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Extreme low birth weight

Lex W Doyle, Sarath Ranganathan, Anjali Haikerwal, Jeanie L Y Cheong
OBJECTIVES: To assess whether preeclampsia was associated with expiratory airflow at school-age in children born either extremely preterm (<28 weeks of gestation) or extremely low birthweight (ELBW; <1000 g birth weight). STUDY DESIGN: Participants comprised 3 cohorts of children born extremely preterm/ELBW in the state of Victoria, Australia, in 1991-1992, 1997, or 2005. Expiratory airflows were measured at age 8 years, and results converted to z scores...
March 11, 2019: Journal of Pediatrics
Scott J Morin, Emre Seli
The majority of offspring born following assisted reproductive technology (ART) achieve equivalent development milestones and demonstrate comparable health as spontaneously conceived children. Yet, multiple studies have suggested offspring conceived with ART have slightly increased risk of metabolic derangements, cardiovascular disease, and malignancy. However, the associations observed in these studies often inadequately control for a variety of confounding variables, such as multiple gestation, premature birth, and low birth weight...
May 2018: Seminars in Reproductive Medicine
Marion Wiegele, Peter Marhofer, Per-Arne Lönnqvist
Caudal epidural blockade in children is one of the most widely administered techniques of regional anaesthesia. Recent clinical studies have answered major pharmacodynamic and pharmacokinetic questions, thus providing the scientific background for safe and effective blocks in daily clinical practice and demonstrating that patient selection can be expanded to range from extreme preterm births up to 50 kg of body weight. This narrative review discusses the main findings in the current literature with regard to patient selection (sub-umbilical vs mid-abdominal indications, contraindications, low-risk patients with spinal anomalies); anatomical considerations (access problems, age and body positioning, palpation for needle insertion); technical considerations (verification of needle position by ultrasound vs landmarks vs 'whoosh' or 'swoosh' testing); training and equipment requirements (learning curve, needle types, risk of tissue spreading); complications and safety (paediatric regional anaesthesia, caudal blocks); local anaesthetics (bupivacaine vs ropivacaine, risk of toxicity in children, management of toxic events); adjuvant drugs (clonidine, dexmedetomidine, opioids, ketamine); volume dosing (dermatomal reach, cranial rebound); caudally accessed lumbar or thoracic anaesthesia (contamination risk, verifying catheter placement); and postoperative pain...
April 2019: British Journal of Anaesthesia
Toshifumi Ikeda, Yuya Ito, Ryosuke Mikami, Koji Matsuo, Naoto Kawamura, Akane Yamoto
BACKGROUND: There is a high incidence of intraventricular hemorrhage in extremely low birth weight (ELBW) infants of low gestational age who exhibit high-grade fluctuations in the perfusion waveform of the internal cerebral vein. This study investigated changes in the hemodynamic status of ELBW infants during initial strong fluctuations in the perfusion waveform of the internal cerebral vein. METHODS: We evaluated the perfusion waveform of the internal cerebral vein in 192 ELBW infants from birth, every 8 h for a total of 120 h...
March 10, 2019: Pediatrics International: Official Journal of the Japan Pediatric Society
Joan T Price, Bellington Vwalika, Bethany L Freeman, Stephen R Cole, Helen B Mulenga, Jennifer Winston, Felistas M Mbewe, Elwyn Chomba, Lynne M Mofenson, Dwight J Rouse, Robert L Goldenberg, Jeffrey S A Stringer
BACKGROUND: Each year, an estimated 15 million babies are born preterm, a global burden borne disproportionately by families in lower-income countries. Maternal HIV infection increases a woman's risk of delivering prematurely, and antiretroviral therapy (ART) may compound this risk. While prenatal progesterone prophylaxis prevents preterm birth among some high-risk women, it is unknown whether HIV-infected women could benefit from this therapy. We are studying the efficacy of progesterone supplementation to reduce the risk of preterm birth among pregnant women with HIV in Lusaka, Zambia...
February 27, 2019: BMC Pregnancy and Childbirth
Shyam Sathanandam, Stephanie Whiting, Jorden Cunningham, David Zurakowski, Leah Apalodimas, B Rush Waller, Ranjit Philip, Athar M Qureshi
BACKGROUND: Patent ductus arteriosus (PDA) is highly prevalent in extremely low birth weight (ELBW), preterm infants. There are diverse management approaches for the PDA in ELBW infants. The objectives of this research were to identify current PDA management practices among cardiologists and neonatologists in the United States, describe any significant differences in management, and describe areas where practices align. METHODS: A survey of 10 questions based on the management of PDA in ELBW infants was conducted among 100 prominent neonatologists from 74 centers and 103 prominent cardiologists from 75 centers...
January 2019: Congenital Heart Disease
Jason Nathaniel Johnson, Shyam Sathanandam, Ronak Naik, Ranjit Philip
Echocardiographic imaging provides real-time guidance during transcatheter patent ductus arteriosus (PDA) closure in extremely low birth weight (ELBW) infants. Transthoracic echocardiogram provides detailed assessment of the PDA and surrounding structures prior to, during, and after transcatheter closure. This article aims to review the different echocardiographic techniques and concepts utilized during transcatheter PDA closure in ELBW infants.
January 2019: Congenital Heart Disease
Shyam Sathanandam, Ashley Gianinni, Eric Sefton, Kaitlyn Greer, Nathan Stecchi, Kimberly Allen, Ranjit Philip, B Rush Waller
OBJECTIVE: The objective of this article is to describe a live case transmission of transcatheter closure of a patent ductus arteriosus (PDA) in an extremely low birth weight (ELBW) infant during the first International PDA Symposium conducted in Memphis, Tennessee. SETTING: A multidisciplinary team approach including audiovisual specialists, information technology specialists, physicians, nurses, and other health care specialists was required to perform the transcatheter PDA closure (TCPC) in an ELBW infant at LeBonheur Children's Hospital and the procedure was broadcast live to the attendees at the International PDA Symposium allowing for a two-way audiovisual discussion during the procedure...
January 2019: Congenital Heart Disease
Shyam Sathanandam, Hitesh Agrawal, Sandeep Chilakala, Jason Johnson, Kimberly Allen, Christopher Knott-Craig, B Rush Waller, Ranjit Philip
OBJECTIVE: Advancements in transcatheter technology have now made it possible to safely close patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants. The objective of this article is to describe our technique for transcatheter PDA closure (TCPC) in ELBW infants. DESIGN: The techniques employed are very specific to this population and are drastically different when compared to the procedure performed in patients weighing >5 kg. SETTING: A multidisciplinary team approach should be taken to evaluate and manage ELBW infants in order to achieve success...
January 2019: Congenital Heart Disease
Leah Apalodimas, Benjamin Rush Waller Iii, Ranjit Philip, Judy Crawford, Jorden Cunningham, Shyam Sathanandam
OBJECTIVES: Patent ductus arteriosus (PDA) is a common finding in preterm infants. A hemodynamically significant PDA may require intervention for closure. This article aims to describe a transcatheter PDA closure (TCPC) program for preterm infants and the components of a comprehensive outpatient follow-up strategy. SETTING: A multidisciplinary team approach including neonatology, cardiology, anesthesiology, medical transport team, pulmonology, cardiac surgery, neurodevelopmental specialist, nutrition, speech therapy, social work, research collaborators, and other health care specialists is integral to the dedicated care and promotion of wellness of extremely low birth weight (ELBW) infants...
January 2019: Congenital Heart Disease
Myriam Almeida-Jones, Nai Yu Tang, Aneela Reddy, Evan Zahn
Clinically significant patent ductus arteriosus (PDA) has been associated with significant morbidity in extremely low birth weight (ELBW) infants. Current management of ELBW infants with hemodynamically significant PDA includes supportive treatment, pharmacological therapy, and surgical ligation. All of these therapeutic options have their advantages and limitations. More recently, transcatheter PDA closure has been described as a viable option in this population. In this paper, we provide a comprehensive review of this emerging procedure...
January 2019: Congenital Heart Disease
Adam Willis, Lillia Pereiras, Tim Head, Genevieve Dupuis, Janet Sessums, Gordon Corder, Kim Graves, Jack Tipton, Shyam Sathanandam
OBJECTIVE: The objective of this article is to describe the elements involved with transporting extremely low birth weight (ELBW) infants from referring centers to our center's neonatal intensive care unit (NICU) and then from the NICU to the catheterization lab for transcatheter closure of patent ductus arteriosus (PDA). SETTING: Several referring centers are over 300 miles away. ELBW infants are transferred in to our NICU safely for the procedure and transferred back following the procedure...
January 2019: Congenital Heart Disease
Alice C Burnett, George Youssef, Peter J Anderson, Julianne Duff, Lex W Doyle, Jeanie L Y Cheong
OBJECTIVE: To examine whether difficulties in emotional, attention, and peer or social functioning (a proposed "preterm behavioral phenotype") co-occur within individual children born extremely preterm (EP; <28 weeks of gestation) and/or extremely low birth weight (ELBW; <1,000 g) and whether different behavioral profiles are related to cognitive and academic outcomes. METHODS: Population-based cohort of all EP/ELBW survivors born in the state of Victoria, Australia, in 2005, and contemporaneous matched controls were recruited at birth...
February 18, 2019: Journal of Developmental and Behavioral Pediatrics: JDBP
Sujata S Ranshing, Ashish R Bavdekar, Umesh V Vaidya, Manas K Behera, Atul M Walimbe, Varanasi Gopalkrishna
Rotavirus infections in neonates are generally nosocomial, and differ from pediatric infections both clinically and epidemiologically. These infections are predominantly asymptomatic and often associated with unusual strains. Globally, so far limited data is available on rotavirus infections in neonates admitted at Neonatal Intensive Care Unit. The aim of the present study is to determine the prevalence of rotavirus among neonates and to study their genetic characteristics. Stool specimens (n = 701) collected from neonates (n = 621) admitted during April 2016 to March 2018 mainly for prematurity, low birth weight and associated respiratory distress syndrome from two hospitals from Pune were tested for rotavirus, genotyped and representative strains were sequenced for the genes encoding outer capsid proteins, VP7 and VP4...
February 19, 2019: Infection, Genetics and Evolution
Andre Krumel Portella, Catherine Paquet, Adrianne Rahde Bischoff, Roberta Dalle Molle, Aida Faber, Spencer Moore, Narendra Arora, Robert Levitan, Patricia Pelufo Silveira, Laurette Dube
Evidence shows that extremes of birth weight (BW) carry a common increased risk for the development of adiposity and related cardiovascular diseases, but little is known about the role of obesogenic behaviors in this process. Moreover, no one has empirically examined whether the relationship between BW, obesogenic behaviors and BMI along the full low-to-high birthweight continuum reflects the U-shape pattern expected from common risk at both BW extremes. Our objective was to characterize physical activity, screen time, and eating behavior and their relationship to BMI as a function of BW among school-aged boys and girls...
2019: PloS One
Nancy A Garofalo, Michael S Caplan
Oropharyngeal administration of mother's own milk-placing drops of milk directly onto the neonate's oral mucosa-may serve to (ex utero) mimic the protective effects of amniotic fluid for the extremely low birth weight infant; providing protection against necrotizing enterocolitis. This article presents current evidence to support biological plausibility for the use of OroPharyngeal Therapy with Mother's Own Milk (OPT-MOM) as an immunomodulatory therapy; an adjunct to enteral feeds of mother's milk administered via a nasogastric or orogastric tube...
March 2019: Clinics in Perinatology
Samuel Wong, Honglang Wang, Robert Tepper, Gregory M Sokol, Rebecca Rose
In a prospective study we describe the delivery of small tidal volumes to extremely low birth weight (ELBW) and very low birth weight (VLBW) infants using a volume-targeted ventilation mode (VTV). Tidal volume delivery was consistent for both ELBW and VLBW infants independent of gestational age, birth weight, and the target volume.
February 12, 2019: Journal of Pediatrics
Gaston Ofman, Trent E Tipple
Preterm birth is a primary cause of worldwide childhood mortality. Bronchopulmonary dysplasia, characterized by impaired alveolar and lung vascular development, affects 25-50% of extremely low birth weight (BW; <1 kg) infants. Abnormalities in lung function persist into childhood in affected infants and are second only to asthma in terms of childhood respiratory disease healthcare costs. While advances in the medical care of preterm infants have reduced mortality, the incidence of BPD has not decreased in the past 10 years...
February 12, 2019: Free Radical Biology & Medicine
Toby Debra Yanowitz, Kevin M Sullivan, Anthony J Piazza, Beverly Brozanski, Isabella Zaniletti, Jotishna Sharma, Robert DiGeronimo, Sujir Pritha Nayak, Rajan Wadhawan, Kristina M Reber, Karna Murthy
PURPOSE: Quantify short-term outcomes associated with initial surgery [laparotomy (LAP) vs. peritoneal drain (PD)] for necrotizing enterocolitis (NEC) in extremely-low-birth-weight (ELBW) infants. METHODS: Using the Children's Hospitals Neonatal Database, we identified ELBW infants <32 weeks' gestation with surgical NEC (sNEC). Unadjusted and multivariable regression analyses were used to estimate the associations between LAP (or PD) and death/short bowel syndrome (SBS) and length of stay (LOS)...
January 19, 2019: Journal of Pediatric Surgery
Zehra Yavas Abali, Gozde Yesil, Tarik Kirkgoz, Sare Betul Kaygusuz, Mehmet Eltan, Serap Turan, Abdullah Bereket, Tulay Guran
BACKGROUND: Biallelic mutations in the TBX19 gene cause severe early-onset adrenal failure due to isolated ACTH deficiency (IAD). This rare disease is characterized by low plasma ACTH and cortisol levels, with normal secretion of other pituitary hormones. Herein, we report a patient with IAD due to a novel TBX19 gene mutation, who is also of tall stature. CASE REPORT: A 48/12 -year-old girl was presented with loss of consciousness due to hypoglycemia. The patient was born at term with a birth weight of 3800 g...
February 12, 2019: Hormones: International Journal of Endocrinology and Metabolism
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