1. Cochrane Database Syst Rev. 2005 Jan 25;(1):CD004210.

Interventions to prevent hypothermia at birth in preterm and/or low birthweightbabies.

McCall EM, Alderdice FA, Halliday HL, Jenkins JG, Vohra S.

Author information: Department of Child Health, Queen's University Belfast, Institute of ClinicalSciences, Grosvenor Road, Belfast, Northern Ireland, UK, BT12 6BJ.e.mccall@qub.ac.uk

Update in Cochrane Database Syst Rev. 2008;(1):CD004210.

BACKGROUND: Hypothermia incurred during routine postnatal resuscitation is aworld-wide issue (across all climates), with associated morbidity and mortality. Keeping vulnerable preterm infants warm is problematic even when recommendedroutine thermal care guidelines are followed in the delivery suite.OBJECTIVES: To assess efficacy and safety of interventions, designed forprevention of hypothermia in preterm and/or low birthweight infants, appliedwithin 10 minutes after birth in the delivery suite compared with routine thermalcare.SEARCH STRATEGY: The standard search strategy of The Cochrane Collaboration wasfollowed. Electronic databases were searched: MEDLINE (1966 to May Week 4 2004 ),CINAHL (1982 to May Week 4 2004), EMBASE (1974 to 09/07/04), the Cochrane CentralRegister of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2004),Database of Abstracts of Reviews of Effects (DARE 1994 to July 2004),conference/symposia proceedings using ZETOC (1993 to July 2004), ISI proceedings (1990 to 09/07/2004) and OCLC WorldCat (July 2004). Identified articles werecross-referenced. No language restrictions were imposed.SELECTION CRITERIA: All trials using randomised or quasi-randomised allocationsto test a specific intervention designed to prevent hypothermia, (apart from'routine' thermal care) applied within 10 minutes after birth in the deliverysuite to infants of < 37 weeks' gestational age or birthweight </=2500 g.DATA COLLECTION AND ANALYSIS: Methodological quality was assessed and data wereextracted for important clinical outcomes including adverse effects of theintervention by at least three independent reviewers. Authors were contacted for missing data. Data were analysed using RevMan 4.2.5. Relative risk (RR), riskdifference (RD) and number needed to treat (NNT) with 95% confidence limits were calculated for each dichotomous outcome and mean differences (MD) with 95%confidence limits for continuous outcomes.MAIN RESULTS: Six studies giving a total of 304 infants randomised and 295completing the studies were included. Four comparisons to 'routine care' wereundertaken within two categories: 1) barriers to heat loss (four studies):plastic wrap or bag (three), stockinet caps (one) and 2) external heat sources(two studies): skin-to-skin (one), transwarmer mattress (one). Plastic barrierswere effective in reducing heat losses in infants < 28 weeks' gestation (threestudies, n = 159; WMD 0.76 degrees C; 95% CI 0.49, 1.03) but not in the 28 to 31 week group. There was insufficient evidence to suggest that plastic wrap reduces

the risk of death within hospital stay (three studies, n = 161; typical RR 0.63; 95% CI 0.32, 1.22; typical RD -0.09; 95% CI -0.20, 0.03). There was no evidenceof a significant difference in major brain injury, mean duration of oxygentherapy or hospitalisation for infants < 29 weeks' gestation. Stockinet caps werenot effective (borderline significant for infants < 2000 g birthweight) inreducing heat losses.Skin-to-skin care was shown to be effective in reducing the risk of hypothermia when compared to conventional incubator care for infants 1200to 2199 g birthweight (one study, n = 31; RR 0.09; 95% CI 0.01, 0.64; NNT 2; 2 to4). The transwarmer mattress significantly kept infants </=1500 g warmer andreduced the incidence of hypothermia on admission to NICU (one study, n = 24; RR 0.30; 95% CI 0.11, 0.83; NNT 2 range 2 to 4).AUTHORS' CONCLUSIONS: Plastic wraps or bags, skin-to-skin care and transwarmermattresses all keep preterm infants warmer, leading to higher temperatures onadmission to neonatal units and less hypothermia. Given the low NNT,consideration should be given to using these interventions in the delivery suite.However, the small numbers of infants and studies and the absence of long termfollow-up mean that firm recommendations for clinical practice cannot be given.There is a need to conduct large, high quality randomised controlled trialslooking at long-term outcomes.

PMID: 15674932 [PubMed - indexed for MEDLINE]

1. World J Pediatr. 2013 Feb;9(1):17-24. doi: 10.1007/s12519-012-0395-8. Epub 2012Dec 29.

Incidence of brain injuries in premature infants with gestational age ≤ 34 weeks in ten urban hospitals in China.

Chen HJ, Wei KL, Zhou CL, Yao YJ, Yang YJ, Fan XF, Gao XR, Liu XH, Qian JH, WuBQ, Wu GQ, Zhang QM, Zhang XL.

Author information: Shanghai Institute for Pediatric Research, Xinhua Hospital Affiliated to ShanghaiJiao Tong University School of Medicine, Shanghai 200092, China. hjchenk@163.com

BACKGROUND: There is a large number (1.5 million per year) of premature births inChina. It is necessary to obtain the authentic incidences of intraventricularhemorrhage (IVH) and periventricular leukomalacia (PVL), the common braininjuries, in Chinese premature infants. The present multicenter study aimed toinvestigate the incidence of brain injuries in premature infants in ten urbanhospitals in China.METHODS: The research proposal was designed by the Subspecialty Group ofNeonatology of Pediatric Society of the Chinese Medical Association. Tenlarge-scale urban hospitals voluntarily joined the multicenter investigation. Allpremature infants with a gestational age ≤ 34 weeks in the ten hospitals weresubjected to routine cranial ultrasound within three days after birth, and thento repeated ultrasound every 3-7 days till their discharge from the hospital from

January 2005 to August 2006. A uniform data collection sheet was designed torecord cases of brain injuries.RESULTS: The incidences of overall IVH and severe IVH were 19.7% (305/1551) and4.6% (72/1551), respectively with 18.4% (56/305) for grade 1, 58.0% (177/305) forgrade 2, 17.7% (54/305) for grade 3 and 5.9% (18/305) for grade 4 in ninehospitals. The incidences of overall PVL and cystic PVL were 5.0% (89/1792) and0.8% (14/1792) respectively, with 84.3% (75/89) for grade 1, 13.5% (12/89) forgrade 2, and 2.2% (2/89) for grade 3 in the ten hospitals. The statisticallysignificant risk factors that might aggravate the severity of IVH were vaginaldelivery (OR=1.883, 95% CI: 1.099-3.228, P=0.020) and mechanical ventilation(OR=4.150, 95% CI: 2.384-7.223, P=0.000). The risk factors that might result inthe development of cystic PVL was vaginal delivery (OR=21.094, 95% CI:2.650-167.895, P=0.000).CONCLUSIONS: The investigative report can basically reflect the incidence ofbrain injuries in premature infants in major big cities of China. Since more than60% of the Chinese population live in the rural areas of China, it is expected toundertake a further multicenter investigation covering the rural areas in thefuture.

PMID: 23275107 [PubMed - indexed for MEDLINE]

1. Zhongguo Dang Dai Er Ke Za Zhi. 2012 Sep;14(9):661-3.

[Effect of chorioamnionitis on brain injury in preterm infants].

[Article in Chinese]

Xu LP, Ren RN, Zhu SB, Zhuang HM, Huang ZL, Yang H.

Author information: Department of Pediatrics, Fujian Medical University, Zhangzhou, Fujian, China.

OBJECTIVE: To explore the association between chorioamnionitis and brain injuryin preterm infants.METHODS: A total of 88 preterm infants (28-34 weeks), who were born between June 2008 and June 2011, were divided into a case group (n=41) and a control group(n=47) according to whether or not they had chorioamnionitis. All the infantswere examined by brain ultrasonography periodically after birth and underwentbrain diffusion weighted imaging (DWI) between 3 and 7 days after birth. The two groups were compared in terms of the incidence of periventricular leukomalacia(PVL) and periventricular and intraventricular hemorrhage (PVH-IVH) by brainmagnetic resonance imaging (MRI) at the corrected gestational age of 40 weeks.RESULTS: There was statistical significance in the incidence of PVL between thecase and the control groups (32% vs 6%; P<0.05), but no significant difference inthe incidence of PVH-IVH between the two groups (27% vs 23%; P>0.05).CONCLUSIONS: Chorioamnionitis is associated with brain injury in preterm infants,increasing the incidence of PVL but having little influence over the incidence ofPVH-IVH.

PMID: 22989433 [PubMed - indexed for MEDLINE]

1. Pediatrics. 2014 Jan;133(1):55-62. doi: 10.1542/peds.2013-0372. Epub 2013 Dec 30.

Intraventricular hemorrhage and neurodevelopmental outcomes in extreme preterm infants.

Bolisetty S, Dhawan A, Abdel-Latif M, Bajuk B, Stack J, Lui K; New South Walesand Australian Capital Territory Neonatal Intensive Care Units' Data Collection.

Collaborators: Bowen J, Bajuk B, Sedgley S, Kecskés Z, Carlisle H, Barnes L,Hunter J, Craven P, Wake C, Glover R, Cruden L, Argomand A, Evans N, Osborn D,Malcolm G, Rieger I, Reid S, Stack J, Callander I, Medlin K, Marcin K, Shingde V,Lampropoulos B, Chin MF, Badawi N, Loughran-Fowlds A, Karskens C, Paradisis M,Kluckow M, Jacobs C, Howard G, Numa A, Williams G, Young J, Tracy M, Luig M,Baird J, Lui K, Oei J, Sutton L, Cameron D.

Author information: FRACP, Division of Newborn Services, Royal Hospital for Women, Barker Street,Locked Bag 2000, Randwick, 2031 NSW, Australia.Srinivas.Bolisetty@sesiahs.health.nsw.gov.au.

OBJECTIVE: Not many large studies have reported the true impact of lower-gradeintraventricular hemorrhages in preterm infants. We studied theneurodevelopmental outcomes of extremely preterm infants in relation to theseverity of intraventricular hemorrhage.METHODS: A regional cohort study of infants born at 23 to 28 weeks' gestation andadmitted to a NICU between 1998 and 2004. Primary outcome measure was moderate tosevere neurosensory impairment at 2 to 3 years' corrected age defined asdevelopmental delay (developmental quotient >2 SD below the mean), cerebralpalsy, bilateral deafness, or bilateral blindness.RESULTS: Of the 1472 survivors assessed, infants with grade III-IVintraventricular hemorrhage (IVH; n = 93) had higher rates of developmental delay(17.5%), cerebral palsy (30%), deafness (8.6%), and blindness (2.2%). Grade I-II IVH infants (n = 336) also had increased rates of neurosensory impairment (22% vs12.1%), developmental delay (7.8% vs 3.4%), cerebral palsy (10.4% vs 6.5%), anddeafness (6.0% vs 2.3%) compared with the no IVH group (n = 1043). Afterexclusion of 40 infants with late ultrasound findings (periventricularleukomalacia, porencephaly, ventricular enlargement), isolated grade I-II IVH (n = 296) had increased rates of moderate-severe neurosensory impairment (18.6% vs12.1%). Isolated grade I-II IVH was also independently associated with a higherrisk of neurosensory impairment (adjusted odds ratio 1.73, 95% confidenceinterval 1.22-2.46).CONCLUSIONS: Grade I-II IVH, even with no documented white matter injury or otherlate ultrasound abnormalities, is associated with adverse neurodevelopmentaloutcomes in extremely preterm infants.

PMID: 24379238 [PubMed - in process]

1. Pediatr Res. 2012 Mar;71(3):253-60. doi: 10.1038/pr.2011.46. Epub 2012 Jan 25.

Cerebral autoregulation in the first day after preterm birth: no evidence ofassociation with systemic inflammation.

Hahn GH, Maroun LL, Larsen N, Hougaard DM, Sorensen LC, Lou HC, Greisen G.

Author information: Department of Neonatology, Copenhagen University Hospital-Rigshospitalet,Copenhagen, Denmark. gwhahn@dadlnet.dk

INTRODUCTION: Both systemic inflammation and impaired cerebral autoregulation(CA) have been associated with brain injury in preterm infants. We hypothesizedthat impaired CA represents a hemodynamic link between inflammation and braininjury.RESULTS: Neither fetal vasculitis nor interleukin-6 (IL-6) affected CAsignificantly. A high level of IL-6 was associated with hypotension (P = 0.03)irrespective of dopamine therapy. The magnitude of impairment in CA increasedwith decreasing mean arterial blood pressure (MAP) (P = 0.02). No significantassociations were found between these parameters and either intraventricularhemorrhage (IVH) (n = 10) or neonatal mortality (n = 8).DISCUSSION: In conclusion, postnatal inflammation was weakly associated witharterial hypotension, and hypotension was weakly associated with impairedautoregulation. There was no direct association, however, between autoregulation and antenatal or postnatal signs of inflammation.METHODS: In our study, 60 infants (mean (±SD) of gestational age (GA) 27 (±1.3)wk) underwent continuous recording of MAP and cerebral oxygenation index (OI) by means of near-infrared spectroscopy (NIRS) for 2.3 ± 0.5 h, starting 18 ± 9 hafter birth. Coherence and transfer function gain between MAP and OI represented the presence and degree of impairment of CA, respectively. We considered fetalvasculitis (placenta histology) to be an antenatal marker of inflammation, andused the level of IL-6 in blood, measured at 18 ± 10 h after birth, as apostnatal marker of inflammation. Definition of hypotension was MAP (mm Hg) ≤ GA (wk).

PMID: 22278187 [PubMed - indexed for MEDLINE]