GLORIA — GEOMAR Library Ocean Research Information Access

1

Online Resource

Incidence of and Neurodevelopmental Outcomes After Late-Onset Meningitis Among Children Born Extremely Preterm

Brumbaugh, Jane E. ; Bell, Edward F. ; Do, Barbara T. ; [et al.]

American Medical Association (AMA) ; 2022

In: JAMA Network Open Vol. 5, No. 12 ( 2022-12-08), p. e2245826-

add to mindlist on the mindlist

Details

In: JAMA Network Open, American Medical Association (AMA), Vol. 5, No. 12 ( 2022-12-08), p. e2245826-

Abstract: Late-onset meningitis (LOM) has been associated with adverse neurodevelopmental outcomes in children born extremely preterm. Objective To report the incidence of LOM during birth hospitalization and neurodevelopmental outcomes at 18 to 26 months’ corrected age. Design, Setting, and Participants This cohort study is a secondary analysis of a multicenter prospective cohort of children born at 22 to 26 weeks’ gestation between 2003 and 2017 with follow-up from 2004 to 2021. The study was conducted at 25 Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network centers. Exposures Culture-confirmed LOM. Main Outcomes and Measures Incidence and microbiology of LOM (2003-2017); lumbar puncture (LP) performance in late-onset sepsis (LOS) evaluations (2011-2017); composite outcome of death or neurodevelopmental impairment (NDI; 2004-2021). Results Among 13 372 infants (median [IQR] gestational age, 25.4 [24.4-26.1] weeks; 6864 [51%] boys), LOM was diagnosed in 167 (1%); LOS without LOM in 4564 (34%); and neither LOS nor LOM in 8641 (65%). The observed incidence of LOM decreased from 2% (95% CI, 1%-3%) in 2003 to 0.4% (95% CI, 0.7%-1.0%) in 2017 ( P & amp;lt; .001). LP performance in LOS evaluations decreased from 36% (95% CI, 33%-40%) in 2011 to 24% (95% CI, 21%-27%) in 2017 ( P & amp;lt; .001). Among infants with culture-confirmed LOS, LP performance decreased from 58% (95% CI, 51%-65%) to 45% (95% CI, 38%-51%; P = .008). LP performance varied by center among all LOS evaluations (10%-59%, P & amp;lt; .001) and among those with culture-confirmed LOS (23%-79%, P & amp;lt; .001). LOM occurred in the absence of concurrent LOS in 27 of 167 cases (16%). The most common LOM isolates were coagulase-negative Staphylococcus (98 [59%]), Candida albicans (38 [23%]), and Escherichia coli (27 [16%]). Death or NDI occurred in 22 of 46 children (48%) with LOM due to coagulase-negative Staphylococcus , 43 of 67 (64%) due to all other bacterial pathogens, and 26 of 33 (79%) due to fungal pathogens. The adjusted relative risk of death or NDI was increased among children with LOM (aOR, 1.53; 95% CI, 1.04-2.25) and among those with LOS without LOM (aOR, 1.41; 95% CI, 1.29-1.54) compared with children with neither infection. Conclusions and Relevance In this cohort study, LP was performed with decreasing frequency, and the observed incidence of LOM also decreased. Both LOM and LOS were associated with increased risk of death or NDI; risk varied by LOM pathogen. The full association of LOM with outcomes of children born extremely preterm may be underestimated by current diagnostic practices.

Type of Medium: Online Resource

ISSN: 2574-3805

URL: Article

DOI: 10.1001/jamanetworkopen.2022.45826

Language: English

Publisher: American Medical Association (AMA)

Publication Date: 2022

detail.hit.zdb_id: 2931249-8

Permalink

	Location	Call Number	Limitation	Availability

Others were also interested in ...

Online Resource

Link to publisher

2

Online Resource

Mortality, In-Hospital Morbidity, Care Practices, and 2-Year Outcomes for Extremely Preterm Infants in the US, 2013-2018

Bell, Edward F. ; Hintz, Susan R. ; Hansen, Nellie I. ; [et al.]

American Medical Association (AMA) ; 2022

In: JAMA Vol. 327, No. 3 ( 2022-01-18), p. 248-

add to mindlist on the mindlist

Details

In: JAMA, American Medical Association (AMA), Vol. 327, No. 3 ( 2022-01-18), p. 248-

Type of Medium: Online Resource

ISSN: 0098-7484

URL: Article

DOI: 10.1001/jama.2021.23580

RVK:

XA 10000

Language: English

Publisher: American Medical Association (AMA)

Publication Date: 2022

detail.hit.zdb_id: 2958-0

detail.hit.zdb_id: 2018410-4

SSG: 5,21

Permalink

	Location	Call Number	Limitation	Availability

Others were also interested in ...

Online Resource

Link to publisher

3

Online Resource

Association of High Screen-Time Use With School-age Cognitive, Executive Function, and Behavior Outcomes in Extremely Preterm Children

Vohr, Betty R. ; McGowan, Elisabeth C. ; Bann, Carla ; [et al.]

American Medical Association (AMA) ; 2021

In: JAMA Pediatrics Vol. 175, No. 10 ( 2021-10-01), p. 1025-

add to mindlist on the mindlist

Details

In: JAMA Pediatrics, American Medical Association (AMA), Vol. 175, No. 10 ( 2021-10-01), p. 1025-

Type of Medium: Online Resource

ISSN: 2168-6203

URL: Article

DOI: 10.1001/jamapediatrics.2021.2041

Language: English

Publisher: American Medical Association (AMA)

Publication Date: 2021

Permalink

	Location	Call Number	Limitation	Availability

Others were also interested in ...

Online Resource

Link to publisher

4

Online Resource

Tissue Oxygenation Changes After Transfusion and Outcomes in Preterm Infants : A Secondary Near-Infrared Spectroscopy Study of the Transfusion of Prematures Randomized Clinical Trial (TOP NIRS)

Chock, Valerie Y. ; Kirpalani, Haresh ; Bell, Edward F. ; [et al.]

American Medical Association (AMA) ; 2023

In: JAMA Network Open Vol. 6, No. 9 ( 2023-09-21), p. e2334889-

add to mindlist on the mindlist

Details

In: JAMA Network Open, American Medical Association (AMA), Vol. 6, No. 9 ( 2023-09-21), p. e2334889-

Abstract: Preterm infants with varying degrees of anemia have different tissue oxygen saturation responses to red blood cell (RBC) transfusion, and low cerebral saturation may be associated with adverse outcomes. Objective To determine whether RBC transfusion in preterm infants is associated with increases in cerebral and mesenteric tissue saturation (Csat and Msat, respectively) or decreases in cerebral and mesenteric fractional tissue oxygen extraction (cFTOE and mFTOE, respectively) and whether associations vary based on degree of anemia, and to investigate the association of Csat with death or neurodevelopmental impairment (NDI) at 22 to 26 months corrected age. Design, Setting, and Participants This was a prospective observational secondary study conducted among a subset of infants between August 2015 and April 2017 in the Transfusion of Prematures (TOP) multicenter randomized clinical trial at 16 neonatal intensive care units of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Preterm neonates with gestational age 22 to 28 weeks and birth weight 1000 g or less were randomized to higher or lower hemoglobin thresholds for transfusion. Data were analyzed between October 2020 and May 2022. Interventions Near-infrared spectroscopy monitoring of Csat and Msat. Main Outcomes and Measures Primary outcomes were changes in Csat, Msat, cFTOE, and mFTOE after transfusion between hemoglobin threshold groups, adjusting for age at transfusion, gestational age, birth weight stratum, and center. Secondary outcome at 22 to 26 months was death or NDI defined as cognitive delay (Bayley Scales of Infant and Toddler Development-III score & amp;lt;85), cerebral palsy with Gross Motor Function Classification System level II or greater, or severe vision or hearing impairment. Results A total of 179 infants (45 [44.6%] male) with mean (SD) gestational age 25.9 (1.5) weeks were enrolled, and valid data were captured from 101 infants during 237 transfusion events. Transfusion was associated with a significant increase in mean Csat of 4.8% (95% CI, 2.7%-6.9%) in the lower–hemoglobin threshold group compared to 2.7% (95% CI, 1.2%-4.2%) in the higher–hemoglobin threshold group, while mean Msat increased 6.7% (95% CI, 2.4%-11.0%) vs 5.6% (95% CI, 2.7%-8.5%). Mean cFTOE and mFTOE decreased in both groups to a similar extent. There was no significant change in peripheral oxygen saturation (SpO 2 ) in either group (0.2% vs −0.2%). NDI or death occurred in 36 infants (37%). Number of transfusions with mean pretransfusion Csat less than 50% was associated with NDI or death (odds ratio, 2.41; 95% CI, 1.08-5.41; P = .03). Conclusions and Relevance In this secondary study of the TOP randomized clinical trial, Csat and Msat were increased after transfusion despite no change in SpO 2 . Lower pretransfusion Csat may be associated with adverse outcomes, supporting further investigation of targeted tissue saturation monitoring in preterm infants with anemia. Trial Registration ClinicalTrials.gov Identifier: NCT01702805

Type of Medium: Online Resource

ISSN: 2574-3805

URL: Article

DOI: 10.1001/jamanetworkopen.2023.34889

Language: English

Publisher: American Medical Association (AMA)

Publication Date: 2023

detail.hit.zdb_id: 2931249-8

Permalink

	Location	Call Number	Limitation	Availability

Others were also interested in ...

Online Resource

Link to publisher

5

Online Resource

Social Determinants of Health and Redirection of Care for Infants Born Extremely Preterm

Brumbaugh, Jane E. ; Bann, Carla M. ; Bell, Edward F. ; [et al.]

American Medical Association (AMA) ; 2024

In: JAMA Pediatrics

add to mindlist on the mindlist

Details

In: JAMA Pediatrics, American Medical Association (AMA)

Abstract: Redirection of care refers to withdrawal, withholding, or limiting escalation of treatment. Whether maternal social determinants of health are associated with redirection of care discussions merits understanding. Objective To examine associations between maternal social determinants of health and redirection of care discussions for infants born extremely preterm. Design, Setting, and Participants This is a retrospective analysis of a prospective cohort of infants born at less than 29 weeks’ gestation between April 2011 and December 2020 at 19 National Institute of Child Health and Human Development Neonatal Research Network centers in the US. Follow-up occurred between January 2013 and October 2023. Included infants received active treatment at birth and had mothers who identified as Black or White. Race was limited to Black and White based on service disparities between these groups and limited sample size for other races. Maternal social determinant of health exposures were education level (high school nongraduate or graduate), insurance type (public/none or private), race (Black or White), and ethnicity (Hispanic or non-Hispanic). Main Outcomes and Measures The primary outcome was documented discussion about redirection of infant care. Secondary outcomes included subsequent redirection of care occurrence and, for those born at less than 27 weeks’ gestation, death and neurodevelopmental impairment at 22 to 26 months’ corrected age. Results Of the 15 629 infants (mean [SD] gestational age, 26 [2] weeks; 7961 [51%] male) from 13 643 mothers, 2324 (15%) had documented redirection of care discussions. In unadjusted comparisons, there was no significant difference in the percentage of infants with redirection of care discussions by race (Black, 1004/6793 [15%] ; White, 1320/8836 [15%]) or ethnicity (Hispanic, 291/2105 [14%] ; non-Hispanic, 2020/13 408 [15%]). However, after controlling for maternal and neonatal factors, infants whose mothers identified as Black or as Hispanic were less likely to have documented redirection of care discussions than infants whose mothers identified as White (Black vs White adjusted odds ratio [aOR], 0.84; 95% CI, 0.75-0.96) or as non-Hispanic (Hispanic vs non-Hispanic aOR, 0.72; 95% CI, 0.60-0.87). Redirection of care discussion occurrence did not differ by maternal education level or insurance type. Conclusions and Relevance For infants born extremely preterm, redirection of care discussions occurred less often for Black and Hispanic infants than for White and non-Hispanic infants. It is important to explore the possible reasons underlying these differences.

Type of Medium: Online Resource

ISSN: 2168-6203

URL: Article

DOI: 10.1001/jamapediatrics.2024.0125

Language: English

Publisher: American Medical Association (AMA)

Publication Date: 2024

Permalink

	Location	Call Number	Limitation	Availability

Others were also interested in ...

Online Resource

Link to publisher

6

Online Resource

Assessment of Corticosteroid Therapy and Death or Disability According to Pretreatment Risk of Death or Bronchopulmonary Dysplasia in Extremely Preterm Infants

Jensen, Erik A. ; Wiener, Laura Elizabeth ; Rysavy, Matthew A. ; [et al.]

American Medical Association (AMA) ; 2023

In: JAMA Network Open Vol. 6, No. 5 ( 2023-05-08), p. e2312277-

add to mindlist on the mindlist

Details

In: JAMA Network Open, American Medical Association (AMA), Vol. 6, No. 5 ( 2023-05-08), p. e2312277-

Abstract: Meta-analyses suggest that corticosteroids may be associated with increased survival without cerebral palsy in infants at high risk of bronchopulmonary dysplasia (BPD) but are associated with adverse neurologic outcomes in low-risk infants. Whether this association exists in contemporary practice is uncertain because most randomized clinical trials administered corticosteroids earlier and at higher doses than currently recommended. Objective To evaluate whether the pretreatment risk of death or grade 2 or 3 BPD at 36 weeks’ postmenstrual age modified the association between postnatal corticosteroid therapy and death or disability at 2 years’ corrected age in extremely preterm infants. Design, Setting, and Participants This cohort study analyzed data on 482 matched pairs of infants from 45 participating US hospitals in the National Institute of Child Health and Human Development Neonatal Research Network Generic Database (GDB). Infants were included in the cohort if they were born at less than 27 weeks’ gestation between April 1, 2011, and March 31, 2017; survived the first 7 postnatal days; and had 2-year death or developmental follow-up data collected between January 2013 and December 2019. Corticosteroid-treated infants were propensity score matched with untreated controls. Data were analyzed from September 1, 2019, to November 30, 2022. Exposure Systemic corticosteroid therapy to prevent BPD that was initiated between day 8 and day 42 after birth. Main Outcomes and Measures The primary outcome was death or moderate to severe neurodevelopmental impairment at 2 years’ corrected age. The secondary outcome was death or moderate to severe cerebral palsy at 2 years’ corrected age. Results A total of 482 matched pairs of infants (mean [SD] gestational age, 24.1 [1.1] weeks]; 270 males [56.0%] ) were included from 656 corticosteroid-treated infants and 2796 potential controls. Most treated infants (363 [75.3%]) received dexamethasone. The risk of death or disability associated with corticosteroid therapy was inversely associated with the estimated pretreatment probability of death or grade 2 or 3 BPD. The risk difference for death or neurodevelopmental impairment associated with corticosteroids decreased by 2.7% (95% CI, 1.9%-3.5%) for each 10% increase in the pretreatment risk of death or grade 2 or 3 BPD. This risk transitioned from estimated net harm to benefit when the pretreatment risk of death or grade 2 or 3 BPD exceeded 53% (95% CI, 44%-61%). For death or cerebral palsy, the risk difference decreased by 3.6% (95% CI, 2.9%-4.4%) for each 10% increase in the risk of death or grade 2 or 3 BPD and transitioned from estimated net harm to benefit at a pretreatment risk of 40% (95% CI, 33%-46%). Conclusions and Relevance Results of this study suggested that corticosteroids were associated with a reduced risk of death or disability in infants at moderate to high pretreatment risk of death or grade 2 or 3 BPD but with possible harm in infants at lower risk.

Type of Medium: Online Resource

ISSN: 2574-3805

URL: Article

DOI: 10.1001/jamanetworkopen.2023.12277

Language: English

Publisher: American Medical Association (AMA)

Publication Date: 2023

detail.hit.zdb_id: 2931249-8

Permalink

	Location	Call Number	Limitation	Availability

Others were also interested in ...

Online Resource

Link to publisher

7

Online Resource

Early-Onset Neonatal Sepsis 2015 to 2017, the Rise of Escherichia coli , and the Need for Novel Prevention Strategies

Stoll, Barbara J. ; Puopolo, Karen M. ; Hansen, Nellie I. ; [et al.]

American Medical Association (AMA) ; 2020

In: JAMA Pediatrics Vol. 174, No. 7 ( 2020-07-06), p. e200593-

add to mindlist on the mindlist

Details

In: JAMA Pediatrics, American Medical Association (AMA), Vol. 174, No. 7 ( 2020-07-06), p. e200593-

Type of Medium: Online Resource

ISSN: 2168-6203

URL: Article

DOI: 10.1001/jamapediatrics.2020.0593

Language: English

Publisher: American Medical Association (AMA)

Publication Date: 2020

Permalink

	Location	Call Number	Limitation	Availability

Others were also interested in ...

Online Resource

Link to publisher

8

Online Resource

Association of Antenatal Steroid Exposure at 21 to 22 Weeks of Gestation With Neonatal Survival and Survival Without Morbidities

Chawla, Sanjay ; Wyckoff, Myra H. ; Rysavy, Matthew A. ; [et al.]

American Medical Association (AMA) ; 2022

In: JAMA Network Open Vol. 5, No. 9 ( 2022-09-26), p. e2233331-

add to mindlist on the mindlist

Details

In: JAMA Network Open, American Medical Association (AMA), Vol. 5, No. 9 ( 2022-09-26), p. e2233331-

Abstract: The provision of antenatal corticosteroids to pregnant patients at gestational age (GA) 22 6/7 weeks or less remains controversial and lacks support from randomized clinical trials. Objective To compare rates of survival and survival without major morbidities among infants born at GA 22 0/7 to 23 6/7 weeks after exposure to antenatal steroids at 22 6/7 weeks’ gestation or less vs no exposure to antenatal steroids. Design, Setting, and Participants This cohort study enrolled infants born at GA 22 0/7 to 23 6/7 weeks between January 1, 2016, and December 31, 2019, at centers in the National Institute of Child Health and Human Development Neonatal Research Network. Infants who did not receive intensive care and infants with antenatal steroid exposure after GA 22 6/7 weeks were excluded. Exposure Infants were classified as having no, partial, or complete exposure to antenatal steroids. Main Outcomes and Measures The primary outcome was survival to discharge. The main secondary outcome was survival without major neonatal morbidity. The associations of differential exposures to antenatal steroids with outcomes were evaluated using logistic regression, adjusting for GA, sex, race, maternal education, small for GA status, mode of delivery, multiple birth, prolonged rupture of membranes, year of birth, and Neonatal Research Network center. Results A total of 431 infants (mean [SD] GA, 22.6 [0.5] weeks; 232 [53.8%] boys) were included, with 110 infants (25.5%) receiving no antenatal steroids, 80 infants (18.6%) receiving partial antenatal steroids, and 241 infants (55.9%) receiving complete antenatal steroids. Seventeen infants were exposed to antenatal steroids at GA 21 weeks. Among infants exposed to complete antenatal steroids, 130 (53.9%) survived to discharge, compared with 30 infants (37.5%) with partial antenatal steroid exposure and 239 infants (35.5%) with no antenatal steroids. Infants born after complete antenatal steroid exposure, compared with those without antenatal steroid exposure, were more likely to survive to discharge (adjusted odds ratio [aOR] , 1.95 [95% CI, 1.07-3.56]) and to survive without major morbidity (aOR, 2.74 [95% CI, 1.19-6.30] ). Conclusions and Relevance In this retrospective cohort study, among infants born between GA 22 0/7 and 23 6/7 weeks who received intensive care, exposure to a complete course of antenatal steroids at GA 22 6/7 weeks or less was independently associated with greater odds of survival and survival without major morbidity. These data suggest that the use of antenatal steroids in patients at GA 22 6/7 weeks or less could be beneficial when active treatment is considered.

Type of Medium: Online Resource

ISSN: 2574-3805

URL: Article

DOI: 10.1001/jamanetworkopen.2022.33331

Language: English

Publisher: American Medical Association (AMA)

Publication Date: 2022

detail.hit.zdb_id: 2931249-8

Permalink

	Location	Call Number	Limitation	Availability

Others were also interested in ...

Online Resource

Link to publisher

9

Online Resource

Association Between Increased Seizures During Rewarming After Hypothermia for Neonatal Hypoxic Ischemic Encephalopathy and Abnormal Neurodevelopmental Outcomes at 2-Year Follow-up : A Nested Multisite Cohort Study

Chalak, Lina F. ; Pappas, Athina ; Tan, Sylvia ; [et al.]

American Medical Association (AMA) ; 2021

In: JAMA Neurology Vol. 78, No. 12 ( 2021-12-01), p. 1484-

add to mindlist on the mindlist

Details

In: JAMA Neurology, American Medical Association (AMA), Vol. 78, No. 12 ( 2021-12-01), p. 1484-

Type of Medium: Online Resource

ISSN: 2168-6149

URL: Article

DOI: 10.1001/jamaneurol.2021.3723

Language: English

Publisher: American Medical Association (AMA)

Publication Date: 2021

Permalink

	Location	Call Number	Limitation	Availability

Others were also interested in ...

Online Resource

Link to publisher