Materiały źródłowe

• #1 Short and Long-Term Outcomes for Extremely Preterm Infants

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4760862/

  Prematurity is the leading cause of infant mortality worldwide. In developed countries, extremely preterm infants contribute disproportionately to both neonatal and infant mortality. Survival of this high-risk population has incrementally improved in recent years. Despite these improvements, approximately 1 in 4 extremely preterm infants dies during the birth hospitalization. Among those who survive, respiratory and other morbidities are common, although their effect on quality of life is variable. In addition, long-term neurodevelopmental impairment is a large concern for patients, clinicians and families. However, the interplay of multiple factors contribute to neurodevelopmental impairment, with measures that change over time and outcomes that can be difficult to define and predict. Understanding outcomes of extremely preterm infants can help better counsel families regarding antenatal and postnatal care and guide strategies to improve survival without morbidity. This review summarizes recent evidence to provide an overview into the short- and long-term outcomes for extremely preterm infants.

• #2

  https://www.who.int/news-room/fact-sheets/detail/preterm-birth

  An estimated 13.4 million babies were born preterm in 2020 (before 37 completed weeks of gestation) (1). […] Approximately 900 000 children die in 2019 of complications of preterm birth (1). Many survivors face a lifetime of disability, including learning disabilities and visual and hearing problems. […] In low-income settings, half of the babies born at or below 32 weeks (2 months early) die due to a lack of feasible, cost-effective care such as warmth, breastfeeding support and basic care for infections and breathing difficulties. […] If a woman experiences preterm labour or is at risk of preterm childbirth, treatments are available to help protect the preterm baby from future neurological impairment as well as difficulties with breathing and infection. […] These reflect new evidence that simple interventions such as kangaroo mother care immediately after birth, early initiation of breastfeeding, use of continuous positive airway pressure (CPAP) and medicines such as caffeine for breathing problems can substantially reduce mortality in preterm and low birthweight babies.

• #3 The Effect of Probiotics on Preterm Birth Rates in Pregnant Women After a Threatened Preterm Birth Episode (The PROPEV Trial)

  https://www.mdpi.com/2227-9059/13/5/1141

  Progress in recent years has allowed for an increase in the survival rate of neonates with very low birth weights. However, prematurity rates have not changed significantly, and increased survival is associated with many respiratory, visual, auditory, neurological, and cognitive complications, as well as certain psychosocial behaviors. […] For this reason, recent trends have involved identifying PTB risk factors and developing prevention strategies. […] Despite the growing interest in the role of the vaginal microbiota in pregnancy outcomes, there is a lack of randomized clinical trials specifically assessing the impact of vaginal probiotic administration in women with a threatened preterm labor episode. […] The aim of this study was to determine whether the use of probiotics in patients at risk of spontaneous PTB reduces the rates of PTB before 37 weeks of gestation due to changes in the vaginal microbiota.

• #4 Prevalence of preterm birth and associated factors among mothers who gave birth in public hospitals of east Gojjam zone, Ethiopia | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-05517-5

  Preterm birth is defined as babies born alive before 37 weeks of pregnancy or fewer than 259 days since the first day of a womans last menstrual period. […] Preterm infants are at risk for specific diseases related to the immaturity of various organ systems. […] The prediction and prevention of preterm birth is a major health care priority. […] During the neonatal period, preterm babies are at a higher risk of serious illness or death. […] Those who survive preterm delivery without proper care are at great risk of chronic impairment and poor quality of life. […] The complication of infants born at preterm gestational age results in a trivial cost to the health sector, parents, and society. […] The proportion of preterm birth in this study was found to be 13.2%. […] The variable with a p-value0.05 was significant.

• #5 Premature babies | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/healthyliving/premature-babies

  The causes of premature labour arent fully understood, so prediction and prevention are difficult. […] The chances of survival for premature babies depend on the degree of prematurity and their birth weight. […] The chance of survival depends on the babys degree of prematurity and birth weight. […] Around one third of babies born at 24 weeks will develop a significant disability such as intellectual disability, cerebral palsy, blindness or deafness.

• #6 Preterm Birth: Premature, Causes, Symptoms & Complications

  https://my.clevelandclinic.org/health/diseases/21479-premature-birth

  Premature or early birth can pose serious health risks to a newborn baby. […] Fortunately, advances in medical technology make it likely that a premature baby can overcome these early obstacles and grow into a healthy child. […] Typically, the earlier a baby is born, the higher the risk for health complications. […] Studies show a baby is more likely to be born healthy when it reaches at least 37 weeks of pregnancy before birth. […] A premature baby doesn’t have enough time to fully develop. This means certain organs and body systems may not be ready to support them in their life outside the uterus. This can cause serious health problems. […] Premature babies are also at a higher risk of developmental challenges during childhood. […] The chances of a premature baby growing up to be healthy are quite good, especially if they were born after 34 weeks of pregnancy. The earlier a baby is born, the more likely they are to have health complications that could affect them later in life. […] No, being born early isn’t a disability. It only increases your risk for certain disabilities. […] Advances in newborn care are helping many preterm infants grow into healthy, robust children.

• #7 Premature babies’ survival rates and health outcomes

  https://www.babycenter.com/baby/premature-babies/whats-the-outlook-for-a-premature-baby-born-at-28-31-33-or-3_10300031

  Babies are preterm if they’re born before your 37th week of pregnancy. […] About 1 in 10 babies in the U.S. were born premature in 2020, according to the Centers for Disease Control and Prevention. […] Preemie babies, especially those born extremely early and at the lowest birth weight (under 2 or even 3 pounds), are at higher risk for health complications and disabilities. […] But luckily, there have been so many medical breakthroughs that preemies today have better chances of surviving and thriving than even 15 years ago. […] In a study of roughly 11,000 extremely premature babies, those born at 22 weeks had a 28 percent survival rate, while those born at 23 weeks had a 55 percent survival rate. […] About 1.5 percent of preemies in this country are born this early. Between 80 and 90 percent of premature babies who reach 28 weeks gestation survive.

• #8 Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: the EPICure studies | The BMJ

  https://www.bmj.com/content/345/bmj.e7961

  Objective To determine outcomes at age 3 years in babies born before 27 completed weeks gestation in 2006, and to evaluate changes in outcome since 1995 for babies born between 22 and 25 weeks gestation. […] Of the 576 babies evaluated after birth in 2006, 13.4% (n=77) were categorised as having severe impairment and 11.8% (n=68) moderate impairment. The prevalence of neurodevelopmental impairment was significantly associated with length of gestation, with greater impairment as gestational age decreased: 45% at 22-23 weeks, 30% at 24 weeks, 25% at 25 weeks, and 20% at 26 weeks (P0.001). […] Survival of babies admitted for neonatal care increased from 39% (35% to 43%) in 1995 to 52% (49% to 55%) in 2006, an increase of 13% (8% to 18%), and survival without disability increased from 23% (20% to 26%) in 1995 to 34% (31% to 37%) in 2006, an increase of 11% (6% to 16%).

• #9 Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: the EPICure studies | The BMJ

  https://www.bmj.com/content/345/bmj.e7961

  Survival and impairment in early childhood are both closely related to gestational age for babies born at less than 27 weeks gestation. […] The high rates of neurological and developmental problems reported in survivors are of concern to both the public and professionals and may be used to counsel parents about critical care decisions around birth. […] The proportion of survivors born between 22 and 25 weeks gestation with severe disability, using 1995 definitions, was 18% (95% confidence interval 14% to 24%) in 1995 and 19% (14% to 23%) in 2006. […] The most common impairment at 3 years of age was developmental or cognitive function.

• #10 Premature babies’ survival rates and health outcomes

  https://www.babycenter.com/baby/premature-babies/whats-the-outlook-for-a-premature-baby-born-at-28-31-33-or-3_10300031

  However, these extremely preterm babies are at a higher risk for medical complications and may face an extended stay in the neonatal intensive care unit (NICU). […] About 1.5 percent of all babies arrive in this time period. Twins, triplets (or more) are 9 times more likely than singletons to be very premature. […] Babies born between these weeks have an excellent chance of staying alive, and 90 percent will have no or minimal long-term health or developmental problems. […] About 1.5 percent of all babies arrive at this time, and about 95 percent of them survive. […] Moderately preterm babies are less likely than babies born earlier to develop serious disabilities resulting from premature birth, though they may have a higher risk than full-term babies for learning and behavioral problems.

• #11 Predicting mortality risk for preterm infants using deep learning models with time-series vital sign data | npj Digital Medicine

  https://www.nature.com/articles/s41746-021-00479-4

  Mortality remains an exceptional burden of extremely preterm birth. […] Computational models that predict the mortality risk of preterm birth in the NICU by integrating vital sign data and static clinical variables in real time may be clinically helpful and potentially superior to static prediction models. […] In conclusion, the proposed model has demonstrated efficacy in predicting the real-time mortality risk of preterm infants in initial NICU hospitalization. […] Accurate estimation of mortality is an important component of antenatal counseling and assists healthcare providers in the allocation of resources. […] While these tools are useful and have gained widespread use, the mortality estimates they provided have several limitations. […] Machine learning and deep learning approaches have been developed for prediction of mortality following preterm birth.

• #12 Prediction of Mortality in Very Premature Infants: A Systematic Review of Prediction Models | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0023441

  Nearly all studies found that a multivariate model predicted mortality better than birth weight or gestational age alone. […] In addition to gestational age and birth weight, eight variables frequently predicted survival: being of average size for gestational age, female gender, non-white ethnicity, absence of serious congenital malformations, use of antenatal steroids, higher 5-minute Apgar score, normal temperature on admission, and clinical or laboratory measures indicating better respiratory status. […] This systematic review provides an overview of existing research in prediction of mortality in very preterm infants. Multivariate models generally predict mortality better than birth weight or gestational age alone. […] Future prediction models could focus on the narrow gestational age and weight ranges where clinicians feel uncertain in delivering a prognosis.

• #13 Development and validation of a risk prediction model of preterm birth for women with preterm labour symptoms (the QUIDS study): A prospective cohort study and individual participant data meta-analysis | PLOS Medicine

  https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003686

  Timely interventions in women presenting with preterm labour can substantially improve health outcomes for preterm babies. […] The primary outcome was spontaneous preterm birth within 7 days of quantitative fFN test. […] The developed risk prediction model for spontaneous preterm birth within 7 days included quantitative fFN, current smoking, not White ethnicity, nulliparity, and multiple pregnancy. […] In this study, we found that a risk prediction model including vaginal fFN concentration and clinical risk factors showed promising performance in the prediction of spontaneous preterm birth within 7 days of test and has potential to inform management decisions for women with threatened preterm labour. […] The model shows promising performance when externally validated and recalibrated in a UK population, with potential net benefit when used to inform clinical decision-making, and is cost effective.

• #14 Predicting developmental outcomes in premature infants by term equivalent MRI: systematic review and meta-analysis | Systematic Reviews | Full Text

  https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-015-0058-7

  This study aims to determine the prognostic accuracy of term MRI in very preterm born (32 weeks) or low-birth-weight (1500 g) infants for long-term (18 months) developmental outcomes. […] Pooled sensitivity and specificity values (95 % confidence interval (CI)) for prediction of CP combining the three different MRI findings (using normal/mild vs. moderate/severe cut-off) were 77 % (53 to 91 %) and 79 % (51 to 93 %), respectively. For prediction of motor function, the values were 72 % (52 to 86 %) and 62 % (29 to 87 %), respectively. Prognostic accuracy for visual and/or hearing problems, neurocognitive, and/or behavioral function was poor. […] This study shows that presence of moderate/severe WMA on MRI around term equivalent age can predict CP and motor function in very preterm or low-birth-weight infants with moderate sensitivity and specificity. Its ability to predict other long-term outcomes such as neurocognitive and behavioral impairments is limited.

• #15

  https://link.springer.com/article/10.1007/s00062-023-01378-9

  Neonates born at 28 weeks of gestation are at risk for neurodevelopmental delay. The aim of this study was to identify quantitative MR-based metrics for the prediction of neurodevelopmental outcomes in extremely preterm neonates. […] There are relationships between relaxometry/DTI-based metrics determined by neuroimaging near term and neurodevelopmental outcomes collected at one year of age. Both modalities bear prognostic potential for the prediction of cognitive and motor outcomes. Thus, quantitative MRI at term-equivalent ages represents a promising approach with which to estimate neurologic development in extremely preterm infants. […] The aim of this exploratory study was to investigate the potential value of relaxation time metrics (i.e., T1-/T2-relaxation times (T1R/T2R)) and DTI parameters (ADC/fractional anisotropy (FA)) for neurologic outcome prediction in a cohort of extremely preterm infants.

• #16

  https://link.springer.com/article/10.1007/s00062-023-01378-9

  Significant correlations were observed between cognitive outcome scores collected at one year of age and T2R (r=0.412; p=0.017) and ADC (r=0.401; p=0.021) of the medulla oblongata, determined at term-equivalent ages. […] Significant correlations were observed between motor outcome scores collected at one year of age and ADC (r=0.408; p=0.018) of the medulla oblongata; T1R (r=0.346; p=0.049), ADC (r=0.414; p=0.017), and FA (r=0.352; p=0.045) of the pontine tegmentum; T1R (r=0.415; p=0.016) of the midbrain; T1R (r=0.513; p=0.002) and T2R (r=0.405; p=0.019) of the right PLIC; and T1R (r=0.504; p=0.003) of the left PLIC, determined at term-equivalent ages. […] The model identified the ADC as the strongest predictor for cognitive development (model 1: R2=0.184; p=0.013). However, the prognostic potential increased when the T2R was considered as a complementary variable (model 2: R2=0.296; p=0.037).

• #17

  https://link.springer.com/article/10.1007/s00062-023-01378-9

  The model identified the T1R (right PLIC) as the strongest predictor for motor development (model 1: R2=0.251; p=0.003). However, the prognostic potential increased when the ADC (medulla oblongata) was considered as a complementary variable (model 2: R2=0.405; p=0.009). […] The findings of this study indicate strong relationships between quantitative metrics determined by MRI near term and neurodevelopmental outcomes at one year corrected-age in children with a history of extreme preterm birth. Moreover, DTI and relaxometry-based imaging bear prognostic potential for the prediction of cognitive and motor outcomes in these fragile patients. Therefore, quantitative MRI represents a promising approach with which to estimate neurologic development, which may increase the value of routine brain imaging at term-equivalent ages in extremely preterm infants.

• #18 Prevalence of preterm birth and associated factors among mothers who gave birth in public hospitals of east Gojjam zone, Ethiopia | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-05517-5

  In multivariable binary logistic regression analysis ANC follow up (AOR=2.87; 95% CI = (1.67, 5.09)), educational status of mother (AOR=2.79; 95% CI = (1.27, 6.67)), husband educational status(AOR=2.11; 95% CI = (1.10, 4.18)), Average monthly family income(AOR=1.95; 95% CI = (1.05, 3.75)), family size(AOR=0.15; 95% CI = (0.03, 0.67)), multifetal gestation (AOR=3.30; 95% CI = (1.29, 8.69), having PROM(AOR=6.46; 95% CI= (2.52, 18.24)), history of chronic illness (AOR=3.94; 95% CI = (1.67, 9.45)), being HIV positive(AOR=6.99; 95% CI= (1.13, 44.65)), APH(AOR=3.62; 95% CI= (1.12, 12.59)), PIH (AOR=3.61; 95% CI= (1.19, 11.84)), mode of delivery (AOR=7.16; 95% CI = (2.09, 29.29)), and onset of labor (AOR=0.10; 95% CI = (0.03, 0.29)) were found to be statistically significant at p-value of 0.05. […] The proportion of preterm birth in public hospitals in the east Gojjam zone is 13.7%.

• #19 The Effect of Probiotics on Preterm Birth Rates in Pregnant Women After a Threatened Preterm Birth Episode (The PROPEV Trial)

  https://www.mdpi.com/2227-9059/13/5/1141

  Preterm birth (PTB) is the leading cause of neonatal death (within the first 28 days of life) and accounts for 27% of neonatal deaths worldwide. The risk of neonatal death decreases as gestational age increases, but according to a non-linear relationship. In addition, PTB has severe consequences for preterm neonates, including increased morbidity and a greater rate of long-term consequences, such as impaired psychomotor development and increased risk of chronic diseases in adulthood. The global rate of PTB is estimated to be approximately 11% (fluctuating by 5% in some European countries and 18% in some African countries). […] Approximately 70% of preterm births are spontaneous, either due to a risk of preterm birth (45%) or due to the premature rupture of membranes (25%); the remaining cases (30%) are a result of maternal or fetal conditions, such as multiple gestations, preeclampsia, antepartum hemorrhage, and fetal growth restriction.

• #20

  https://www.who.int/news-room/fact-sheets/detail/preterm-birth

  WHO is committed to reducing the health problems and lives lost as a result of preterm birth, including working with Member States and partners to implement Every newborn: an action plan to end preventable deaths. […] WHO also supports countries to implement WHO’s guidelines, aimed at reducing the risk of negative pregnancy outcomes, including preterm births, and ensuring a positive pregnancy and postnatal experience for all women and their infants.

• #21 Prediction of school outcome after preterm birth: a cohort study | Archives of Disease in Childhood

  https://adc.bmj.com/content/104/4/348

  Preterm birth is a relatively common event, with 6% of infants being born 4 or more weeks before their due date. […] Ex-preterm children are more likely to struggle at school than term peers. […] It is unclear if preterm infants demonstrate catch up or begin to struggle more as they grow. […] Early educational measures are correlated with later measures. […] The trajectory of educational measures in preterm infants varies compared with that of their term peers. […] Most of the catch up seems to occur in the first few years at school. […] This work further emphasises the importance of early schooling and environment in these infants and suggests that support, long after the premature birth, may have additional benefits. […] The results in this work suggest that preterm infants demonstrate some evidence of catch up during the first few years at school, with a closing of the gap in low scores, and better prediction of their final score once they have reached KS2. Premature infants appear to have similar trajectories to their peers after this point.

• #22 The Effect of Probiotics on Preterm Birth Rates in Pregnant Women After a Threatened Preterm Birth Episode (The PROPEV Trial)

  https://www.mdpi.com/2227-9059/13/5/1141

  Progress in recent years has allowed for an increase in the survival rate of neonates with very low birth weights. However, prematurity rates have not changed significantly, and increased survival is associated with many respiratory, visual, auditory, neurological, and cognitive complications, as well as certain psychosocial behaviors. […] For this reason, recent trends have involved identifying PTB risk factors and developing prevention strategies. […] Despite the growing interest in the role of the vaginal microbiota in pregnancy outcomes, there is a lack of randomized clinical trials specifically assessing the impact of vaginal probiotic administration in women with a threatened preterm labor episode. […] The aim of this study was to determine whether the use of probiotics in patients at risk of spontaneous PTB reduces the rates of PTB before 37 weeks of gestation due to changes in the vaginal microbiota.

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