A study of survival of very low birth weight neonates in a tertiary care hospital

Background: Preterm birth is one of the major clinical problems in Obstetrics and Neonatology as it is associated with perinatal mortality, serious neonatal morbidity and in some cases childhood disability. Very low birth weight (VLBW) neonates comprise between 4-8% of live-births but about one-third of deaths during the neonatal period occur in this group of newborns. Data on the probability of survival of infant in high risk pregnancies can be of great value in guiding management. The objective is to study the survival at discharge of VLBW neonates admitted in a tertiary care hospital.Methods: Retrospective observational study of all VLBW infants admitted in Aditya Hospital NICU over 3 years between 1-7-2011 to 30-6-2014. Descriptive and inferential statistical analysis has been carried out in the present study.Results: In the present study maternal PROM was seen in 32.9% of cases, Preeclampsia in 31.7% of cases which constituted the most important antenatal risk factor for VLBW followed by multiple gestations in 25.2%. Common morbidities in VLBW neonates are Neonatal jaundice, Probable sepsis, Apnea of prematurity and RDS. Survival improved with increasing gestational age and weight.Conclusions: Birth weight and gestational age specifically predicts survival of preterm VLBW babies, facilitating decision making for obstetricians, neonatologists and parents. In the present study total survival rate was 86.6% with a mortality of 13.4%.

Factors associated with inter-institutional variations in sepsis rates of very-low-birth-weight infants in 34 Malaysian neonatal intensive care units

<p><b>INTRODUCTION</b>This study aimed to determine whether patient loads, infant status on admission and treatment interventions were significantly associated with inter-institutional variations in sepsis rates in very-low-birth-weight (VLBW) infants in the Malaysian National Neonatal Registry (MNNR).</p><p><b>METHODS</b>This was a retrospective study of 3,880 VLBW (≤ 1,500 g) infants admitted to 34 neonatal intensive care units (NICUs) in the MNNR. Sepsis was diagnosed in symptomatic infants with positive blood culture.</p><p><b>RESULTS</b>Sepsis developed in 623 (16.1%) infants; 61 (9.8%) had early-onset sepsis (EOS) and 562 (90.2%) had late-onset sepsis (LOS). The median EOS rate of all NICUs was 1.0% (interquartile range [IQR] 0%, 2.0%). Compared with NICUs reporting no EOS (n = 14), NICUs reporting EOS (n = 20) had significantly higher patient loads (total live births, admissions, VLBW infants, outborns); more mothers with a history of abortions, and antenatal steroids and intrapartum antibiotic use; more infants requiring resuscitation procedures at birth; higher rates of surfactant therapy, pneumonia and insertion of central venous catheters. The median LOS rate of all NICUs was 14.5% (IQR 7.8%, 19.2%). Compared with NICUs with LOS rates below the first quartile (n = 8), those above the third quartile (n = 8) used less intrapartum antibiotics, and had significantly bigger and more mature infants, more outborns, as well as a higher number of sick infants requiring ventilator support and total parenteral nutrition.</p><p><b>CONCLUSION</b>Patient loads, resuscitation at birth, status of infants on admission and treatment interventions were significantly associated with inter-institutional variations in sepsis.</p>

Does Oral Lansoprazole Really Reduce Gastric Acidity in VLBW Premature Neonates?

Premature neonates of very low birth weight (VLBW) whose treatment required the use of naso-gastric tube feeding were investigated. 10 infants suspected of having GERD (gastroesophageal reflux) received oral lansoprazole therapy by tube administration. 9 other infants formed a control group. In the treated group a fasting pH was determined before treatment and again after 7 days treatment. The control group was similarly assessed at an interval of 7 days. Despite acid reduction, the post-treatment pH mean of 1.31 would continue to pose a threat to the esophageal mucosa. The physiology of neonatal acid secretion is discussed to explain these findings.

Risk of Surgery for Retinopathy of Prematurity in Very Low Birth Weight Infants

PURPOSE: The main postnatal risk factors of retinopathy of prematurity (ROP) were described as prolonged oxygen therapy and lower gestational age. Recent data suggest poor early weight gain during the first weeks of life, which can be an additional predictor of severe ROP. We aimed to analyze the risk factors associated with requiring operation for ROP in preterm infants with very low birth weight (VLBW). METHODS: In a retrospective case control study, from January 2004 to June 2010, 140 VLBW infants diagnosed as ROP by the International classification of ROP were recruited. There were 14% of infants with stage 1 disease, 65.7% stage 2, and 20% stage 3 or more. A group requiring a laser surgery for ROP was 66 infants, and a group not requiring surgery was 74 infants. RESULTS: By a univariate analysis, antenatal steroid, chorioamnionitis, gestational age, birth weight, days on oxygen, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalasia and sepsis were significantly associated with ROP requiring surgery. Weight differences between birth and each from 4 to 12 weeks were significantly lower in the infants requiring surgery (P<0.05). However, after adjustment for gestational age in logistic regression, weight difference between birth and 8th week was a significant predictive factor for the requirement of surgery in infants with ROP (OR, 0.998; 95% CI, 0.996-0.999, P=0.013). CONCLUSION: We suggest that careful monitoring of weight change and aggresive nutritional support for poorly growing infants, during the first 8 weeks of life, may possibly prevent laser surgery of ROP in preterm VLBW infants.

Crecimiento intrahospitalario de RN de muy bajo peso en el centro materno infantil: comparación con NEOCOSUR / In-hospital weight gain in very low birth weight newborns at the centro materno-infantil of Asuncion, Paraguay: comparison with the NEOCOSUR database

Objetivos: Determinar el crecimiento intrahospitalario y las prácticas alimentarias de los RNMBP en la Unidad de Neonatología de la Cátedra y Servicio de Pediatría del Hospital de Clínicas sede San Lorenzo. Metodología: Estudio observacional analítico retrospectivo. Fueron incluidos los RN nacidos en el hopistal, asistidos en la Unidad de Cuidados Intensivos Neonatales (UCIN) con peso al nacer (PN) entre 500 y 1500 grs, de enero 2007 a diciembre 2009 seguidos desde su nacimiento hasta el alta; registrándose la evolución del peso y las prácticas alimentarias. Fueron considerados como grupo control los RNMBP de la red NEOCOSUR nacidos en el mismo periodo. Resultados: Nacieron 140 RNMBP, fueron incluidos 93 RN, la sobrevida al alta fue de 66,4%. El promedio de PN: 1187 ± 201 grs, a los 7días de vida 1091 ± 200 grs; con promedio de pérdida de 95,4 ± 5,6 grs que corresponde a 8% con relación PN; siendo la pérdida por día de 13,6 grs. A los 28 días de vida el promedio de peso fue de 1470 ± 271 grs; con variación de peso entre la semana de vida y los 28 días de 293 ± 79,4 grs, con ganancia de peso de 26,5%, correspondiendo a una ganancia estimada/día de 10,5 grs. Al alta el promedio de peso fue de 2140 ± 356 grs, con una variación de peso con relación al nacimiento de 930 ± 97 gramos, ganancia de peso de 85,3%, correspondiente a 14,5 grs de aumento/día. Recibieron NPT 69 RNMBP, los aminoácidos (AA) se iniciaron a los 2,7 ± 3,6 días y los lípidos a los 3,9 ± 3,4 días. En el NEOCOSUR, iniciaron AA a los 1,6 ± 1,8 días y lípidos a los 2 ± 1,8 días. Del total recibieron NPT 2346 RNMBP (89%). La alimentación enteral fue iniciada en la UCIN a los 4,1 ± 3,6 días y en el NEOCOSUR a los 3,2 ± 3 días. Se alcanzó el volumen de 100 ml/kg/día a los 14 ± 8 días en la UCIN, y en el NEOCOSUR a los 13,1 ± 8,4 días de vida...

Introduction: Assessing the growth and nutritional status of newborns (NB) is very important because of how strongly both factors are associated with overall health and development. Growth is associated with nutritional practices; with differences in calorie and protein intake varying according to when enteral and parenteral feeding of the VLBWI are begun. Objectives: To determine in-hospital weight gain and feeding practices for VLBWI in the Neonatal Unit of the Pediatrics Department of the Centro Materno-Infantil (CMI), of the School of Medical Sciences, National University of Asunción (UNA). Methodology: A retrospective, observational, and analytical study. Patients included were NB treated in the CMI Neonatal Intensive Care Unit (NICU) with birth weights between 500 and 1500 grams between 1 January 2007 and 31 December 2009. Their development, weight, and food intake were recorded in follow up from birth until discharge to home. VLBW newborns in the NEOCOSUR database for the same period of time served as the control group. Results: Of the 140 VLBW newborns in that time period, 93 met inclusion criteria, and their rate of survival to discharge was 66.4%. Average birth weight was 1187 ± 201 grams, while on day 7 weight was 1091 ± 200 grams: an average loss of 95.4 ± 5.6 grams, corresponding to 8% of birth weight, and a daily rate of loss of 13.6 grams per day. At 28 days of age, average weight was 1470 ± 271 grams, with weight gain from day 7 to day 28 days of 293 ± 79.4 grams, a gain of 26.5%, corresponding to an estimated gain of 10.5 grams per day. At discharge, the average weight was 2140 ± 356 grams: a variation of weight relative to birthweight of 930 ± 97 grams (85.3%), corresponding to a gain of 14.5 grams per day. Among the 69 (74%) of VLBW newborn who received total parenteral nutrition (TPN), total days of hospitalization averaged 16 ± 9.4, while amino acid supplementation was begun at 2.7 ± 3.6 days and lipids at 3.9 ± 3.4 days...

Growth of Very Low Birth-Weight Indian Infants During Hospital Stay.

Objectives: To evaluate the growth pattern of Very Low Birth Weight (VLBW) infants (birthweight <1500g) during hospital stay and to compare the growth of Small for gestational age (SGA) and Appropriate for gestational age (AGA) infants. Study design: Prospective observational study. Setting. Level III Neonatal Intensive Care Unit (NICU) in Northern India. Participants: A cohort of 97 VLBW infants, admitted to NICU at Sir Ganga Ram Hospital, from 1 January, 2007 to 31 July, 2008. Intervention/Measurement: Weight, length and head circumference (HC) were serially measured from birth till discharge and respective Z scores were calculated as per data from Fenton’s references. Growth was also assessed by superimposing these trends on Ehrenkranz’s postnatal growth charts. Results: The mean Z scores for weight, length and HC at birth were –1.17, –1.09 and –0.54, respectively. These decreased to –2.16, –2.24 and –1.35, respectively by discharge. Both SGA and AGA infants exhibited a decrease of approximately 1 Z score in all parameters. On postnatal charts, growth of infants remained at or above respective reference lines, except in those below 1000g at birth. Average daily weight gain after regaining birth weight was 15.18 ± 1.7 g/kg/d, whereas the increase in HC and length were 0.48 ± 0.2 cm/week and 0.60 ± 0.4 cm/week, respectively. These increments when compared to the intrauterine growth rates, indicated discrepant growth trends. Conclusions: VLBW infants suffered significant growth lag during NICU stay and exhibited disproportionately slow growth of HC and length.

Can the special care neonatal unit admission cut-off be lowered down to 1500g babies.

Objective. The study was conducted to find out whether there is any significant difference in outcome if low birth weight babies weighing between 1500g and 1800g are managed by keeping them with their mothers, i.e., without special care neonatal unit (SCNU) admission. Methods. It was a retrospective study for which data was collected from past medical record section of 6 months duration from 01.07.06 to 31.12.06, Medical College, Kolkata. The subject of the study was babies born with weight between 1500g and 2000g, divided into 2 groups. Group A representing babies born between weight 1500g and 1800g, groups B representing babies born between 1801g and 2000g. The groups were compared with regard to four variable namely average material age, sex of the babies, singleton or twin pregnancy, mode of delivery and gestational maturity. Test of one proportion was used for statistical analysis of outcome. Results. Total number of live born babies in group A were 198 and in group B 223. Two group were comparable with respect to average maternal age (23.7 yr), sex distribution, singleton or twin pregnancy and number of cesarian section or vaginal delivery and proportion of small for gestational age (SGA) babies. In both the group 13 babies required SCNU admission after being given to their mothers in the postnatal ward. No significant difference in outcome was observed between the groups. Conclusion. We conclude that the recommended guidelines for giving institutional care to babies below 1800g may be lowered down to 1500g. However, more babies should be evaluated prospectively, over a longer duration of time, before changing the standard guidelines.

Extracción manual de leche materna para el mantenimiento de la lactancia / Manual removal of breast milk for the maintenance of lactation

Objetivos. Determinar a través de extracción manual, el volumen de calostro, leche de transición y leche materna madura producidos por las madres de niños prematuros y medir el incremento de peso de estos niños alimentados exclusivamente con leche materna madura utilizando sonda orogástrica.Material y métodos. Estudio longitudinal, realizado en el Servicio de Neonatología del Hospital de la Mujer, ciudadde La Paz. Fueron incluidos doce madres y sus hijos prematuros y se aplicó una encuesta con variables sociodemográficas.Se registró la producción por extracción manual, de calostro, leche de transición y leche materna madura y la ganancia diaria de peso de los niños prematuros alimentados exclusivamente con leche materna madura utilizando sonda orogástrica. Resultados. Las madres producen mediante extracción manual, calostro en un promedio de 71 ml/día (+/- 41,6 DE)de 1 a 4 días, leche de transición 207 ml/día (+/- 81,9 DE) de 5 a 10 días y leche madura 333 ml/día (+/- 105,1 DE)de 11 a 17 días. Las madres de niños de Muy bajo peso al nacer (MBPN), producen un mayor volumen de calostro, leche de transición y madura. El volumen de leche madura producida es mayor en madres de niños Pequeños para la edad gestacional (PEG), en comparación con madres de niños Adecuados para la edad gestacional (AEG). Los niños estudiados fueron alimentados exclusivamente con leche materna, de los cuales 83,3...

Objectives. To determine through the manual extraction, the volumes of colostrum, transition milk and mature maternal milk produced by premature children's mothers, and to measure the increase in these children's weight nourished exclusively with mature maternal milk using orogastric tube. Material and methods. A longitudinal study, carried out in the Service of Neonatology at the “Hospital de la Mujer”, in the city of La Paz. Twelve mothers and their premature sons were enrolled, and an inquiry with socio-demographic variables was applied. The maternal production of milk by manual extraction and a daily increase in the premature children’s weight nourished exclusively with mature maternal milk using orogastric tube was registered. Results. Mothers produce through manual extraction an average of 71 ml/day (+/- 41.6 SD) of colostrum between 1 to 4 days; transition milk of 207 ml/day (+/- 81.9 SD) between 5 to 10 days, and mature milk of 333 ml/day (+/- 105.1 SD) between 11 to 17 days.The mothers of children who are Very low birth weight (VLBW) produce a larger volume of colostrum, transition milk and mature milk. The volume of mature milk produced is larger in mothers of children who are Small for gestational age (SGA) in comparison to mothers of children who are Appropriate for gestational age (AGA).The children included in this study were nourished exclusively from maternal milk, from them 83.3% presented an adequate increase in weight. The average increase in weight from the tenth day to the seventeenth day oscillates between 18 and 40 grams per day.Conclusions.The manual extraction of mother’s milk allows for delayed suckle, giving volumes superior to the requirements of the lactant. These findings are important for nutritional education, and are a favorable alternative for mothers of premature children, or mothers who are studying, working or cannot suckle for any other reason.

Perinatal factor and neonatal outcome of very low birth weight infants with leukemoid reaction / 대한주산의학회잡지

PURPOSE:Leukemoid reaction (LR) represents inflammatory reaction in very low birth weight (VLBW) infants, and has been reported to relate with the development of bronchopulmonary dysplasia (BPD). This study was done to assess the relationship between perinatal characteristics and neonatal outcome of leukemoid reaction in VLBW infants. METHODS:Three hundred and seventy two VLBW infants admitted to the NICUs of SNUCH and SNUBH between June 2005 to June 2008 were studied in a retrospective case-controlled manner. Of these VLBW infants, 32 LR (+) infants were compared with 83 LR (-) infants who were matched for gestational age and birth weight with respect to perinatal and neonatal clinical characteristics. LR was defined as a white blood cell (WBC) count of more than 40,000 cells/mm3 or absolute neutrophil count of more than 30.000 cells/mm3 during the first month of life. RESULTS:Of 413 VLBW infants, There was no significant difference between the LR (+) and LR (-) infants in sex, Apgar scores, maternal peripheral WBC count, the use of antenatal steroids and maternal age. Comparing with LR (-) infants, LR (+) infants had a higher positive rate for amniotic fluid culture (67% vs 11%; P< or =0.01), U. ureaplasma in amniotic fluid (52% vs 10%; P=0.01), histologic chorioamnionitis (81% vs 33%; P=0.01) and funisitis (50% vs 7%; P=0.01). The incidences of respiratory distress syndrome, patent ductus arteriosus, necrotizing enterocolitis, sepsis, intraventricular hemorrhage and BPD showed no significant difference between LR (+) and LR (-) infants. CONCLUSION:LR during the first month of life in VLBW infants was associated with chorioamnionitis, but not with the incidence of bronchopulmonary dysplasia or other neonatal morbidities. These findings suggest that LR may be a simple reflection of transient accelerated neutrophil production induced by prenatal inflammation without significant neonatal consequences.

Neurodevelopmental Outcomes of Very Low Birth Weight Infants

PURPOSE: The objective of this study was to observe the neurodevelopmental outcomes of the surviving very low birth weight infants (VLBWIs) and to identify the perinatal risk factors having influences on to poor neurodevelopmental outcomes . METHODS: The VLBWIs weighing 500 to 1,499 g at birth who had survived to discharge from one NICU during about a 2 year period were followed-up and assessed with using the Baley Scales of Infant Development-Second Edition (BSID-II) test and neurologic examinations when the infants corrected age was between 12 and 24 months. Developmental delay was defined as a MDI less than 70 or a PDI less than 70. The birthweight specific rates of developmental delay and cerebral palsy were examined. The perinatal data were retrospectively collected from the medical records to identify peinatal risk factors that had an influence on poor neurologic outcomes. RESULTS: Thirty three (42.9%) of the 77 VLBWIs were assessed with the BSID-II and neurologic examination, when their corrected age was between 12 and 24 months. The rate of developmental delay and cerebral palsy in the assessed infants was 15.2% and 21.2%, respectively. Extremely low birth weight infants (ELBWIs) had high rates of developmental delay (30.8%) and cerebral palsys (30.8%). Maternal old age (>35 years, odds ratio=18.0, 95% CI, 1.2-262.7, P=0.035) and periventricular leukomalacia (PVL, odds ratio=12.6, 95% CI, 1.1-148.1, P=0.044) were independently associated with developmental delay and cerebral palsy, respectively. CONCLUSION: Significant poor neurodevelopmental outcome for the VLBW infants needs a more extended follow-up study for development, and especially for the ELBWIs.

Low Birth Weight, Very Low Birth Weight Rates of Newborn Infants in Korea

This study was conducted to obtain the low birth weight (LBW) rate and the very low birth weight (VLBW) rate of newborn infants based on a large population in Korea. We analyzed 108, 486 live birth data, collected from 75 hospitals and clinics located in Korea, whose gestational age (GA) were greater than 23 weeks, for 1 yr from January 1st to December 31st 2001. These data included birth weight, GA, gender of the infants, delivery type, maternal age, and the presence of multiple pregnancies. The mean birth weight and GA of a crude population are 3, 188+/-518 g and 38.7+/-2.1 weeks, respectively. The LBW and the VLBW rates are 7.2% and 1.4%, respectively. The preterm birth rate (less than 37 completed weeks of gestation) is 8.4% and the extremely preterm birth rate (less than 32 completed weeks of gestation) is 1.7%. The mean birth weights for female infants, multiple births, and births delivered by cesarean section were lower than those for male, singletons, and births delivered vaginally. The risk of delivering LBW or VLBW infant was higher for the teenagers and the elderly women (aged 35 yr and more). Although our study did not include the total birth data in 2001, rates of LBW and VLBW which we obtained, could be helpful for future studies on birth weight, frequency of high risk infants and perinatal risk factors.

Double-blind Randomized Dose Controlled Multicenter Study on Prevention of Anemia in VLBW Premature Infants Treated with High Dose rhEPO (recombinant human erythropoietin)

PURPOSE: Very low birth weight infants frequently suffer severe anemia. This study was designed to evaluate the effectiveness of rhEPO for prevention of anemia of prematurity and for reduction of the need for transfusion in very low birth weight infants. METHODS: Eighty very low birth weight infants(<1.5 kg) whose gestational age was under 33 weeks were enrolled at 9 university hospital in Korea. This study was conducted as a double-blind randomized, dose-controlled study. In high dose EPO group, 500 IU/kg of rhEPO was subcutaneously administered every other day for 17 times. In low dose EPO group, 250 IU/kg of rhEPO was subcutaneously administered every other day for 17 times. In control group, placebo was administered in the same manner. The effectiveness of rhEPO was evaluated for multiple parameters. RESULTS: 1) Infants receiving high dose rhEPO showed a significant increase in hemoglobin and hematocrit by 3 weeks(P<0.05). 2) Infants receiving high & low dose rhEPO showed an increase in reticulocyte count by 1 week(P<0.05). 3) There were no significant changes in platelet, WBC count, and ANC in each group. 4) Serum concentration of erythropoietin, iron, TIBC and ferritin were highly variable in study patients.5) Incidence of anemia k transfusion in high dose rhEPO group was lower than low dose and control group(P<0.05). 6) Number of patients who did not receive transfusion and whose hematocrit did not fall below 30% in high dose rhEPO group was significantly higher than in low dose and control group(P<0.01). CONCLUSION: High dose recombinant human erythropoietin(rhEPO) treatment for anemia of prematurity may minimize the decrease in hemoglobin and hematocrit, rapidly increase reticulocyte count and reduce the need for transfusion.

Effect of Intravenous Immunoglobulin(IVIG) on Renal Function in Very Low Birth Weight Infants

PURPOSE: This study was conducted to evaluate the effect of IVIG infusion on renal function in VLBW infants. IVIG has been proved quite safe in neonates given prophylactic and therapeutic doses. But nephrotoxicity is not recognized as adverse in IVIG therapy, only several previous adult cases have been noted. METHODS: For a total of ten VLBW infants who had not been received any medication except parenteral nutrition, vitamin and Fe supplements was assigned for study. To observe changes in renal function after preventive dose of IVIG administration(500mg/kg, 1dose) serum BUN and creatinine, 2-microglobulin( 2-MG) and N-acetyl- -D-glucosaminidase(NAG) were obtained prior to study and 1, 3 and 7 days after infusion. RESULTS: 1) There were no elevation of serum BUN and creatinine after IVIG administration, 2) There was transient increase of urine NAG from 1.1+/-0.7 u/mg creatinine before infusion to 2.7+/-5.3 u/mg creatinine on the first day of infusion, which was not statistically significat, decreasing to pretreatment level on the 3rd and 7th days after infusion. 3) There was transient increase of urine 2-MG from 294.6+/-223.8 microgram/mg creatinine before infusion to 680.0+/-108.9 microgram/mg creatinine on the first day and 416.0+/-246.3 microgram/mg creatinine on 3rd day after infusion, which was not statistically significant. CONCLUSIONS: It was found that prophylactic dose of IVIG in VLBW infants does not cause clinically significant impairment of renal function. but mild increment of urine NAG and 2-MG may suggest the possibility of renal tubular damage. Based on these results, further evaluation of the effect of IVIG on renal function in VLBW infant is recommended.