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Background In single-center studies, both preterm birth and low birth weight (LBW) are associated with worse outcomes in childhood nephrotic syndrome. Using the Nephrotic Syndrome Study Network (NEPTUNE) observational cohort, we tested the hypothesis that in patients with nephrotic syndrome, hypertension, proteinuria status, and disease progression would be more prevalent and more severe in subjects with LBW and prematurity singly or in combination (LBW/prematurity). Methods Three hundred fifty-nine adults and children with focal segmental glomerulosclerosis (FSGS) or minimal change disease (MCD) and available birth history were included. Estimated glomerular filtration rate (eGFR) decline and remission status were primary outcomes, and secondary outcomes were kidney histopathology, kidney gene expression, and urinary biomarkers. Logistic regression was used to identify associations with LBW/prematurity and these outcomes. Results We did not find an association between LBW/prematurity and remission of proteinuria. However, LBW/prematurity was associated with greater decline in eGFR. This decline in eGFR was partially explained by the association of LBW/prematurity with APOL1 high-risk alleles, but the association remained after adjustment. There were no differences in kidney histopathology or gene expression in the LBW/prematurity group compared to normal birth weight/term birth. Conclusion LBW and premature babies who develop nephrotic syndrome have a more rapid decline in kidney function. We did not identify clinical or laboratory features that distinguished the groups. Additional studies in larger groups are needed to fully ascertain the effects of (LBW) and prematurity alone or in combination on kidney function in the setting of nephrotic syndrome., Author(s): Sangeeta Hingorani [sup.1] , Keisha L. Gibson [sup.2] , Yuping Xie [sup.3] , Yujie Wang [sup.4] , Sean Eddy [sup.4] , John Hartman [sup.4] , Matthew Sampson [sup.5] [sup.6] [...]

Background Preterm birth alters nephrogenesis and reduces the total nephron number. Intrauterine growth restriction (IUGR) seems to worsen nephron loss, but only a few studies have investigated its role in neonatal kidney impairment. We investigated whether IUGR, defined as reduced estimated fetal growth and/or placental flow alterations and low birth weight z-score, increases the risk of developing acute kidney injury (AKI) in very preterm infants. Methods We performed a retrospective study including infants born with a birth weight (BW) [less than or equal to] 1500 g and/or gestational age (GA) [less than or equal to] 32 weeks admitted to our center between January 2016 and December 2021. Neonatal AKI was defined according to the neonatal KDIGO classification based on the decline of urine output and/or creatinine elevation. We used multivariable linear regressions to verify the association between AKI and GA, BW z-score, IUGR definition, and hemodynamically significant patent ductus arteriosus (PDA). Results We included 282 infants in the analysis, with a median (IQR) GA = 29.4 (27.4, 31.3) weeks, BW = 1150 (870, 1360) g, and BW z-score = - 0.57 (- 1.64, 0.25). AKI was diagnosed in 36 (13%) patients, and 58 (21%) had PDA. AKI was significantly associated with BW z-score (beta (std. error) = - 0.08 (0.03), p = 0.008) and severe IUGR (beta (std. error) = 0.21 (0.08), p = 0.009), after adjusting for GA and PDA. Conclusions Our data suggest that low BW z-score and IUGR could represent adjunctive risk factors for kidney impairment in preterm babies. Graphical abstract, Author(s): Mariateresa Sinelli [sup.1] , Emanuela Zannin [sup.1] , Daniela Doni [sup.1] , Sara Ornaghi [sup.2] [sup.3] , Eleonora Acampora [sup.2] , Nadia Roncaglia [sup.2] , Patrizia Vergani [sup.2] [sup.3] [...]

Background: Necrotizing enterocolitis remains a leading cause of morbidity and mortality in premature infants. The role of prophylactic probiotics in its prevention is unclear. This study evaluates the effect of routine probiotics on the incidence and severity of necrotizing enterocolitis in infants with very low birth weight in the neonatal intensive care unit. Methods: This retrospective cohort study compared infants cared for at a single institution before and after implementation of routine probiotic administration (2014-2018). Babies born after July 2016 received probiotics containing Bifidobacterium and Lactobacillus daily until 35 weeks corrected gestational age. Baseline characteristics, necrotizing enterocolitis incidence and severity, infections, mortality, and length of stay were compared between groups. Results: Of the 665 infants included in the study, 310 received probiotics and 355 did not. The 2 groups did not differ with regard to gestational age, birth anthropometrics, mode of delivery, comorbidities, and type of enteral feed. The incidence of necrotizing enterocolitis (Bell's stage 2 of 3) was similar between groups (4% v. 5%, p = 0.35), as was its severity (p = 0.10). In addition, there were no significant differences in mortality and length of stay between the groups. Significantly fewer infants receiving probiotics developed infections (27% v. 34%, p = 0.046), with the rate of urinary tract infections having the largest reduction. Conclusion: The routine use of Bifidobacterium and Lactobacillus probiotics in infants with very low birth weight did not significantly affect the incidence and severity of necrotizing enterocolitis. However, the use of probiotics was associated with fewer overall infections. Contexte : L'entérocolite nécrosante demeure une importante cause de morbidité et de mortalité chez les nourrissons prématurés. Le rôle des probiotiques prophylactiques pour la prévention de l'entérocolite nécrosante reste à déterminer. Cette étude évalue l'effet de l'administration systématique de probiotiques sur l'incidence et la gravité de l'entérocolite nécrosante chez les nourrissons de très faible poids à la naissance dans les unités de soins intensifs néonataux. Méthodes : Cette étude de cohorte rétrospective a comparé les nourrissons soignés dans un seul établissement avant et après la mise en place d'un protocole d'administration systématique de probiotiques (2014- 2018). Les bébés nés après juillet 2016 ont reçu des probiotiques à base de Bifidobacterium et de Lactobacilles jusqu'à un âge gestationnel corrigé de 35 semaines. Les caractéristiques de départ, l'incidence et la gravité de l'entérocolite nécrosante, les infections, la mortalité et la durée de l'hospitalisation ont été comparées entre les groupes. Résultats : Parmi les 665 nourrissons inclus dans l'étude, 310 ont reçu des probiotiques, contre 355 qui n'en ont pas reçus. Les 2 groupes étaient semblables aux plans de l'âge gestationnel, des paramètres anthropométriques, du type d'accouchement, des comorbidités et du mode d'alimentation entérale. L'incidence de l'entérocolite nécrosante (stade de Bell 2 sur 3) était semblable entre les groupes (4% c. 5%, p = 0,35), tout comme la gravité (p = 0,10). De plus, on n'a noté aucune différence significative aux plans de la mortalité et de la durée de l'hospitalisation entre les groupes. Un nombre significativement moindre de nourrissons traités par probiotiques ont présenté des infections (27% c. 34%, p = 0,046); la réduction la plus marquée concernant les infections urinaires. Conclusion : L'utilisation systématique de probiotiques à base de Bifidobacterium et de Lactobacilles chez les nourrissons de très faible poids à la naissance n'a pas significativement modifié l'incidence ni la gravité de l'entérocolite nécrosante. Par contre, elle a été associée à une baisse globale du nombre d'infections., Necrotizing enterocolitis remains a leading cause of morbidity and mortality in premature infants, particularly those with very low birth weight (< 1500g). (1-3) Despite efforts to prevent necrotizing enterocolitis, including [...]

Objectives To assess whether adherence to institutional car seat tolerance screening (CSTS) guidelines differed for infants born preterm (PTM), term low birth weight (T-LBW), or both preterm and low birth weight (P-LBW), and to examine the association between CSTS adherence and patient characteristics. Study Design Within two large academic and community hospitals, we retrospectively reviewed all infants meeting institutional criteria (< 37 weeks' gestation and/or < 2.27 kg) for CSTS from 2014 to 2018. Multivariable logistic regression evaluated the association of patient characteristics with institutional CSTS guideline adherence. Results 4374 eligible infants were born PTM (50.9%), T-LBW (6.5%), or P-LBW (42.6%). Adherence rates were 92.7% in the neonatal intensive care unit (NICU) and 95.2% in the well-baby nursery with initial CSTS failure rates of 6.1% and 9.9%, respectively. Adherence was lowest among T-LBW (80.7%) compared to PTM (95.1%) or P-LBW (92.2%) infants in the NICU (p < 0.001) and well-baby nursery (81.6%, 96.7% and 97.1%, respectively, p < 0.001). In bivariate analyses, gestational age, birth weight, insurance, race, hospital type, discharge year, and preferred language were associated with adherence. In fully-adjusted models, adherence was positively associated with lower gestational age, higher birth weight, non-Medicaid insurance, and later discharge year (NICU) and lower gestational age and later discharge year (well-baby nursery). Conclusions Adherence was lower for T-LBW than PTM or P-LBW infants, despite similar CSTS failure rates. Disparities in adherence among Medicaid-insured patients in the NICU warrant further study. Future studies are needed to clarify the benefit of CSTS and increase adherence in high-risk populations., Author(s): Skyler McLaurin-Jiang [sup.1] [sup.2] [sup.5] , Morris Weinberger [sup.3] , Victor Ritter [sup.4] , T. Michael O'Shea [sup.1] , Kori B. Flower [sup.1] Author Affiliations: (1) grid.10698.36, 0000000122483208, Department [...]

Background Developmental programming of chronic kidney disease (CKD) in young adults is linked to preterm birth and intrauterine growth restriction (IUGR). Which confers a higher risk of progression to chronic kidney damage in children with very low birth weight (VLBW; born weighing < 1500 g): prematurity or IUGR? Methods This is a national historical cohort study of children with VLBW cared for in perinatal medical centers in Japan. Predictive factors included three latent variables (prematurity, IUGR, stress during neonatal period) and eight observed variables (gestational age, birth weight Z-score, maternal age, duration of treatment with antibiotics and diuretics, maternal smoking, late-onset circulatory collapse, kidney dysfunction) during the perinatal period. The primary endpoint was estimated glomerular filtration rate (eGFR) at age [greater than or equal to] 3 years. A structural equation model was used to examine the pathologic constitution. Results The 446 children with VLBW included 253 boys and 193 girls, of mean age 5.8 ± 2.6 years and mean eGFR 111.7 ml/min/1.73 m.sup.2 at last encounter. Pathway analyses showed intrauterine malnutrition ([beta] = 0.85) contributed more to chronic kidney damage than stress during the neonatal period ([beta] = - 0.19) and prematurity ([beta] = 0.12), and kidney dysfunction and late-onset circulatory collapse were important observed variables in stress during the neonatal period. Conclusions IUGR was more harmful to future kidneys of VLBW neonates. Neonatal kidney dysfunction and late-onset circulatory collapse were important risk factors for subsequent CKD development. This emphasizes the need for obstetricians to monitor for fetal growth restriction and neonatologists to minimize neonatal stress to prevent CKD in later life., Author(s): Osamu Uemura [sup.1] [sup.2] [sup.3] , Kenji Ishikura [sup.4] [sup.5] , Tetsuji Kaneko [sup.6] , Daishi Hirano [sup.7] , Yuko Hamasaki [sup.8] , Masao Ogura [sup.4] , Naoaki Mikami [...]

Background Low birth weight (LBW)/prematurity have been proposed as risk factors for the development of kidney disease in adulthood. Whether there is an association between LBW/prematurity and poor renal outcomes in childhood onset nephrotic syndrome remains unknown. Methods Children with nephrotic syndrome diagnosed between 1 and 18 years of age were followed prospectively from 1996 to 2016 at The Hospital for Sick Children (N = 377). LBW/prematurity was defined as birth weight < 2500 g or gestational age < 36 weeks. Normal birth weight (NBW) was defined as birth weight [greater than or equal to] 2500 g. Measures evaluating clinical course of nephrotic syndrome include initial steroid-resistant nephrotic syndrome (SRNS), time to first relapse, and frequently relapsing nephrotic syndrome. Kaplan-Meier survival analysis, logistic regression, and Cox proportional hazards regression were used to determine the association of LBW/prematurity with clinical outcomes. Results Median birth weights in LBW/premature (n = 46) and NBW (n = 331) children were 2098 g (interquartile range [IQR] 1700-2325 g) and 3317 g (IQR 2977-3685 g), respectively. Odds of having SRNS were 3.78 (95% confidence interval [CI] 1.28-11.21) times higher among LBW/premature children than NBW children. An 8% decrease in odds of developing SRNS was observed for every 100 g increase in birth weight (adjusted odds ratio [OR] 0.92; 95% CI 0.86-0.98). Median time to first relapse did not differ (hazard ratio [HR] 0.89; 95% CI 0.53-1.16). Conclusions LBW/premature children were more likely to develop SRNS but did not have a difference in time to first relapse with NBW children. Understanding the impact and mechanism of birth weight and steroid-resistant disease needs further study., Author(s): Natalia Konstantelos [sup.1] [sup.2] , Tonny Banh [sup.1] , Viral Patel [sup.2] , Jovanka Vasilevska-Ristovska [sup.1] , Karlota Borges [sup.1] , Neesha Hussain-Shamsy [sup.2] , Damien Noone [sup.2] [sup.3] [...]

To evaluate the relationship between changes in fecundity rates and maternal age and the impact of maternal age on low birth weight (LBW) rates in a developed region in southern Brazil. A time series study evaluating birth weight and maternal ages through the born alive information system (SINASC) in Porto Alegre from 1996 to 2008. The Chi-square test for trends was used to evaluate the trend of LBW and fecundity rates at each maternal age. Population attributed risk (PAR) was used to calculate the impact of maternal age on LBW rates. The study included 271,100 newborns. There was a significant reduction in fecundity rates in all age groups younger than 34 years, but especially in the groups between 20 and 29 years. Overall LBW increased from 9.3 to 10.7 % (P < 0.001). The PAR for LBW showed a reduction in the group from 17 to 19 years (from 1.7 % in 1996-1999 to 0.1 % in 2004-2008), and an increase in the groups from 35 to 39 years (from 2.0 % in 1996-1999 to 2.3 % in 2004-2008) and above 40 (from 1.1 % in 1996-1999 to 1.5 % in 2004-2008). There was a significant change in fecundity pattern in the last 12 years in southern Brazil. Adolescent mothers were surpassed by mothers over 30 years of age in terms of vulnerability for LBW babies. The results show a change in the maternal age distribution towards older mothers, accompanied by an increasing incidence of LBW. This demographic transition also involved a paradoxical pattern with a remarkable reduction in fecundity rates in intermediate maternal age groups with concomitant increase in their risk for LBW. Keywords Maternal age * Low birth weight * Pregnancy rate * Demographic transition, Introduction Pregnancy during adolescence or after 35 years of age has been associated with unfavorable outcomes. The high rates of low birth weight ( Brazil is undergoing an intense process [...]

In this study we used receiver-operating characteristic (ROC) analysis to comparatively evaluate maternal periodontal parameters to predict preterm (PB) delivery and low birth weight (LBW) delivery among Jordanian women. A total of 277 pregnant women (20 weeks of gestation or less) had periodontal examination at baseline and followed up until delivery. Gestational age and birth weight were retrieved from their medical records. ROC curve analyses were used to examine the overall discriminatory power of the studied periodontal parameters to predict PB, LBW, and PB or LBW. For the three outcome variables, the area under curve (AUC) ranged from 0.84 to 0.87 for average clinical attachment level (CAL), 0.78-0.86 for percent of sites with CAL ≥ 5 mm, 0.63-0.74 for percent of sites with CAL ≥ 6 mm, and 0.71-0.82 for number of missing teeth indicating that they had high discriminating power to predict adverse pregnancy outcomes. All other parameters had AUC less than 0.60 and thus had low discriminating power. Average CAL performed the best in predicting the studied adverse pregnancy outcomes because it has the highest AUC. The severity and extent of periodontal disease as measured by CAL can be used to predict the occurrence of adverse pregnancy outcomes. Keywords Preterm birth * Low birth weight * Clinical attachment loss * Number of teeth * Receiver-operating characteristic curve * Periodontal disease, Introduction Preterm low birth weight (PLBW) is a major clinical problem contributing to 80% of perinatal mortality and 50% of neurologic problems in the neonatal period in developed countries [1]. [...]

The aim of this paper was to investigate the association between birthweight and prevalence of food allergies using a national sample of US children. Adult report of birthweight and child food allergies were obtained for years 2005-2009 from the National Health Interview Survey (NHIS), a cross-sectional household survey of the US population. A total of 51,748 children aged 0-17 years were included in the analyses representing over 73 million children. Multivariable logistic regression analyses examined associations between birthweight categories and food allergies stratified by age and gender; accounting for the complex design of NHIS. Children aged 6-12 years who were born very low birthweight (500-1,499 g) were more likely to have reported food allergy compared to referent (3,000-3,499 g),OR = 1.72; 95% CI: 1.02-2.91. However, there was no clear trend of an association between birthweight and food allergy with increasing or decreasing birthweight across all ages. Estimates were generally stronger in younger male children as compared to estimates in females of the same age group. Marginal associations for respiratory allergy (OR = 1.52; 95% CI: 1.02-2.29) and hay fever (OR = 1.54; 95% CI: 0.93-2.54) were observed among very low birthweight children aged 0-5 years. There was limited evidence for a clear association between birthweight and food allergy. Marginal associations observed in children weighing 500-1,499 g at birth support efforts to minimize preterm births and very low birthweight given the increase in pediatric food allergies and the large number of children born low birthweight each year in the US. Keywords Food allergy * Birthweight * Children * Respiratory allergy * Hay fever, Introduction The significance of food allergy research has been increasing in the United States (US), particularly among pediatric populations. Recent national survey estimates report a prevalence of 3.9% of food [...]

BACKGROUND: Numerous studies have linked criteria air pollutants with adverse birth outcomes, but there is less information on the importance of specific emission sources, such as traffic, and air toxics. [...]

Low birth weight (LBW) is associated with type 2 diabetes and depression, which may be related to prenatal stress and insulin resistance as a result of chronic hypothalamic-pituitary-adrenal (HPA) axis hyperactivity. We examined whether treatment with a selective serotonin reuptake inhibitor [escitalopram (ESC)] could downregulate HPA axis activity and restore insulin sensitivity in LBW rats. After 4-5 wk of treatment, ESC-exposed LBW (SSRI-LBW) and saline-treated control and LBW rats (Cx and LBW) underwent an oral glucose tolerance test or a hyperinsulinemic euglycemic clamp to assess whole body insulin sensitivity. Hepatic phosphoenolpyruvate carboxykinase (PEPCK) mRNA expression and red skeletal muscle PKB Ser[sup.473] phosphorylation were used to assess tissue-specific insulin sensitivity, mRNA expression of the hypothalamic mineralocorticoid receptor was five-fold upregulated in LBW (P < 0.05 vs. Cx), accompanied by increased corticosterone release during restraint stress and total 24-h urinary excretion (P < 0.05 vs. Cx), whole body insulin resistance (P < 0.001 vs. Cx), and impaired insulin suppression of hepatic PEPCK mRNA expression (P < 0.05 vs. Cx). Additionally, there was a tendency for reduced red muscle PKB Ser[sup.473] phosphorylation. The ESC treatment normalized corticosterone secretion (P < 0.05 vs. LBW), whole body insulin sensitivity (P < 0.01) as well as postprandial suppression of hepatic mRNA PEPCK expression (P < 0.05), and red muscle PKB Ser[sup.473] phosphorylation (P < 0.01 vs. LBW). We conclude that these data suggest that the insulin resistance and chronic HPA axis hyperactivity in LBW rats can be reversed by treatment with an ESC, which downregulates HPA axis activity, lowers glucocorticoid exposure, and restores insulin sensitivity in LBW rats. selective serotonin reuptake inhibitors doi:10.1152/ajpendo.00606.2009.

Individuals born with low birth weight (LBW) are at risk of developing type 2 diabetes mellitus (T2D), which may be precipitated by physical inactivity. Twenty-two LBW subjects and twenty-three controls were studied before and after bed rest by the hyperinsulinemic euglycemic clamp combined with indirect calorimetry and infusion of stable isotope tracers and preceded by an intravenous glucose tolerance test. LBW subjects had a similar body mass index but elevated abdominal obesity compared with controls. The basal rate of whole body lipolysis (WBL) was elevated in LBW subjects with and without correction for abdominal obesity before and after bed rest (all P = 0.01). Skeletal muscle hormone-sensitive lipase (HSL) protein expression and phosphorylation at Ser565 were similar in the two groups. Bed rest resulted in a decrease in WBL and an increased skeletal muscle HSL Ser565 phosphorylation indicating a decreased HSL activity in both groups. All subjects developed peripheral insulin resistance in response to bed rest (all P < 0.0001) with no differences between groups. LBW subjects developed hepatic insulin resistance in response to bed rest. In conclusion, increased WBL may contribute to the development of hepatic insulin resistance when exposed to bed rest in LBW subjects. Nine days of bed rest causes severe peripheral insulin resistance and reduced WBL and skeletal muscle HSL activity, as well as a compensatory increased insulin secretion, with no differences in LBW subjects and controls. physical inactivity; insulin resistance; prediabetic subjects doi:10.1152/ajpendo.00223.2009.

A study was conducted to evaluate the association between very preterm and very low-birth-weight (VLBW) children from birth to adolescence and motor development. Results indicated that being very preterm or VLBW did result in some form of motor impairment throughout childhood.

Low birth weight is associated with an increased risk of hypertension and renal dysfunction at adulthood. Such an association has been shown to involve a reduction of nephron endowment and to be enhanced by accelerated postnatal growth in humans. However, while low-birth-weight infants often undergo catch-up growth, little is known about the long-term vascular and renal effects of accelerated postnatal growth. We surimposed early postnatal overfeeding (OF; reduction of litter size during the suckling period) to appropriate-birth-weight (NBW+OF) and intrauterine growth restriction (IUGR; IUGR+OF) pups, obtained after a maternal gestational low-protein diet. Blood pressure (systolic blood pressure; SBP) and renal function (glomerular filtration rate; GFR) were measured in young and aging offspring. Glomerulosclerosis and nephron number were determined in aging offspring (22 too). Nephron number was reduced in both IUGR and IUGR+OF male offspring (by 24 and 26%). GFR was reduced by 40% in 12-too-old IUGR+OF male offspring, and both NBW+OF and IUGR+OF aging male offspring had sustained hypertension (+25 mmHg) and glomernlosclerosis, while SBP and renal function were unaffected in IUGR aging offspring. Female offspring were unaffected. In conclusion, in this experimental model, early postnatal OF in the neonatal period has major long-lasting effects. Such effects are gender dependent. Reduced nephron number alone, associated with IUGR, may not be sufficient to induce long-lasting physiological alterations, and early postnatal OF acts as a 'second hit.' Early postnatal OF is a suitable model with which to study the long-term effects of postnatal growth in the pathogenesis of vascular disorders and renal disease. nephrogenesis; nephron number; catch-up growth; hypertension; glomernlosclerosis; developmental origins of adult diseases; low birth weight doi:10.1152/ajprenal.90704.2008.

A multicenter, randomized, double-blind, placebo-controlled trial of fluconazole is performed for the prevention of fungal colonization and infection in very-low birth-weight neonates, which indicated that prophylactic fluconazole reduces invasive candida infection.

Using evidences from Norway the relation between birth weight and short-run and long-run health, education and economic outcomes of the individual in adulthood, is studied.

OBJECTIVE. Our goal was to investigate whether outcome in extremely low birth weight infants changes over time in Finland. PATIENTS AND METHODS. All infants with a birth weight < 1000 g born in Finland in 1996-1997 and 1999-2000 were included in the study. Perinatal and follow-up data were collected in a national extremely low birth weight infant research register. Data concerning cerebral palsy and visual impairment were obtained from hospitals, the national discharge, and visual impairment registers. RESULTS. A total of 529 and 511 extremely low birth weight infants were born during 1996-1997 and 1999-2000. No changes were detected in prenatal, perinatal, neonatal, and postneonatal mortality rates between the periods. The survival rates including stillborn infants were 40% and 44%. The incidence of respiratory distress syndrome and septicemia increased from 1996-1997 to 1999-2000 (75% vs 83% and 23% vs 31%). The overall incidence of intraventricular hemorrhage increased (29% vs 37%), but the incidence of intraventricular hemorrhage grades 3 through 4 did not (16% vs 17%). The rates of oxygen dependency at the age corresponding with 36 gestational weeks, retinopathy of prematurity stages 3 to 5, cerebral palsy, and severe visual impairment did not change. Mortality remained higher in 1 university hospital area during both periods compared with the other 4 areas, but no regional differences in morbidity were detected during the later period. CONCLUSIONS. No significant changes were detected in birth or mortality rate in extremely low birth weight infants born in Finland during the late 1990s, but some neonatal morbidities seemed to increase. Regional differences in mortality were detected in both cohorts. Repeated long-term follow-up studies on geographically defined very preterm infant cohorts are needed for establishing reliable outcome data of current perinatal care. Regional differences warrant thorough audits to assess causalities. Key Words low gestational age, mortality, neonatal morbidity, cerebral palsy, visual impairment, THE MORE ACTIVE approach to antenatal and perinatal treatment of most immature infants has recently been shown to decrease stillbirth rates and increase the survival at gestational weeks (GWs) from [...]

BACKGROUND. Children born extremely premature ( METHODS. We performed a follow-up study of 5319 children born between January 1990 and June 1992. We got the information on birth weight and gestational age from birth registration forms; when the children were between 9 and 11 years of age, we gathered information about their school performance (reading, spelling, and arithmetic) from questionnaires completed by the parents and the children&apos;s primary school teachers. RESULTS. The association between birth weight and reading, as well as spelling and arithmetic disabilities, showed a graded relationship, with children who weighed CONCLUSIONS. Gestational age and birth weight were associated with school performance in the 10-year-old child and the association extended into the reference range of both birth weight and gestational age. Key Words prematurity, low birth weight, learning disabilities Abbreviations IQ--intelligence quotient OR--odds ratio CI--confidence interval AOR--adjusted odds ratio, THE SURVIVAL RATES of extremely premature ( Most of our colleagues have focused primarily on children born with a very low birth weight ( A recent follow-up study with questionnaire [...]

BACKGROUND. Recent investigations have reported an influence of thrombophilic mutations and antithrombotic risk factors with development of intraventricular hemorrhage. It was our objective for this study to investigate the impact of genetic polymorphisms of hemostasis genes on the primary outcome measures of sepsis, bronchopulmonary dysplasia, intraventricular hemorrhage, and periventricular leukomalacia in a large cohort of very low birth weight infants. METHODS. There were 586 very low birth weight infants enrolled prospectively in a multicenter trial between September 2003 and July 2005, and an additional 595 very low birth weight infants, who had been recruited in a previous prospective trial, were studied. DNA samples were taken by buccal swab, and genotypes of factor V Leiden mutation, prothrombin G20210A mutation, the factor VII-323 del/ins polymorphism, and the factor XIII-Val34Leu polymorphisms were determined by polymerase chain reaction and restriction enzyme digestion. RESULTS. In contrast to data published previously, the frequency of intraventricular hemorrhage or periventricular leukomalacia was not significantly influenced by any of the genetic variants tested. Carriers of the factor XIII-Val34Leu polymorphism, however, had a higher sepsis rate and a longer period of hospital care compared with noncarriers. The factor VII-323 del/ins polymorphism was found to be a potential protective factor against bronchopulmonary dysplasia. CONCLUSIONS. We could not confirm previously reported associations of hemostasis gene variants and development of intraventricular hemorrhage in very low birth weight infants. To better understand gene-disease associations in very low birth weight infants, the prospective development of large-scale cohorts with well-defined phenotypes and corresponding DNA samples is essential. Key Words VLBW, outcome, hemostasis genes, polymorphism Abbreviations VLBW--very low birth weight IVH--intraventricular hemorrhage PVL--periventricular leukomalacia BPD--bronchopulmonary dysplasia ROP--retinopathy of prematurity, GENETIC ASSOCIATION STUDIES have been applied to a wide range of complex diseases to identify populations who are at an increased risk. For example, substantial progress has been made in [...]

BACKGROUND. Neonatal hypotension may be a risk factor for neurologic impairment. Few studies have examined the impact of low blood pressure in extremely low birth weight (ELBW) infants weighing 400 to 999 g on neurodevelopmental outcome. OBJECTIVES. We set out to explore the relationship between treated hypotension in the first 72 hours of life and perinatal factors, morbidity, and mortality in ELBW infants and then to compare neurosensory outcome in ELBW infants with treated hypotension and those who never received treatment for hypotension. DESIGN/METHODS. We performed chart review of all 156 ELBW infants admitted to our level III NICU in 1998-1999. Infants had 'treated hypotension' if they received fluid pushes, corticosteroids, and/or vasopressors during the first 72 hours of life in an attempt to increase blood pressure. Follow-up included neurologic examination, Bayley Scales of Infant Development, vision and hearing evaluation. Statistical analysis was performed by using SPSS II.O. Univariate and multivariate analyses were conducted to determine morbidities associated with treated hypotension. RESULTS. Fifty-nine infants received treatment for hypotension. Ninety-seven infants did not. The groups had similar race, gender, delivery mode, chorioamnionitis, and maternal socioeconomic status. Thirty-eight (24%) infants expired, including 20 who received treatment for hypotension. Of the 156 infants in the study group, no underwent neurodevelopment testing, and 103 were able to undergo complete neurodevelopment testing and Bayley examination. Multivariate analysis controlling for socioeconomic status and neonatal morbidity revealed that treated hypotension is associated with delayed motor development and hearing loss. CONCLUSIONS. Treated hypotension in ELBW infants in the first 72 hours of life is associated with significant short-term and long-term morbidity. Infants with treated hypotension are more likely to have delayed motor development, hearing loss, and death. Key Words blood pressure, extremely low birth vi/eight, neonatal morbidity, hearing loss, THERE ARE ~30000 extremely low birth weight (ELBW) infants (birth weight Hypotension is a common problem in the ELBW population, with an estimated incidence of 20% to 45%. (3) There [...]

The appropriate determination of adequate tissue perfusion and the best approach to treatment of perceived abnormalities in blood pressure in the neonate remain controversial. There is no consensus regarding the actual definition of hypotension in the neonate or how best to raise perceived low blood pressure. In addition, there is no direct and prospectively collected information available on the result of treatment of a "low" blood pressure on neonatal morbidity and mortality. It also has not been clearly demonstrated that bringing systemic blood pressure to a "normal" range improve outcomes. However, it is widely accepted by clinicians that early and aggressive treatment of hypotension leads to improved neurologic outcome and survival in the neonate. Commonly used therapeutic maneuvers to correct systemic hypotension in the neonate include volume expansion, inotropic agents, and corticosteroids. Although there is a paucity of research on the cardiovascular response to these commonly used agents in neonates, among the commonly used inotropic drugs dopamine has been shown to be more effective than dobutamine in raising blood pressure in the neonate. The cardiology group focused on the use of inotropes, particularly dopamine and dobutamine, to treat very low birth weight infants with cardiac instability and neonatal postoperative cardiac patients. The cardiology group identified key issues that must be considered when designing studies of inotropic agents in preterm infants and proposed 2 clinicaltrial designs: (1) a placebo-controlled trial with rescue for symptomatic infants; and (2) a targeted--blood pressure study. The first trial design would answer questions concerning efficacy of treatment with inotropic agents in this population. The second trial design would address concerns related to the lack of knowledge on normal blood pressure ranges in this population. The group identified specific design elements that would need to be addressed for the complicated trial design to study inotropic agents in neonates. Key Words hypotension, inotropic agents, neonatal blood pressure, dopamine, dobutamine Abbreviations VLBW--very low birth weight IVH--intraventricular hemorrhage PVL--periventricular leukomalacia, FEW ASPECTS OF neonatal care have generated more controversy than those surrounding the appropriate determination of adequate tissue perfusion and the best approach to treatment of perceived abnormalities in blood [...]

OBJECTIVE. To assess whether improvements in cognitive and behavioral development seen in preschool educational programs persist, we compared those in a multisite randomized trial of such a program over the first 3 years of life (INT) to those with follow-up only (FUO) at 18 months of age. METHODS. This was a prospective follow-up of the Infant Health and Development Program at 8 sites heterogeneous for sociodemographic characteristics. Originally 985 children were randomized to the INT (n = 377) or FUO (n = 608) groups within 2 birth weight strata: heavier low birth weight (HLBW; 2001-2499 g) and lighter low birth weight (LLBW; [less than or equal to] 2000 g). Primary outcome measures were the Peabody Picture Vocabulary Test (PPVT-III), reading and mathematics subscales of the Woodcock-Johnson Tests of Achievement, youth self-report on the Total Behavior Problem Index, and high-risk behaviors on the Youth Risk Behavior Surveillance System (YRBSS). Secondary outcomes included Weschler full-scale IQ, caregiver report on the Total Behavior Problem Index, and caregiver and youth self-reported physical health using the Medical Outcome Study measure. Assessors were masked as to study status. RESULTS. We assessed 636 youths at 18 years (64.6% of the 985, 72% of whom had not died or refused at prior assessments). After adjusting for cohort attrition, differences favoring the INT group were seen on the Woodcock-Johnson Tests of Achievement in math (5.1 points), YRBSS (-0.7 points), and the PPVT-III (3.8 points) in the HLBW youth. In the LLBW youth, the Woodcock-Johnson Tests of Achievement in reading was higher in the FUO than INT group (4.2). CONCLUSIONS. The findings in the HLBW INT group provide support for preschool education to make long-term changes in a diverse group of children who are at developmental risk. The lack of observable benefit in the LLBW group raises questions about the biological and educational factors that foster or inhibit sustained effects of early educational intervention. Key Words early intervention, long-term results, low birth weight, randomized controlled trial Abbreviations IHDP--Infant Health and Development Program LLBW--lighter low birth weight HLBW--heavier low birth weight INT--intervention FUO--follow-up only YRBSS--Youth Risk Behavior Surveillance System BPI--Behavior Problem Index WASI--Weschler Abbreviated Scale of Intelligence PPVT-III--Peabody Picture Vocabulary Test-Version III HSG--high school graduate CI--confidence interval LSW--low birth weight, INTENSIVE EARLY EDUCATIONAL interventions have been documented to improve the cognitive outcomes (1) and, in some cases, reduce antisocial behavior early in the school experience. (2) In several single-site, randomized [...]

Study is conducted to describe and compare the achievement and the age at attainment of the markers such as getting a job, living independently, and parenthood between extremely low-birth-weight (ELBW) and normal birth weight young adults. Results indicate that significant majority of ELBW infants have overcome their earlier difficulties to become functional young adults.

Abstract. Very low-birth weight infants with patent ductus arteriosus (PDA) accompanied by severe heart failure do not respond to indomethacine therapy. It is essential to stabilize the general condition of [...]

Objective. No uniform method for calculating growth velocity (GV) (grams per kilogram per day) among extremely low birth weight (ELBW) infants has been reported. Because the calculation of actual GV is so labor intensive, investigators have estimated GV with varying approaches, making comparisons across studies difficult. This study compares the accuracy of 3 mathematical methods used for estimating average GV, namely, 2-point models using the difference between weights at 2 time points divided by time and weight (either birth weight [BW] or average weight), linear regression models that are normalized for either BW or average weight, and an exponential model. The accuracy of all models was compared with actual GVs calculated from daily weight measures for a group of ELBW infants. Methods. Actual GVs were calculated from daily weights for 83 ELBW infants admitted to the special care nursery and were compared with estimated GVs from each of the 5 models for the same infants. Results. The exponential model, using weights from 2 time points, ie, GV = [1000 x ln([W.sub.n]/[W.sub.1])]/([D.sub.n] - [D.sub.1]), was extremely accurate, with mean absolute errors of 0.02% to 0.10%. The 2-point and linear models were highly inaccurate when BW was used in the denominator, with mean absolute errors of 50.3% to 96.4%. The 2-point and linear models were fairly accurate when average weight was used in the denominator, with mean absolute errors of 0.1% to 8.97%. Additional analyses showed that the accuracy of the 2-point and linear model estimates was affected significantly by the combination of BW, length of stay, and chronic lung disease, whereas the exponential model was not affected by these combined factors. Conclusions. GV estimates calculated with 3 commonly used models varied widely, compared with actual GVs; however, the exponential model estimates were extremely accurate. The exponential model provides the accuracy and ease of use that are lacking in current methods applied to infant growth research. Pediatrics 2005; 116:1466-1473; infant, extremely low birth weight, growth velocity, mathematical model prematurity. ABBREVIATIONS. BW, birth weight; ELBW, extremely low birth weight; GV, growth velocity; LOS, length of stay; ANCOVA, analysis of covariance., In the United States, 22 845 extremely low birth weight (ELBW) infants (birth weight [BW] of The measurement of postnatal growth is central to clinical care and research for ELBW [...]

Objective. This study evaluated the impact of changes in perinatal management on neurodevelopmental impairment (NDI) at 18 to 22 months' corrected age of low gestation (22-26 weeks) and higher gestation (27-32 weeks) extremely low birth weight infants (401-1000 g birth weight) who were cared for in the National Institute of Child Health and Human Development Neonatal Research Network during 3 epochs (1993-1994, 1995-1996, and 1997-1998). It was hypothesized that outcomes would improve over the 3 epochs. Methods. A multicenter cohort study was conducted of the outcomes of 3785 infants with assessments at 18 to 22 months' corrected age. Regression analyses were completed to evaluate for epoch effects, gestational age effects, and time plus gestational age interaction. Regression analyses were also performed to identify the independent associations of epoch and 4 study perinatal interventions: antenatal steroids (yes, no), high-frequency ventilation (yes, no), number of days to regain birth weight as a marker of nutritional intake, and postnatal steroids for treatment of bronchopulmonary dysplasia (yes, no) with outcomes. Results. Survival improved for both the low (55%-61%) and higher (82%-86%) gestational age groups during the 3 epochs. Regression analyses indicated that the decreased risk for adverse outcome was significantly lower in epoch 2 compared with epoch 1 with decreased rates of low Bayley Mental Development Index (MDI) and neurodevelopmental impairment (NDI). Antenatal steroids were associated with decreased risk for moderate to severe cerebral palsy (CP) and low Bayley Psychomotor Development Index. High-frequency ventilation was associated with a low Bayley MDI and NDI, and postnatal steroids were associated with moderate to severe CP, any CP, low Bayley MDI, low Bayley Psychomotor Development Index, and increased NDI. Conclusion. Survival of extremely low birth weight infants improved between 1993 and 1998. Although some outcomes remained unchanged, the rates of low Bayley MDI scores and NDI improved. Antenatal steroid administration was the only study intervention associated with improved outcomes. Pediatrics 2005;116:635-643; extremely low birth weight, neurologic outcome, impairment, cerebral palsy, Bayley, antenatal steroids., ABBREVIATIONS. ELBW, extremely low birth weight; NICHD, National Institute of Child Health and Development; BPD; bronchopulmonary dysplasia; BSID-II, Bayley Scales of Infant Development II; MDI, Mental Development Index; PDI, Psychomotor [...]

Objective. The Bayley Scales of Infant Development, Second Edition (BSID II) are commonly used to assess outcomes of extremely low birth weight (ELBW) infants. We sought to assess the predictive validity of the BSID II Mental Developmental Index (MDI) for cognitive function at school age. Design/Methods. Of 330 ELBW infants admitted in 1992-1995, 238 (72%) survived to the age of 8 years, of whom 200 (84%) were tested at both 20 months&apos; corrected age (CA) and 8 years. Mean birth weight was 811 g, mean gestational age was 26.4 weeks, 41% were boys, and 60% were black. Measures included the BSID II at 20 months&apos; CA and the Kaufman Assessment Battery for Children (KABC) Mental Processing Composite (MPC) at 8 years&apos; postnatal age. BSID II MDI and MPC scores were compared and the predictive validity calculated for all 200 ELBW children and for the 154 ELBW neurosensory-intact subgroup. Predictors of stability or change in cognitive scores were examined via logistic regression adjusting for gender and sociodemographic status. Results. For all ELBW children, the mean MDI was 75.6 [+ or -] 16 versus a mean KABC of 87.8 [+ or -] 19. For the neurosensory-intact subgroup, the mean MDI was 79.3 [+ or -] 16 and the mean KABC was 92.3 [+ or -] 15. Rates of cognitive impairment, defined as an MDI or KABC of 70. Conclusions. The predictive validity of a subnormal MDI for cognitive function at school age is poor but better for ELBW children who have neurosensory impairments. We are concerned that decisions to provide intensive care for ELBW infants in the delivery room might be biased by reported high rates of cognitive impairments based on the use and presumptive validity of the BSID II MDI. Pediatrics 2005;116:333-341; extremely low birth weight, prematurity, outcome, prediction, intelligence, school age. ABBREVIATIONS. ELBW, extremely low birth weight; MDI, Mental Developmental Index; BSID II, Bayley Scales of Infant Development, Second Edition; CA, corrected age; MPC, Mental Processing Composite; SES, socioeconomic status; CI, confidence interval; VLBW, very low birth weight., The increased survival of infants of extremely low birth weight (ELBW) in the 1990s, which resulted from advances in perinatal care, has been accompanied by high rates of neonatal complications [...]

Neurosensory, developmental, and medical conditions together with the associated functional limitations and special health care needs of extremely low-birth-weight (ELBW) children compared with normal-birth-weight (NBW) term-born children are examined. Findings reveal that the ELBW survivors in school at age 8 years who were born during the 1990s period have considerable long-term health and educational needs.