The participants were a subgroup of the Helsinki Study of VeryLowBirthWeight Adults, which has been described in detail [5,6]. Briefly, the original study cohort comprised 335 consecutive VLBW (< 1500g) infants (of whom 178 were women) who were born between January 1978 and December 1985 and who were discharged alive from the neonatal intensive care unit of Children ’ s Hospital at the Helsinki University Central Hospital in Finland. For each VLBW survivor, the next term born (gestational age > 37 weeks) single- ton infant of the same sex, and not small for gestational age (SGA, birthweight < -2SD) was selected to act as control (n = 367, of whom 201 women). We invited 255 VLBW (139 women) and 314 term (169 women) partici- pants who lived in the greater Helsinki area to a clinical examination, and 166 (95 women, 68% of those invited) and 172 (103 women, 61%) agreed to participate.
Background: Although the mortality and morbidity rates for VeryLowBirthWeight (VLBW) and Extremely LowBirthWeight (ELBW) neonates have improved over last few decades, they still remain highly vulnerable groups. This study determines the neonatal morbidity and mortality within first four weeks of life in VLBW and ELBW neonates. Methods: It was a hospital based prospective study conducted in the department of paediatrics at GB Pant hospital, an associated hospital of Government Medical College Srinagar. All included neonates were evaluated in neonatology section and were followed up to 4 weeks of life. Standard protocols were used for management of these neonates. Results: A total of 116 neonates were included in the study. Among the 116 neonates 82 (70.69%) were VLBW and 34 (29.31%) were ELBW. 28 (34.14%) VLBW and 18 (52.94%) ELBW neonates died. Among the morbidities Respiratory Distress Syndrome was found in 35.37% of VLBW and 70.59% of ELBW neonates, out of which 12.20% VLBW and 20.58% ELBW neonates developed Bronchopulmonary dysplasia. Perinatal asphyxia was found in 20.73% of VLBW and 29.41% of ELBW neonates and Pathological apnea occurred in 28.04% VLBW and 85.29% ELBW neonates. 40.24% VLBW and 73.53% ELBW neonates developed clinically significant jaundice requiring treatment. Clinical sepsis was found in 43.90% VLBW and 67.65% ELBW neonates while as culture proven sepsis was found in 26.83% VLBW and 41.18% ELBW neonates. Intra ventricular haemorrhage was found in 15.85% VLBW and 52.94% ELBW neonates. Necrotizing enterocolitis developed in 18.29% VLBW and 35.29% ELBW neonates. Retinopathy of prematurity was found in 21.95% VLBW and 26.47% ELBW neonates. Patent ductus arteriosus was found in 14.63% VLBW and 32.35% ELBW neonates.
between 1978 and 1985 and who attended the clinical examinations of the Helsinki Study of VeryLowBirthWeight Adults, 96 randomly selected participants (52 subjects with VLBW and 44 control subjects born at term) were enrolled for the stress test. Each participant provided informed consent. Five participants withdrew after baseline recording, and 2 participants were ex- cluded from analysis because they were blind and the stress test could not be performed adequately. BP data were not obtained for 8 participants because of technical problems in BP monitoring. The remaining study sample included 44 young adults with VLBW (24 women and 20 men) and 37 control subjects (22 women and 15 men). The VLBW participants were all born prema- turely, with gestational ages ranging from 24.7 to 35.6 weeks and birth weights ranging from 600 to 1480 g. Within the VLBW group, there were 20 participants born SGA (birthweight for gestational age below ⫺ 2 SD) and 24 born AGA (birthweight for gestational age above ⫺ 2 SD). The control subjects were born at term and AGA, with gestational ages ranging from 38.0 to 42.3 weeks and birth weights ranging from 2520 to 4900 g.
The main objective of the present study was to test whether verylowbirthweight (VLBW; ⬍ 1500 g) is related to increased prevalence of sleep-disordered breathing in young adulthood. The second objective of the study was to investigate whether pregnancy-related risk factors, such as maternal smoking during pregnancy, preeclampsia, intrauterine growth retardation, and me- chanical ventilation, are related to sleep-disordered breathing. Characterization of risk factors for SBD may facilitate new alternatives to early intervention, as well as provide insights to our understanding of pathophysi- ological mechanisms of development of sleeping prob- lems.
In childhood, verylowbirthweight (VLBW) survivors have, on average, poorer lung function, particularly those with a history of bronchopulmonary dysplasia (BPD) but possibly also those without such a history. 1–4 Lung function in adults who were born as small preterm infants has not been extensively studied, even though this factor is, in addition to smoking, 1 of the strongest predictors of obstructive airways disease in later life. 5 Much of
Paternal race/ethnicity is an important predictor of verylowbirthweight among non-Hispanic Caucasian and Hispanic mothers. This relationship is significant apart from marital status and maternal factors such as age, plurality, and smoking. Among non-Hispanic Caucasian mothers, African American paternal race was associated with increased odds of VLBW compared to non-Hispanic Caucasian paternal race. Studies have previously identified a graded increase in risk for stillbirth among infants born to families with non-Hispanic Caucasian maternal and African American paternal race, African American mater- nal and non-Hispanic Caucasian paternal race, and African American maternal and paternal race, respectively . Similar trends have been identified for pre-term birth and lowbirthweight [23,24,26]. Notably, the current study did not identify a significant difference in birth outcomes among African American mothers with African American paternal race listed on the birth certificate compared to non-Hispanic Caucasian paternal race. Prior studies have not been able to examine this difference due to lack of sample size  or have found greater risk among African-American couples [23,26]. Further research is needed to clarify this difference.
Over the last decades, the number of infants that survive a preterm birth has increased due to the progress in peri- natal care. With the increase of surviving preterm infants and VeryLowBirthWeight (VLBW) infants, another problem arises: the proportion of disabilities within this group of newborns also increases [1,2]. In the Netherlands the prevalence of live born preterms (22–37 weeks of ges- tation) is 7.3%. Within this group, 1.1% is born extremely preterm (22 – 32 weeks of gestation) and 1.0% has a VLBW (<1500 grams). Most of the infants with a VLBW are also born preterm . Follow-up studies of those born with a VLBW show a wide variety of impairments , such as neurodevelopmental disabilities , blindness, deafness [6,7] and issues with growth  and learning . A study
Regional birth and death rates were calculated for all live births of ⱖ500 g within the Cincinnati region during the study period. Lowbirthweight (LBW) rates were calculated for infants of 1500 to 2499 g, and VLBW rates were calculated for infants of 500 to 1499 g. Mortality rates are reported as the number of deaths per 1000 live births in each birthweight category. The risk-adjusted effects of birth hospital type (non-SPC vs SPC) on VLBW infant outcomes were evaluated using multivariable logistic regression performed in 2 stages. In the first stage, the effect of birth hospital type, controlling for nonpractice infant and maternal variables, was determined using a backward stepwise algorithm. In this algorithm, all variables were initially entered into the model. At each successive stage of the model-building process, the least significant predictor variable was removed until all variables that remained in the model met a significance level of .05. In the second analysis, a backward stepwise regression analysis was performed, including both the maternal and infant variables and the practice variables (CRIB score, antenatal glucocorticoid use, and intrapar- tum antibiotics use). In this model, practice variables were added to the model sequentially. Data were managed and analyzed using SAS statistical software (SAS Institute, Inc, Cary, NC).
The nutritional need of a premature infant is characteristically dependent upon parenteral nutrition (PN) provided during the early postnatal life, especially for verylowbirthweight (VLBW) infants (birthweight of less than 1500g). In these VLBW infants, full enteral feedings are essentially postponed because of the seriousness of medical problems associated with prematurity, such as immature lung function (which frequently requires endotracheal intubation and mechanical ventilation), hypothermia, infections, and hypotension. In addition, early enteral feeds are also delayed because of concern of aggressive feeding leading to complications, such as feeding intolerance or necrotizing enterocolitis. Partial parenteral nutrition (PPN) is a supplemental form of nourishment delivered intravenously in patients who are sick or injured and in whom a feeding tube cannot be used. This nutritional supplement is only used for a short period of time until the full recovery of the baby or until establishment of normal feeds. Glucose, amino acids, salts, lipids, and vitamins are combined in varying amounts in the PPN to meet the needs of the patient.
(VLBW [⬍1500 g]), extremely lowbirthweight (ELBW [ ⬍ 1000 g]), and critically ill PT infants have increased survival rates substantially, thereby add- ing challenges in the selection and optimization of appropriate immunization regimens for infants with immature or impaired cellular and humoral immune systems. Several studies have examined the safety, immunogenicity, efficacy, and durability of immune responses to hepatitis B virus (HBV), diphtheria and tetanus toxoids and acellular pertussis (DTaP), inac- tivated poliovirus (IPV), Haemophilus influenzae type b (Hib), influenza, and pneumococcal conjugate vac- cines when given to PT and LBW infants. 6 – 8 Several
Extremely lowbirthweight babies have shown high mortality and morbidity compared to verylowbirthweight babies and its related death multiply when associated with complications like hyaline membrane disease, hypoxic ischemic encephalopathy, sepsis. Death rate and the complications of verylowbirthweight and extremely lowbirthweight babies can be reduced by improving the standards of existing management system of new-born care. Further researches are also to be carried out to bridge up the gaps and to find out the preventable factors which will help to decrease the preterm mortality. Mortality and morbidity of verylowbirthweight (VLBW) babies In SNCU settings are at par with tertiary care settings.
ony-stimulating factors, such as erythropoietin and gran- ulocyte colony-stimulating factor, which regulate eryth- ropoiesis and granulopoiesis. We speculate that imbalance of these factors with increased reticulocyto- poiesis in response to anemia of prematurity may explain this phenomenon. We recommend avoiding institution of aggressive, potentially harmful therapy for this phe- nomenon in healthy, growing VLBW infants. Pediatrics 2000;106(4). URL: http://www.pediatrics.org/cgi/content/ full/106/4/e55; neutropenia, absolute neutrophil count, verylowbirthweight, infants, sepsis.
has questioned the cost-effectiveness arguments made in the prior literature for such interventions as prenatal care, however. One criticism has been the inaccuracy of measures of treatment costs for lowbirthweight infants. This study demonstrates that any prenatal intervention that results in a normal birth instead of a VLBW birth results in approxi- mately $59 700 in first year medical savings for med- ical care provided to the infant (in 1987 constant dollars). Even a shift in the birthweight distribution can produce significant savings. For infants with birth weights . 750 g, a shift of 250 g at birth saves an average of $12 000 to $16 000 (as shown in Table 5, shifting from the 750 to 999 g range to the 1000 to 1249 g range decreased average treatment costs by $15 800; from the 1000 to 1249 g to the 1250 to 1499 g range decreases average treatment costs by $12 300.) in first year medical costs and a shift of 500 g gener- ates $28 000 in savings. (A shift from the 750 to 999 g range to the 1250 to 1499 g range decreases average treatment costs by $28 100.) However, there is a threshold effect on birthweight. Shifts that move infants from the lowest birthweight ranges (,750 g), in which mortality is highest, will actually increase treatment costs. An increase in birthweight from , 750 g to between 750 and 999 g increases treatment costs by $29 300; an increase to the 1000 to 1249 range increases costs by $13 500. However, these increased expenditures also produce more survivors and have the effect of moving infants into ranges in which medical care is more cost effective, with fewer treat- ment resources expended per survivor produced.
Background. Refeeding Syndrome (RFS) is a well-known group of symptoms which occur after the intro- duction of enteral or parenteral nutrition in undernourished patients. Intrauterine growth restriction (IUGR) is the equivalent of postnatal RFS following the beginning of feeding. The aggressive parenteral nutrition of neonates with verylowbirthweight (VLBW) resulting from the termination of intrauterine transplacental nutrition is a source of biochemical disorders.
CONCLUSIONS. From parents’ point of view, significant pro- portions of verylowbirthweight adolescents experience more emotional and behavioral problems and less com- petence than normative adolescents. In contrast, verylowbirthweight adolescents state less problems and similar or higher competence than normative adoles- cents. Verylowbirthweight adolescent girls report more emotional and behavioral problems compared with their parents than verylowbirthweight adolescent boys do. Externalizing problems in verylowbirthweight adolescent girls are often not recognized by parents. To better understand these seemingly para- doxical findings and to develop adequate intervention programs, there is a need for prospective longitudinal studies.
syndrome or meconium ileus and those that under- went a laparotomy or ileostomy were identified through our database. Fifty-seven infants were elim- inated from the study, 28 on the basis of diagnosis of NEC, 9 with diagnoses of spontaneous perforation not associated with delayed meconium passage or meconium plug found at laparotomy, and 15 with structural intestinal problems including gastroschi- sis, intestinal atresia/stricture, tracheoesophageal fistula, Hirschsprung’s disease, and intestinal malro- tation. On review of hospital charts, 4 infants iden- tified as having meconium plug through the data- base did not have any intestinal problem during their hospital stay. One chart was unavailable for review. Descriptive information concerning the remaining 21 patients with meconium obstruction is presented in Table 1. All infants were of verylowbirthweight, with a mean weight of 819 ⫾ 196 g (mean ⫾ SD) and a mean gestational age of 27 ⫾ 2.4 weeks. The control group was well matched for birthweight, gestational age, and gender. Thirty-three percent of the infants with meconium obstruction were SGA, compared with 17% in the control, but the association was not statistically significant. Fifty-seven percent of the in- fants with meconium obstruction had an identifiable maternal risk factor associated with decreased pla- cental perfusion including preeclampsia, eclampsia, chronic hypertension, diabetes mellitus with arterial involvement, oligohydramnios, and chronic placen- tal abruption. Infants with meconium obstruction were more likely than controls to have associated prenatal complications including maternal treatment with magnesium sulfate (odds ratio [OR]: 3.9; confi- dence interval [CI]: 1.0, 8.8; P ⫽ .048), pregnancy- induced hypertension (OR: 7.2; CI: 1.5, 14.8; P ⫽ .007), and maternal chronic hypertension (OR: 7.0; CI: 1.5, 22.7; P ⫽ .008). We did not find significant associations between meconium obstruction and SGA, maternal diabetes, oligohydramnios, or chronic placental abruption.
al., 2014).The use of pharmacological management reported in research (Tronco et al., 2010) corroborates the assistance found in the present study, the use of vasoactive drugs in neonates with hemodynamic shock, after volumetric resource, has been much discussed which scheme to use. He found that the use of dobutamine in combination with noradrenaline exerts an early reversal effect on hemodynamic instability. This relates to improved prognosis and the rate of cardiac resuscitation. Studies show concern about describing the use of sedatives and analgesics in newborns. Their findings were similar to the present study, reporting that the use of midazolam and fentanyl to relieve neonatal pain and stress, triggered by several factors such as prolonged mechanical ventilation, inadequate nutrition, episodes of oxygen saturation drops, intense lighting, constant noise, multiple procedures, describing that the use must be individualized. When evaluating the ventilatory resources performed in the study, mechanical ventilation was present in most infants, 162 (92.04%), noninvasive in nine (5.11%) and circulating oxygen therapy in five (2.82%).Regarding the length of stay in this study, we found that most newborns remained in the NICU up to seven days 98 (55.68%), and 78 (44.7%) had a longer stay in the units. In the studies found in the literature, a mean hospitalization of approximately that found in this study in Rio Grande do Sul NICU in 2006 was observed, with hospitalization time of lowbirthweight infants ranging from 01 to 160 days, with average hospitalization time of neonates. 19.6 days (Araújo et al., 2005) and in the NICU of Minas Gerais, between 2012 and 201316, with an average of 21 days, showing a considerable discrepancy of our average results of 13.15 days. Therefore, such data may infer that the average length of stay tends to be characterized according to the severity of the public assisted there, suggesting higher average length of stay in those more complex NICUs located in hospitals with high risk of maternal and child referral. The present study showed that the main complications during hospitalization occurred in almost all of the research subjects 171 (97.15%), and of these the hypovolemic shock occurred in 64 (36.36%) followed by sepses 61 (34.65%) followed by pulmonary hemorrhage 30 (17.04%) demonstrating that the same ventilatory, nutritional and drug strategy needs to be differentiated according to gestational age and weight of the newborns at work.