Document Detail


Using a count of neonatal morbidities to predict poor outcome in extremely low birth weight infants: added role of neonatal infection.
MedLine Citation:
PMID:  19117897     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: A count of 3 neonatal morbidities (bronchopulmonary dysplasia, brain injury, and severe retinopathy of prematurity) strongly predict the risk of death or neurosensory impairment in extremely low birth weight infants who survive to 36 weeks' postmenstrual age. Neonatal infection has also been linked with later impairment. We examined whether the addition of infection to the count of 3 neonatal morbidities further improves the prediction of poor outcome.
METHODS: We studied 944 infants who participated in the Trial of Indomethacin Prophylaxis in Preterms and survived to 36 weeks' postmenstrual age. Culture-proven sepsis, meningitis, and stage II or III necrotizing enterocolitis were recorded prospectively. We investigated the incremental prognostic importance of neonatal infection by adding terms for the different types of infection to a logistic model that already contained terms for the count of bronchopulmonary dysplasia, brain injury, and severe retinopathy. Poor outcome at 18 months of age was death or survival with 1 or more of the following: cerebral palsy, cognitive delay, severe hearing loss, and bilateral blindness.
RESULTS: There were 414 (44%) infants with at least 1 episode of infection or necrotizing enterocolitis. Meningitis and the presence of any type of infection added independent prognostic information to the morbidity-count model. The odds ratio associated with infection or necrotizing enterocolitis in this model was 50% smaller than the odds ratio associated with each count of the other 3 neonatal morbidities. Meningitis was rare and occurred in 22 (2.3%) of 944 infants.
CONCLUSIONS: In this cohort of extremely low birth weight infants who survived to 36 weeks' postmenstrual age, neonatal infection increased the risk of a late death or survival with neurosensory impairment. However, infection was a weaker predictor of poor outcome than bronchopulmonary dysplasia, brain injury, and severe retinopathy.
Authors:
Dirk Bassler; Barbara J Stoll; Barbara Schmidt; Elizabeth V Asztalos; Robin S Roberts; Charlene M T Robertson; Reg S Sauve;
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pediatrics     Volume:  123     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-01-01     Completed Date:  2009-02-06     Revised Date:  2014-09-15    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  313-8     Citation Subset:  AIM; IM    
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00009646
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MeSH Terms
Descriptor/Qualifier:
Communicable Diseases / microbiology,  mortality*
Female
Humans
Infant
Infant, Extremely Low Birth Weight*
Infant, Newborn
Infant, Premature, Diseases / microbiology,  mortality*
Male
Morbidity / trends
Predictive Value of Tests
Risk Factors
Survival Rate / trends
Treatment Outcome
Grant Support
ID/Acronym/Agency:
M01 RR 00070/RR/NCRR NIH HHS; M01 RR 00997/RR/NCRR NIH HHS; M01 RR000070-46/RR/NCRR NIH HHS; M01 RR000997/RR/NCRR NIH HHS; M01 RR000997-34/RR/NCRR NIH HHS; U10 HD021364-14/HD/NICHD NIH HHS; U10 HD021373-25/HD/NICHD NIH HHS; U10 HD021385/HD/NICHD NIH HHS; U10 HD021385-19/HD/NICHD NIH HHS; U10 HD021397-16/HD/NICHD NIH HHS; U10 HD027851-19/HD/NICHD NIH HHS; U10 HD027880-17/HD/NICHD NIH HHS; U10 HD027881-10/HD/NICHD NIH HHS; U10 HD027904/HD/NICHD NIH HHS; U10 HD027904-15/HD/NICHD NIH HHS; U10 HD034216/HD/NICHD NIH HHS; U10 HD034216-14/HD/NICHD NIH HHS; U10 HD21364/HD/NICHD NIH HHS; U10 HD21373/HD/NICHD NIH HHS; U10 HD21385/HD/NICHD NIH HHS; U10 HD27851/HD/NICHD NIH HHS; U10 HD27880/HD/NICHD NIH HHS; U10 HD27881/HD/NICHD NIH HHS; U10 HD27904/HD/NICHD NIH HHS; U10 HD34216/HD/NICHD NIH HHS; UL1 TR000041/TR/NCATS NIH HHS
Investigator
Investigator/Affiliation:
A Solimano / ; M Whitfield / ; F Germain / ; J Tomlinson / ; A Peliowski / ; P Etches / ; B Young / ; C M T Robertson / ; D McMillan / ; R Sauve / ; L Bourcier / ; H Christianson / ; K Sankaran / ; B Andreychuk / ; M Seshia / ; O Casiro / ; V Debooy / ; V Cook / ; C M G Cronin / ; D Moddemann / ; N Granke / ; C Nwaesei / ; L St Aubin / ; D Reid / ; D Lee / ; C Kenyon / ; L Whitty / ; J Farrell / ; B Schmidt / ; S Saigal / ; P Gillie / ; J Dix / ; B Zhang / ; A Ohlsson / ; E Asztalos / ; L Wiley / ; A James / ; K F W Young Tai / ; M Clarke / ; M Vincer / ; S Stone / ; R Kohan / ; N French / ; H Benninger / ; C Barnett / ; R Haslam / ; J Ramsay / ; P Davis / ; L Doyle / ; B Faber / ; K Callanan / ; S Fraser / ; K Lui / ; M Rochefort / ; E McAvoy / ; P Colditz / ; M Pritchard / ; P Steer / ; D I Tudehope / ; V Flenady / ; J Hegarty / ; L Mildenhall / ; W Smith / ; L McCarthy / ; T F Fok / ; D K Stevenson / ; B Fleisher / ; B Ball / ; L A Papile / ; G Laadt / ; C Backstrom / ; J E Tyson / ; S Broyles / ; S Madison / ; W A Carlo / ; K Nelson / ; M Collins / ; S Johnson / ; S Shankaran / ; V Delaney-Black / ; G Muran / ; D Driscoll / ; B J Stoll / ; N Simon / ; E Hale / ; A A Fanaroff / ; D Wilson / ; M Hack / ; N Newman / ; C R Bauer / ; A M Worth / ; W Griffin / ; W Oh / ; B R Vohr / ; A Hensman / ; B Schmidt / ; P Davis / ; D Moddemann / ; A Ohlsson / ; R S Roberts / ; S Saigal / ; A Solimano / ; M Vincer / ; L Wright / ; M Gent / ; W Fraser / ; M Perlman / ; R Adkins / ; L Elden / ; C M T Robertson / ; B R Vohr / ; S Gray / ; R S Roberts / ; K Thorpe / ; N LaPierre /
Comments/Corrections

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