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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
The clustering of disorders in infants born before the 28th week of gestation
Alan Leviton1, Olaf Dammann, Stephen Engelke
1Neurology Department, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA. alan.leviton@childrens.harvard.edu
Insights
Infants born extremely preterm experience clustered disorders, with necrotizing enterocolitis (NEC) frequently linked to brain damage, severe bronchopulmonary dysplasia, and retinopathy of prematurity. Early bacteremia also increases risks for other severe conditions in preterm infants.
Area of Science:
- Neonatal Medicine
- Perinatal Epidemiology
- Critical Care Pediatrics
Background:
- Infants born extremely preterm (<28 weeks gestation) are at high risk for multiple morbidities.
- Understanding the clustering of these disorders is crucial for improving outcomes.
Purpose of the Study:
- To investigate whether common disorders in extremely preterm infants occur together (cluster).
Main Methods:
- Observational cohort study of 1223 infants born before 28 weeks gestation.
- Assessed diagnoses of cerebral white matter damage, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), and bacteremia at 36 weeks postmenstrual age.
Main Results:
- Severe NEC (Bell stage IIIb) was associated with increased risk of cerebral white matter damage, severe ROP (stage 3+), and severe BPD.
- Early bacteremia increased the risk of late bacteremia and severe ROP.
- Severe ROP was linked to increased risk of severe BPD and both early and late bacteremia.
Conclusions:
- Necrotizing enterocolitis (NEC) is a common factor in the clustering of morbidities in extremely preterm infants.
- Evidence suggests NEC may contribute to damage in other organs, potentially through circulating factors.
Aim:
To see whether disorders prevalent in infants born extremely preterm cluster.
Design:
Observational cohort study.
Setting:
University-affiliated newborn intensive care nurseries.
Subjects:
One thousand two hundred and twenty-three infants born before the 28th week of gestation who survived until 36 weeks postmenstrual age when the diagnosis of bronchopulmonary dysplasia (BPD) could be made.
Interventions:
None.
Main Outcome Measures:
Cerebral white matter damage (an echolucent lesion, or moderate or severe ventriculomegaly on a protocol cranial ultrasound scan), BPD, retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC) and early and late bacteremia.
Results:
After adjustment for gestational age, children who had severe NEC (Bell stage IIIb) were at increased risk of cerebral white matter damage, severe ROP (stage 3+), and severe BPD (defined as both oxygen and ventilator dependent). Children who had early bacteremia were at increased risk of late bacteremia and severe ROP. Those who had severe ROP were at increased risk of severe BPD and both early and late bacteremia.
Conclusions:
Necrotizing enterocolitis is the disorder common to most of the clusters, but we do not know if its onset occurred before the others. Organ-damage-promoting substances, however, have been found in the circulation of newborn animals with bowel inflammation, supporting the view that NEC contributes to the damage of other organs.
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