Renato Soibelmann Procianoy

Hyaline membrane disease and intraventricular haemorrhage in small for gestational age infants.

19 small for gestational age (SGA) infants with gestational ages less than or equal to 32 weeks were matched with 19 appropriate for gestational age (AGA) preterm neonates with similar risk factors for intraventricular haemorrhage and hyaline membrane disease. Gestational age, 1- and 5-minute Apgar scores, type of delivery, survival rate, use of corticosteroids before delivery, sex, twinning, presence of premature rupture of membranes, and birth date were comparable in the two groups. Gestational age of both groups was 30 (+/- 1.8) weeks, and birthweights were 919 (+/- 202) g (SGA group) and 1268 (+/- 212) g (AGA group). The incidences of hyaline membrane disease and intraventricular haemorrhage were different: 74 and 42% respectively for AGA neonates, 5 and 11% respectively for SGA infants. We suggest that a stressful environment in utero may enhance maturation and prevent hyaline membrane disease and intraventricular haemorrhage.

AN ASSOCIATION BETWEEN RETINOPATHY OF PREMATURITY AND INTRAVENTRICULAR HEMORRHAGE IN VERY LOW BIRTH WEIGHT INFANTS

ABSTRACT Procianoy, R. S., Garcia‐Prats, J. A., Hittner, H. M., Adams, J. M. and Rudolph, A. J. (Department of Pediatrics, Baylor College of Medicine, Texas Childrens Hospital, Houston, Texas). An association between retinopathy of prematurity and intraventricular hemorrhage in very low birth weight infants. Acta Paediatr Scand, 70:473,.–An association between cicatricial retinopathy of prematurity and intraventricular hemorrhage in very low birth weight infants was investigated retrospectively. Newborns were studied who weighed ≤1500 g at birth, who were ≤32 weeks gestational age and appropriate by weight, and admitted in the first 24 hours of life to our Neonatal Intensive Care Unit. Diagnosis of retinopathy of prematurity was made by retinal examination at approximately 4 weeks of age. Diagnosis of intraventricular hemorrhage was made by computerized tomography and clinical findings. A total of 138 infants were studied and divided into two groups: (A) birth weight ≤1000 g (31); (B) birth weight 1 001–1 500 g (107). There was a statistically significant association between cicatricial retinopathy of prematurity and intraventricular hemorrhage in both groups. There were no statistical differences between birth weight, gestational age, duration of oxygen therapy, highest oxygen concentration received, Apgar scores, incidence of hyaline membrane disease and patent ductus arteriosus between cicatricial retinopathy of prematurity and no retinopathy of prematurity patients in either group. This association may be an important consideration in the pathogenesis of both vascular diseases.

THE HYALINE MEMBRANE DISEASE–INTRAVENTRICULAR HEMORRHAGE RELATIONSHIP IN THE VERY LOW BIRTH WEIGHT INFANT: PERINATAL ASPECTS

ABSTRACT. A large retrospective clinical study is reported confirming pathologic studies upon the effect of hyaline membrane disease on the occurrence of intraventricular hemorrhage in very low birth weight infants. Two hundred and twenty infants with birth weight 1500 g and gestational age 32 weeks were studied. Infants with hyaline membrane disease (112) had 56 % incidence of intraventricular hemorrhage whereas of those without hyaline membrane disease (108) only 31% developed intraventricular hemorrhage (p < 0.001). When controlled for gestational age, the more immature infants ( 1000 g) exhibited no difference in the occurrence of intraventricular hemorrhage whether hyaline membrane disease coexisted or not. In the 1001–1500 g group, the occurrence of hyaline membrane disease with intraventricular hemorrhage was significant (p < 0.001). The association of lower Apgar scores and the influence of intermittent positive pressure ventilation in infants with intraventricular hemorrhage is discussed. Extreme immaturity negates all perinatal clinical expertise in determining neonatal outcome. Therefore, carrying pregnancies beyond 28 weeks gestation is mandatory. Beyond 28 weeks, pulmonary maturity and the influence of therapeutic modalities and maternal transport become increasingly important.

Use of indomethacin and its relationship to retinopathy of prematurity in very low birthweight infants.

The relationship between the use of indomethacin, a prostaglandin inhibitor, for closure of patent ductus arteriosus (PDA) and the occurrence of retinopathy of prematurity was investigated retrospectively. 63 preterm infants less than or equal to 1500 g who were less than or equal to 32 weeks gestational age, appropriate weight for gestational age, with a diagnosis of PDA, and admitted during the first 24 hours of life were studied. Diagnosis of retinopathy was made by retinal examination when each infant was about 4 weeks. Diagnosis of PDA was made by clinical, radiological, and echocardiographic findings. 15 patients were treated with indomethacin because of severe congestive heart failure. There were no differences between gestational ages, birthweights, duration of oxygen therapy, or incidence of retinopathy in treated and untreated patients. We suggest that the use of indomethacin for PDA closure does not increase the incidence of retinopathy in very low birthweight infants.

Attention-Deficit/Hyperactivity Disorder and Very Preterm/Very Low Birth Weight: A Meta-analysis

In this meta-analytic study, we document that VP/VLBW infants have a higher risk of later ADHD, defined both categorically and dimensionally. CONTEXT: Although very preterm (VP), extremely preterm (EP), very low birth weight (VLBW), and extremely low birth weight (ELBW) newborns seem to have a higher risk of later attention-deficit/hyperactivity disorder (ADHD), the magnitude of the risk is not well-defined. OBJECTIVE: To systematically review and meta-analyze the risk of VP/VLBW and EP/ELBW individuals to develop a ADHD categorical diagnosis or dimensional symptomatology compared with controls with normal weight and/or birth age. DATA SOURCES: We used PsycINFO, Medline, Embase, and Cochrane databases. STUDY SELECTION: We selected cross-sectional, prospective, or retrospective studies with no time or language restriction. DATA EXTRACTION: Independent reviewers screened and extracted data using predefined standard procedures. RESULTS: In 12 studies (N = 1787), researchers relying on a categorical diagnosis showed that both VP/VLBW and EP/ELBW subjects have a higher ADHD risk (odds ratio [OR] = 3.04 higher than controls; 95% confidence interval [CI] 2.19 to 4.21). In subgroup analyses, we demonstrated that the more extreme the cases, the higher the ORs (VP/VLBW: OR = 2.25 [95% CI 1.56 to 3.26]; EP/ELBW: OR = 4.05 [95% CI 2.38 to 6.87]). We drew data from 29 studies (N = 3504) on ADHD symptomatology and found significant associations with inattention (standardized mean difference [SMD] = 1.31, 95% CI 0.66 to 1.96), hyperactivity and impulsivity (SMD = 0.74, 95% CI 0.35 to 1.13), and combined symptoms (SMD = 0.55, 95% CI 0.42 to 0.68) when compared with controls. LIMITATIONS: Heterogeneity was significantly high for all analyses involving the 3 ADHD dimensions. CONCLUSIONS: With our results, we provide evidence that VP/VLBW subjects have an increased risk of ADHD diagnosis and symptomatology compared with controls, and these findings are even stronger in the EP/ELBW group. Future researchers should address which risk factors related to prematurity or low birth weight lead to ADHD.

1222 Assessment of the Contribution of Cytokine Plasmatic Levels to Detect Retinopathy of Prematurity

Objective: To evaluate the association of plasmatic levels of IL-6, IL-8, IL-10, IL-1 β, and TNF- α with the presence of any stage of ROP or with ROP stages 3 or more in very low birth weight preterm infants with clinical early-onset sepsis. Design Methods: From July 2005 to October 2007, inborn preterm infants with birth weight ≤ 1500 grams and gestational age ≤32 weeks with clinical early-onset sepsis were included in a prospective cohort study. We excluded patients that died before 6 weeks of life, had major malformations or congenital infections. Plasma was assayed for IL-6, IL-8, IL-10, IL-1 β, and TNF- α in the same sample collected for sepsis work up. ROP was diagnosed in screening assessments in NICU. The highest stage of ROP was considered. Results: We enrolled 74 patients (mean gestational age: 29.5 ±0.2 weeks; mean birth weight:1110 ±230 grams) that were followed from birth to hospital discharge; 49 (66.2%) had no ROP and 25 (33.8%) had any stage ROP(17 had stages 1 or 2, and 8 had stage 3 or more). All median cytokine plasmatic levels were similar between no ROP and ROP patients. Only low birth weight and low gestational age were significantly associated with any stage and severe ROP. Conclusions: There was no association between altered plasmatic levels of cytokines with any stage of ROP or with ROP stages 3 or more in very low birth weight infants with early-onset sepsis. Low birth weight and gestational age were important factors for ROP occurrence.