%), and 36.2% (32.4% to 40.1%), respectively. Survival without severe or moderate neuromotor or sensory disabilities among live births increased between 1997 and 2011, from 45.5% (39.2% to 51.8%) to 62.3% (57.1% to 67.5%) at 25-26 weeks’ gestation, but no change was observed at 22-24 weeks’ gestation. At 32-34 weeks’ gestation, there was a non-statistically significant increase in survival without severe or moderate neuromotor or sensory disabilities (P=0.61), but the proportion of survivors with cerebral palsy declined (P=0.01).Conclusions In this large cohort of preterm infants, rates of survival and survival without severe or moderate neuromotor or sensory disabilities have increased during the past two decades, but these children remain at high risk of developmental delay.
Journal Article
Oxygen Saturation and Outcomes in Preterm Infants
This report of the three BOOST II trials, undertaken to examine optimum oxygen saturation in extremely preterm infants, showed that targeting levels below 90% with the use of current oximeter calibrations was associated with increased mortality.
The clinically appropriate range for oxygen saturation in preterm infants is unknown. Trials in the 1950s showed that unrestricted oxygen increased the rate of severe retinopathy of prematurity. However, when oxygen was subsequently restricted, increased mortality was observed.
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The first Benefits of Oxygen Saturation Targeting (BOOST) trial showed that in preterm infants who were still receiving oxygen at 32 weeks' gestation, targeting a higher oxygen-saturation range prolonged oxygen dependence.
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Observational studies suggested that higher oxygen-saturation levels may increase rates of retinopathy of prematurity.
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In five randomized, masked trials with similar protocols conducted in the United States,
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Australia, New Zealand, . . .
Journal Article