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Postnatal cytomegalovirus infections did not alter amplitude-integrated electroencephalography signals or general movements in preterm infants.
Neubauer V
,Gande N
,Winkler I
,Posod A
,Schreiner C
,Hammerl M
,Kiechl-Kohlendorfer U
,Griesmaier E
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Cycled light in the intensive care unit for preterm and low birth weight infants.
Preterm and low birth weight infants are at an early stage of development, and do not receive adequate maternal circadian signals. They are often cared for over prolonged periods of hospitalisation in neonatal intensive care units (NICU), where environmental circadian stimuli are lacking. Exposure to artificial light-dark cycles may stimulate the development of the circadian system and improve clinical outcomes. However, it remains uncertain whether cycled light (CL) is preferable to near darkness (ND) or continuous bright light (CBL) in fostering development and maturation, and reducing adverse neonatal health outcomes. This is an update of an earlier Cochrane review, last published in 2016.
To evaluate the benefits and harms of CL in preterm and low birth weight infants compared to ND or CBL.
We searched CENTRAL, PubMed, Embase, and two trial registries to September 2023. We also checked reference lists, and searched for retractions of included studies.
We included randomised controlled trials (RCTs) or quasi-RCTs in preterm infants (< 37 weeks' postmenstrual age (PMA)), or those with a low birth weight (< 2500 g), admitted and cared for in an NICU or a step-down unit, comparing CL with ND or CBL.
We used the standard review methods of the Cochrane Neonatal Review Group to assess the methodological quality of studies. We used the fixed-effect model with risk ratio (RR) and mean difference (MD), with their 95% confidence intervals (CIs) for dichotomous data. Our primary outcomes were (1) growth at three and six months' corrected age, (2) major neurodevelopmental disability, and (3) adverse effects. Our secondary outcomes were (4) retinopathy of prematurity, (5) duration of initial hospitalisation, (6) duration of oxygen treatment, and (7) parent satisfaction. We used GRADE to assess the certainty of evidence for each outcome.
We included 20 studies with 1633 infants. Data for meta-analysis were available for 11 studies (1126 infants). One study with multiple arms was included in both comparisons. We rated the overall risk of bias at the study level as high or unclear for all 20 studies that had one or several unclear or high risk of bias judgements across the domains. Cycled light versus dimmed light or near darkness (10 studies) The evidence is very uncertain about the effect of cycled light compared to dimmed light (reduction of illumination levels) or near darkness on weight at three months (MD 24.79, 95% CI -262.33 to 311.91; 2 studies, 187 infants; very low-certainty evidence), and weight at six months (MD 202, 95% CI -109.68 to 513.68; 1 study, 147 infants; very low-certainty evidence). The studies did not report any data for major neurodevelopmental disability. No data are available for adverse effects; it is uncertain if the absence of adverse effects is because none occurred, or because they were not identified and recorded. The evidence is very uncertain about the effect of cycled light compared to dimmed light or near darkness on the likelihood of developing retinopathy of prematurity of any stage (RR 0.89, 95% CI 0.76 to 1.03; 3 studies, 307 infants; very low-certainty evidence), and severe retinopathy of prematurity of stage 3 or higher (RR 0.98, 95% CI 0.59 to 1.61; 4 studies, 454 infants; very low-certainty evidence). Cycled light compared to dimmed light or near darkness may have little to no effect on the duration of initial hospitalisation (MD -3.04, 95% CI -7.86 to 1.78; 5 studies, 550 infants; very low-certainty evidence), but the evidence is very uncertain. Cycled light versus continuous bright light (11 studies) No data are available on the following primary outcomes, as no studies reported them: growth at three and six months' corrected age, major neurodevelopmental disability, and adverse effects. It is uncertain if the absence of adverse effects is because none occurred or because they were not identified and recorded. No data are available on retinopathy of prematurity, as no studies reported it. Cycled light compared to continuous bright light may reduce the duration of initial hospitalisation, but the evidence is very uncertain (MD -9.86, 95% CI -10.09 to -9.63; 5 studies, 499 infants; very low-certainty evidence).
Despite identifying 20 studies, we remain uncertain about the effect of CL compared to ND or CBL on all outcomes of interest in this review. In addition, a few critical outcomes were not reported by any of the included studies. The evidence remains uncertain about whether CL is the right choice in the NICU. The physician should always weigh the benefits and risks, based on the effects of the different options in the specific setting.
Morag I
,Xiao YT
,Bruschettini M
《Cochrane Database of Systematic Reviews》
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Inhaled bronchodilators for the prevention and treatment of chronic lung disease in preterm infants.
Chronic lung disease (CLD) occurs frequently in preterm infants and is associated with respiratory morbidity. Bronchodilators have the potential effect of dilating small airways with muscle hypertrophy. Increased compliance and tidal volume, and decreased airway resistance, have been documented with the use of bronchodilators in infants with CLD. Therefore, bronchodilators are widely considered to have a role in the prevention and treatment of CLD, but there remains uncertainty as to whether they improve clinical outcomes. This is an update of the 2016 Cochrane review.
To determine the effect of inhaled bronchodilators given as prophylaxis or as treatment for chronic lung disease (CLD) on mortality and other complications of preterm birth in infants at risk for or identified as having CLD.
An Information Specialist searched CENTRAL, MEDLINE, Embase, CINAHL and three trials registers from 2016 to May 2023. In addition, the review authors undertook reference checking, citation searching and contact with trial authors to identify additional studies.
We included randomised and quasi-randomised controlled trials involving preterm infants less than 32 weeks old that compared bronchodilators to no intervention or placebo. CLD was defined as oxygen dependency at 28 days of life or at 36 weeks' postmenstrual age. Initiation of bronchodilator therapy for the prevention of CLD had to occur within two weeks of birth. Treatment of infants with CLD had to be initiated before discharge from the neonatal unit. The intervention had to include administration of a bronchodilator by nebulisation or metered dose inhaler. The comparator was no intervention or placebo.
We used the standard methodological procedures expected by Cochrane. Critical outcomes included: mortality within the trial period; CLD (defined as oxygen dependency at 28 days of life or at 36 weeks' postmenstrual age); adverse effects of bronchodilators, including hypokalaemia (low potassium levels in the blood), tachycardia, cardiac arrhythmia, tremor, hypertension and hyperglycaemia (high blood sugar); and pneumothorax. We used the GRADE approach to assess the certainty of the evidence for each outcome.
We included two randomised controlled trials in this review update. Only one trial provided useable outcome data. This trial was conducted in six neonatal intensive care units in France and Portugal, and involved 173 participants with a gestational age of less than 31 weeks. The infants in the intervention group received salbutamol for the prevention of CLD. The evidence suggests that salbutamol may result in little to no difference in mortality (risk ratio (RR) 1.08, 95% confidence interval (CI) 0.50 to 2.31; risk difference (RD) 0.01, 95% CI -0.09 to 0.11; low-certainty evidence) or CLD at 28 days (RR 1.03, 95% CI 0.78 to 1.37; RD 0.02, 95% CI -0.13 to 0.17; low-certainty evidence), when compared to placebo. The evidence is very uncertain about the effect of salbutamol on pneumothorax. The one trial with usable data reported that there were no relevant differences between groups, without providing the number of events (very low-certainty evidence). Investigators in this study did not report if side effects occurred. We found no eligible trials that evaluated the use of bronchodilator therapy for the treatment of infants with CLD. We identified no ongoing studies.
Low-certainty evidence from one trial showed that inhaled bronchodilator prophylaxis may result in little or no difference in the incidence of mortality or CLD in preterm infants, when compared to placebo. The evidence is very uncertain about the effect of salbutamol on pneumothorax, and neither included study reported on the incidence of serious adverse effects. We identified no trials that studied the use of bronchodilator therapy for the treatment of CLD. Additional clinical trials are necessary to assess the role of bronchodilator agents in the prophylaxis or treatment of CLD. Researchers studying the effects of inhaled bronchodilators in preterm infants should include relevant clinical outcomes in addition to pulmonary mechanical outcomes.
Ng G
,Bruschettini M
,Ibrahim J
,da Silva O
... -
《Cochrane Database of Systematic Reviews》
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Noise or sound management in the neonatal intensive care unit for preterm or very low birth weight infants.
Infants in the neonatal intensive care unit (NICU) are subjected to different types of stress, including sounds of high intensity. The sound levels in NICUs often exceed the maximum acceptable level recommended by the American Academy of Pediatrics, which is 45 decibels (dB). Hearing impairment is diagnosed in 2% to 10% of preterm infants compared to only 0.1% of the general paediatric population. Bringing sound levels under 45 dB can be achieved by lowering the sound levels in an entire unit; by treating the infant in a section of a NICU, in a 'private' room, or in incubators in which the sound levels are controlled; or by reducing sound levels at the individual level using earmuffs or earplugs. By lowering sound levels, the resulting stress can be diminished, thereby promoting growth and reducing adverse neonatal outcomes. This review is an update of one originally published in 2015 and first updated in 2020.
To determine the benefits and harms of sound reduction on the growth and long-term neurodevelopmental outcomes of neonates.
We used standard, extensive Cochrane search methods. On 21 and 22 August 2023, a Cochrane Information Specialist searched CENTRAL, PubMed, Embase, two other databases, two trials registers, and grey literature via Google Scholar and conference abstracts from Pediatric Academic Societies.
We included randomised controlled trials (RCTs) or quasi-RCTs in preterm infants (less than 32 weeks' postmenstrual age (PMA) or less than 1500 g birth weight) cared for in the resuscitation area, during transport, or once admitted to a NICU or stepdown unit. We specified three types of intervention: 1) intervention at the unit level (i.e. the entire neonatal department), 2) at the section or room level, or 3) at the individual level (e.g. hearing protection).
We used the standardised review methods of Cochrane Neonatal to assess the risk of bias in the studies. We used the risk ratio (RR) and risk difference (RD), with their 95% confidence intervals (CIs), for dichotomous data. We used the mean difference (MD) for continuous data. Our primary outcome was major neurodevelopmental disability. We used GRADE to assess the certainty of the evidence.
We included one RCT, which enroled 34 newborn infants randomised to the use of silicone earplugs versus no earplugs for hearing protection. It was a single-centre study conducted at the University of Texas Medical School in Houston, Texas, USA. Earplugs were positioned at the time of randomisation and worn continuously until the infants were 35 weeks' postmenstrual age (PMA) or discharged (whichever came first). Newborns in the control group received standard care. The evidence is very uncertain about the effects of silicone earplugs on the following outcomes. • Cerebral palsy (RR 3.00, 95% CI 0.15 to 61.74)and Mental Developmental Index (MDI) (Bayley II) at 18 to 22 months' corrected age (MD 14.00, 95% CI 3.13 to 24.87); no other indicators of major neurodevelopmental disability were reported. • Normal auditory functioning at discharge (RR 1.65, 95% CI 0.93 to 2.94) • All-cause mortality during hospital stay (RR 2.07, 95% CI 0.64 to 6.70; RD 0.20, 95% CI -0.09 to 0.50) • Weight (kg) at 18 to 22 months' corrected age (MD 0.31, 95% CI -1.53 to 2.16) • Height (cm) at 18 to 22 months' corrected age (MD 2.70, 95% CI -3.13 to 8.53) • Days of assisted ventilation (MD -1.44, 95% CI -23.29 to 20.41) • Days of initial hospitalisation (MD 1.36, 95% CI -31.03 to 33.75) For all outcomes, we judged the certainty of evidence as very low. We identified one ongoing RCT that will compare the effects of reduced noise levels and cycled light on visual and neural development in preterm infants.
No studies evaluated interventions to reduce sound levels below 45 dB across the whole neonatal unit or in a room within it. We found only one study that evaluated the benefits of sound reduction in the neonatal intensive care unit for hearing protection in preterm infants. The study compared the use of silicone earplugs versus no earplugs in newborns of very low birth weight (less than 1500 g). Considering the very small sample size, imprecise results, and high risk of attrition bias, the evidence based on this research is very uncertain and no conclusions can be drawn. As there is a lack of evidence to inform healthcare or policy decisions, large, well designed, well conducted, and fully reported RCTs that analyse different aspects of noise reduction in NICUs are needed. They should report both short- and long-term outcomes.
Sibrecht G
,Wróblewska-Seniuk K
,Bruschettini M
《Cochrane Database of Systematic Reviews》
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Perception of quality of life in school-age children born before 32 weeks of gestational age.
Preterm infants with bronchopulmonary dysplasia (BPD) are at increased risk of disruptions in their quality of life (QoL) at school age, often associated with respiratory morbidity and the need for ongoing hospital care. The objective of this study is to assess the impact of BPD on the perceived quality of life in preterm infants at school age. We conducted a prospective observational study of infants born at less than 32 weeks gestation who were admitted to our neonatal unit between January 2012 and December 2014. These children were followed up, and at ages 8 to 10 years, their quality of life was assessed using the Pediatric Quality of Life (PedsQL) questionnaire, with higher scores indicating poorer quality of life. The study included 102 patients with a mean gestational age of 29.42 weeks (SD 1.87) and a mean birth weight of 1221.36 g (SD 347.25), with an average age of 8.59 years (SD 0.90) at the time of the survey. Patients with BPD 2-3 exhibited a significantly poorer perception of "total quality of life" (p = 0.03) and in the "social activities" domain (p = 0.02) compared to those without BPD or with BPD 1, even after adjusting for gestational age in a multivariate model. No significant differences were observed for the "health and activities" domain (p = 0.31), "emotional state" domain (p = 0.58), or "school activities" domain (p = 0.33). Patients who experienced asthma symptoms during follow-up had a poorer perception of total quality of life than those who did not (20.53 (SD 6.19) vs. 11.89 (SD 1.44), p < 0.01). No significant differences were found between patients without a diagnosis of BPD and those with grade 1 BPD. Similarly, no significant differences were observed when comparing patients of less than 28 weeks gestational age and more than 28 weeks of gestational age.
In our population of preterm school-aged children with grades 2-3 BPD, worse perceived quality of life was reported compared to those with no BPD or grade 1 BPD. Preterm children who developed asthma symptoms during the follow-up period also reported lower perceived quality of life. No differences in QoL were observed between patients with no BPD and those with grade 1 BPD, or between those born before and after 28 weeks of gestation. These findings highlight the importance of assessing the QoL in preterm patients with BPD, particularly those with grade 2-3 BPD or asthma symptoms, as early assessment can help identify patients who may benefit from targeted interventions to improve quality of life and long-term outcomes.
• Survival rates of extremely preterm infants have increased significantly in recent years, but respiratory morbidity, particularly bronchopulmonary dysplasia, remains a common problem. The impact of BPD on the quality of life of preterm infants, particularly at school age, is still debated. BPD is associated with an increased risk of asthma and abnormal lung function, but its effect on QoL is not fully understood.
• Preterm infants with grade 2-3 BPD have a significantly worse perception of QoL at school age, especially in the domain of "social activities". This finding emphasises the need for long-term follow-up and possible interventions to improve QoL, especially in terms of social integration. Asthma symptoms during childhood also contribute to poorer QoL perceptions, highlighting the importance of early diagnosis and effective treatment.
Merino-Hernández A
,Muñoz-Cutillas A
,Ramos-Navarro C
,Bellón-Alonso S
,Rodríguez-Cimadevilla JL
,González-Pacheco N
,Sánchez-Luna M
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