Hyperbilirubinemia and Neurodevelopmental Outcome of Very Low Birthweight Infants: Results from the LIFT Cohort

Bilirubin-related neurotoxicity is an important clinical issue in very low birthweight (VLBW) infants, and the existing literature is inconsistent.To analyze the relationship between maximal serum unconjugated bilirubin levels (SBL) and neurodevelopmental outcome at 2-year corrected age in VLBW infants.Phototherapy was initiated in all infants born before 33 weeks of gestation, according to Maisels' recommendations. Neurodevelopmental assessment at 2-year corrected age was performed in all infants that survived. SBLs collected during the first week of life were used to define three tertiles of max-SBL. The first tertile corresponded to infants with the lowest max-SBL. percentile curves of SBLs in infants with an optimal outcome). When Maisels' recommendations were applied, max SBLs were higher in 8% of infants weighing 1001–1500 g and in 15% of infants weighing less than 1001 g. Our data seems to validate Maisels' recommendations in the overall population of infants born before 33 weeks of gestation, but not in infants weighing less than 1001 g

Characteristics of the study population.

<p>Characteristics of the study population.</p

Changes in mean serum unconjugated bilirubin levels (SBL) during the first week of life in relation to birthweight.

<p>This figure shows three graphs: (1) the upper graph concerns infants with birthweight under 1500 g; (2) the intermediary graph concerns infants with birthweight between 1001 and 1500 g, and (3) the lower graph concerns the smallest infants (under 1001 g). Each graph is composed by four curves: three curves representing changes in mean SBL in infants of the first tertile (line a), second tertile (line b) and third tertile (line c). The fourth curve (dotted line or line d) represents the 95^th percentile of SBL in infants with an optimal neurological outcome at 2-year corrected age.</p

Association between maximal serum non-conjugated bilirubin level and non-optimal neurological outcome at 2-year corrected age (n = 631).

<p>Pregnancy characteristics included prenatal corticosteroid treatment, multiple pregnancies, hypertension during pregnancy, premature rupture of membranes >24 h and cesarean section. Mother characteristics included health insurance for low financial income and upper socio-demographic level. Infant characteristics included GA, birthweight, small for GA and gender. Neonatal hospitalization characteristics included surfactant therapy, maternofetal sepsis, nosocomial sepsis, bronchopulmonary dysplasia, hemodynamic failure and patent ductus arteriosus requiring treatment.</p

Association between maximal non conjugated bilirubin level and non-optimal neurological outcome in 631 infants at 2-year corrected age (subpopulations studies).

<p>Adjustment was performed for pregnancy, infant and neonatal hospitalization characteristics. Pregnancy characteristics included prenatal corticosteroid treatment, multiple pregnancies, hypertension during pregnancy, premature rupture of membranes >24 h, and cesarean section. Mother characteristics included health insurance for low financial income and upper socio-demographic level. Infant characteristics included GA, birthweight, small for GA, gender. Neonatal hospitalization characteristics included surfactant therapy, maternofetal sepsis, nosocomial sepsis, bronchopulmonary dysplasia, hemodynamic failure and patent ductus arteriosus requiring treatment.</p

Association between neonatal characteristics of 631 infants and non-optimal neurological outcome at 2-year corrected age.

<p>Association between neonatal characteristics of 631 infants and non-optimal neurological outcome at 2-year corrected age.</p

Prescription of Aminoglycosides in 23 French Neonatal Intensive Care Units

International audienceBackground: Aminoglycosides are the most prescribed antibiotics in neonatal intensive care units (NICU). Reducing exposure to antibiotics in the NICU is highly desirable, particularly through benchmarking methods. Methods: Description of aminoglycosides prescriptions in 23 French NICU using the same computerized system over a 4-year period (2017–2020). A benchmarking program of antibiotics prescription was associated. Results: The population included 53,818 patients. Exposition rates to gentamicin and amikacin were 31.7% (n = 17,049) and 9.1% (n = 4894), respectively. Among neonates exposed to gentamicin, 90.4% of gentamicin and 77.6% of amikacin treatments were started within the 1st week of life. Among neonates exposed to amikacin, 77.6% started amikacin within the 1st week. The average daily dose of gentamicin at first prescription increased over the study period from 3.9 in 2017 to 4.4 mg/kg/d in 2020 (p < 0.0001). Conversely, the corresponding amikacin daily doses decreased from 13.0 in 2017 to 12.3 mg/kg/d in 2020 (p = 0.001). The time interval between the first 2 doses of gentamicin was mainly distributed in 3 values during the first week of life: 49.4% at 24 h, 26.4% at 36 h, and 22.9% at 48 h. At first amikacin prescription, the time interval was distributed in 4 categories: 48% at 24 h, 4.1% at 30 h, 8.5% at 36 h, and 37.1% at 48 h. As compared to literature guidelines, the rates of overdose and underdose in gentamicin (1.5% and 2.7%) and amikacin (0.3% and 1.0%). They significantly decreased for gentamicin over the study period. In multivariate analysis, the factors significantly associated with GENT overdose were the year of admission, prematurity, length of stay, and duration of the treatment. Conclusion: This prescription strategy ensured a low rate of overdose and underdose, and some benefits of the benchmarking program is suggested

Characteristics of prescription in 29 Level 3 Neonatal Wards over a 2-year period (2017-2018). An inventory for future research

International audienceThe primary objective of this study is to determine the current level of patient medication exposure in Level 3 Neonatal Wards (L3NW). The secondary objective is to evaluate in the first month of life the rate of medication prescription not cited in the Summary of Product Characteristics (SmPC). A database containing all the medication prescriptions is collected as part of a prescription benchmarking program in the L3NW