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3. Randomized Trial of Late Surfactant Treatment in Ventilated Preterm Infants Receiving Inhaled Nitric Oxide

Author

Strong, S. Hamilton, Immamura-Ching, J., Orfanos-Villalobos, M., Williams, C., Horton, D., Pacello, L., Willard, A., Gauldin, C., Holmes, A., Johnson, P., Meinert, K., Reynolds, A.M., Lucie, J., Conway, P., Sacilowski, M.l., Leadersdorff, M., Orbank, P., Wynn, K., deUngria, M., Khan, J., Hamann, K., Schau, M., Hopkins, B., Jenson, J., Garcia, C., Shariff, J., McGovern, R., Adelman, J., Combs, A., Tjersland, M., Walker, S., Howland, E., Longoria, J., Meo, H., McDavid, G., Burson, K., Hinojosa, R., Johnson, C., Miller, K., Rogers, S., Wright, S., Barnette, K., Kellum, A., Burke, M., Hayes, C., Chadwick, S., Howard, D., Kennedy, C., Prince, R., Stefanescu, B., Helderman, J., Warden, K., Brown, P., Griffin, J., Conley, L., Georgieff, M., Davern, B., Mills, M., Ritter, S., Wagner, C., Fanning, D., Roberson, J., Lampland, A., Meyers, P., Brey, A., Worwa, C., Dixon, P., Ebert, G., Hejl, C., Maxwell, M., McCullough, K., El Abiad, M.T., Talati, A., Dempsey, S., Gammage, K., Gower, G., James, K., LeNoue, P., Bell, S., Bruton, D., Beaulieu, M., Williams, R., Barron-Nelson, R., Taylor, S., Sikes, N.C., Lowe, G., Proffitt, B., Chapin, C., Horneman, H., Kelley, S., Vittinghoff, E., Hietpas, J., Denton, L., Wu, L., Jobe, A., Fanaroff, A., Clemons, T., Glantz, L., Reboussin, D., Van Meurs, K., Allen, M., Vohr, B., Ballard, R., Ballard, P., Blaisdell, C., Durand, D., Black, D., Eichenwald, E., Keller, R., Mammel, M., Merrill, J., Rogers, E., Ryan, R., Truog, W., Asselin, J., Newton, N., Ballard, Roberta A., Keller, Roberta L., Black, Dennis M., Ballard, Philip L., Merrill, Jeffrey D., Eichenwald, Eric C., Truog, William E., Mammel, Mark C., Steinhorn, Robin H., Rogers, Elizabeth E., Ryan, Rita M., Durand, David J., Asselin, Jeanette M., Bendel, Catherine M., Bendel-Stenzel, Ellen M., Courtney, Sherry E., Dhanireddy, Ramasubbareddy, Hudak, Mark L., Koch, Frances R., Mayock, Dennis E., McKay, Victor J., O'Shea, T. Michael, Porta, Nicolas F., Wadhawan, Rajan, and Palermo, Lisa

Published
2016
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19. Regional brain volume abnormalities and long-term cognitive outcome in preterm infants.

Author

Peterson, Bradley S., Vohr, Betty, Staib, Lawrence H., Cannistraci, Christopher J., Dolberg, Aaron, Schneider, Karen C., Katz, Karol H., Westerveld, Michael, Sparrow, Sara, Anderson, Adam W., Duncan, Charles C., Markuch, Robert W., Gore, John C., Ment, Laura R., Peterson, B S, Vohr, B, Staib, L H, Cannistraci, C J, Dolberg, A, and Schneider, K C

Subjects
BRAIN abnormalities, PREMATURE infant physiology, BRAIN research, COGNITION disorders in children
Abstract

Context: Preterm infants have a high prevalence of long-term cognitive and behavioral disturbances. However, it is not known whether the stresses associated with premature birth disrupt regionally specific brain maturation or whether abnormalities in brain structure contribute to cognitive deficits.Objective: To determine whether regional brain volumes differ between term and preterm children and to examine the association of regional brain volumes in prematurely born children with long-term cognitive outcomes.Design and Setting: Case-control study conducted in 1998 and 1999 at 2 US university medical schools.Participants: A consecutive sample of 25 eight-year-old preterm children recruited from a longitudinal follow-up study of preterm infants and 39 term control children who were recruited from the community and who were comparable with the preterm children in age, sex, maternal education, and minority status.Main Outcome Measures: Volumes of cortical subdivisions, ventricular system, cerebellum, basal ganglia, corpus callosum, amygdala, and hippocampus, derived from structural magnetic resonance imaging scans and compared between preterm and term children; correlations of regional brain volumes with cognitive measures (at age 8 years) and perinatal variables among preterm children.Results: Regional cortical volumes were significantly smaller in the preterm children, most prominently in sensorimotor regions (difference: left, 14.6%; right, 14.3% [P<.001 for both]) but also in premotor (left, 11.2%; right, 12.6% [P<.001 for both]), midtemporal (left, 7.4% [P =.01]; right, 10.2% [P<.001]), parieto-occipital (left, 7.9% [P =.01]; right, 7.4% [P =.005]), and subgenual (left, 8.9% [P =.03]; right, 11.7% [P =.01]) cortices. Preterm children's brain volumes were significantly larger (by 105. 7%-271.6%) in the occipital and temporal horns of the ventricles (P<. 001 for all) and smaller in the cerebellum (6.7%; P =.02), basal ganglia (11.4%-13.8%; PConclusions: Our data indicate that preterm birth is associated with regionally specific, long-term reductions in brain volume and that morphological abnormalities are, in turn, associated with poorer cognitive outcome. JAMA. 2000;284:1939-1947. [ABSTRACT FROM AUTHOR]

Published
2000
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41. Higher or Lower Hemoglobin Transfusion Thresholds for Preterm Infants.

Author

Kirpalani, H., Bell, E. F., Hintz, S. R., Tan, S., Schmidt, B., Chaudhary, A. S., Johnson, K. J., Crawford, M. M., Newman, J. E., Vohr, B. R., Carlo, W. A., D'Angio, C. T., Kennedy, K. A., Ohls, R. K., Poindexter, B. B., Schibler, K., Whyte, R. K., Widness, J. A., Zupancic, J. A. F., and Wyckoff, M. H.

Subjects
*NEURODEVELOPMENTAL treatment for infants, *PREMATURE infants, *HEMOGLOBINS, *HOSPITAL admission & discharge, *WEIGHT in infancy, *BIRTH weight
Abstract

BACKGROUND: Limited data suggest that higher hemoglobin thresholds for red-cell transfusions demay reduce the risk of cognitive delay among extremely-low-birth-weight infants with anemia. METHODS: We performed an open, multicenter trial in which infants with a birth weight of 1000 g or less and a gestational age between 22 weeks 0 days and 28 weeks 6 days were randomly assigned within 48 hours after delivery to receive red-cell transfu- sions at higher or lower hemoglobin thresholds until 36 weeks of postmenstrual age or discharge, whichever occurred first. The primary outcome was a composite Supof death or neurodevelopmental impairment (cognitive delay, cerebral palsy, or hearing or vision loss) at 22 to 26 months of age, corrected for prematurity. RESULTS: A total of 1824 infants (mean birth weight, 756 g; mean gestational age, 25 .9 weeks) underwent randomization. There was a between-group difference of 1.9 g per deciliter (19 g per liter) in the pretransfusion mean hemoglobin levels throughout the treatment period. Primary outcome data were available for 1692 infants (92.8%). Of845 infants in the higher-threshold group, 423 (50.F/o) died or survived with neurodevelopmental impairment, as compared with 422 of 847 infants (49.896) in the lower-threshold group (relative risk adjusted for birth-weight stratum and center, 1.00; 95% confidence interval [CI], 0.92 to 1.10; P=0.93). At 2 years, the higher- and lower-threshold groups had similar incidences ofdeath (16.2% and 15.0°/0, respectively) and neurodevelopmental impairment (39.6% and 40.3%, respectively). At discharge from the hospital, the incidences of survival without severe complications were 28.5% and 30.996, respectively. Serious adverse events occurred in 22.7% and 21.7°/0, respectively. CONCLUSIONS: In extremely-low-birth-weight infants, a higher hemoglobin threshold for red-cell transfusion did not improve survival without neurodevelopmental impairment at 22 to 26 months of age, corrected for prematurity. [ABSTRACT FROM AUTHOR]

Published
2020
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