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  • American Academy of Pediatrics (AAP)  (15)
  • 2000-2004  (15)
  • 1
    Online Resource
    Online Resource
    Effects of Early Erythropoietin Therapy on the Transfusion Requirements of Preterm Infants Below 1250 Grams Birth Weight: A Multicenter, Randomized, Controlled Trial
    American Academy of Pediatrics (AAP) ; 2001
    In:  Pediatrics Vol. 108, No. 4 ( 2001-10-01), p. 934-942
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 108, No. 4 ( 2001-10-01), p. 934-942
    Abstract: Infants of ≤1250 g birth weight receive multiple erythrocyte transfusions during their hospitalization. We hypothesized that early erythropoietin (Epo) and iron therapy would 1) decrease the number of transfusions received (infants 401-1000 g birth weight; trial 1) and 2) decrease the percentage of infants who received any transfusions (1001–1250 g birth weight; trial 2). Methods. A total of 172 infants in trial 1 and 118 infants in trial 2 were randomized to treatment (Epo, 400 U/kg 3 times weekly) or placebo/control. Therapy was initiated by 4 days after birth and continued through the 35th postmenstrual week. All infants received supplemental parenteral and enteral iron. Complete blood and reticulocyte counts were measured weekly, and ferritin concentrations were measured monthly. Transfusions were administered according to protocol. Phlebotomy losses and transfusion data were recorded. Results. Treated and placebo/control infants in trial 1 received a similar number of transfusions (4.3 ± 3.6 vs 5.2 ± 4.2, respectively). A similar percentage of treated and control infants in trial 2 received at least 1 transfusion (37% vs 46%). Reticulocyte counts were higher in treated infants during each week of the study in both trials. Hematocrits were higher among treated infants from week 2 on in both trials. Ferritin concentrations were higher in placebo/controls than in treated infants at weeks 4 and 8 in trial 1 and at week 4 in trial 2. No adverse effects of Epo or supplemental iron occurred. Conclusion. The combination of early Epo and iron as administered in this study stimulated erythropoiesis in infants who were ≤1250 g at birth. However, the lack of impact on transfusion requirements fails to support routine use of early Epo.neonate, intravenous iron, donor exposure.
    Type of Medium: Online Resource
    ISSN: 1098-4275 , 0031-4005
    URL: Article
    DOI: 10.1542/peds.108.4.934
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2001
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  • 2
    Online Resource
    Online Resource
    Association Between Peak Serum Bilirubin and Neurodevelopmental Outcomes in Extremely Low Birth Weight Infants
    American Academy of Pediatrics (AAP) ; 2003
    In:  Pediatrics Vol. 112, No. 4 ( 2003-10-01), p. 773-779
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 112, No. 4 ( 2003-10-01), p. 773-779
    Abstract: Objective. To assess the association between peak total serum bilirubin (PSB) levels during the first 2 weeks of life and neurodevelopmental outcomes of extremely low birth weight (ELBW) infants at 18 to 22 months’ postmenstrual age. Methods. A retrospective analysis was conducted of a cohort of ELBW infants (401–1000 g) who survived to 14 days of age in the 12 participating centers of the National Institute of Child Health and Human Development Neonatal Research Network between January 1, 1994, and December 31, 1997. Demographic and clinical risk factors and PSB levels during the first 14 days were analyzed with reference to death or adverse neurodevelopmental outcomes at 18 to 22 months’ postmenstrual age. The neurodevelopmental variables considered were Psychomotor Developmental Index (PDI) & lt;70, Mental Developmental Index (MDI) & lt;70, moderate or severe cerebral palsy (CP), hearing impairment (needs hearing aids), and a composite category designated as neurodevelopmental impairment (NDI). The NDI is defined as infants with any 1 or more of the following: PDI & lt;70, MDI & lt;70, moderate to severe CP, bilateral blindness, or bilateral hearing impairment requiring amplification. Results. The subjects of this cohort analysis are infants who were admitted to the Network centers during calendar years 1994–1997 and survived beyond 14 days and had PSB recorded during the 14-day period. From this cohort, 3246 infants survived at discharge, 79 died after discharge, and 592 were lost to follow-up. Thus, 2575 of 3167 infants were seen in the follow-up clinics with a compliance rate of 81%. Logistic regression analysis showed that various demographic and clinical variables are associated with poor neurodevelopmental outcomes. After adjustment for these risk factor, significant association were found between PSB (mg/dL) and death or NDI (odds ratio: 1.068; 95% confidence interval [CI]: 1.03–1.11); PDI & lt;70 (R = 1.057; 95% CI: 1.00–1.12), and hearing impairment requiring hearing aids (odds ratio: 1138; 95% CI: 1.00–1.30). There was no significant association between PSB (mg/dL) and CP, MDI & lt;70, and NDI. Conclusions. PSB concentrations during the first 2 weeks of life are directly correlated with death or NDI, hearing impairment, and PDI & lt;70 in ELBW infants. The statistical association based on retrospective analysis of observational data and relatively small effect size should be interpreted with caution. Furthermore, because of the possibility of compounding effects of variables on outcome, the potential benefits of moderate hyperbilirubinemia and the potential adverse effects of phototherapy, a randomized, controlled trial of aggressive and conservative phototherapy is needed to address this controversial issue.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.112.4.773
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2003
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  • 3
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    Online Resource
    Persistent Pulmonary Hypertension of the Newborn in the Era Before Nitric Oxide: Practice Variation and Outcomes
    American Academy of Pediatrics (AAP) ; 2000
    In:  Pediatrics Vol. 105, No. 1 ( 2000-01-01), p. 14-20
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 105, No. 1 ( 2000-01-01), p. 14-20
    Abstract: In the era before widespread use of inhaled nitric oxide, to determine the prevalence of persistent pulmonary hypertension (PPHN) in a multicenter cohort, demographic descriptors of the population, treatments used, the outcomes of those treatments, and variation in practice among centers. Study Design. A total of 385 neonates who received ≥50% inspired oxygen and/or mechanical ventilation and had documented evidence of PPHN (2D echocardiogram or preductal or postductal oxygen difference) were tracked from admission at 12 Level III neonatal intensive care units. Demographics, treatments, and outcomes were documented. Results. The prevalence of PPHN was 1.9 per 1000 live births (based on 71 558 inborns) with a wide variation observed among centers (.43–6.82 per 1000 live births). Neonates with PPHN were admitted to the Level III neonatal intensive care units at a mean of 12 hours of age (standard deviation: 19 hours). Wide variations in the use of all treatments studied were found at the centers. Hyperventilation was used in 65% overall but centers ranged from 33% to 92%, and continuous infusion of alkali was used in 75% overall, with a range of 27% to 93% of neonates. Other frequently used treatments included sedation (94%; range: 77%–100%), paralysis (73%; range: 33%–98%), and inotrope administration (84%; range: 46%–100%). Vasodilator drugs, primarily tolazoline, were used in 39% (range: 13%–81%) of neonates. Despite the wide variation in practice, there was no significant difference in mortality among centers. Mortality was 11% (range: 4%–33%). No specific therapy was clearly associated with a reduction in mortality. To determine whether the therapies were equivalent, neonates treated with hyperventilation were compared with those treated with alkali infusion. Hyperventilation reduced the risk of extracorporeal membrane oxygenation without increasing the use of oxygen at 28 days of age. In contrast, the use of alkali infusion was associated with increased use of extracorporeal membrane oxygenation (odds ratio: 5.03, compared with those treated with hyperventilation) and an increased use of oxygen at 28 days of age. Conclusions. Hyperventilation and alkali infusion are not equivalent in their outcomes in neonates with PPHN. Randomized trials are needed to evaluate the role of these common therapies.
    Type of Medium: Online Resource
    ISSN: 1098-4275 , 0031-4005
    URL: Article
    DOI: 10.1542/peds.105.1.14
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2000
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  • 4
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    To Tap or Not to Tap: High Likelihood of Meningitis Without Sepsis Among Very Low Birth Weight Infants
    American Academy of Pediatrics (AAP) ; 2004
    In:  Pediatrics Vol. 113, No. 5 ( 2004-05-01), p. 1181-1186
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 113, No. 5 ( 2004-05-01), p. 1181-1186
    Abstract: Context. Neonatal meningitis is associated with significant morbidity and mortality. We speculated that meningitis may be underdiagnosed among very low birth weight (VLBW) infants because of the failure to perform lumbar punctures (LPs) in infants with suspected sepsis. Objective. This study was undertaken to review the epidemiology of late-onset meningitis in VLBW (401–1500 g) infants and to evaluate the concordance of cerebrospinal fluid (CSF) and blood culture (BC) results. Methods. VLBW infants (excluding those with intraventricular shunts) born at centers of the National Institute of Child Health and Human Development Neonatal Research Network from September 1, 1998, through December 31, 2001, were studied. Late-onset meningitis was defined by culture-based criteria and classified as meningitis with or without associated sepsis. Unadjusted comparisons were made using χ2 tests and adjusted comparisons using regression models. Results. Of 9641 VLBW infants who survived & gt;3 days, 2877 (30%) had ≥1 LPs, and 6056 (63%) had ≥1 BC performed after day 3. One hundred thirty-four infants had late-onset meningitis (1.4% of all patients; 5% of those with an LP). Pathogens associated with meningitis were similar to those associated with sepsis. One third (45 of 134) of the infants with meningitis had negative BCs. Lower gestational age and prior sepsis increased risk for meningitis. Compared with uninfected infants, those with meningitis had a longer time on mechanical ventilation (28 vs 18 days), had longer hospitalizations (91 vs 79 days), were more likely to have seizures (25% vs 2%), and were more likely to die (23% vs 2%). Conclusions. Meningitis is a serious complication among VLBW infants, associated with increased severity of illness and risk of death. Of note, one third of the infants with meningitis had meningitis in the absence of sepsis. Because CSF cultures were performed only half as often as BCs, this discordance in blood and CSF culture results suggests that meningitis may be underdiagnosed among VLBW infants.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.113.5.1181
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2004
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  • 5
    Online Resource
    Online Resource
    Intracranial Hemorrhage in Very Low-birthweight Infants
    American Academy of Pediatrics (AAP) ; 2000
    In:  NeoReviews Vol. 1, No. 3 ( 2000-03-01), p. e43-e43
    Details
    In: NeoReviews, American Academy of Pediatrics (AAP), Vol. 1, No. 3 ( 2000-03-01), p. e43-e43
    Type of Medium: Online Resource
    ISSN: 1526-9906
    URL: Article
    DOI: 10.1542/neo.1-3-e43
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2000
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  • 6
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    Late-Onset Sepsis in Very Low Birth Weight Neonates: The Experience of the NICHD Neonatal Research Network
    American Academy of Pediatrics (AAP) ; 2002
    In:  Pediatrics Vol. 110, No. 2 ( 2002-08-01), p. 285-291
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 110, No. 2 ( 2002-08-01), p. 285-291
    Abstract: Objective. Late-onset sepsis (occurring after 3 days of age) is an important problem in very low birth weight (VLBW) infants. To determine the current incidence of late-onset sepsis, risk factors for disease, and the impact of late-onset sepsis on subsequent hospital course, we evaluated a cohort of 6956 VLBW (401–1500 g) neonates admitted to the clinical centers of the National Institute of Child Health and Human Development Neonatal Research Network over a 2-year period (1998–2000). Methods. The National Institute of Child Health and Human Development Neonatal Research Network maintains a prospective registry of all VLBW neonates admitted to participating centers within 14 days of birth. Expanded infection surveillance was added in 1998. Results. Of 6215 infants who survived beyond 3 days, 1313 (21%) had 1 or more episodes of blood culture-proven late-onset sepsis. The vast majority of infections (70%) were caused by Gram-positive organisms, with coagulase-negative staphylococci accounting for 48% of infections. Rate of infection was inversely related to birth weight and gestational age. Complications of prematurity associated with an increased rate of late-onset sepsis included patent ductus arteriosus, prolonged ventilation, prolonged intravascular access, bronchopulmonary dysplasia, and necrotizing enterocolitis. Infants who developed late-onset sepsis had a significantly prolonged hospital stay (mean length of stay: 79 vs 60 days). They were significantly more likely to die than those who were uninfected (18% vs 7%), especially if they were infected with Gram-negative organisms (36%) or fungi (32%). Conclusions. Late-onset sepsis remains an important risk factor for death among VLBW preterm infants and for prolonged hospital stay among VLBW survivors. Strategies to reduce late-onset sepsis and its medical, social, and economic toll need to be addressed urgently.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.110.2.285
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2002
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  • 7
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    The Maternal Lifestyle Study: Effects of Substance Exposure During Pregnancy on Neurodevelopmental Outcome in 1-Month-Old Infants
    American Academy of Pediatrics (AAP) ; 2002
    In:  Pediatrics Vol. 110, No. 6 ( 2002-12-01), p. 1182-1192
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 110, No. 6 ( 2002-12-01), p. 1182-1192
    Abstract: Objective. This was a prospective longitudinal multisite study of the effects of prenatal cocaine and/or opiate exposure on neurodevelopmental outcome in term and preterm infants at 1 month of age. Methods. The sample included 658 exposed and 730 comparison infants matched on race, gender, and gestational age (11.7% born & lt;33 weeks’ gestational age). Mothers were recruited at 4 urban university-based centers and were mostly black and on public assistance. Exposure was determined by meconium assay and self-report with alcohol, marijuana, and tobacco present in both groups. At 1 month corrected age, infants were tested by masked examiners with the NICU Network Neurobehavioral Scale and acoustical cry analysis. Exposed and comparison groups were compared adjusting for covariates (alcohol, marijuana, tobacco, birth weight, social class, and site). Separate analyses were conducted for level of cocaine exposure. Results. On the NICU Network Neurobehavioral Scale, cocaine exposure was related to lower arousal, poorer quality of movement and self-regulation, higher excitability, more hypertonia, and more nonoptimal reflexes with most effects maintained after adjustment for covariates. Some effects were associated with heavy cocaine exposure, and effects were also found for opiates, alcohol, marijuana, and birth weight. Acoustic cry characteristics that reflect reactivity, respiratory, and neural control of the cry sound were also compromised by prenatal drug exposure, including cocaine, opiates, alcohol, and marijuana and by birth weight. Fewer cry effects remained after adjustment for covariates. Conclusions. Cocaine effects are subtle and can be detected when studied in the context of polydrug use and level of cocaine exposure. Effects of other drugs even at low thresholds can also be observed in the context of a polydrug model. The ability to detect these drug effects requires a large sample and neurobehavioral tests that are differentially sensitive to drug effects. Long-term follow-up is necessary to determine whether these differences develop into clinically significant deficits.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.110.6.1182
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2002
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  • 8
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    The Maternal Lifestyle Study: Cognitive, Motor, and Behavioral Outcomes of Cocaine-Exposed and Opiate-Exposed Infants Through Three Years of Age
    American Academy of Pediatrics (AAP) ; 2004
    In:  Pediatrics Vol. 113, No. 6 ( 2004-06-01), p. 1677-1685
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 113, No. 6 ( 2004-06-01), p. 1677-1685
    Abstract: Objective. To evaluate the direct effects of prenatal cocaine exposure and prenatal opiate exposure on infant mental, motor, and behavioral outcomes longitudinally between 1 and 3 years old. Methods. As part of a prospective, longitudinal, multisite study, the Bayley Scales of Infant Development II were administered to 1227 infants who were exposed to cocaine (n = 474), opiates (n = 50), cocaine and opiates (n = 48), and neither substance (n = 655) at 1, 2, and 3 years of corrected age by certified, masked examiners. Hierarchic linear modeling of the 1-, 2-, and 3-year scores was conducted using cocaine and opiate exposure as predictors with and without controlling for covariates. Results. Overall retention was 88.4% and did not differ by cocaine or opiate exposure. Overall (at 1, 2, and 3 years), cocaine-exposed infants scored 1.6 Mental Development Index points below infants who were not exposed to cocaine. Opiate-exposed infants scored 3.8 Psychomotor Development Index points below infants who were not exposed to opiates. Neither the cocaine nor the opiate effect remained significant after controlling for covariates. Neither cocaine nor opiate exposure was associated with the Behavioral Record Score during the examination. Low birth weight and indices of nonoptimal caregiving were associated with lower Mental Development Index, Psychomotor Development Index, and Behavioral Record Score scores for all groups of infants. Conclusions. In the largest at-risk sample observed longitudinally to date, infant prenatal exposure to cocaine and to opiates was not associated with mental, motor, or behavioral deficits after controlling for birth weight and environmental risks.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.113.6.1677
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2004
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  • 9
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    Summary Statistics of Neonatal Intensive Care Unit Network Neurobehavioral Scale Scores From the Maternal Lifestyle Study: A Quasinormative Sample
    American Academy of Pediatrics (AAP) ; 2004
    In:  Pediatrics Vol. 113, No. Supplement_2 ( 2004-03-01), p. 668-675
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 113, No. Supplement_2 ( 2004-03-01), p. 668-675
    Abstract: Descriptive statistics for the Neonatal Intensive Care Unit Network Neurobehavioral Scale summary scores are provided based on data from 1388 1-month-old infants in the Maternal Lifestyle Study (MLS) of prenatal drug exposure and child outcome. The multisite MLS is described, followed by tables with descriptive statistics and percentile for the Neonatal Intensive Care Unit Network Neurobehavioral Scale summary scores. The tables include data for the entire MLS sample as well as tables by drug exposure status, gestational age, poverty status, sex, race and ethnicity, and MLS study site. These tables can be used as quasinorms for comparison with other infants of this age.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.113.S2.668
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2004
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  • 10
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    Whole-Body Hypothermia for Neonatal Encephalopathy: Animal Observations as a Basis for a Randomized, Controlled Pilot Study in Term Infants
    American Academy of Pediatrics (AAP) ; 2002
    In:  Pediatrics Vol. 110, No. 2 ( 2002-08-01), p. 377-385
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 110, No. 2 ( 2002-08-01), p. 377-385
    Abstract: Objective. Modest reduction in brain temperature is a promising therapy to reduce brain damage after neonatal encephalopathy as a result of acute perinatal asphyxia. The efficacy of modest hypothermia may in part be dependent on the stability of the desired brain temperature. The objective of this study was 1) to evaluate in newborn animals a commercially available cooling system (Blanketrol II Hyperthermia-Hypothermia system) to control brain temperature during whole-body hypothermia and 2) to use the results of the animal experiments to perform a pilot study evaluating the feasibility of whole-body hypothermia as a neuroprotective therapy for newborns with encephalopathy at birth. Methods. In the animal investigation, 3 miniature swine were instrumented and ventilated, and temperature probes were placed in the esophagus and the brain (1 cm and 2 cm beneath the parietal cortical surface and the dura). Body cooling was achieved using the automatic control mode (servo) of the cooling system. In the human investigation, 19 term infants with moderate or severe encephalopathy were randomized to either normothermia (n = 10) or hypothermia (n = 9) within 6 hours of birth. Whole-body hypothermia was achieved using the hyperthermia-hypothermia cooling system with servo control of esophageal temperature to 34.5°C for 72 hours followed by slow rewarming. Results. In the animal investigation, body cooling with the animal lying on a single blanket resulted in rapid cooling of the body within 90 minutes. Repetitive cyclical swings in esophageal temperature of 1.7 ± 0.2°C (mean ± standard deviation) around the set point of 33.5°C were reduced to 0.7 ± 0.2°C when a second, larger blanket was attached and suspended. Esophageal temperature was a good marker of deep brain temperature (esophageal to 2-cm brain difference: 0.1 ± 0.3°C). In the human investigation, the infants were randomized at 4.1 ± 1.3 hours (mean ± standard deviation) after birth. Age at randomization was similar in the 2 groups. Cooling was initiated at an average age of 5.3 hours. Target temperature of 34.5°C was achieved within 30 minutes and remained constant throughout the intervention period. Heart rate decreased to 108 ± 14 beats per minute (bpm) at 60 minutes and remained between 115 and 130 bpm for the duration of cooling compared with 130 to 145 bpm in the normothermia group. Blood pressure was similar in the 2 groups. No adverse events occurred during 72 hours of cooling. The mortality rate and frequency of persistent pulmonary hypertension, renal failure, hepatic dysfunction, and need for pressor support were similar in both groups. Conclusions. Animal studies showed that a simple modification of a commercially available cooling system (2 blankets attached, subject lying on 1 and the second hanging freely) results in stable core body and brain temperature when used in the automatic control mode. The pilot study in term infants with encephalopathy using this cooling system demonstrates feasibility of initiating whole-body hypothermia at & lt;6 hours of age to a constant esophageal temperature using servo control and provides no evidence that hypothermia involved greater hazard than benefit.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.110.2.377
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2002
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