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Objective This study aimed to identify extremely premature infants (< 31 weeks of gestation and/or <1,500 g) affected by congenital hypothyroidism (CH) with delayed elevation of thyrotropin (TSH) and to evaluate the detection strategy for this pathology in our reference screening population. Study Design A descriptive and retrospective study was carried out with samples collected from western Andalusia and the autonomous city of Ceuta. Results This protocol allowed us to detect six neonates with delayed TSH elevation. One of them, due to serious heart problems, died without being able to confirm CH. In two neonates, however, it was possible to detect CH, another two presented a persistent TSH elevation but normal free T4, and another one presented a temporary TSH elevation. Conclusion It is essential to repeat the CH screening in extremely premature infants, not only at the age of 15 days but also with a third sample at the moment of hospital discharge to detect cases with delayed TSH elevation. Key Points The Newborn Screening Programs are an essential activity of preventive medicine. Extremely preterm infants have a very high risk of CH. Optimal management of thyroid dysfunction in this population remains to be established. [ABSTRACT FROM AUTHOR]

Objective This study aimed to determine the association between daily fluid intake and the duration of hemodynamically significant patent ductus arteriosus (hsPDA). Study Design This is a retrospective cohort study of extremely preterm infants (<29 weeks) admitted in the Neonatal Intensive Care Unit of the Advent Health for Children from January 2013 to March 2016, if hsPDA was diagnosed in first week of life and serial echocardiograms were available. Diagnosis of hsPDA was based on a scoring system and its duration was estimated from serial echocardiograms. Cohort was divided into two groups based on duration of hsPDA (<1week, group A and ≥1 week, group B). Daily fluid intake was categorized as prescribed and actual. Prescribed volume was ordered by clinicians based on birth weight, not including trophic feeds, intravenous (IV) boluses or transfusions, etc. Actual intake was calculated by the electronic medical records based on daily weights and included all enteral or parenteral fluids. Multivariate analysis was performed to determine an association between total daily fluid intake over the first week of life and the duration of hsPDA. Two groups were compared to observe the difference between prescribed and actual daily fluid intakes. Results We enrolled 50 infants in group A and 76 in group B. Infants in group B were of significantly lower gestation and required prolonged ventilation and hospitalization. An association between higher fluid intake in the first 2 days of life and prolonged duration of hsPDA was confirmed by multivariate analysis. Actual fluid intake was significantly higher than prescribed total fluid intake in first 4 days of life for infants in both groups. Conclusion In extremely preterm infants, higher fluid intake in first 2 days of life is associated with prolonged duration of hsPDA. Actual daily fluid intake can be significantly higher than prescribed daily fluids due to daily weight changes and additional fluid administration. Key Points In preterm infants, actual daily fluid intake may be higher than prescribed volume. Higher daily fluid intake in first week of life is associated with prolonged duration of PDA. PDA scoring system can be helpful for objective assessment of PDA in preterm infants. [ABSTRACT FROM AUTHOR]

Objective The study aimed to evaluate the association between bronchopulmonary dysplasia (BPD) development at 36 weeks' postmenstrual age (PMA) and Gram-negative bacteria in tracheal aspirate cultures among extremely preterm infants. Study Design This study has a retrospective cohort. Patients were 155 infants aged less than or equal to 26 gestational weeks who were admitted to the neonatal intensive care unit of Osaka Women's and Children's Hospital from 2009 to 2018. Primary outcome was respiratory outcomes expressed as BPD development. Multivariable logistic regression analysis was used to identify neonatal and bacterial factors associated with BPD. Results After adjusting for gestational age, birth weight, sex, chorioamnionitis, Gram-positive cocci (GPC) and Gram-negative rods (GNRs) in tracheal aspirate cultures within 28 days after birth, GNRs were significantly associated with BPD development (odds ratio [OR]: 3.88, 95% confidence interval [CI]: 1.68–8.94). In contrast, GPCs were not associated with BPD development (OR: 0.47, 95% CI: 0.05–1.61). Conclusion Gram-negative bacteria in tracheal cultures within 28 days of birth are associated with BPD development in infants aged less than or equal to 26 gestational weeks. Key Points BPD is a factor for morbidity in extremely preterm infants. Respiratory infection is an adverse outcome of BPD. GNRs in tracheal cultures soon after birth disturb BPD development. GPC was not associated with BPD development. [ABSTRACT FROM AUTHOR]

Objective A significant variability exists for diagnosis and treatment of hypotension in extremely preterm infants. Benefits of the use of vasopressors remain unclear. We wanted to identify the risk factors associated with use of vasopressors in the first week of life and their impact on outcomes of extremely preterm infants. Study Design Retrospective review of all newborns ≤28 weeks of gestational age (GA) admitted in neonatal intensive care unit from October 1, 2012, to October 31, 2015, done. Data regarding antenatal and neonatal characteristics and outcomes were recorded. Study infants were divided into two cohorts and compared based on vasopressor use. Chi-square, t -test, and multiple logistic regression were performed as appropriate and significance set at p <0.05. Results Of 213 extremely preterm infants, 90 (42.3%) received vasopressors in first week of life. The mean arterial pressure (MAP) at admission in these infants was significantly lower than that of infants who did not require vasopressors (27 ± 8 vs. 30 ± 6 mm Hg, p < 0.05). Vasopressors were initiated within 24 hours in 91% of babies. After controlling for other variables, use of vasopressors was significantly higher in infants with lower birth weight (odds ratio [OR]: 3.2, 95% confidence interval [CI]: 1.6–8.3), 5-minute Apgar's score ≤5 (OR: 1.8, 95% CI: 1.2–3.12), and admission hypothermia (OR: 2.7, 95% CI: 1.3–4.9). The use of vasopressors was significantly associated with severe intraventricular hemorrhage (IVH), even after controlling for other significant variables (OR: 5.9, 95% CI: 1.6–9.3). Conclusion Lower birth weight, low 5-minute Apgar's score, and admission hypothermia are characteristics associated with early use of vasopressors in extremely preterm infants. Infants treated with vasopressors are at a higher risk of developing severe IVH. Key Points Low systemic blood pressure is a very common problem in the extremely preterm population. In clinical practice, mean arterial blood pressure (BP) less than the infants GA in week is typically considered to be "low BP." About 50% of infants born at <29 weeks of GA received very preterm in the first week of life. Use of vasopressors is associated with a higher incidence of intraventricular hemorrhage in extremely preterm population. [ABSTRACT FROM AUTHOR]

Objective  To evaluate the association between endotracheal tube (ETT) tip position and adverse pulmonary outcomes using chest X-ray (CXR) in extremely preterm infants in whom ETT insertion length was estimated using weight + 6 guide (adding 6 cms to the infant's weight in kg). Study Design  CXRs of 85 infants performed in the first week were reviewed for right-sided atelectasis, air leaks, and uneven lung inflation. The first CXR was later reviewed to document the ETT tip. Regression analysis was performed to find the association between ETT tip position and adverse outcome after adjusting for other confounders. Results  Forty (46%) infants had ETT tip placement between the first and second thoracic vertebrae (optimal position) compared with 45 (53%) who had the ETT tip placement outside this range (suboptimal position). Infants with suboptimal ETT were ventilated for a longer period (6.1 vs. 15.9 days; p  = 0.004). The odds of adverse outcomes was 11.6 (95% confidence interval: 3.03, 44.1) times higher among infants who did not have ETT at the optimal position compared with infants who had ETT at the optimal position. Conclusion  Weight + 6 guide is not recommended to estimate ETT insertion length in extremely preterm infants. Gestation-based guide may be more appropriate to estimate ETT insertion length in this group of infants. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to examine the association between umbilical catheters and a composite outcome of mortality or major neonatal morbidity in extremely preterm infants. Study Design Data were abstracted from the Canadian Neonatal Network database for infants born at <29 weeks' gestational age and admitted to 29 neonatal intensive care units between January 2010 and December 2012. Four groups were identified: those with no umbilical catheters, umbilical venous catheters (UVCs), umbilical artery catheters (UACs), and those with both UVCs and UACs. The outcomes were compared among the groups using univariate and multivariable analyses. Results Of 4,623 eligible infants, 820 (17.7%) had no catheters, 1,032 (22.3%) a UVC only, 120 (2.6%) a UAC only, and 2,651 (57.3%) had both catheters. After adjustment for acuity and other potential confounders, umbilical catheters were associated with higher odds of mortality or any major morbidity (UVC vs. no catheter: adjusted odds ratio [aOR]: 1.47; 95% CI: 1.18-1.85; UAC vs. no catheter: aOR: 1.67; 95% CI: 1.05-2.63; and both UVC + UAC vs. no catheter: aOR: 2.17; 95% CI: 1.79-2.70). Conclusion Most of the infants born at <29 weeks' gestation had UVC and/or UAC placement. The presence of either catheter was associated with mortality or major morbidity, and the association was stronger when both catheters were present. [ABSTRACT FROM AUTHOR]