Antenatal exposure to magnesium sulfate and neonatal outcomes in very low birth weight infants: a multicenter study.

OBJECTIVE: To explore the association between antenatal magnesium sulfate (MgSO4), mortality and incidence of intraventricular hemorrhage (IVH) in very low birth weight (VLBW) infants. STUDY DESIGN: Retrospective, cohort study of infants <32 weeks' GA born at centers of NEOCOSUR Network between January 2015 and December 2020. Subjects were categorized as exposed vs non-exposed to antenatal MgSO4. Primary outcomes were death, incidence of severe IVH (Grade III-IV) and severe IVH/death. Secondary outcomes included relevant morbidities. RESULTS: 7418 VLBW infants were eligible. Antenatal MgSO4 was associated with a significantly decreased death rate after admission (aOR 0.67 [95% CI, 0.49-0.94]) and severe IVH/ death (aOR 0.68 [95% CI, 0.50-0.93]). No significant reduction in severe IVH was observed (aOR 1.11 [95% CI, 0.72-1.71]). No differences between groups were observed in rates of morbidities. CONCLUSION: Antenatal MgSO4 was associated with a decreased death rate after admission and in severe IVH/ death.

Mortality in very low birth weight (VLBW) infants in South American NEOCOSUR Neonatal Network: timing and causes / Mortalidad en recién nacidos de muy bajo peso al nacer en la Red Neonatal NEOCOSUR: causalidad y temporalidad.

INTRODUCTION: Mortality in very low birth weight infants (VLBWIs) has remained at ~26% in the past 16 years in the NEOCOSUR Neonatal Network. OBJECTIVE: Mortality in very low birth weight infants (VLBWIs) has remained at ~26% in the past 16 years in the NEOCOSUR Neonatal Network. POPULATION AND METHODS: Observational, multicenter cohort study; retrospective analysis of data collected prospectively. Newborn infants born between 24 and 31+6 weeks of gestation age with a birth weight between 500 and 1500 g in the 26 sites of the NEOCOSUR Neonatal Network were included. The causes of death were analyzed depending on whether they occurred in the delivery room (DR) or in the neonatal intensive care unit (NICU). The postnatal age at time of death was determined using the KaplanMeier test. RESULTS: Observational, multicenter cohort study; retrospective analysis of data collected prospectively. Newborn infants born between 24 and 31+6 weeks of gestation age with a birth weight between 500 and 1500 g in the 26 sites of the NEOCOSUR Neonatal Network were included. The causes of death were analyzed depending on whether they occurred in the delivery room (DR) or in the neonatal intensive care unit (NICU). The postnatal age at time of death was determined using the KaplanMeier test. CONCLUSIONS: Important differences were observed in the causes of death of VLBWIs depending on their occurrence in the DR or the NICU. Infectious and respiratory conditions were the most relevant factors following admission to the NICU.

Introducción. La mortalidad de los recién nacidos de muy bajo peso de nacimiento (RNMBPN) se ha mantenido en ~26 % en los últimos 16 años en la Red Neonatal NEOCOSUR. Objetivo. Determinar la causa de muerte de los RNMBPN y su temporalidad en el período 20072016 en la Red Neonatal NEOCOSUR. Población y métodos. Estudio observacional de cohorte multicéntrica; análisis retrospectivo de datos obtenidos prospectivamente. Se incluyeron recién nacidos entre 24 y 31+6 semanas de edad gestacional y peso de nacimiento de 500-1500 g, en 26 centros de la Red Neonatal NEOCOSUR. Las causas de muerte se analizaron según ocurriera en sala de partos (SP) o durante la estadía en la unidad de cuidados intensivos neonatales (UCIN). La edad posnatal de muerte se determinó a través de análisis de Kaplan-Meier. Resultados. Se incluyeron un total de 11753 RNMBPN con una mortalidad global del 25,6 %. Las causas de muerte predominantes en SP fueron malformaciones congénitas (43,3 %), enfermedades respiratorias (14,3 %) y prematuridad (11,4 %). Las causas de muerte predominantes en UCIN fueron las respiratorias (24,2 %) e infecciosas (24,1 %). La edad promedio de muerte fue de 10,2 días y mediana de 4 días. El 10,2 % de las muertes ocurrieron en SP; el 21,5 %, durante el primer día; el 52 % ocurrió en los primeros 4 días y el 63,8 %, durante la primera semana de vida. , A través de los años, la mortalidad de los recién nacidos de muy bajo peso de nacimiento (RNMBPN) se ha mantenido estable, en torno al 26 % en la Red Neonatal NEOCOSUR.1 Esta mortalidad es mayor que la reportada por otras redes neonatales de países desarrollados. Así, los datos de la Red Suiza dan cuenta de una mortalidad de solo un 11 % entre los años 2012 a 2014 para el mismo grupo de recién nacidos.2 La red internacional iNEO, que agrupa 10 redes a lo largo del mundo, describe una mortalidad global del 9,1 % en RNMBPN de entre 24 a 32 semanas de edad gestacional entre los años 2007 y 2015.3 Por otra parte, la Red Neonatal Brasilera informa una mortalidad de 30 % en RNMBPN.4 f. Red Neonatal del Cono Sur (www. neocosur.org). Correspondencia: Alberto Toso: aatoso@ uc.cl Financiamiento: Ninguno. Conflicto de intereses: Ninguno que declarar. Recibido: 12-8-2021 Aceptado: 12-1-2022 Conclusiones. Se encuentran importantes diferencias en las causas de muerte de RNMBPN según ocurra en SP o en UCIN. Las infecciosas y respiratorias son las más relevantes luego del ingreso a la unidad de cuidados intensivos.

Mortalidad en recién nacidos de muy bajo peso al nacer en la Red Neonatal NEOCOSUR: causalidad y temporalidad / Mortality in very low birth weight (VLBW) infants in South American NEOCOSUR Neonatal Network: timing and causes

Introducción. La mortalidad de los recién nacidos de muy bajo peso de nacimiento (RNMBPN) se ha mantenido en ~26 % en los últimos 16 años en la Red Neonatal NEOCOSUR. Objetivo. Determinar la causa de muerte de los RNMBPN y su temporalidad en el período 20072016 en la Red Neonatal NEOCOSUR. Población y métodos. Estudio observacional de cohorte multicéntrica; análisis retrospectivo de datos obtenidos prospectivamente. Se incluyeron recién nacidos entre 24 y 31+6 semanas de edad gestacional y peso de nacimiento de 500-1500 g, en 26 centros de la Red Neonatal NEOCOSUR. Las causas de muerte se analizaron según ocurriera en sala de partos (SP) o durante la estadía en la unidad de cuidados intensivos neonatales (UCIN). La edad posnatal de muerte se determinó a través de análisis de Kaplan-Meier. Resultados. Se incluyeron un total de 11.753 RNMBPN con una mortalidad global del 25,6 %. Las causas de muerte predominantes en SP fueron malformaciones congénitas (43,3 %), enfermedades respiratorias (14,3 %) y prematuridad (11,4 %). Las causas de muerte predominantes en UCIN fueron las respiratorias (24,2 %) e infecciosas (24,1 %). La edad promedio de muerte fue de 10,2 días y mediana de 4 días. El 10,2 % de las muertes ocurrieron en SP; el 21,5 %, durante el primer día; el 52 % ocurrió en los primeros 4 días y el 63,8 %, durante la primera semana de vida. Conclusiones. Se encuentran importantes diferencias en las causas de muerte de RNMBPN según ocurra en SP o en UCIN. Las infecciosas y respiratorias son las más relevantes luego del ingreso a la unidad de cuidados intensivos.

Introduction. Mortality in very low birth weight infants (VLBWIs) has remained at ~26% in the past 16 years in the NEOCOSUR Neonatal Network. Objective. To determine the cause of death of VLBWIs and its temporality in the 2007-2016 period in the NEOCOSUR Neonatal Network. Population and methods. Observational, multicenter cohort study; retrospective analysis of data collected prospectively. Newborn infants born between 24 and 31+6 weeks of gestation age with a birth weight between 500 and 1500 g in the 26 sites of the NEOCOSUR Neonatal Network were included. The causes of death were analyzed depending on whether they occurred in the delivery room (DR) or in the neonatal intensive care unit (NICU). The postnatal age at time of death was determined using the KaplanMeier test. Results. A total of 11 753 VLBWIs were included; overall mortality was 25.6%. The prevailing causes of death in the DR were congenital malformations (43.3%), respiratory diseases (14.3%), and prematurity (11.4%). The prevailing causes of death in the NICU were respiratory diseases (24.2%) and infections (24.1%). The average and median age at death were 10.2 and 4 days, respectively. Also, 10.2% of deaths occurred in the DR; 21.5% on day 1, 52% in the first 4 days, and 63.8% in the first week of life. Conclusions. Important differences were observed in the causes of death of VLBWIs depending on their occurrence in the DR or the NICU. Infectious and respiratory conditions were the most relevant factors following admission to the NICU.

Producción de leche materna y estado emocional en madres de recién nacidos de muy bajo peso / Breast milk production and emotional state in mothers of very low birth weight infants

Introducción. Existe poca evidencia de la influencia de variables emocionales en la lactancia de madres de recién nacidos de muy bajo peso al nacer (RNMBPN). El objetivo de este estudio fue medir la producción de leche materna (PLM) en dos momentos de la internación neonatal y su asociación con los niveles de ansiedad, depresión y autoeficacia en lactancia en madres de RNMBPN.Población y métodos. Estudio prospectivo, observacional, multicéntrico en madres de RNMBPN (500-1500 g), en 9 centros de la Red NEOCOSUR. La PLM se obtuvo midiendo lo extraído por cada madre. Se utilizaron las escalas STAI para ansiedad, BDI para depresión, y, la escala piloto ALMA para autoeficacia. Estas fueron aplicadas a los 14 días de vida y a las 36 semanas posmenstruales. Se registraron, además, las características biosociales de madres y neonatos. Resultados. Participaron 118 madres. La PLM media a los 14 días fue de 169 ml (desvío estándar ­DE­ ± 132,4) y de 285 ml (DE ± 266,9) a las 36 semanas, y se asoció significativamente con percepción de autoeficacia en lactancia (p < 0,001), que se mantuvo durante la hospitalización. Existió una tendencia a menor producción en madres con mayores índices de depresión a los 14 días de vida de su hijo, pero no a las 36 semanas. No se encontró asociación entre PLM y ansiedad. No se encontraron asociaciones consistentemente significativas con variables biosociales. Conclusión. La PLM se asoció positivamente con autoeficacia en lactancia; no se encontró asociación con ansiedad y depresión en madres de RNMBPN

Introduction. There is little evidence regarding the influence of emotional variables on breastfeeding among mothers of very low birth weight infants (VLBWIs). The objective of this study was to measure breast milk production (BMP) at two points in time during neonatal hospitalization and its association with anxiety, depression, and breastfeeding self-efficacy levels among mothers of VLBWIs.Population and methods. Prospective, observational, and multicenter study in mothers of VLBWIs (500-1500 g) from 9 NEOCOSUR Network centers. BMP was obtained by measuring the amount extracted by each mother. The STAI scale was used for anxiety, the BDI scale for depression, and the ALMA pilot scale for self-efficacy. They were administered at 14 days of life and at 36 weeks of postmenstrual age. The biosocial characteristics of mothers and neonates were also recorded.Results. A total of 118 mothers participated. Mean BMP was 169 mL (standard deviation [SD]: ± 132.4) at 14 days and 285 mL (SD: ± 266.9) at 36 weeks, and it was significantly associated with the perception of breastfeeding self-efficacy (p < 0.001), which was maintained during hospitalization. There was a lower production trend among mothers with higher depression indices at 14 days of life, but not at 36 weeks. No association was observed between BMP and anxiety. No consistently significant associations were observed with biosocial variables.Conclusion. BMP was positively associated with breastfeeding self-efficacy; no association was observed with anxiety and depression among mothers of VLBWIs

Breast milk production and emotional state in mothers of very low birth weight infants. / Producción de leche materna y estado emocional en madres de recién nacidos de muy bajo peso.

INTRODUCTION: There is little evidence regarding the influence of emotional variables on breastfeeding among mothers of very low birth weight infants (VLBWIs). The objective of this study was to measure breast milk production (BMP) at two points in time during neonatal hospitalization and its association with anxiety, depression, and breastfeeding self-efficacy levels among mothers of VLBWIs. POPULATION AND METHOS: Prospective, observational, and multicenter study in mothers of VLBWIs (500-1500 g) from 9 NEOCOSUR Network centers. BMP was obtained by measuring the amount extracted by each mother. The STAI scale was used for anxiety, the BDI scale for depression, and the ALMA pilot scale for selfefficacy. They were administered at 14 days of life and at 36 weeks of postmenstrual age. The biosocial characteristics of mothers and neonates were also recorded. RESULTS: A total of 118 mothers participated. Mean BMP was 169 mL (standard deviation [SD]: ± 132.4) at 14 days and 285 mL (SD: ± 266.9) at 36 weeks, and it was significantly associated with the perception of breastfeeding self-efficacy (p < 0.001), which was maintained during hospitalization. There was a lower production trend among mothers with higher depression indices at 14 days of life, but not at 36 weeks. No association was observed between BMP and anxiety. No consistently significant associations were observed with biosocial variables. CONCLUSION: BMP was positively associated with breastfeeding self-efficacy; no association was observed with anxiety and depression among mothers of VLBWIs.

Introducción. Existe poca evidencia de la influencia de variables emocionales en la lactancia de madres de recién nacidos de muy bajo peso al nacer (RNMBPN). El objetivo de este estudio fue medir la producción de leche materna (PLM) en dos momentos de la internación neonatal y su asociación con los niveles de ansiedad, depresión y autoeficacia en lactancia en madres de RNMBPN. Población y métodos. Estudio prospectivo, observacional, multicéntrico en madres de RNMBPN (500-1500 g), en 9 centros de la Red NEOCOSUR. La PLM se obtuvo midiendo lo extraído por cada madre. Se utilizaron las escalas STAI para ansiedad, BDI para depresión, y, la escala piloto ALMA para autoeficacia. Estas fueron aplicadas a los 14 días de vida y a las 36 semanas posmenstruales. Se registraron, además, las características biosociales de madres y neonatos. Resultados. Participaron 118 madres. La PLM media a los 14 días fue de 169 ml (desvío estándar ­DE­ ± 132,4) y de 285 ml (DE ± 266,9) a las 36 semanas, y se asoció significativamente con percepción de autoeficacia en lactancia (p < 0,001), que se mantuvo durante la hospitalización. Existió una tendencia a menor producción en madres con mayores índices de depresión a los 14 días de vida de su hijo, pero no a las 36 semanas. No se encontró asociación entre PLM y ansiedad. No se encontraron asociaciones consistentemente significativas con variables biosociales. Conclusión. La PLM se asoció positivamente con autoeficacia en lactancia; no se encontró asociación con ansiedad y depresión en madres de RNMBPN.

Trends in Perinatal Practices and Neonatal Outcomes of Very Low Birth Weight Infants during a 16-year Period at NEOCOSUR Centers.

OBJECTIVE: To describe trends in mortality, major morbidity, and perinatal care practices of very low birth weight infants born at NEOCOSUR Neonatal Network centers from January 1, 2001, through December 31, 2016. STUDY DESIGN: A retrospective analysis of prospectively collected data from all inborn infants with a birthweight of 500-1500 g and 23-35 weeks of gestation. RESULTS: We examined data for 13 987 very low birth weight infants with a mean birth weight of 1081 ± 281 g and a gestational age of 28.8 ± 2.9 weeks. Overall mortality was 26.8% without significant changes throughout the study period. Decreases in early onset sepsis from 6.3% to 2.8% (P <.001), late onset sepsis from 21.1% to 19.5% (P = .002), retinopathy of prematurity from 21.3% to 13.8% (P <.001), and hydrocephalus from 3.8% to 2.4% (P <.001), were observed. The incidence for bronchopulmonary dysplasia decreased from 17.3% to 16% (P = .043), incidence of severe intraventricular hemorrhage was 10.4%, necrotizing enterocolitis 11.1%, and periventricular leukomalacia 3.8%, and did not change over the study period. Administration of antenatal corticosteroids increased from 70.2% to 82.3% and cesarean delivery from 65.9% to 75.4% (P <.001). The use of conventional mechanical ventilation decreased from 67.7% to 63.9% (P <.001) and continuous positive airway pressure use increased from 41.3% to 64.3% (P <.001). Survival without major morbidity increased from 37.4% to 44.5% over the study period (P <.001). CONCLUSIONS: Progress in perinatal and neonatal care at network centers was associated with an improvement in survival without major morbidity of very low birth weight infants during a 16-year period. However, overall mortality remained unchanged.

Hypopharyngeal oxygen concentration and pressures delivered by low flow nasal cannula in preterm infants: Relationship with flow, gas mixture, and infant's weight.

BACKGROUND: Low flow nasal cannula (LFNC) are frequently used in preterm infants. However, the delivered inspired oxygen concentration and airway pressures are not well established. OBJECTIVE: To determine the fraction of inspired oxygen (FiO2 ) and hypopharyngeal pressures generated by LFNC at different gas flows, gas mixture concentrations and infant's weight. DESIGN/METHODS: Serial samples of hypopharyngeal gas were obtained in 33 very low birth weight infants who were receiving oxygen with LFNC. Measurements were obtained with different gas flows and oxygen concentrations. FiO2 was measured using an electrochemical cell analyzer and hypopharyngeal pressures with a pressure transducer. RESULTS: 33 infants with a mean BW of 910 ± 284 g and 27 ± 1.7 weeks gestational age were studied at 36 ± 22 days after birth. FiO2 increased proportionally to gas flow, but with large variability: median (range) FiO 2 were 0.33 (0.23-0.54), 0.44 (0.29-0.67), 0.57 (0.33-0.81), and 0.69 (0.51-0.92) at 0.1, 0.3, 0.5, and 1 L/minute, respectively. Significantly higher mean FiO 2 were observed despite low flows in infants ≤ 1000 g compared to those > 1000 g (0.5 ± 0.1 vs 0.4 ± 0.07 at 0.3 L/minute; 0.66 ± 0.09 vs 0.5 ± 0.08 with 0.5 L/minute, respectively, P < .05). Hypopharyngeal pressures increased proportionally to gas flow with high variability: mean ± standard deviation pressures were 1.5 ± 0.8; 2.8 ± 1.2; 4.6 ± 1.3; 6.1 ± 1.6 cm H 2 O at 0.5, 1, 2, and 3 L/minute of gas flow. Peak pressures > 15 cm H 2 O were frequently observed with gas flows ≥ 2 L/min. CONCLUSIONS: Large variability in FiO2 and hypopharyngeal pressures were observed with oxygen administration through LFNC. Very high FiO 2 were observed despite low flows in infants < 1000 g. Excessive peak pressures can be generated with flows ≥ 2 L/minute especially among infants < 1000 g.

Bronchopulmonary dysplasia: risk prediction models for very-low- birth-weight infants.

OBJECTIVE: Our objective is to develop risk prediction models for moderate/severe bronchopulmonary dysplasia (BPD) and BPD and/or death in very-low-birth-weight infants (VLBWI) at birth, 3, 7, and 14 postnatal days. STUDY DESIGN: It is a multicenter study including 16,407 infants weighing 500-1500 g (2001-2015) from the Neocosur Network. BPD was defined as oxygen dependency at 36 weeks. Variables were selected using forward logistic regression models. Predictive values were evaluated using the ROC curve. RESULTS: In total, 2580 (15.7%) presented BPD and 6121 (37.3%) BPD/death. The AUC values for the BPD models were 0.788, 0.818, 0.827, and 0.894 respectively. For BPD/death, the AUC values were 0.860, 0.869, 0.867, and 0.906. BW and gestational age had higher contribution at birth; at later ages, the length of oxygen therapy and ventilation had the highest contribution. All AUC values were statistically significant when compared with a neutral value of 0.5 (p-value < 0.001). CONCLUSIONS: We developed high predictive power models for moderate/severe BPD and BPD/death at four postnatal ages.

Late Onset Sepsis in Very Low Birth Weight Infants in the South American NEOCOSUR Network.

BACKGROUND: The main aim is to determine the incidence and associated factors of late onset sepsis (LOS) in very low birth weight infants (500-1500 g), from the NEOCOSUR Network during years 2001-2013. Secondary objectives are to describe the microbiology of the first and second episode of LOS and to study the association between catheter dwell time and LOS. METHODS: Demographic information and outcome data are prospectively and routinely collected across the network using predefined diagnostic criteria and online data entry. LOS was confirmed by isolation of the organism in blood or through cerebrospinal fluid in cultures. The participating countries were Argentina, Brazil, Chile, Paraguay, Peru and Uruguay. RESULTS: Overall incidence was 22.2% (3066/13,821). Infants who developed LOS were smaller by weight and gestational age; also, they feature less prenatal care and prenatal steroids, and longer hospital stays. A greater number of infants in the LOS group had 1 minute Apgar Scores ≤3. Multivariate logistic regression analysis showed a positive association between LOS and necrotizing enterocolitis, mechanical ventilation requirements, patent ductus arteriosus, oxygen dependency at 36 weeks and death. The majority of first LOS episode was caused by coagulase-negative staphylococci (44.3%). An increased risk of LOS was observed in relation to catheter dwell time (6% per day of stay of central lines). CONCLUSIONS: The incidence of LOS was associated with mechanical ventilation, patent ductus arteriosus, necrotizing enterocolitis and death. LOS was an important cause of morbidity and mortality in very low birth weight infants in our network, and coagulase-negative staphylococci was the most frequent causative microorganism.

Estrés en padres de recién nacidos prematuros de muy bajo peso hospitalizados en unidades de cuidados intensivos neonatales. Estudio multicéntrico / Stress in parents of very low birth weight preterm infants hospitalized in neonatal intensive care units. A multicenter study

Introducción. El nacimiento de un hijo prematuro es un evento estresante para sus padres. El objetivo de este estudio fue determinar el estrés inicial de padres de recién nacidos de muy bajo peso de nacimiento (RNMBPN) hospitalizados en 12 unidades de cuidados intensivos neonatales en una red neonatal sudamericana, identificar los factores asociados y comparar el nivel de estrés parental en centros públicos vs. privados. Población y métodos. Estudio transversal en madres/padres de RNMBPN (de 500 a 1500 g). El estrés parental inicial se midió utilizando la Escala de Estrés Parental en una escala de 1 (bajo estrés) a 5 (alto estrés). Las características sociodemográficas de las madres/padres y de los neonatos fueron recolectadas y asociadas a los niveles de estrés parental. Resultados. Participaron del estudio 273 padres / madres de un total de 218 RNMBPN. La encuesta fue aplicada en el 5,9 ± 2,0 días de vida del recién nacido. El estrés parental total promedio fue de 3,1 ± 0,8, y la subescala rol parental fue aquella que puntuó más alto (3,6). Tener un menor nivel educacional, estar desempleado, no haber tomado al recién nacido en brazos y el requerimiento de apoyo ventilatorio se asociaron a mayor estrés parental. El estrés fue mayor en madres que en padres y en centros públicos que en privados. Conclusiones. En padres de RNMBPN, se encontró un estrés inicial moderado. El factor más relevante fue la alteración en su rol parental. El estrés parental fue mayor en las madres y en los centros públicos. Se requiere una mayor sensibilización, investigación e intervención en esta área.

Introduction. The birth of a premature baby is a stressful event for parents. The objective of this study was to determine early stress in parents of very low birth weight infants (VLBWIs) hospitalized in 12 neonatal intensive care units from a South American Neonatal Network, to identify associated factors, and to compare the level of parental stress in public versus private healthcare facilities. Population and Methods. Cross-sectional study in mothers/fathers of VLBWIs (500 to 1500 g). Early parental stress was measured using the Parental Stressor Scale, with a score from 1 (low stress) to 5 (high stress). The sociodemographic characteristics of parents and newborn infants were collected and associated with levels of parental stress. Results. The study included273 fathers/mothers of a total of218 VLBW preterm infants. The survey was administered at 5.9 ± 2.0 days of life. The average total parental stress was 3.1 ± 0.8, and the highest score was obtained for the parental role subscale (3.6). A lower education level, unemployment, not having held the newborn infant, and respiratory support requirement were associated with higher parental stress levels. Stress was higher among mothers than fathers, and at public facilities versus private ones. Conclusions. Among parents of VLBWIs, a moderate early parental stress was observed. Parental role alteration was the most relevant factor. Parental stress was higher among mothers and at public healthcare facilities. A greater sensitization, further research and interventions in this area are required.

Estrés en padres de recién nacidos prematuros de muy bajo peso hospitalizados en unidades de cuidados intensivos neonatales. Estudio multicéntrico / Stress in parents of very low birth weight preterm infants hospitalized in neonatal intensive care units. A multicenter study

Introducción. El nacimiento de un hijo prematuro es un evento estresante para sus padres. El objetivo de este estudio fue determinar el estrés inicial de padres de recién nacidos de muy bajo peso de nacimiento (RNMBPN) hospitalizados en 12 unidades de cuidados intensivos neonatales en una red neonatal sudamericana, identificar los factores asociados y comparar el nivel de estrés parental en centros públicos vs. privados. Población y métodos. Estudio transversal en madres/padres de RNMBPN (de 500 a 1500 g). El estrés parental inicial se midió utilizando la Escala de Estrés Parental en una escala de 1 (bajo estrés) a 5 (alto estrés). Las características sociodemográficas de las madres/padres y de los neonatos fueron recolectadas y asociadas a los niveles de estrés parental. Resultados. Participaron del estudio 273 padres / madres de un total de 218 RNMBPN. La encuesta fue aplicada en el 5,9 ± 2,0 días de vida del recién nacido. El estrés parental total promedio fue de 3,1 ± 0,8, y la subescala rol parental fue aquella que puntuó más alto (3,6). Tener un menor nivel educacional, estar desempleado, no haber tomado al recién nacido en brazos y el requerimiento de apoyo ventilatorio se asociaron a mayor estrés parental. El estrés fue mayor en madres que en padres y en centros públicos que en privados. Conclusiones. En padres de RNMBPN, se encontró un estrés inicial moderado. El factor más relevante fue la alteración en su rol parental. El estrés parental fue mayor en las madres y en los centros públicos. Se requiere una mayor sensibilización, investigación e intervención en esta área.(AU)

Introduction. The birth of a premature baby is a stressful event for parents. The objective of this study was to determine early stress in parents of very low birth weight infants (VLBWIs) hospitalized in 12 neonatal intensive care units from a South American Neonatal Network, to identify associated factors, and to compare the level of parental stress in public versus private healthcare facilities. Population and Methods. Cross-sectional study in mothers/fathers of VLBWIs (500 to 1500 g). Early parental stress was measured using the Parental Stressor Scale, with a score from 1 (low stress) to 5 (high stress). The sociodemographic characteristics of parents and newborn infants were collected and associated with levels of parental stress. Results. The study included273 fathers/mothers of a total of218 VLBW preterm infants. The survey was administered at 5.9 ± 2.0 days of life. The average total parental stress was 3.1 ± 0.8, and the highest score was obtained for the parental role subscale (3.6). A lower education level, unemployment, not having held the newborn infant, and respiratory support requirement were associated with higher parental stress levels. Stress was higher among mothers than fathers, and at public facilities versus private ones. Conclusions. Among parents of VLBWIs, a moderate early parental stress was observed. Parental role alteration was the most relevant factor. Parental stress was higher among mothers and at public healthcare facilities. A greater sensitization, further research and interventions in this area are required.(AU)

Stress in parents of very low birth weight preterm infants hospitalized in neonatal intensive care units. A multicenter study.

INTRODUCTION: The birth of a premature baby is a stressful event for parents. The objective of this study was to determine early stress in parents of very low birth weight infants (VLBWIs) hospitalized in 12 neonatal intensive care units from a South American Neonatal Network, to identify associated factors, and to compare the level of parental stress in public versus private healthcare facilities. POPULATION AND METHODS: Cross-sectional study in mothers/fathers of VLBWIs (500 to 1500 g). Early parental stress was measured using the Parental Stressor Scale, with a score from 1 (low stress) to 5 (high stress). The sociodemographic characteristics of parents and newborn infants were collected and associated with levels of parental stress. RESULTS: The study included 273 fathers/mothers of a total of 218 VLBW preterm infants. The survey was administered at 5.9 ± 2.0 days of life. The average total parental stress was 3.1 ± 0.8, and the highest score was obtained for the parental role subscale (3.6). A lower education level, unemployment, not having held the newborn infant, and respiratory support requirement were associated with higher parental stress levels. Stress was higher among mothers than fathers, and at public facilities versus private ones. CONCLUSIONS: Among parents of VLBWIs, a moderate early parental stress was observed. Parental role alteration was the most relevant factor. Parental stress was higher among mothers and at public healthcare facilities. A greater sensitization, further research and interventions in this area are required.

Impact of maternal diabetes mellitus on mortality and morbidity of very low birth weight infants: a multicenter Latin America study / Impacto da diabetes mellitus maternal sobre a mortalidade e morbidade de crianças com muito baixo peso ao nascer: um estudo em diversos centros da América Latina

OBJECTIVES: To compare mortality and morbidity in very low birth weight infants (VLBWI) born to women with and without diabetes mellitus (DM). METHODS: This was a cohort study with retrospective data collection (2001-2010, n = 11.991) from the NEOCOSUR network. Adjusted odds ratios and 95% confidence intervals were calculated for the outcome of neonatal mortality and morbidity as a function of maternal DM. Women with no DM served as the reference group. RESULTS: The rate of maternal DM was 2.8% (95% CI: 2.5-3.1), but a significant (p = 0.019) increase was observed between 2001-2005 (2.4%, 2.1-2.8) and 2006-2010 (3.2%, 2.8-3.6). Mothers with DM were more likely to have received a complete course of prenatal steroids than those without DM. Infants of diabetic mothers had a slightly higher gestational age and birth weight than infants of born to non-DM mothers. Distribution of mean birth weight Z-scores, small for gestational age status, and Apgar scores were similar. There were no significant differences between the two groups regarding respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, and patent ductus arteriosus. Delivery room mortality, total mortality, need for mechanical ventilation, and early-onset sepsis rates were significantly lower in the diabetic group, whereas necrotizing enterocolitis (NEC) was significantly higher in infants born to DM mothers. In the logistic regression analysis, NEC grades 2-3 was the only condition independently associated with DM (adjusted OR: 1.65 [95% CI: 1.2 -2.27]). CONCLUSIONS: VLBWI born to DM mothers do not appear to be at an excess risk of mortality or early morbidity, except for NEC. .

OBJETIVOS: Comparar mortalidade e morbidade em crianças de muito baixo peso (MBP) filhas de mães com e sem diabetes mellitus (DM). MÉTODOS: Estudo de coorte com coleta retrospectiva de dados (2001-2010, n = 11.991) da rede Neocosur. Odds ratios ajustados foram calculados para mortalidade e morbilidade neonatal em função da DM materna. Mulheres sem DM serviram como grupo de referência. RESULTADOS: A taxa de DM materna foi de 2,8% (IC 95% 2,5-3,1), mas um aumento significativo (p = 0,019) entre 2001-2005 (2,4%) e 2006-2010 (3,2%) foi observado. As mães com DM eram mais propensas a ter recebido um curso completo de esteroides pré-natais do que as sem DM. Os bebês de mães diabéticas tinham uma idade gestacional e peso ao nascer um pouco maior do que crianças filhas de não DM. A distribuição dos escores z do peso ao nascer, pequeno para idade gestacional e de Apgar foi semelhante. Não houve diferenças significativas entre os dois grupos em termos de síndrome do desconforto respiratório, displasia broncopulmonar, hemorragia intraventricular, leucomalácia periventricular e persistência do ductus arteriosus. Mortalidade na sala de parto, mortalidade total, necessidade de ventilação mecânica e taxas de sepse neonatal precoce foram significativamente menores no grupo diabético, enquanto enterocolite necrosante (NEC) foi significativamente maior em recém-nascidos de mães diabéticas. Em análises de regressão logística NEC foi a única condição independentemente associada com DM (OR ajustado 1,65 [IC 95% 1,21 -2,27]). CONCLUSÕES: Crianças MBP de DM não parecem estar em um excesso de risco de mortalidade ou morbidade precoce, exceto NEC. .

Impact of maternal diabetes mellitus on mortality and morbidity of very low birth weight infants: a multicenter Latin America study.

OBJECTIVES: To compare mortality and morbidity in very low birth weight infants (VLBWI) born to women with and without diabetes mellitus (DM). METHODS: This was a cohort study with retrospective data collection (2001-2010, n=11.991) from the NEOCOSUR network. Adjusted odds ratios and 95% confidence intervals were calculated for the outcome of neonatal mortality and morbidity as a function of maternal DM. Women with no DM served as the reference group. RESULTS: The rate of maternal DM was 2.8% (95% CI: 2.5-3.1), but a significant (p=0.019) increase was observed between 2001-2005 (2.4%, 2.1-2.8) and 2006-2010 (3.2%, 2.8-3.6). Mothers with DM were more likely to have received a complete course of prenatal steroids than those without DM. Infants of diabetic mothers had a slightly higher gestational age and birth weight than infants of born to non-DM mothers. Distribution of mean birth weight Z-scores, small for gestational age status, and Apgar scores were similar. There were no significant differences between the two groups regarding respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, and patent ductus arteriosus. Delivery room mortality, total mortality, need for mechanical ventilation, and early-onset sepsis rates were significantly lower in the diabetic group, whereas necrotizing enterocolitis (NEC) was significantly higher in infants born to DM mothers. In the logistic regression analysis, NEC grades 2-3 was the only condition independently associated with DM (adjusted OR: 1.65 [95% CI: 1.2 -2.27]). CONCLUSIONS: VLBWI born to DM mothers do not appear to be at an excess risk of mortality or early morbidity, except for NEC.

Supervivencia y morbilidad en recién nacidos de muy bajo peso al nacer en una Red Neonatal sudamericana / Survival and morbidity of very low birth weight infant in a South American Neonatal Network

Objetivo. Analizar la supervivencia y morbilidad relevante según edad gestacional (EG) en recién nacidos de muy bajo peso de nacimiento (RNMBPN) o < 1500 g y, con estos resultados, confeccionar una cartilla para proporcionar información a profesionales de la salud perinatal y padres de prematuros de muy bajo peso. Diseño del estudio. Se utilizaron los datos recogidos prospectivamente de los recién nacidos con peso al nacer de 500 a 1500 g ingresados a 45 centros participantes de la Red Neonatal Neocosur entre enero de 2001 y diciembre de 2011. Resultados. Se analizaron los datos de 8234 RNMBPN con EG entre 24 +0 y 31 +6 semanas. La mortalidad global fue 26% (IC 95% 25,0-26,9), que incluye 2,6% que falleció en sala de partos. Las cartillas de supervivencia y morbilidad para cada semana de gestación se construyeron a partir de los datos obtenidos. La supervivencia al momento del alta aumentó de 29% a las 24 semanas de EG a 91% a las 31 semanas (p < 0,001). La incidencia de morbilidad neonatal relevante se relacionó inversamente con la EG (p < 0,001). Globalmente, 30,8% presentó retinopatía del prematuro; 25%, displasia broncopulmonar; 10,9%, enterocolitis necrotizante; 7,2%, hemorragia intraventricular grave; y 4,6%, leucomalacia periventricular. De los sobrevivientes, 47,3% no presentó ninguna de estas 5 patologías. Conclusiones. Se desarrolló un instrumento de utilidad clínica, con datos regionales actualizados, que determina semana a semana la supervivencia y morbilidad de los RN que nacen entre las 24 +0 y las 31 +6 semanas de EG. Esta información puede emplearse en la toma de decisiones perinatales y en la información parental.

Objective. To analyze survival and relevant morbidity by gestational age (GA) in very low birth weight (VLBW) infants (<1500 g) and, based on these data, develop a fact sheet to provide information to perinatal healthcare providers and very low birth weight preterm infants ́parents. Study Design. Data were prospectively collected in relation to newborn infants with a birth weight between 500 g and 1500 g admitted to 45 sites of the Neocosur Neonatal Network (Red Neonatal Neocosur) between January 2001 and December 2011. Results. Data on 8234 VLBW with a GA between 24 +0 and 31 +6 weeks were analyzed. Overall mortality was 26% (95% CI: 25.0-26.9), including 2.6% of deaths in the delivery room. Fact sheets for survival and morbidity for each week of gestation were developed based on collected data. Survival at discharge increased from 29% at 24 weeks of GA to 91% at 31 weeks of GA (p < 0.001). The incidence of relevant neonatal morbidity was inversely related to GA (p < 0.001). Overall, 30.8% had retinopathy of prematurity, 25% bronchopulmonary dysplasia, 10.9% necrotizing enterocolitis, 7.2% severe intraventricular hemorrhage, and 4.6% periventricular leukomalacia. Among survivors, 47.3% had none of these five conditions. Conclusions. A tool for use in a clinical setting was developed based on updated regional data for establishing week-to-week survival and morbidity of newborn infants born between 24 +0 and 31 +6 weeks of GA. This information could be used to make decisions related to perinatal care and for counseling parents.

Survival and morbidity of very low birth weight infant in a South American neonatal network.

OBJECTIVE: To analyze survival and relevant morbidity by gestational age (GA) in very low birth weight (VLBW) infants (<1500 g) and, based on these data, develop a fact sheet to provide information to perinatal healthcare providers and very low birth weight preterm infants' parents. STUDY DESIGN: Data were prospectively collected in relation to newborn infants with a birth weight between 500 g and 1500 g admitted to 45 sites of the Neocosur Neonatal Network (Red Neonatal Neocosur) between January 2001 and December 2011. RESULTS: Data on 8234 VLBW with a GA between 24+0 and 31+6 weeks were analyzed. Overall mortality was 26% (95% CI: 25.0-26.9), including 2.6% of deaths in the delivery room. Fact sheets for survival and morbidity for each week of gestation were developed based on collected data. Survival at discharge increased from 29% at 24 weeks of GA to 91% at 31 weeks of GA (p < 0.001). The incidence of relevant neonatal morbidity was inversely related to GA (p < 0.001). Overall, 30.8% had retinopathy of prematurity, 25% bronchopulmonary dysplasia, 10.9% necrotizing enterocolitis, 7.2% severe intraventricular hemorrhage, and 4.6% periventricular leukomalacia. Among survivors, 47.3% had none of these five conditions. CONCLUSIONS: A tool for use in a clinical setting was developed based on updated regional data for establishing week-to-week survival and morbidity of newborn infants born between 24+0 and 31+6 weeks of GA. This information could be used to make decisions related to perinatal care and for counseling parents.

Clinical utility of early amplitude integrated EEG in monitoring term newborns at risk of neurological injury / Utilidade clínica de um monitoramento por EEG de amplitude integrada precoce em recém-nascidos a termo com risco de lesão neurológica

OBJECTIVE: to test the clinical utility of an early amplitude-integrated electroencephalography (aEEG) to predict short-term neurological outcome in term newborns at risk of neurology injury. METHODS: this was a prospective, descriptive study. The inclusion criteria were neonatal encephalopathy, neurologic disturbances, and severe respiratory distress syndrome. Sensitivity, specificity, positive and negative predictive values, and likelihood ratio (LR) were calculated. Clinical and demographic data were analyzed. Neurological outcome was defined as the sum of clinical, electroimaging, and neuroimaging findings. RESULTS: ten of the 21 monitored infants (48%) presented altered short-term neurologic outcome. The aEEG had 90% sensitivity, 82% specificity, 82% positive predictive value, and 90% negative predictive value. The positive LR was 4.95, and the negative LR was 0.12. In three of 12 (25%) encephalopathic infants, the aEEG allowed for a better definition of the severity of their condition. Seizures were detected in eight infants (38%), all subclinical at baseline, and none had a normal aEEG background pattern. The status of three infants (43%) evolved and required two or more drugs for treatment. CONCLUSIONS: in infants with encephalopathy or other severe illness, aEEG disturbances occur frequently. aEEG provided a better classification of the severity of encephalopathy, detected early subclinical seizures, and allowed for monitoring of the response to treatment. aEEG was a useful tool at the neonatal intensive care unit for predicting poor short-term neurological outcomes for all sick newborn. .

OBJETIVO: testar a utilidade clínica do aEEG precoce em recém-nascidos a termo com risco delesão neurológica, para prever resultados neurológicos de curto prazo. MÉTODOS: estudo prospectivo e descritivo. Os critérios de inclusão foram encefalopatia neonatal, distúrbios neurológicos e bebês com SARA grave. Sensibilidade, especificidade, valor preditivo positivo e negativo e razão de verossimilhança foram calculados. Dados clínicos edemográficos foram analisados. O resultado neurológico foi definido como a soma de conclusões clínicas, de eletro e de neuroimagem. RESULTADOS: dentre os 21 neonatos monitorados, dez (48%) apresentaram resultado neurológico de curto prazo alterado. O aEEG apresentou sensibilidade de 90%, especificidade de 82%, valor preditivo positivo de 82% e valor preditivo negativo de 90%. A VR positiva foi de 4,95, e a RV negativa de 0,12. Em três dos 12 (25%) neonatos com encefalopatia foi possível definir melhora gravidade de sua condição pelo aEEG. Foram detectadas convulsões em oito neonatos (38%), todas subclínicas no início do estudo, e nenhum apresentou um padrão histórico normal no aEEG. O estado de três neonatos (43%) evoluiu e exigiu dois ou mais medicamentos para tratamento. CONCLUSÕES: em neonatos com encefalopatia ou outra doença grave, os distúrbios no aEEGocorrem com mais frequência. O aEEG forneceu uma classificação melhor da gravidade da encefalopatia, detectou convulsões subclínicas precoces e permitiu que fosse feito o monitoramento da resposta ao tratamento. O aEEG é uma ferramenta útil para prever resultados neurológicos de curto prazo em todos os bebês doentes na UTIN. .

Clinical utility of early amplitude integrated EEG in monitoring term newborns at risk of neurological injury.

OBJECTIVE: to test the clinical utility of an early amplitude-integrated electroencephalography (aEEG) to predict short-term neurological outcome in term newborns at risk of neurology injury. METHODS: this was a prospective, descriptive study. The inclusion criteria were neonatal encephalopathy, neurologic disturbances, and severe respiratory distress syndrome. Sensitivity, specificity, positive and negative predictive values, and likelihood ratio (LR) were calculated. Clinical and demographic data were analyzed. Neurological outcome was defined as the sum of clinical, electroimaging, and neuroimaging findings. RESULTS: ten of the 21 monitored infants (48%) presented altered short-term neurologic outcome. The aEEG had 90% sensitivity, 82% specificity, 82% positive predictive value, and 90% negative predictive value. The positive LR was 4.95, and the negative LR was 0.12. In three of 12 (25%) encephalopathic infants, the aEEG allowed for a better definition of the severity of their condition. Seizures were detected in eight infants (38%), all subclinical at baseline, and none had a normal aEEG background pattern. The status of three infants (43%) evolved and required two or more drugs for treatment. CONCLUSIONS: in infants with encephalopathy or other severe illness, aEEG disturbances occur frequently. aEEG provided a better classification of the severity of encephalopathy, detected early subclinical seizures, and allowed for monitoring of the response to treatment. aEEG was a useful tool at the neonatal intensive care unit for predicting poor short-term neurological outcomes for all sick newborn.

Survival and morbidity of very low birth weight infant in a South American neonatal network. / Survival and morbidity of very low birth weight infant in a South American neonatal network.

OBJECTIVE: To analyze survival and relevant morbidity by gestational age (GA) in very low birth weight (VLBW) infants (<1500 g) and, based on these data, develop a fact sheet to provide information to perinatal healthcare providers and very low birth weight preterm infants parents. STUDY DESIGN: Data were prospectively collected in relation to newborn infants with a birth weight between 500 g and 1500 g admitted to 45 sites of the Neocosur Neonatal Network (Red Neonatal Neocosur) between January 2001 and December 2011. RESULTS: Data on 8234 VLBW with a GA between 24+0 and 31+6 weeks were analyzed. Overall mortality was 26

(95

CI: 25.0-26.9), including 2.6

of deaths in the delivery room. Fact sheets for survival and morbidity for each week of gestation were developed based on collected data. Survival at discharge increased from 29

at 24 weeks of GA to 91

at 31 weeks of GA (p < 0.001). The incidence of relevant neonatal morbidity was inversely related to GA (p < 0.001). Overall, 30.8

had retinopathy of prematurity, 25

bronchopulmonary dysplasia, 10.9

necrotizing enterocolitis, 7.2

severe intraventricular hemorrhage, and 4.6

periventricular leukomalacia. Among survivors, 47.3

had none of these five conditions. CONCLUSIONS: A tool for use in a clinical setting was developed based on updated regional data for establishing week-to-week survival and morbidity of newborn infants born between 24+0 and 31+6 weeks of GA. This information could be used to make decisions related to perinatal care and for counseling parents.

Center variability in risk of adjusted length of stay for very low birth weight infants in the Neocosur South American Network.

OBJECTIVES: To develop a prediction model for hospital length of stay (LOS) in very low birth weight (VLBW) infants and to compare this outcome among 20 centers within a neonatal network. METHODS: Data from 7,599 infants with birth weights of 500-1,500 g born between the years 2001-2008 were prospectively collected. The Cox regression model was employed to develop two prediction models: an early model based upon variables present at birth, and a late one that adds relevant morbidities for the first 30 days of life. RESULTS: Median adjusted estimated LOS from birth was 59 days - 28 days after 30-day point of survival. There was a high correlation between models (r = 0.92). Expected/observed LOS varied widely among centers, even after correction for relevant morbidity after 30 days. Median observed LOS (range: 45-70 days), and postmenstrual age at discharge (range: 36.4-39.9 weeks) reflect high inter-center variability. CONCLUSION: A simple model, with factors present at birth, can predict a VLBW infant's LOS in a neonatal network. Significant variability in LOS was observed among neonatal intensive care units. We speculate that the results originate in differences in inter-center practices.