Variation in follow-up for children born very preterm in Europe

Background: Children born very preterm (<32 weeks of gestation) face high risks of neurodevelopmental and health difficulties compared with children born at term. Follow-up after discharge from the neonatal intensive care unit is essential to ensure early detection and intervention, but data on policy approaches are sparse. Methods: We investigated the characteristics of follow-up policy and programmes in 11 European countries from 2011 to 2022 using healthcare informant questionnaires and the published/grey literature. We further explored how one aspect of follow-up, its recommended duration, may be reflected in the percent of parents reporting that their children are receiving follow-up services at 5 years of age in these countries using data from an area-based cohort of very preterm births in 2011/12 (N = 3635). Results: Between 2011/12 and 22, the number of countries with follow-up policies or programmes increased from 6 to 11. The policies and programmes were heterogeneous in eligibility criteria, duration and content. In countries that recommended longer follow-up, parent-reported follow-up rates at 5 years of age were higher, especially among the highest risk children, born <28 weeks’ gestation or with birthweight <1000 g: between 42.1% and 70.1%, vs. <20% in most countries without recommendations. Conclusions: Large variations exist in follow-up policies and programmes for children born very preterm in Europe; differences in recommended duration translate into cross-country disparities in reported follow-up at 5 years of age

ADVANCED QUANTIFICATION OF THE NEONATAL HEART-RATE VARIABILITY BY SPECTRAL ANALYSIS

Peer Reviewe

Reintubation and risk of morbidity and mortality in preterm infants after surfactant replacement therapy

Background: In preterm infants at risk for RDS, reintubation following surfactant replacement therapy and successful extubation may be associated with poor clinical outcomes. Methods: Initial extubation, reintubation, mortality, and major morbidity rates associated with prematurity from two surfactant trials utilizing lucinactant, colfosceril palmitate, beractant, and poractant alfa were compared for reintubated infants versus infants who were not reintubated, and among treatment groups. Results: Initial extubation rates were similar among surfactant treatments in both trials (80-84%; p = ns). Reintubated infants had significantly higher mortality rates versus infants who were successfully extubated and never reintubated (18% vs. 0.5% respectively; OR 42 [CI 15.1-114]). Reintubated infants also had higher rates of BPD (OR 8.2; CI 5.8-11.5), air leak (3.0; 2.1-4.5), sepsis (3.6; 2.6-4.9), NEC (2.6; 1.8-3.7), IVH (3.3; 2.4-4.5), and PVL (1.8; 1.1-2.8). Reintubation rates were lower (p &lt

Umbilical cord serum magnesium level and neonatal outcome in group of neonates at 30-34 gestational age

Aim of study. To find correlation between the umbilical serum cord magnesium concentration in a group of newborns without antenatal exposition to magnesium sulphate and the neonatal outcome as well as to compare the neonatal outcome of babies with maternal magnesium sulphate treatment. Results. In a group of 82 newborns (31-34 GA; birth body weight <1500 g) the umbilical cord serum magnesium concentrations was assayed. Three subgroups of neonates were set apart: first group (N) with a normal magnesium level (n=28), the second group (n=19) with magnesium concentration <0.75 mmol/dl (D), and the third group (Mg) consisting of 35 newborn antenatally exposed to magnesium sulphate. These groups were similar (no statistical significances) in terms of birth body weight, gestational age, Apgar score and umbilical blood pH. Gradual decrease in magnesium concentration in relation to increase of gestational age was observed. In groups: D, N, Mg, gradual reduction of hospitalization time (p<0.05), risk of death, time of respiratory support, time of oxygen therapy, rate of bronchopulmonary dysplasia, periventricular leucomalation (p<0.05) were observed respectively. Likewise, a rate of serious neurological complication (IVH/ PVL) in group D was higher in comparison to groups N and Mg (although without statistical sig-nificances). Conclusion. Our results confirm that umbilical cord magnesium concentration in VLBW neonates have an influence on neonatal outcome. Although it is premature to recommend ordering maternal magnesium sulphate treatment to improve neonatal outcome, in our opinion the data presented here should at least induce magnesium concentration monitoring in pregnant women and magnesium deficiency correction

Variations in the organization of obstetric and neonatal care in Europe

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