Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0728731 (prematurity)
 7,134 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The opportunities for very low birth weight infants (birth weight < 1500 g) and extremely low birth weight infants (birth weight < 1000 g) to undergo surgery are increasing. These infants are prone to prematurity-related morbidities including respiratory distress syndrome, intraventricular haemorrhage, periventricular leukomalacia, retinopathy of prematurity, patent ductus arteriosus and necrotising enterocolitis. Evidence is accumulating that preterm infants are also sensitive to pain and stress. The pharmacokinetics of drugs in preterm infants is not fully understood but smaller doses of anaesthetic drugs are usually required in preterm infants compared to term infants and older children and their effects last longer due to low clearance rates and longer elimination half-lives. Key anaesthetic considerations are (i) inspired oxygen concentration that should be adjusted to avoid hyperoxia, (ii) haemodynamic parameters that should be kept stable and (iii) prevention of hypothermia by using adequate measures to keep the infants warm. These precautions must be continuously taken during the operation and the transport to and from the operating theatre.
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PMID:Anaesthetic considerations for the management of very low and extremely low birth weight infants. 1517 4

The number of infants born prematurely has been increasing over the past few years; their survival rate has also been increasing because of the multiple advances in health care. The premature infants usually have a number of medical problems, asphyxia, ROP, NEC, HMD, BPD, deficient drug metabolism, IVH, hematologic derangements, temperature dysregulation, and they present often to surgery. The different medical problems associated with prematurity can be challenging for the anesthesiologist. Preterm infants require adequate anesthesia since they are capable of mounting a stress response otherwise. Preoperative evaluation of the medical problems of the infant is essential. Data on anesthetic requirements of premature is that few prematures require less anesthesia than mature newborns. Anesthesia can be induced with inhaled anesthetic agents but these cause hypotension. Thiopental or fentanyl given intravascular can be used instead. Fentanyl can be also used for maintenance. Ventilation should be manipulated during the operation to accommodate for the change in compliance and resistance due to retractors and packs. Fluid losses should be well estimated and replaced. Emergence is as dangerous as induction and involves the risk of apnea.
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PMID:Anesthesia for the premature infant. 1525 69

We studied the maternal and neonatal profile and outcome of extremely low birth weight (ELBW) babies at the level III neonatal intensive care unit (NICU) in Delhi. Case records of ELBW inborn babies delivered between August 2000 and August 2001 were analysed by using a pre-set proforma. A total of 52 ELBW babies were admitted to the NICU in the relevant period, of whom 30 (57%) survived. Maternal anaemia, previous preterm delivery and pregnancy-induced hypertension (PIH) were the common predisposing factors for preterm delivery. Mean gestational age was 27.8 weeks and mean birth weight was 831 g. The highest mortality (55%) was seen in babies with 26-28 weeks'gestation and those in the birth weight category of < 800 g. Neonatal hyperbilirubinaemia (78%) and hyaline membrane disease/respiratory distress syndrome (65%) were the most common causes of morbidity. A total of 25 babies were mechanically ventilated while 24 (46%) received total parenteral nutrition. Sepsis, pulmonary haemorrhage, intracranial haemorrhage and necrotizing enterocolitis accounted for the deaths in the study population. Retinopathy of prematurity screening was performed in 35 babies (68%), of whom 22 were found to be normal. According to the International Classification of Retinopathy of Prematurity, most babies (72%) had involvement of zone 3 and stage I (63%). The incidence was highest in 26-28 weeks'gestation babies (71%) and the < 800 g birth weight category (62%). Maternal risk factors such as anaemia and PIH commonly predispose to preterm delivery. There is an alarmingly high mortality in this population. Effective steps are required not only to avoid extreme prematurity but also to reduce morbidity and mortality of all newborns weighing <1000 g at birth.
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PMID:Maternal and neonatal profile and immediate outcome in extremely low birth weight babies in Delhi. 1526 50

Premature infants born with IUGR are at a several-fold increased risk for mortality and major neonatal morbidities, including RDS, BPD, ROP, and NEC. These severe complications of prematurity are intensified by the effect of suboptimal fetal growth. The possible pathophysiologic processes initiated in utero and continuing after birth have been discussed. Recently reported data suggest that IUGR is a risk factor in programming for the later development of cardiovascular diseases, hypertension, and diabetes mellitus in adult life. Experimental research related to the pathophysiology and etiology of these conditions may enable appropriate intervention directed at reducing the excess risk associated with the short- and long-term mortality and morbidity among premature SGA infants.
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PMID:Prematurity and intrauterine growth retardation--double jeopardy? 1532 32

IL-10 is an anti-inflammatory cytokine that may have a protective role in acute lung injury. IL-10 expression is affected by a single-nucleotide polymorphism (SNP) located at position -1082 (G to A). The A allele is associated with lower IL-10 production. Low IL-10 production has been linked to the development of BPD. Thus, the IL-10 -1082 SNP may be a genetic risk factor for the development of BPD in the premature newborn. The IL-10 -1082 SNP was determined in 294 (235 African American, 56 Caucasian, and 3 Hispanic) mechanically ventilated very low birth weight (VLBW) infants and compared to outcome (death and/or development of BPD). Differences in groups were analyzed using ANOVA (continuous variables) or chi square (proportions). The frequency of the A allele in our population was 0.62. Thirty-nine (13.3%) infants were homozygous GG, 146 (49.7%) were heterozygous GA, and 109 (37.0%) were homozygous AA. There were no significant differences between genotype groups with respect to ethnic origin, gender, need for surfactant replacement therapy, and isolation of Ureaplasma urealyticum or Mycoplasma hominis from tracheal aspirates at birth. However, AA infants were slightly more mature and of greater birth weight than GA infants (26.9 +/- 0.2 weeks vs. 26.3 +/- 0.2 weeks, P < 0.05, and 940 +/- 22 g vs. 882 +/- 18 g, P < 0.05, respectively). There was no significant effect of the IL-10 -1082 SNP on mortality or the development of BPD (O2 on 28 days or 36 weeks postconceptional age). However, when considered together, the IL-10 -1082 AA/GA genotypes (lower IL-10 production) were associated with a trend toward reduction in risk for the combined outcome of BPD or death (18/39 vs. 80/255, respectively; P = 0.068). The incidence of other complications of prematurity (retinopathy of prematurity, intraventricular hemorrhage, or periventricular leukomalacia) was not different between groups. In conclusion, the IL-10 -1082 G/A SNP does not have a major influence on mortality or the development of BPD in ventilated VLBW infants.
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PMID:Interleukin-10 -1082 G/A polymorphism and risk of death or bronchopulmonary dysplasia in ventilated very low birth weight infants. 1567 10

IGF-I is important for somatic growth and development of the human fetus and neonate. IGF-I also plays an important role in normal vascularization of human retina, as it has been suggested that insufficient IGF-I may be a factor in the development of retinopathy of prematurity. The principal regulator of the bioavailability of IGF-I in the circulation is IGF binding protein 3 (IGFBP-3). The aim of this study was to study factors associated with postnatal serum concentrations of IGF-I and of IGFBP-3 in preterm infants from birth to an age corresponding to 40 wk postmenstruation. We conducted a prospective, longitudinal study in which we measured serum IGF-I and IGFBP-3 concentrations in 76 preterm infants from birth (postmenstrual ages 23-32 wk) until discharge from hospital around 40 wk. Information regarding nutrition, weight gain, maternal factors, and treatment with corticosteroids were collected weekly. Variables found to be associated with postnatal change over time of serum IGF-I and IGFBP-3 were postmenstrual age (p<0.001), weight gain (standard deviation score) (p<0.001), and enteral intake of protein (p<0.001). Male gender was associated with lower IGF-I levels (p<0.001). The relationship between protein intake and IGF-I (and also between protein intake and IGFBP-3) was positive, as was the relationship between weight gain and IGF-I (and between weight gain and IGFBP-3). These results indicate that the degree of prematurity, low enteral protein intake, male gender, and slow weight gain are associated with a slower postnatal increase of IGF-I in preterm infants.
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PMID:The role of maternal factors, postnatal nutrition, weight gain, and gender in regulation of serum IGF-I among preterm infants. 1569 99

With improved survival of very low birth weight infants in China over the last decade, chronic lung disease of prematurity (CLD) is only now becoming prevalent. As a result the management of CLD in China is only now beginning. In this paper, we describe the practice of managing these infants with as much evidence base as possible but often the management is based on other published papers in China and elsewhere and other people's personal experience. It appears that oxygen therapy is important to the survival of CLD infants but blood oxygen concentrations must be monitored closely in infants needing oxygen supplementation. We aim for a target range for oxygen saturation range of between 90%-95% to prevent retinopathy of prematurity. Although dexamethasone is effective in the treatment of CLD particularly extubation of preterm infants from mechanical ventilation, we restrict its use in severe infant due to their side effects. We have little experience of home oxygen and are only now setting up management protocols for oxygen use for CLD in both hospital and at home. We hope that the survival and outlook for these infants with CLD will improve over the next few years.
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PMID:Management of infants with chronic lung disease of prematurity in China. 1574 69

This study evaluated the impact of premature birth on the development of local and global motion processing in a group of very low birthweight (<1500 g), 5- to 8-year-old children. Sensitivity to first- and second-order local motion stimuli and coherence thresholds for global motion in random dot kinematograms were measured. Relative to full-term controls, premature children showed deficits on all three aspects of motion processing. These problems could not be accounted for by stereo deficits, amblyopia, or attentional problems. A history of mild retinopathy of prematurity and/or intraventricular hemorrhage increased risk, but deficits were observed in some children with no apparent ocular or cerebral pathology. It is important to note that, despite the observed group differences, individual profiles of performance did vary; the results suggest that these three forms of motion processing may involve separate neural mechanisms. These findings serve to increase our understanding of the organization and functional development of motion-processing subsystems in humans, and of the impact of prematurity and associated complications on visual development.
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PMID:Deficits in the processing of local and global motion in very low birthweight children. 1615 49

The number and total volume of blood transfusions received by premature babies is, after gestational age and birth weight a good predictor of the likelihood of developing chronic lung disease of prematurity (CLD) and retinopathy of prematurity (ROP). Oxidative damage, inflammation and pulmonary infections are also strongly associated with the development of CLD. It is currently not clear whether there is a causal relationship between the receipt of blood transfusions and oxidative damage, infection, inflammation and CLD in these babies. Strong arguments may be made both for and against a causal relationship. The babies who receive blood transfusions are usually smaller than those who do not, and are ventilated, often with high oxygen levels, for a longer period of time. The longer the baby is on a ventilator the more likely it is to develop pulmonary infection and inflammation. All these factors will promote free radical production and oxidative damage irrespective of the receipt of blood transfusion. This would argue against a causal relationship. On the other hand, an argument may be presented which is based on iron promoted free radical generation, infection and fibrosis consequent to the breakdown of haeme released from transfused erythrocytes. Haeme is broken down by haeme oxygenase (HO) to iron, CO and bilirubin. Under normal circumstances the products of HO activity are beneficial to the organism, but when HO activity is excessive, the products are potentially damaging. Free iron, (in the Fe2+ form) if not sequestered with protein or urate, will generate highly toxic free radicals via the Fenton and Heber-Wiess reactions, predispose the tissue to infection and promote fibrosis. The iron chelating ability of the premature baby appears to be limited so that it would be difficult to deal with any increase in free iron production. Free iron will in turn induce HO activity leading to a potentially serious positive feedback process. The lung is particularly sensitive to iron induced HO activity. In addition, HO activity may be enhanced by other events occurring in the premature lung such as the production of proinflammatory cytokines and the reduced level of glutathione. Thus, the possibility of a causal relationship clearly exists and needs to be examined. This can be attempted by measuring the products of HO activity in relation to the receipt of blood transfusions.
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PMID:Is there a causal relationship between the receipt of blood transfusions and the development of chronic lung disease of prematurity? 1623 59

The aim of the study was to determine the prognostic value of some pathologies related to prematurity in the development of stage 3 ROP in children with extremely low birth-weight. The group of 35 prematures with diagnosed 3rd stage ROP and 64 prematures without ROP was examined. The presence of the respiratory distress syndrome (RDS), persistent ductus arteriosus (PDA), necrotizing enterocolitis (NEC) and intraventricular haemorrhages (IVH) were analyzed. RDS was more frequent in prematures with 3rd stage ROP (p=0.005, OR=3.59). There was significant difference between the frequency of IVH in both groups (p = 0.03), but the odds ratio was significantly high only in the children with the 3rd stage IVH (OR=2.42). PDA was diagnosed more frequently in children with 3rd stage ROP but the difference was not statistically significant (p= 0.1 52, OR=1.80). There was significant difference between the groups when comparing the incidence of NEC (p=0.03, OR=3.34). The pathologies of the prematurity such as RDS, NEC and grade III IVH are the predictive factors for the development of stage 3 ROP (p=0.03, OR=3.34).
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PMID:[The relation between the clinical state of the premature and the development of 3rd stage of retinopathy of prematurity]. 1641


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