Fetal Growth Restriction and Chronic Lung Disease among infants born before the 28th week of gestation

Carl Bose, Linda J Van Marter, Matthew Laughon, T Michael O'Shea, Elizabeth N Allred, Padmani Karna, Richard A Ehrenkranz, Kim Boggess, Alan Leviton, Extremely Low Gestational Age Newborn Study Investigators

Pediatrics 2009;124;e450-e458

PubMed Link

Among the prenatal factors, B. Wt z scores, used as a marker of FGR, provided most information about CLD risk. Indicators of placental inflammation and infection not associated with ↑risk of CLD. W/i ~all strata of prenatal, placental, and neonatal variables, FGRs infants were at ↑CLD risk. FGR was the only maternal or prenatal characteristic that was highly predictive of CLD after adjustment for other risks.

Developmental correlates of head circumference at birth and at two years in a cohort of ELGANs

Karl C K Kuban, Elizabeth N Allred, T Michael O'Shea, Nigel Paneth, Sjirk Westra, Cindy Miller, N Paul Rosman, Alan Leviton

J Pediatr 2009;155:344-9.e1-3

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A total of 11% of infants in our sample had MC at 2 years. MC at 2 years, but not at birth, predicts severe motor and cognitive impairments at 2 years. A total of 71% of children with congenital MC had a normal HC at 2 years and had neurodevelopmental outcomes ~ those with nl HC at birth and 2 years. Among children with MC at 2 years, more than half had a MDI <70, and nearly a third had CP. The risks were increased if child also had cerebral WM damage on neonatal HUS.Among ELGANs, MC at 2 yrs, but not at birth, is associated with motor and cognitive impairment at age 2.

Nutritional practices and growth velocity in the first month of life in extremely premature infants

Camilia R Martin, Yolanda F Brown, Richard A Ehrenkranz, T Michael O'Shea, Elizabeth N Allred, Mandy B Belfort, Marie C McCormick, Alan Leviton, Extremely Low Gestational Age Newborns Study Investigators

Pediatrics 2009;124:649-57

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Protein and fat delivery ~current nutritional recommendations, whereas CBH & total energy intake delivery did not. Yet, GV of infants > current guideline of 15 g/kg per/d. Yet, we found growth restriction (ie, weight for GA < 10th centile) in 75% of infants at 28 d. Early nutrients is important determinant of postnatal growth. Extrauterine growth restriction remains high in ELGANs even when w/GV rate within current guidelines.

Chronic lung disease and developmental delay at two years of age in children born before 28 weeks gestation

Matthew Laughon, Michael T O'Shea, Elizabeth N Allred, Carl Bose, Karl Kuban, Linda J Van Marter, Richard A Ehrenkranz, Alan Leviton, ELGAN Study Investigators

Pediatrics 2009;124:637-48.

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49% of ELGANs had CLD; of these, 14% received MV at 36 wks PM age. ELGANs w/o CLD had lowest risk of a MDI or PDI <55, followed by ELGANs with CLD not receiving MV, and ELGANs with CLD receiving MV (9%, 12%, and 18% for the MDI and 7%, 10%, and 20% for the PDI, respectively). In TORM models, the risk of an MDI of <55 ass’ed w/following variables: GA <25 wks; single mother; late bacteremia; PTX; and NEC. The risk of PDI of <55 ass’ed w/single mother, complete course of ACS, early & persistent pulm dysfunction, pulm deterioration during 2nd postnatal wk, PTX, and PIE. CLD, without or with MV, not ass’ed w/risk of either low MDI or low PDI.

Perinatal correlates of Ureaplasma urealyticum in placenta parenchyma of singleton pregnancies that end before 28 weeks of gestation

I Nicholas Olomu, Jonathan L Hecht, Andrew O Onderdonk, Elizabeth N Allred, Alan Leviton, Extremely Low Gestational Age Newborn Study Investigators

Pediatrics 2009;123:1329-136.

PubMed Link

U urealyticum was recovered from 6% and bacteria from 47%; 47% of placentas had no bacteria detectable. The presence of U urealyticum in placental parenchyma before 28 weeks is associated with increased risk of preterm labor and delivery, higher risk of fetal and maternal inflammation, and increased risk of intraventricular hemorrhage and echolucent brain lesions but not of early neonatal death.

Patterns of respiratory disease during the first two postnatal weeks in extremely premature infants

Matthew Laughon, Elizabeth N Allred, Carl Bose, T Michael O'Shea, Linda J Van Marter, Richard A Ehrenkranz, Alan Leviton, ELGAN Study Investigators

Pediatrics 2009;123:1124 -1131.

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20% of infants had consistently low fraction of inspired oxygen, ~ 38% had pulm deterioration, and remaining 43% had consistently high fraction of inspired O2 (early and persistent lung dysfunction). Infants w/pulm deterioration had lower GA and lower B Wts, had higher SNAP, and received more respiratory support. Gender, multifetal pregnancy, C/S, ACS, chorioamnionitis, & funisitis not associated w/pulm deterioration. Incidence of CLD, O2 tx at 36 wks’, was 17% in low fraction of inspired O2 group, 51% in pulm deterioration group, & 67% in early/persistent pulm dysfunction group.

Positive screening on the Modified-Checklist for Autism in Toddlers (M-CHAT) in Extremely Low Gestational Age Newborns

Karl C K Kuban, T Michael O'Shea, Elizabeth N Allred, Helen Tager-Flusberg, Donald J Goldstein, Alan Leviton

J Pediatr 2009;154:535-540.e1

PubMed Link

Odds for screening + on M-CHAT ↑ 23-fold for those unable to sit or stand and 7-fold if unable to walk. Children with QP were 13 X more likely to screen +, and those with HP 4 X more likely to screen +. Children with major vision or hearing impairments were 8 X more likely to screen +. Odds for screening + were increased 13-fold with MDI <55 and > than 4-fold for MDI 55-69. Even after motor, cognitive, visual, & hearing impairments eliminated, 10% screened +: double expected rate.

Cranial ultrasound lesions in the NICU predict cerebral palsy at age 2 years in children who were born at extremely low gestational age

Karl C K Kuban, Elizabeth N Allred, T Michael O'Shea, Nigel Paneth, Marcello Pagano, Olaf Dammann, Alan Leviton, Adré Du Plessis, Sjirk J Westra, Cindy R Miller, Haim Bassan, Kalpathy Krishnamoorthy, Joseph Junewick, Nicholas Olomu, Elaine Romano, Joanna Seibert, Steve Engelke, Padmani Karna, Daniel Batton, Sunila E O'Connor, Cecelia E Keller, ELGAN study investigators

J Child Neurol 2009;24:63-72

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HUS in 1053 infants were read with respect to IVH, VMeg, and EL. Standardized neuro exams classified CP, and functional impairment. 44% w/ VMeg and 52% w/ EL developed cerebral palsy. Compared with no ultrasound abnormalities, children with were 24 X > likely to have QP and 29 X > likely to have HP. Children w/VMeg were 17 X > likely to have QP or HP. 43 % w/CP had nl HUS. EL, late VMeg had ↑probability of CP, esp QP. Nearly ½ w/CP had no HUS abnormality.

Pregnancy disorders that lead to delivery before the 28th week of gestation: and epidemiologic approach to classification

T F McElrath, J L Hecht, O Dammann, K Boggess, A Onderdonk, G Markenson, M Harper, E Delpapa, E N Allred, A Leviton, ELGAN Study Investigators

Am J Epidemiol 2008;168:980-9

PubMed Link

We enrolled 1,006 women who delivered a liveborn singleton ELGAN infants. Each delivery classified by presentation: preterm labor (40%), prelabor premature rupture of membranes (23%), preeclampsia (18%), placental abruption (11%), cervical incompetence (5%), and fetal indication/intrauterine growth restriction (3%). Using factor analysis, the authors found 2 broad patterns. One pattern, characterized by histo chorioamnionitis and placental microbe recovery, was associated with preterm labor, prelabor PROM, placental abruption, and cervical insufficiency. The other, had paucity of orgs and inflammation but presence of histo features of abnl placentation, & ass’ed w/PET and IUGR. Preterm delivery disorders may be separated into two groups: those with intrauterine inflammation and those associated with aberrations of placentation.

An algorithm for identifying and classifying cerebral palsy in young children

Karl C K Kuban, Elizabeth N Allred, Michael O'Shea, Nigel Paneth, Marcello Pagano, Alan Leviton, ELGAN Study Cerebral Palsy-Algorithm Group

J Pediatr 2008;153:466-472

PubMed Link

Of 1056 children examined, 11.4% had an algorithm-based CP. Of these, 31% had DP, 17% had HP, and 52% had QP. Children with QP were 9 X more likely than DP (76% versus 8%) to be more highly impaired and 5 X more likely to be microcephalic (43% versus 8%). They were > than 2 X as likely as children with DP to have MDI <70 and were MCHAT+ 76% compared with DP (30%) and w/oCP (18%).