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  • 1
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    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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  • 2
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    Neonatal Encephalopathy: Treatment With Hypothermia
    American Academy of Pediatrics (AAP) ; 2010
    In:  NeoReviews Vol. 11, No. 2 ( 2010-02-01), p. e85-e92
    Details
    In: NeoReviews, American Academy of Pediatrics (AAP), Vol. 11, No. 2 ( 2010-02-01), p. e85-e92
    Abstract: This article evaluates the pathophysiology of brain injury from hypoxia-ischemia in preclinical models and the role of hypothermia as neuroprotection following this injury. The diagnosis of encephalopathy due to hypoxia and ischemia in term and near-term infants following acute perinatal asphyxia is clarified. The neuroprotective effect of hypothermia when initiated before 6 hours of age for 72 hours to a depth of 33.0°C to 34.0°C in reducing death and disability is reviewed. Therapeutic hypothermia is safe and effective when applied according to published clinical trial protocols, although gaps in knowledge still remain.
    Type of Medium: Online Resource
    ISSN: 1526-9906
    URL: Article
    DOI: 10.1542/neo.11-2-e85
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2010
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  • 3
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    Effect of Prophylactic Phenobarbital on Intraventricular Hemorrhage in High-Risk Infants
    American Academy of Pediatrics (AAP) ; 1984
    In:  Pediatrics Vol. 73, No. 4 ( 1984-04-01), p. 435-439
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 73, No. 4 ( 1984-04-01), p. 435-439
    Abstract: Forty-two premature infants less than 24 hours of age, with normal admission echoencephalograms, were randomly assigned to control or phenobarbital treatment groups. Infants in the treated group received two loading doses of 10 mg/kg of phenobarbital 12 hours apart, followed by a maintenance dose of 2.5 mg/kg every 12 hours for 6 days. Serial echoencephalograms were obtained in both groups. The groups were comparable with regard to birth weight, gestational age, and potential risk factors for subependymal-intraventricular hemorrhage. Ten infants (48%) in each group developed hemorrhage. The hemorrhages in the phenobarbital-treated group were significantly less severe than those in the control group. The phenobarbital-treated infants who bled, however, were also significantly larger and more mature than control infants who bled. The results of this study indicate no effect of phenobarbital on the incidence of subependymal-intraventricular hemorrhage, but a possible beneficial effect on the severity of hemorrhage.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.73.4.435
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 1984
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  • 4
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    Medical Care Costs of High-Risk Infants After Neonatal Intensive Care: A Controlled Study
    American Academy of Pediatrics (AAP) ; 1988
    In:  Pediatrics Vol. 81, No. 3 ( 1988-03-01), p. 372-378
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 81, No. 3 ( 1988-03-01), p. 372-378
    Abstract: Total medical care costs were studied prospectively from neonatal intensive care unit (NICU) discharge to 3 years of age for 60 children, 35 of whom had neurologic and/or developmental deficits detected immediately following NICU discharge and 25 children did not. At the end of the study period the children were classified as unhandicapped (group A), mildly handicapped (group B), or moderately-severely handicapped (group C). Medical costs are reported per infant per month following NICU discharge (mean ± SD). The outpatient costs in group A were $31 ± 23 as compared with $86 ± 93 in group B and $109 ± 59 in group C (A & lt; B, A & lt; C; P & lt; .001). The greatest contributor to outpatient costs was occupational and physical therapy (with unproven efficiency to date). The inpatient costs were $31 ± 56 in group A, $328 ± 574 in group B, and $542 ± 737 in group C (A & lt; C; P & lt; .01). The US Department of Agriculture estimates of medical costs of raising a child at home ranges from $22 to $26.80 per month. The cost of raising one of our NICU infants in an institution was $1,216 per month. Children with and without neurodevelopmental deficits after NICU discharge have significantly higher medical costs than children without.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.81.3.372
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 1988
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  • 5
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    Adverse Neurodevelopmental Outcomes Among Extremely Low Birth Weight Infants With a Normal Head Ultrasound: Prevalence and Antecedents
    American Academy of Pediatrics (AAP) ; 2005
    In:  Pediatrics Vol. 115, No. 3 ( 2005-03-01), p. 673-680
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 115, No. 3 ( 2005-03-01), p. 673-680
    Abstract: Objective. Severe abnormalities of the head ultrasound (HUS) are important predictors of cerebral palsy (CP) and mental retardation, and a normal HUS usually ensures the absence of major impairments. With the increasing survival of extremely low birth weight (ELBW) infants (birth weight & lt;1000 g), the prognostic significance of a normal HUS may differ. This study examined the prevalence of and risk factors for CP and impaired mental development among ELBW infants with a normal HUS. Methods. Study infants were ELBW infants who were cared for in Neonatal Research Network centers in the years 1995–1999, had a normal early and late HUS, survived to discharge, and returned for follow-up assessments at 18 to 22 months' corrected age. The outcomes of interest were a score & lt;70 on the Bayley Scales of Infant Development-II Mental Developmental Index (MDI) and CP. Risk factors included maternal demographics; infant characteristics; and interventions or morbidities related to the lung, infection, and nutrition. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). A time-oriented approach was used to select variables for inclusion in logistic models. Results. Of 1749 infants with a normal early and late HUS (performed at a mean age of 6 and 47 days, respectively), 1473 (84%) returned for follow-up assessment. Infants had a birth weight of 792 ± 134 g (mean ± SD) and gestational age of 26 ± 2 weeks. Rates of CP and MDI & lt;70 were 9.4% and 25.3%, respectively, and 29.2% of infants had either CP or MDI & lt;70. In multivariate analyses, factors associated with CP were male gender (OR: 1.8; 95% CI: 1.2–2.6), multiple birth, (OR: 1.6; 95% CI: 1.1–2.5), decreasing birth weight (OR: 1.3 for each 100-g decrease; 95% CI: 1.1–1.5), pneumothorax (OR: 2.3; 95% CI: 1.2–4.4), and days of conventional ventilation (OR: 1.2 for each additional 10 days; 95% CI: 1.1–1.3). With the exception of pneumothorax, these same factors were associated with MDI & lt;70, in addition to less maternal education (OR: 1.4; 95% CI: 1.0–1.9) and Medicaid or lack of coverage for maternal insurance (OR: 1.7; 95% CI: 1.2–2.4). Conclusions. Nearly 30% of ELBW infants with a normal HUS had either CP or a low MDI. Risk factors that are associated with this high rate of adverse outcomes include pneumothorax, prolonged exposure to mechanical ventilation, and educational and economic disadvantage. Improvements in pulmonary care to reduce duration of ventilation and avoid air leaks might improve neurodevelopmental outcome for ELBW infants.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2004-0667
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2005
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  • 6
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    PREDICTIVE VALUE OF AMPLITUDE-INTEGRATED ELECTROENCEPHALOGRAPHY ON OUTCOME IN NEONATAL EXTRACORPOREAL MEMBRANE OXYGENATION
    American Academy of Pediatrics (AAP) ; 2008
    In:  Pediatrics Vol. 121, No. Supplement_2 ( 2008-01-01), p. S140-S140
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 121, No. Supplement_2 ( 2008-01-01), p. S140-S140
    Abstract: INTRODUCTION: The early and accurate assessment of cerebral function in neonates who undergo extracorporeal membrane oxygenation (ECMO) may identify high-risk infants who are amenable to neuroprotective strategies or, at least, in need of more detailed neuroimaging and neurodevelopmental follow-up. OBJECTIVE: The specific aims of this study were to assess the clinical utility and long-term predictive value of amplitude-integrated electroencephalography (aEEG) in neonatal ECMO. METHODS: Thirty-four infants who required ECMO for respiratory failure were enrolled in the study prospectively. Serial aEEGs were recorded before, during, and after ECMO and classified by 2 independent interpreters on the basis of background pattern and amplitude criteria. Surviving infants were followed up to 18 to 22 months and assessed with a structured neurologic examination and formal developmental testing by using the Bayley Scales of Infant Development II. The primary outcome was death or neurodevelopmental impairment (defined as moderate-to-severe cerebral palsy and/or a Mental Developmental Index or Psychomotor Development Index score of & lt;70). RESULTS: Preliminary data analysis on the first 20 patients was performed. Thirteen patients survived, 3 died while on ECMO, and 4 died before discharge. All surviving infants were evaluated at follow-up. A severely abnormal aEEG predicted death or moderate-to-severe neurodevelopmental impairment with a sensitivity of 0.85 (95% confidence interval [CI]: 0.70–0.95), a specificity of 0.57 (95% CI: 0.3–0.76), a positive predictive value of 0.79 (95% CI: 0.65–0.88), and a negative predictive value of 0.67 (95% CI: 0.35–0.88). CONCLUSIONS: aEEG is a useful neuromonitoring tool during neonatal ECMO.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2007-2022MMMMM
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2008
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  • 7
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    Outcomes of Safety and Effectiveness in a Multicenter Randomized, Controlled Trial of Whole-Body Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy
    American Academy of Pediatrics (AAP) ; 2008
    In:  Pediatrics Vol. 122, No. 4 ( 2008-10-01), p. e791-e798
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 122, No. 4 ( 2008-10-01), p. e791-e798
    Abstract: BACKGROUND. Whole-body hypothermia reduced the frequency of death or moderate/severe disabilities in neonates with hypoxic-ischemic encephalopathy in a randomized, controlled multicenter trial. OBJECTIVE. Our goal was to evaluate outcomes of safety and effectiveness of hypothermia in infants up to 18 to 22 months of age. DESIGN/METHODS. A priori outcomes were evaluated between hypothermia (n = 102) and control (n = 106) groups. RESULTS. Encephalopathy attributable to causes other than hypoxia-ischemia at birth was not noted. Inotropic support (hypothermia, 59% of infants; control, 56% of infants) was similar during the 72-hour study intervention period in both groups. Need for blood transfusions (hypothermia, 24%; control, 24%), platelet transfusions (hypothermia, 20%; control, 12%), and volume expanders (hypothermia, 54%; control, 49%) was similar in the 2 groups. Among infants with persistent pulmonary hypertension (hypothermia, 25%; control, 22%), nitric-oxide use (hypothermia, 68%; control, 57%) and placement on extracorporeal membrane oxygenation (hypothermia, 4%; control, 9%) was similar between the 2 groups. Non–central nervous system organ dysfunctions occurred with similar frequency in the hypothermia (74%) and control (73%) groups. Rehospitalization occurred among 27% of the infants in the hypothermia group and 42% of infants in the control group. At 18 months, the hypothermia group had 24 deaths, 19 severe disabilities, and 2 moderate disabilities, whereas the control group had 38 deaths, 25 severe disabilities, and 1 moderate disability. Growth parameters were similar between survivors. No adverse outcomes were noted among infants receiving hypothermia with transient reduction of temperature below a target of 33.5°C at initiation of cooling. There was a trend in reduction of frequency of all outcomes in the hypothermia group compared with the control group in both moderate and severe encephalopathy categories. CONCLUSIONS. Although not powered to test these secondary outcomes, whole-body hypothermia in infants with encephalopathy was safe and was associated with a consistent trend for decreasing frequency of each of the components of disability.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2008-0456
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2008
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  • 8
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    Outcome of Term Infants Using Apgar Scores at 10 Minutes Following Hypoxic-Ischemic Encephalopathy
    American Academy of Pediatrics (AAP) ; 2009
    In:  Pediatrics Vol. 124, No. 6 ( 2009-12-01), p. 1619-1626
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 124, No. 6 ( 2009-12-01), p. 1619-1626
    Abstract: OBJECTIVE: The objective of this study was to determine whether Apgar scores at 10 minutes are associated with death or disability in early childhood after perinatal hypoxic-ischemic encephalopathy. METHODS: This was a secondary analysis of infants who were enrolled in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network hypothermia trial. Infants who were born at ≥36 weeks’ gestation and had clinical and/or biochemical abnormalities at birth and encephalopathy at & lt;6 hours were studied. Logistic regression and classification and regression-tree analysis were used to determine associations between Apgar scores at 10 minutes and neurodevelopmental outcome, adjusting for covariates. Death or disability (moderate or severe) at 18 to 22 months of age was the measured outcome. RESULTS: Twenty of 208 infants were excluded (missing data). More than 90% of the infants had Apgar scores of 0 to 2 at 1 minute, and Apgar scores at 5 and 10 minutes shifted to progressively higher values; at 10 minutes, 27% of infants had Apgar scores of 0 to 2. After adjustment, each point decrease in Apgar score at 10 minutes was associated with a 45% increase in the odds of death or disability. Death or disability occurred in 76%, 82%, and 80% of infants with 10-minute Apgar scores of 0, 1, and 2, respectively. Classification and regression-tree analysis indicated that Apgar scores at 10 minutes were discriminators of outcome. CONCLUSIONS: Apgar scores at 10 minutes provide useful prognostic data before other evaluations are available for infants with hypoxic-ischemic encephalopathy. Death or moderate/severe disability is common but not uniform with Apgar scores of & lt;3; caution is needed before adopting a specific time interval to guide duration of resuscitation.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2009-0934
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2009
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  • 9
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    Outcome Trajectories in Extremely Preterm Infants
    American Academy of Pediatrics (AAP) ; 2012
    In:  Pediatrics Vol. 130, No. 1 ( 2012-07-01), p. e115-e125
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 130, No. 1 ( 2012-07-01), p. e115-e125
    Abstract: Methods are required to predict prognosis with changes in clinical course. Death or neurodevelopmental impairment in extremely premature neonates can be predicted at birth/admission to the ICU by considering gender, antenatal steroids, multiple birth, birth weight, and gestational age. Predictions may be improved by using additional information available later during the clinical course. Our objective was to develop serial predictions of outcome by using prognostic factors available over the course of NICU hospitalization. METHODS: Data on infants with birth weight ≤1.0 kg admitted to 18 large academic tertiary NICUs during 1998–2005 were used to develop multivariable regression models following stepwise variable selection. Models were developed by using all survivors at specific times during hospitalization (in delivery room [n = 8713], 7-day [n = 6996] , 28-day [n = 6241], and 36-week postmenstrual age [n = 5118] ) to predict death or death/neurodevelopmental impairment at 18 to 22 months. RESULTS: Prediction of death or neurodevelopmental impairment in extremely premature infants is improved by using information available later during the clinical course. The importance of birth weight declines, whereas the importance of respiratory illness severity increases with advancing postnatal age. The c-statistic in validation models ranged from 0.74 to 0.80 with misclassification rates ranging from 0.28 to 0.30. CONCLUSIONS: Dynamic models of the changing probability of individual outcome can improve outcome predictions in preterm infants. Various current and future scenarios can be modeled by input of different clinical possibilities to develop individual “outcome trajectories” and evaluate impact of possible morbidities on outcome.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2011-3693
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2012
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  • 10
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    Ten-Year Review of Major Birth Defects in VLBW Infants
    American Academy of Pediatrics (AAP) ; 2013
    In:  Pediatrics Vol. 132, No. 1 ( 2013-07-01), p. 49-61
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 132, No. 1 ( 2013-07-01), p. 49-61
    Abstract: Birth defects (BDs) are an important cause of infant mortality and disproportionately occur among low birth weight infants. We determined the prevalence of BDs in a cohort of very low birth weight (VLBW) infants cared for at the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NRN) centers over a 10-year period and examined the relationship between anomalies, neonatal outcomes, and surgical care. METHODS: Infant and maternal data were collected prospectively for infants weighing 401 to 1500 g at NRN sites between January 1, 1998, and December 31, 2007. Poisson regression models were used to compare risk of outcomes for infants with versus without BDs while adjusting for gestational age and other characteristics. RESULTS: A BD was present in 1776 (4.8%) of the 37 262 infants in our VLBW cohort. Yearly prevalence of BDs increased from 4.0% of infants born in 1998 to 5.6% in 2007, P & lt; .001. Mean gestational age overall was 28 weeks, and mean birth weight was 1007 g. Infants with BDs were more mature but more likely to be small for gestational age compared with infants without BDs. Chromosomal and cardiovascular anomalies were most frequent with each occurring in 20% of affected infants. Mortality was higher among infants with BDs (49% vs 18%; adjusted relative risk: 3.66 [95% confidence interval: 3.41–3.92]; P & lt; .001) and varied by diagnosis. Among those surviving & gt;3 days, more infants with BDs underwent major surgery (48% vs 13%, P & lt; .001). CONCLUSIONS: Prevalence of BDs increased during the 10 years studied. BDs remain an important cause of neonatal morbidity and mortality among VLBW infants.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2012-3111
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2013
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