| 1. |
- Backes, Carl H., et al.
(author)
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Management, treatment and ethical considerations in the care of mother-infant dyads at less than 25 weeks of gestations
- 2022
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In: Seminars in Perinatology. - : Elsevier. - 0146-0005 .- 1558-075X. ; 46:1
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Journal article (peer-reviewed)abstract
- Infants born at less than 25 weeks of gestation represent a small fraction of all preterm births. Caring for these fragile patients is complex because of their significant risks of mortality and adverse outcomes. In the last decades, in view of decreased mortality without increased morbidity as reported from different centers, many clinicians are now more likely to consider providing intensive care treatment to infants born at less than 25 weeks of gestation. But in other settings, palliative care is still considered standard practice, particularly at 22 and 23 weeks of gestation.
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| 2. |
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| 3. |
- Backes, Carl, et al.
(author)
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Outcomes Following a Comprehensive versus a Selective Approach for Infants Born at 22 Weeks of Gestation.
- 2019
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In: Journal of Perinatology. - : Springer Science and Business Media LLC. - 0743-8346 .- 1476-5543. ; 39:1, s. 39-47
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Journal article (peer-reviewed)abstract
- Objective: To examine outcomes at two institutions with different approaches to care among infants born at 22 weeks of gestation.Study design: Retrospective, cohort study (2006–2015). Enrollment was limited to mother–infant dyads at 22 weeks of gestation. Proactive care was defined as provision of antenatal corticosteroids and neonatal resuscitation and intensive care. One center (Uppsala, Sweden; UUCH) provided proactive care to all mother–infant dyads (comprehensive center); the other center (Nationwide Children’s Hospital, USA; NCH) initiated or withheld treatment based on physician and family preferences (selective center). Differences in outcomes between the two centers were evaluated.Result: Among 112 live-born infants at 22 weeks of gestation, those treated at UUCH had in-hospital survival rates higher than those at NCH (21/40, 53% vs. 6/72, 8%; P < 0.01). Among the subgroup of infants receiving proactive care (UUCH: 40/40, 100%; NCH: 16/72, 22%) survival was higher at UUCH than at NCH (21/40, 53% vs. 3/16, 19%; P < 0.05).Conclusion: Even when mother–infant dyads were provided proactive care at NCH (selective center), survival was lower than infants provided proactive care at UUCH (comprehensive center). Differences between the approaches to care at the two centers at 22 weeks of gestation merits further investigation.
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| 4. |
- Cristea, A. Ioana, et al.
(author)
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Approaches to Interdisciplinary Care for Infants with Severe Bronchopulmonary Dysplasia: A Survey of the Bronchopulmonary Dysplasia Collaborative
- 2022
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In: American Journal of Perinatology. - : Georg Thieme Verlag KG. - 0735-1631 .- 1098-8785.
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Journal article (peer-reviewed)abstract
- Objective: Bronchopulmonary dysplasia (BPD) remains the most common late morbidity for extremely premature infants. Care of infants with BPD requires a longitudinal approach from the neonatal intensive care unit to ambulatory care though interdisciplinary programs. Current approaches for the development of optimal programs vary among centers.Study design: We conducted a survey of 18 academic centers that are members of the BPD Collaborative, a consortium of institutions with an established interdisciplinary BPD program. We aimed to characterize the approach, composition, and current practices of the interdisciplinary teams in inpatient and outpatient domains.Results: Variations exist among centers, including composition of the interdisciplinary team, whether the team is the primary or consult service, timing of the first team assessment of the patient, frequency and nature of rounds during the hospitalization, and the timing of ambulatory visits postdischarge.Conclusion: Further studies to assess long-term outcomes are needed to optimize interdisciplinary care of infants with severe BPD.Key points: · Care of infants with BPD requires a longitudinal approach from the NICU to ambulatory care.. · Benefits of interdisciplinary care for children have been observed in other chronic conditions.. · Current approaches for the development of optimal interdisciplinary BPD programs vary among centers..
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| 5. |
- Diderholm, Barbro, 1965-, et al.
(author)
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The Impact of Restricted versus Liberal Early Fluid Volumes on Plasma Sodium, Weight Change, and Short-Term Outcomes in Extremely Preterm Infants
- 2022
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In: Nutrients. - : MDPI AG. - 2072-6643. ; 14:4
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Journal article (peer-reviewed)abstract
- The optimal fluid requirements for extremely preterm infants are not fully known. We examined retrospectively the fluid intakes during the first week of life in two cohorts of extremely preterm infants born at 22-26 weeks of gestation before (n = 63) and after a change from a restrictive to a more liberal (n = 112) fluid volume allowance to improve nutrient provision. The cohorts were similar in gestational age and birth weight, but antenatal steroid exposure was more frequent in the second era. Although fluid management resulted in a cumulative difference in the total fluid intake over the first week of 87 mL/kg (p < 0.001), this was not reflected in a mean weight loss (14 +/- 5% at a postnatal age of 4 days in both groups) or mean peak plasma sodium (142 +/- 5 and 143 +/- 5 mmol/L in the restrictive and liberal groups, respectively). The incidences of hypernatremia (>145 and >150 mmol/L), PDA ligation, bronchopulmonary dysplasia, and IVH were also similar. We conclude that in this cohort of extremely preterm infants a more liberal vs. a restricted fluid allowance during the first week had no clinically important influence on early changes in body weight, sodium homeostasis, or hospital morbidities.
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| 6. |
- Erdeve, Omer, et al.
(author)
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An Update on Patent Ductus Arteriosus and What is Coming Next
- 2022
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In: TURKISH ARCHIVES OF PEDIATRICS. - : AVES Publishing Co.. - 2757-6256. ; 57:2, s. 118-131
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Research review (peer-reviewed)abstract
- Patent ductus arteriosus is the most common cardiovascular condition in preterm infants. There is a significant uncertainty about when and how to close ductus arteriosus in preterm infants due to a high spontaneous closure rate even in very immature preterm infants. Diagnosis and management of patent ductus arteriosus remain a challenge for both neonatologists and pediatric cardiologists. Researchers have tried to define a balance between an expectant approach and active treatment in selected infants. This review aimed to focus on the pathophysiology and management of patent ductus arteriosus and to make suggestions about approaches that might eliminate the association of morbidities with patent ductus arteriosus.
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| 7. |
- Hoffsten, Alice, et al.
(author)
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Early Postnatal Comprehensive Biomarkers Cannot Identify Extremely Preterm Infants at Risk of Developing Necrotizing Enterocolitis.
- 2021
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In: Frontiers in pediatrics. - : Frontiers Media S.A.. - 2296-2360. ; 9
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Journal article (peer-reviewed)abstract
- Background: Necrotizing enterocolitis (NEC) is a fatal disease where current diagnostic tools are insufficient for preventing NEC. Early predictive biomarkers could be beneficial in identifying infants at high risk of developing NEC. Objective: To explore early biomarkers for predicting NEC in extremely preterm infants (EPIs). Methods: Blood samples were collected on day 2 (median 1.7; range 1.5-2.0) from 40 EPI (median 25 gestational weeks; range 22-27): 11 developed NEC and 29 did not (controls). In each infant, 189 inflammatory, oncological, and vascular proteomic biomarkers were quantified through Proximity Extension Assay. Biomarker expression and clinical data were compared between the NEC group and Controls. Based on biomarker differences, controls were sorted automatically into three subgroups (1, 2, and 3) by a two-dimensional hierarchical clustering analysis. Results: None of the biomarkers differed in expression between all controls and the NEC group. Two biomarkers were higher in Control 1, and 16 biomarkers were lower in Control group 2 compared with the NEC group. No biomarker distinguished Control 3 from the NEC group. Perinatal data were similar in the whole population. Conclusions: Early postnatal comprehensive biomarkers do not identify EPIs at risk of developing NEC in our study. Future studies of predictors of NEC should include sequential analysis of comprehensive proteomic markers in large cohorts.
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| 8. |
- Hoffsten, Alice, et al.
(author)
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Paneth cell proteins DEFA6 and GUCA2A as tissue markers in necrotizing enterocolitis
- 2023
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In: European Journal of Pediatrics. - : Springer Nature. - 0340-6199 .- 1432-1076. ; 182:6, s. 2775-2784
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Journal article (peer-reviewed)abstract
- Previous studies suggest that Paneth cells are involved in NEC development. Defensin alpha 6 (DEFA6) and guanylate cyclase activator 2A (GUCA2A) are selective protein markers of Paneth cells. The objective was to explore DEFA6 and GUCA2A expression in intestinal tissue samples from newborn infants with and without NEC. Tissue samples from histologically intact intestine were analyzed from 70 infants: 43 underwent bowel resection due to NEC and 27 controls were operated due to conditions such as intestinal atresia, dysmotility, aganglionosis, pseudo-obstruction or volvulus. Each tissue sample was immunohistochemically stained for DEFA6 and GUCA2A. Semi-automated digital image analysis was performed to determine protein expression. Clinical data and protein expressions were compared between the groups. DEFA6 expression was lower in the NEC group (p = 0.006). Low DEFA6 correlated with risk of developing NEC in a logistic regression analysis, independently of gestational age and birth weight (OR 0.843 [CI 0.732–0.971]; p = 0.018). GUCA2A expression did not differ between the two groups.Conclusion: Lower expression of DEFA6 together with intact GUCA2A expression indicates that NEC patients have well-defined Paneth cells but diminished defensin activity. Our results suggest that DEFA6 could be used as a biomarker for NEC.What is Known:• Previous studies of defensin activity in NEC have been inconsistent, showing that defensin levels may be increased or diminished in NEC. GUCA2A has to our knowledge never been studied in NEC.What is New:• This study benchmarks two specific Paneth cell markers (DEFA6 and GUCA2A) and their activity in individuals with and without NEC.• The key finding is that the NEC group had a lower DEFA6 expression compared to the Controls, while the expression of GUCA2A did not differ between the groups.
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| 9. |
- Hoffsten, Alice, et al.
(author)
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The value of autopsy in preterm infants at a Swedish tertiary neonatal intensive care unit 2002-2018
- 2021
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In: Scientific Reports. - : Springer Nature. - 2045-2322. ; 11
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Journal article (peer-reviewed)abstract
- Reliable data on causes of death (COD) in preterm infants are needed to assess perinatal care and current clinical guidelines. In this retrospective observational analysis of all deceased preterm infants born <37 weeks' gestational age (n=278) at a Swedish tertiary neonatal intensive care unit, we compared preliminary COD from Medical Death Certificates with autopsy defined COD (2002-2018), and assessed changes in COD between two periods (period 1:2002-2009 vs. period 2:2011-2018; 2010 excluded due to centralized care and seasonal variation in COD). Autopsy was performed in 73% of all cases and was more than twice as high compared to national infant autopsy rates (33%). Autopsy revised or confirmed a suspected preliminary COD in 34.9% of the cases (23.6% and 11.3%, respectively). Necrotizing enterocolitis (NEC) as COD increased between Period 1 and 2 (5% vs. 26%). The autopsy rate did not change between the two study periods (75% vs. 71%). We conclude that autopsy determined the final COD in a third of cases, while the incidence of NEC as COD increased markedly during the study period. Since there is a high risk to determine COD incorrectly based on clinical findings in preterm infants, autopsy remains a valuable method to obtain reliable COD.
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| 10. |
- Kielt, Matthew, et al.
(author)
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Classifying multicenter approaches to invasive mechanical ventilation for infants with bronchopulmonary dysplasia using hierarchical clustering analysis
- 2023
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In: Pediatric Pulmonology. - : John Wiley & Sons. - 8755-6863 .- 1099-0496. ; 58:8, s. 2323-2332
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Journal article (peer-reviewed)abstract
- IntroductionEvidence-based ventilation strategies for infants with severe bronchopulmonary dysplasia (BPD) remain unknown. Determining whether contemporary ventilation approaches cluster as specific BPD strategies may better characterize care and enhance the design of clinical trials. The objective of this study was to test the hypothesis that unsupervised, multifactorial clustering analysis of point prevalence ventilator setting data would classify a discrete number of physiology-based approaches to mechanical ventilation in a multicenter cohort of infants with severe BPD.MethodsWe performed a secondary analysis of a multicenter point prevalence study of infants with severe BPD treated with invasive mechanical ventilation. We clustered the cohort by mean airway pressure (MAP), positive end expiratory pressure (PEEP), set respiratory rate, and inspiratory time (Ti) using Ward's hierarchical clustering analysis (HCA).ResultsSeventy-eight patients with severe BPD were included from 14 centers. HCA classified three discrete clusters as determined by an agglomerative coefficient of 0.97. Cluster stability was relatively strong as determined by Jaccard coefficient means of 0.79, 0.85, and 0.77 for clusters 1, 2, and 3, respectively. The median PEEP, MAP, rate, Ti, and PIP differed significantly between clusters for each comparison by Kruskall–Wallis testing (p < 0.0001).ConclusionsIn this study, unsupervised clustering analysis of ventilator setting data identified three discrete approaches to mechanical ventilation in a multicenter cohort of infants with severe BPD. Prospective trials are needed to determine whether these approaches to mechanical ventilation are associated with specific severe BPD clinical phenotypes and differentially modify respiratory outcomes.
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| 11. |
- Lewis, Tamorah R., et al.
(author)
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Association of Racial Disparities With In-Hospital Outcomes in Severe Bronchopulmonary Dysplasia
- 2022
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In: JAMA pediatrics. - : American Medical Association (AMA). - 2168-6203 .- 2168-6211. ; 176:9, s. 852-859
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Journal article (peer-reviewed)abstract
- Importance: Bronchopulmonary dysplasia (BPD) is the most common serious morbidity of preterm birth. Short-term respiratory outcomes for infants with the most severe forms of BPD are highly variable. The mechanisms that explain this variability remain unknown and may be mediated by racial disparities.Objective: To determine the association of maternal race with death and length of hospital stay in a multicenter cohort of infants with severe BPD.Design, setting, and participants: This multicenter cohort study included preterm infants enrolled in the BPD Collaborative registry from January 1, 2015, to July 19, 2021, involving 8 BPD Collaborative centers located in the US. Included patients were born at less than 32 weeks' gestation, had a diagnosis of severe BPD as defined by the 2001 National Institutes of Health Consensus Criteria, and were born to Black or White mothers.Exposures: Maternal race: Black vs White.Main outcomes and measures: Death and length of hospital stay.Results: Among 834 registry infants (median [IQR] gestational age, 25 [24-27] weeks; 492 male infants [59%]) meeting inclusion criteria, the majority were born to White mothers (558 [67%]). Death was observed infrequently in the study cohort (32 [4%]), but Black maternal race was associated with an increased odds of death (adjusted odds ratio, 2.1; 95% CI, 1.2-3.5) after adjusting for center. Black maternal race was also significantly associated with length of hospital stay (adjusted between-group difference, 10 days; 95% CI, 3-17 days).Conclusions and relevance: In a multicenter severe BPD cohort, study results suggest that infants born to Black mothers had increased likelihood of death and increased length of hospital stay compared with infants born to White mothers. Prospective studies are needed to define the sociodemographic mechanisms underlying disparate health outcomes for Black infants with severe BPD.
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| 12. |
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| 13. |
- Markasz, Laszlo, et al.
(author)
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CD44 and RHAMM expression patterns in the human developing lung
- 2021
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In: Pediatric Research. - : Nature Publishing Group. - 0031-3998 .- 1530-0447. ; 89, s. 134-142
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Journal article (peer-reviewed)abstract
- Background: The hyaluronan (HA) receptors CD44 and RHAMM (CD168) are involved in cellular proliferation, differentiation, and motility. As previously investigated, HA and RHAMM expression in human neonatal lungs correlates to gestational age (GA) and air content.Methods: CD44 immunofluorescence was analyzed in postmortem lung samples from infants (n=93;22-41GA) by digital image analysis together with clinical data, including RHAMM expression, lung air and HA content by hierarchical clustering.Results: Five groups were defined according to RHAMM/CD44 expression, GA, and postnatal age (PNA): extremely-to-very preterm (EVP;22-31GA; Groups 1-2), moderately preterm-to-term (MPT;31-41GA; Groups 3-4) and mixed preterm-to-term (27-40GA; Group 5). CD44 correlated linearly with RHAMM in MPT (r=0.600;p<0.004). In EVP, high CD44 and low RHAMM corresponded with high PNA and lung air content independently of HA and GA (Group 1 vs 2;p<0.05 respectively). In MPT, high and low CD44 corresponded with low and high RHAMM independently of GA, HA and lung air content (Group 3 vs 4;p<0.001). No correlation between CD44 and GA/PNA at death was observed. Conclusions: A linear correlation between CD44 and RHAMM expression occurs during the late saccular phase of lung development at birth, whereas postnatal influences on CD44 and RHAMM expression in extremely-to-very preterm infants cannot be excluded.
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| 14. |
- Markasz, Laszlo, et al.
(author)
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Cluster Analysis of Early Postnatal Biochemical Markers May Predict Development of Retinopathy of Prematurity
- 2020
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In: Translational Vision Science & Technology. - : Association for Research in Vision and Ophthalmology (ARVO). - 2164-2591. ; 9:13
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Journal article (peer-reviewed)abstract
- Purpose: Growth factors and inflammatory and angiogenetic proteins are involved in the development of retinopathy of prematurity (ROP). However, no early biochemical markers are in clinical use to predict ROP. By performing cluster analysis of multiple biomarkers, we aimed to determine patient groups with high and low risk for developing ROP.Methods: In total, 202 protein markers in plasma were quantified by proximity extension assay from 35 extremely preterm infants on day 2 of life. Infants were sorted in groups by automated two-dimensional hierarchical clustering of all biomarkers. ROP was classified as stages I to III with or without surgical treatment. Predictive biomarkers were evaluated by analysis of variance and detected differences by two-sided paired t-test with Bonferroni corrections for multiple comparisons.Results: Differences in 39 biochemical markers divided infants without ROP into two control groups (control 1, n = 7; control 2, n = 5; P < 0.05). Sixty-six biochemical markers defined differences between the control groups (n = 13) and all ROP infants (n = 23; P < 0.05). PARK7, VIM, MPO, CD69, and NEMO were markedly increased in control 1 compared to all ROP infants (P < 0.001). Lower TNFRSF4 and higher HER2 and GAL appeared in infants with ROP as compared to control 1 and/or 2 (P < 0.05, respectively).Conclusions: Our data suggest that early elevated levels of PARK7, VIM, MPO, CD69, and NEMO may be associated with lower risk of developing ROP. Lower levels of TNFRSF4 with higher levels of HER2 and GAL may predict ROP development.Translational Relevance: Cluster analysis of early postnatal biomarkers may help to identify infants with low or high risk of developing ROP.
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| 15. |
- Markasz, Laszlo, et al.
(author)
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Collagen type IV alpha 1 chain (COL4A1) expression in the developing human lung
- 2024
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In: BMC Pulmonary Medicine. - : Springer Nature. - 1471-2466. ; 24:1
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Journal article (peer-reviewed)abstract
- BackgroundCollagen type IV alpha 1 chain (COL4A1) in the basement membrane is an important component during lung development, as suggested from animal models where COL4A1 has been shown to regulate alveolarization and angiogenesis. Less is known about its role in human lung development. Our aim was to study COL4A1 expression in preterm infants with different lung maturational and clinical features.MethodsCOL4A1 expression in 115 lung samples from newborn infants (21-41 weeks' gestational age; 0-228 days' postnatal age [PNA]) was studied by immunohistochemistry combined with digital image analysis. Cluster analysis was performed to find subgroups according to immunohistologic and clinical data.ResultsPatients were automatically categorized into 4 Groups depending on their COL4A1 expression. Expression of COL4A1 was mainly extracellular in Group 1, low in Group 2, intracellular in Group 3, and both extra- and intracellular in Group 4. Intracellular/extracellular ratio of COL4A1 expression related to PNA showed a distinctive postnatal maturational pattern on days 1-7, where intracellular expression of COL4A1 was overrepresented in extremely preterm infants.ConclusionsCOL4A1 expression seems to be highly dynamic during the postnatal life due to a possible rapid remodeling of the basement membrane. Intracellular accumulation of COL4A1 in the lungs of extremely premature infants occurs more frequently between 1 and 7 postnatal days than during the first 24 hours. In view of the lung arrest described in extremely preterm infants, the pathological and/or developmental role of postnatally increased intracellular COL4A1 as marker for basement membrane turnover, needs to be further investigated.
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| 16. |
- Markasz, Laszlo, et al.
(author)
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The receptor for hyaluronan-mediated motility (RHAMM) expression in neonatal bronchiolar epithelium correlates negatively with lung air content
- 2018
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In: Early Human Development. - : Elsevier BV. - 0378-3782 .- 1872-6232. ; 127, s. 58-68
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Journal article (peer-reviewed)abstract
- Introduction: The receptor for hyaluronan-mediated motility (RHAMM) may have an important role in lung development. The aim of this study was to examine the expression of hyaluronan (HA) content and RHAMM during postnatal lung development by analyzing human lung specimens from ventilated newborn infants with a variety of lung diseases at different gestational and postnatal ages.Materials and methods: Ninety four patient samples were evaluated. RHAMM expression was studied by immunohistochemistry combined with digital image analysis. Cluster analysis was performed to find subgroups according to immuno-histological and clinical data. We present a computerized method that describes the air content of the lung by determining the fraction of the parenchyma-covered area in lung sections. HA content was estimated by radiometric assay.Results: The patients could be sorted into groups by hierarchical clustering. Five of six groups showed individual patterns according to RHAMM expression and HA content. Negative correlation was observed between air content and RHAMM expression in the bronchiolar epithelium irrespective of clustered groups. Lung hypoplasia appeared in two distinctive groups, with significant differences in lung development and RHAMM expression.Conclusions: RHAMM expression may show dynamic changes during pathological processes in the neonatal lung. The distribution of RHAMM in the lung tissue is heterogeneous with a predominance to the bronchiolar epithelium. We found a negative correlation between lung air content and RHAMM expression in bronchiolar epithelium.
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| 17. |
- McKinney, Robin L., et al.
(author)
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Multicenter Experience with Neurally Adjusted Ventilatory Assist in Infants with Severe Bronchopulmonary Dysplasia
- 2021
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In: American Journal of Perinatology. - : Georg Thieme Verlag KG. - 0735-1631 .- 1098-8785. ; 38, s. E162-E166
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Journal article (peer-reviewed)abstract
- Objective The aim of this study is to determine patterns of neurally adjusted ventilatory assist (NAVA) use in ventilator-dependent preterm infants with evolving or established severe bronchopulmonary dysplasia (sBPD) among centers of the BPD Collaborative, including indications for its initiation, discontinuation, and outcomes.Study Design Retrospective review of infants with developing or established sBPD who were placed on NAVA after ≥4 weeks of mechanical ventilation and were ≥ 30 weeks of postmenstrual age (PMA).Results Among the 13 sites of the BPD collaborative, only four centers (31%) used NAVA in the management of infants with evolving or established BPD. A total of 112 patients met inclusion criteria from these four centers. PMA, weight at the start of NAVA and median number of days on NAVA, were different among the four centers. The impact of NAVA therapy was assessed as being successful in 67% of infants, as defined by the ability to achieve respiratory stability at a lower level of ventilator support, including extubation to noninvasive positive pressure ventilation or support with a home ventilator. In total 87% (range: 78–100%) of patients survived until discharge.Conclusion We conclude that NAVA can be used safely and effectively in selective infants with sBPD. Indications and current strategies for the application of NAVA in infants with evolving or established BPD, however, are highly variable between centers. Although this pilot study suggests that NAVA may be successfully used for the management of infants with BPD, sufficient experience and well-designed clinical studies are needed to establish standards of care for defining the role of NAVA in the care of infants with sBPD.
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| 18. |
- McKinney, R. L., et al.
(author)
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Novel forms of ventilation in neonates : Neurally adjusted ventilatory assist and proportional assist ventilation
- 2024
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In: Seminars in Perinatology. - : Elsevier. - 0146-0005 .- 1558-075X. ; 48:2
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Research review (peer-reviewed)abstract
- Patient-triggered modes of ventilation are currently the standard of practice in the care of term and preterm infants. Maintaining spontaneous breathing during mechanical ventilation promotes earlier weaning and possibly reduces ventilator-induced diaphragmatic dysfunction. A further development of assisted ventilation provides support in proportion to the respiratory effort and enables the patient to have full control of their ventilatory cycle. In this paper we will review the literature on two of these modes of ventilation: neurally adjusted ventilatory assist (NAVA) and proportional assist ventilation (PAV), propose future studies and suggest clinical applications of these modes.
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| 19. |
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| 20. |
- Munsters, Josanne, 1986-, et al.
(author)
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Skin conductance measurement as a selective and continuous pain assessment method during eye examinations for retinopathy of prematurity
- 2023
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In: Global Pediatrics. - : Elsevier. - 2667-0097. ; 4
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Journal article (peer-reviewed)abstract
- BackgroundAssessing and managing pain in newborns is important for normal development and reduction of morbidity.AimTo assess whether skin conductance measurements (SCM) can be used as an objective method for measuring procedural pain during screening for retinopathy of prematurity (ROP) in preterm infants and to identify painful components of the examination.Methods65 separate SCM were performed in 33 infants born at <32 weeks gestational age (wGA) eligible for ROP screening (median 26+4 wGA, range 23+3 to 31+3; median weeks postmenstrual age 37+2, range 31+0 to 49+6). SCM was measured before, during and after eye examination (fundoscopy and/or wide-field digital retinal imaging [WFDRI]), and compared to changes in heart rate (HR), pulse oximetry saturation (SpO2) and behavioral state measured with the Neonatal Pain, Agitation and Sedation Scale (N-PASS).ResultsA major increase of SCM could be seen during both fundoscopy and WFDRI (p<0.01, respectively). No correlation was found between SCM and wGA. N-PASS changed significantly during ROP examination (p<0.01). While N-PASS could only distinguish painful response from baseline during fundoscopy and WFDRI, SCM detected responses during each stage of the investigations i.e. the application of mydriatics, fundoscopy, anesthetic drops, speculum and WFDRI. HR increased only during digital retinal imaging (p = 0.049), while SpO2 decreased only during fundoscopy (p = 0.042).ConclusionSCM may be used as a continuous and objective method to evaluate pain and its intensity during screening for ROP, enabling the separation of the different painful components of the investigation. Selecting and grading the different painful stages improves the possibility to assess and continue to improve pain management more specifically in these patients.
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| 21. |
- Norman, Mikael, et al.
(author)
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Respiratory support of infants born at 22-24 weeks of gestational age
- 2022
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In: Seminars in Fetal & Neonatal Medicine. - : Elsevier. - 1744-165X .- 1878-0946. ; 27:2
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Research review (peer-reviewed)abstract
- Lung immaturity and acute respiratory failure are the major problems in the care of extremely preterm infants. Most infants with gestational age (GA) 22-24 weeks will need mechanical ventilation and many will depend on some type of respiratory support, invasive and non-invasive for extended periods. There is ongoing gap in knowledge regarding optimal respiratory support and applying strategies that are effective in more mature populations is not easy or even suitable because lung maturation differs in smaller infants. Better strategies on how to avoid lung damage and to promote growth and development of the immature lung are warranted since increased survival is accompanied by increasing rates of bronchopulmonary dysplasia and concerns over long-standing reductions in lung function.This review focuses on some aspects of respiratory care of infants born at 22-24 weeks of GA.
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| 22. |
- Olsson, Karl Wilhelm, 1985-, et al.
(author)
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A Matched Case Control Study of Surgically and Non-surgically Treated Patent Ductus Arteriosus in Extremely Pre-term Infants
- 2021
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In: Frontiers in Pediatrics. - : Frontiers Media S.A.. - 2296-2360. ; 9
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Journal article (peer-reviewed)abstract
- Introduction: There are still uncertainties about the timing and indication for surgical ligation of patent ductus arteriosus (PDA) in pre-term infants, where lower gestational age (GA) usually is predictive for surgical treatment.Objective: Our aim was to assess differences in clinical characteristics and outcomes between surgically treated and matched non-surgically treated PDA in extremely pre-term infants.Methods: All extremely pre-term infants born 2010-2016 with surgically treated PDA (Ligated group; n = 44) were compared to non-surgically treated infants (Control group; n = 44) matched for gestational age (+/-1 week) and time of birth (+/-1 month). Perinatal parameters, echocardiographic variables, details of pharmacological PDA treatment, morbidity, and mortality were assessed.Result: Mean GA and birthweight were similar between the Ligated group (24(+5) +/- 1(+3) weeks and 668 +/- 170 g) and the Control group (24(+5) +/- 1(+3) weeks and 704 +/- 166 g; p = 1.000 and p = 0.319, respectively). Infants in the Ligated group had larger ductal diameters prior to pharmacological treatment, and lack of diameter decrease and PDA closure after treatment (p = 0.022, p = 0.043 and 0.006, respectively). Transfusions, post-natal steroids and invasive respiratory support were more common in the Ligated group. Except for a higher incidence of severe bronchopulmonary dysplasia (BPD) in the Ligated group there were no other differences in outcomes or mortality between the groups.Conclusion: Early large ductal diameter and reduced responsiveness to pharmacological treatment predicted the need for future surgical ligation in this matched cohort study of extremely pre-term infants where the effect of GA and differences in treatment strategies were excluded. Besides an increased incidence of severe BPD in the Ligated group, no other differences in morbidity or mortality were detected.
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| 23. |
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| 24. |
- Olsson, Karl Wilhelm, 1985-, et al.
(author)
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Early haemodynamically significant patent ductus arteriosus does not predict future persistence in extremely preterm infants
- 2019
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In: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 108:9, s. 1590-1956
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Journal article (peer-reviewed)abstract
- AimWe assessed whether early haemodynamically significant patent ductus arteriosus (hsPDA) predicted persistent patent ductus arteriosus (PDA) in extremely preterm infants.MethodsThis prospective observational study of 60 infants born at 22–27 weeks of gestational age (GA) without any major congenital anomalies or heart defects was conducted at Uppsala University Children's Hospital from November 2012 to May 2015. Respiratory and systemic circulatory parameters were continuously recorded, and echocardiographic examinations performed daily during the first three days of life. Pharmacological treatment was initiated if hsPDA was found on days two to seven. Persistent PDA was diagnosed if hsPDA remained after pharmacological treatment or pharmacological treatment was contraindicated.ResultsThe infants (56% male) had a median GA of 25 + 2 weeks and 50% received pharmacological treatment. PDA was persistent in 30% and ultimately closed or insignificant in 70%. hsPDA on days two to seven was not associated with future persistent PDA (p = 1.000). Mechanical ventilation (p = 0.025), high mean airway pressure (p = 0.020) and low ductal maximal flow velocity (Vmax) (p = 0.024) on day two were associated with future persistent PDA.ConclusionEarly hsPDA did not predict persistent PDA, but the early need for assisted ventilation and low ductal Vmax were associated with future persistent PDA in these extremely preterm infants.
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- Olsson, Karl Wilhelm, 1985-, et al.
(author)
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Exploration of potential biochemical markers for persistence of patent ductus arteriosus in preterm infants at 22–27 weeks’ gestation
- 2019
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In: Pediatric Research. - : Springer Science and Business Media LLC. - 0031-3998 .- 1530-0447. ; 86, s. 333-338
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Journal article (peer-reviewed)abstract
- BackgroundEarly identification of infants at risk for complications from patent ductus arteriosus (PDA) may improve treatment outcomes. The aim of this study was to identify biochemical markers associated with persistence of PDA, and with failure of pharmacological treatment for PDA, in extremely preterm infants.MethodsInfants born at 22–27 weeks’ gestation were included in this prospective study. Blood samples were collected on the second day of life. Fourteen biochemical markers associated with factors that may affect PDA closure were analyzed and related to persistent PDA and to the response of pharmacological treatment with ibuprofen.ResultsHigh levels of B-type natriuretic peptide, interleukin-6, -8, -10, and -12, growth differentiation factor 15 and monocyte chemotactic protein 1 were associated with persistent PDA, as were low levels of platelet-derived growth factor. High levels of erythropoietin were associated with both persistent PDA and failure to close PDA within 24 h of the last dose of ibuprofen.ConclusionsHigh levels of inflammatory markers were associated with the persistence of PDA. High levels of erythropoietin were associated with both the persistence of PDA and failure to respond to pharmacological treatment.
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