Care and Outcome of the Extreme Preterm Infant

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Neonatology".

Deadline for manuscript submissions: 10 November 2024 | Viewed by 2681

Special Issue Editor


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Guest Editor
Department of Newborn & Developmental Medicine, Sunnybrook Health Sciences Centre, Department of Paediatrics, University of Toronto, Toronto, ON M5A 1B2, Canada
Interests: neonatal care and neurodevelopmental outcomes; clinical trials; breastfeeding in the preterm population; breast milk enhancement
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Special Issue Information

Dear Colleagues,

Over the last 10–20 years, there have been significant gains in the care of preterm infants at less than 30 weeks of gestation. We have been able to improve our skill set in the fields of respiratory and hemodynamic management so that neonatal morbidity is steadily declining in overall incidence for preterm infants, particularly in infants at 28–29 weeks of gestation. As we become more proficient in the care of these infants, we begin to translate these skill sets for the more extreme preterm infants, those at <26 weeks of gestation but most importantly the infants born below 24 weeks of gestation. These infants are not only preterm but are also physiologically immature, which adds a dimension in their care and ultimate survival. It is now important to share how we can optimize survival but also ensure that there are positive outcomes both in neonatal morbidities and neurodevelopmental outcomes. How these very extreme preterm infants traverse the neonatal pathways will play a significant role in how they are able to develop as a functioning child. The traditional outcomes of death, cerebral palsy, vision and hearing deficits, and cognitive deficits may not be adequate in evaluating how these extreme preterm infants present post-discharge. We need to go beyond theses traditional outcomes and look at functional outcomes as we explore our ongoing approaches in care. In addition, we need to explore how parents use coping skills in the 20–30 weeks of neonatal care their infants may have.

I hope that this Special Issue will be an opportunity to look at how we can optimize care for these infants and their parents.

Dr. Elizabeth Asztalos
Guest Editor

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Keywords

  • extreme prematurity
  • neonatal morbidities
  • ventilatory management
  • nutrition
  • developmental care
  • parental care
  • functional neurodevelopmental outcomes
  • family impact and stress

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Published Papers (1 paper)

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Research

15 pages, 3180 KiB  
Article
Growth and Neurodevelopmental Outcomes of Preterm Infants Born < 26 Weeks Gestation before and after Implementation of a Nutrition-Care Bundle
by Giulia Res, Rosine F. Bishara, Paige Terrien Church, Rena Rosenthal, Rita Maria Bishara, Annie Dupuis, Elizabeth Asztalos and Rudaina Banihani
Children 2024, 11(4), 475; https://doi.org/10.3390/children11040475 - 15 Apr 2024
Viewed by 1765
Abstract
Background: This study aimed to assess the impact of a nutrition-care bundle on growth and neurodevelopmental outcomes of micro-preterm infants born in a level III neonatal intensive care unit (NICU) by two years corrected age. Methods: A nutrition-care bundle emphasizing the prompt initiation [...] Read more.
Background: This study aimed to assess the impact of a nutrition-care bundle on growth and neurodevelopmental outcomes of micro-preterm infants born in a level III neonatal intensive care unit (NICU) by two years corrected age. Methods: A nutrition-care bundle emphasizing the prompt initiation of parenteral nutrition at birth, initiation of enteral feeds within 6 h after birth, and early addition of human milk fortifiers was implemented in 2015 for infants born < 26 weeks gestation. This before-and-after study evaluated growth and neurodevelopmental outcomes in infants born between 2012–2013 (before-nutrition-bundle, BNB) and 2016–2017 (after-nutrition-bundle, ANB). Results: A total of 145 infants were included in the study. Infants in the ANB group (n = 73) were smaller (birthweight and gestational age), and there were more male infants and multiples included compared to the BNB group (n = 72). Enteral feeds and fortifiers started earlier in the ANB group. Growth velocity and weight z-score changes were similar in both groups during NICU stay and post-discharge. Systemic steroid use, but not cohort, was linked to lower Bayley scores across all domains. Conclusions: Implementing a nutrition-care bundle was not consistently associated with improved weight gain and neurodevelopmental outcomes in the micro-preterm infant population, possibly due to ongoing high-quality nutritional care by the clinical team. Full article
(This article belongs to the Special Issue Care and Outcome of the Extreme Preterm Infant)
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