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Biomedical subjects

Eric C Eichenwald

Publications and source records attributed to Eric C Eichenwald.

9 recordsLinked to original sources
PubMed2006

Inhaled nitric oxide in preterm infants undergoing mechanical ventilation.

BACKGROUND: Bronchopulmonary dysplasia in premature infants is associated with prolonged hospitalization, as well as abnormal pulmonary and neurodevelopmental outcome. In animal models, inhaled nitric oxide improves both gas exchange and lung structural development, but the use of this therapy in infants at risk for bronchopulmonary dysplasia is controversial. METHODS: We conducted a randomized, stratified, double-blind, placebo-controlled trial of inhaled nitric oxide at 21 centers involving infants with a birth weight of 1250 g or less who required ventilatory support between 7 and 21 days of age. Treated infants received decreasing concentrations of nitric oxide, beginning at 20 ppm, for a minimum of 24 days. The primary outcome was survival without bronchopulmonary dysplasia at 36 weeks of postmenstrual age. RESULTS: Among 294 infants receiving nitric oxide and 288 receiving placebo birth weight (766 g and 759 g, respectively), gestational age (26 weeks in both groups), and other characteristics were similar. The rate of survival without bronchopulmonary dysplasia at 36 weeks of postmenstrual age was 43.9 percent in the group receiving nitric oxide and 36.8 percent in the placebo group (P=0.042). The infants who received inhaled nitric oxide were discharged sooner (P=0.04) and received supplemental oxygen therapy for a shorter time (P=0.006). There were no short-term safety concerns. CONCLUSIONS: Inhaled nitric oxide therapy improves the pulmonary outcome for premature infants who are at risk for bronchopulmonary dysplasia when it is started between 7 and 21 days of age and has no apparent short-term adverse effects. (ClinicalTrials.gov number, NCT00000548 [ClinicalTrials.gov] .).

Administration, Inhalation↗
PubMed2006

Lower oxygen saturation alarm limits decrease the severity of retinopathy of prematurity.

PURPOSE: To determine whether lowering oxygen saturation alarm limits for infants at risk for retinopathy of prematurity (ROP) reduces its incidence and/or severity. METHODS: Oximetry alarm limits were lowered to 85% and 93% for all infants with a birth weight 1250 g or less and/or gestational age 28 weeks or less, and maintained until 32 weeks' postmenstrual age or until oxygen saturations were consistently greater than 93% in room air. The new policy was effective for infants born on or after June 1, 2003. ROP data were prospectively collected, and we compared the rate and severity of ROP in the year after the oximeter alarm policy change to the rates in the immediately preceding 3 years. RESULTS: In the year after the oximeter alarm limit policy change, 4 of 72 infants developed prethreshold ROP compared with 44 of 251 infants in the previous 3-year epoch (17.5% vs 5.6%, p=0.01). Similarly, only 6 of 144 eyes developed prethreshold ROP in the year after the policy change, compared with 84 of 502 in the previous 3 years (16.7% vs 4.2%, p=0.001). CONCLUSIONS: A simple change in oximeter alarm parameters in the first weeks of life for infants with a birth weight 1250 g or less may decrease the incidence of prethreshold ROP.

Disease Progression↗
PubMed2005

No increase in rates of early-onset neonatal sepsis by antibiotic-resistant group B Streptococcus in the era of intrapartum antibiotic prophylaxis.

OBJECTIVE: The aim of this study was to assess the rate of early-onset neonatal sepsis by antibiotic-resistant group B Streptococcus. STUDY DESIGN: The time-trend study was conducted at a tertiary care center over the following periods: no protocol for group B Streptococcus prophylaxis (1990 to 1992), risk-based protocol (1993 to 1996), and screening-based protocol (1997 to 2002). RESULTS: A total of 120,952 neonates were born with 118 cases of group B Streptococcus early-onset neonatal sepsis. The rate of group B Streptococcus early-onset neonatal sepsis decreased significantly (from 2.0 to 1.1 to 0.4 per 1000 births, P < .0001). No group B Streptococcus isolate was resistant to ampicillin, penicillin, cefazolin, or vancomycin. From 1997 to 2002, there were 3 clindamycin-resistant group B Streptococcus isolates (14%). The rate of erythromycin-resistant group B Streptococcus early-onset neonatal sepsis did not change (from 0.14 to 0.03 to 0.08 per 1000 births, P = .6). However, cases of erythromycin-resistant group B Streptococcus early-onset neonatal sepsis accounted for an increasing proportion of the remaining cases of group B Streptococcus early-onset neonatal sepsis (from 7.0% to 2.6% to 23.8%, P = .07). CONCLUSION: We found no increase in rates of antibiotic-resistant group B Streptococcus early-onset neonatal sepsis.

Age of Onset↗
PubMed2005

Interneonatal intensive care unit variation in growth rates and feeding practices in healthy moderately premature infants.

BACKGROUND: Variation in care and outcomes of very low birth weight infants (VLBW) in neonatal intensive care units (NICU) has been widely reported in the past decade. Less is known about care provided to healthy premature infants born between 30 and 35 weeks gestational age (GA). We have previously reported inter-NICU variation in discharge (D/C) timing and achievement of maturational milestones in this population. OBJECTIVE: To compare inter-NICU growth outcomes and feeding practices in healthy, moderately premature infants. METHODS: Records of 450 infants, 30 to 35 weeks gestation, without medical or surgical complications, and consecutively discharged from 15 Massachusetts NICUs (nine Level II and six Level III) were reviewed. Final analyses included 382 infants with hospital length of stay >6 days (d). RESULTS: GA at birth and birth weight (BW) were 33.2 weeks (SD 1.2) and 2024 g (389). Mean Z-score decreased 0.67z (0.37) from birth to D/C. Weight loss from birth to 7 d averaged 4.0%. Mean growth velocity from 7 d to D/C was 13.3 g/k/d (5.2) with net growth velocity of 5.5 g/k/d (5.6). Mean net growth velocity ranged from 0.1 to 8.4 g/k/d (p<0.001) among study NICUs. Time of initiation, rate of advancement and caloric density of feedings also varied significantly between NICUs. CONCLUSION: Mean NICU growth velocity of healthy, moderately premature infants did not achieve in utero growth standards. There was significant inter-NICU variation in growth outcomes and feeding practices. Further study is needed to identify practices associated with better growth in this healthy moderately premature infant population.

Energy Intake↗
PubMed2005

Early-onset group B streptococcal disease in the era of maternal screening.

BACKGROUND: With the widespread implementation of intrapartum antibiotic prophylaxis (IAP), the rate of early-onset neonatal sepsis and meningitis caused by Streptococcus agalactiae (group B streptococcus [GBS]) has decreased dramatically, especially in term infants. However, cases of GBS disease continue to occur despite IAP and incur significant morbidity and mortality. Inaccurate screening results, improper implementation of IAP, or antibiotic failure all may contribute to persistent disease. OBJECTIVE: To determine if clinical, procedural, or microbiologic factors influenced persistent early-onset GBS disease (EOGBS) cases in a single large maternity service after the institution of a screening-based protocol for IAP. METHODS: Retrospective review of all cases of culture-proven EOGBS at the Brigham and Women's Hospital (Boston, MA) from 1997 to 2003. Serotyping and surface protein analyses were performed on available disease isolates. RESULTS: A total of 67260 infants were live-born during this period. Twenty-five cases of EOGBS (0.37 of 1000 live births) were identified. The overall incidence of EOGBS progressively decreased with different approaches to IAP. Of the 25 cases identified after institution of a screening-based protocol, 17 (68%) occurred in term infants (1 death), and 8 (32%) occurred in preterm infants (3 deaths). Among the mothers of term infants, 14 of 17 (82%) had been screened GBS negative; 1 was GBS unknown. More than half of the mothers of term infants who had screened GBS negative (8 of 14) had intrapartum risk factors for neonatal infection but did not receive antibiotics before delivery. Ten of the 17 term infants were evaluated for infection because of clinical signs of illness, and the remainder were evaluated because of intrapartum sepsis risk factors. Of the mothers of preterm infants, by the time of delivery 3 of 8 had been documented as GBS positive, 2 of 8 had been documented GBS negative, and 3 of 8 remained unknown. Only 1 of 25 women received adequate IAP, but the isolate was resistant to the administered antibiotic (clindamycin). Antibiotic resistance was not a factor in any other case, and no dominant serovariant was identified among tested isolates. Procedural errors (lack of recognition of documented GBS colonization or failure to evaluate infants at risk for sepsis) were identified in 4 cases. CONCLUSIONS: The majority of the remaining cases of EOGBS occurred in infants whose mothers screened negative for GBS colonization. Even in the setting of a maternal GBS-screening program, efforts to evaluate and treat infants with intrapartum clinical risk factors for early-onset sepsis remain important. Until effective vaccines against GBS are available for clinical use, development and implementation of rapid and sensitive techniques for screening for GBS status and antibiotic susceptibility at presentation may help prevent additional cases of invasive GBS disease.

Antibiotic Prophylaxis↗
PubMed2004

Early experience alters brain function and structure.

OBJECTIVE: To investigate the effects of early experience on brain function and structure. METHODS: A randomized clinical trial tested the neurodevelopmental effectiveness of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). Thirty preterm infants, 28 to 33 weeks' gestational age (GA) at birth and free of known developmental risk factors, participated in the trial. NIDCAP was initiated within 72 hours of intensive care unit admission and continued to the age of 2 weeks, corrected for prematurity. Control (14) and experimental (16) infants were assessed at 2 weeks' and 9 months' corrected age on health status, growth, and neurobehavior, and at 2 weeks' corrected age additionally on electroencephalogram spectral coherence, magnetic resonance diffusion tensor imaging, and measurements of transverse relaxation time. RESULTS: The groups were medically and demographically comparable before as well as after the treatment. However, the experimental group showed significantly better neurobehavioral functioning, increased coherence between frontal and a broad spectrum of mainly occipital brain regions, and higher relative anisotropy in left internal capsule, with a trend for right internal capsule and frontal white matter. Transverse relaxation time showed no difference. Behavioral function was improved also at 9 months' corrected age. The relationship among the 3 neurodevelopmental domains was significant. The results indicated consistently better function and more mature fiber structure for experimental infants compared with their controls. CONCLUSIONS: This is the first in vivo evidence of enhanced brain function and structure due to the NIDCAP. The study demonstrates that quality of experience before term may influence brain development significantly.

Brain↗
PubMed2003

Pro/con clinical debate: High-frequency oscillatory ventilation is better than conventional ventilation for premature infants.

Arguably one of the most important advances in critical care medicine in recent years has been the understanding that mechanical ventilators can impart harm and that lung-protective ventilation strategies can save lives. High-frequency oscillatory ventilation appears ideally suited for lung protection at first glance. Two camps of opinion exist, however, even in neonates where this modality has been most extensively studied. In the present debate, the prevailing arguments from each of those camps are made available for the reader to decide.

Attitude of Health Personnel↗
PubMed2003

Cost-effectiveness analysis of predischarge monitoring for apnea of prematurity.

OBJECTIVE: It is standard practice to defer discharge of premature infants until they have achieved a set number of days without experiencing apnea. The duration of this period, however, is highly variable across institutions, and there is scant literature on its effectiveness or value-for-money. Our objective was to establish the economic impact of varying durations of predischarge observation for apnea of prematurity. METHODS: Using computer simulation, we compared the alternatives of hospital monitoring for 1 to 10 days, after apparent cessation of apnea, with no monitoring and with the next longest period of monitoring. The daily probability of apnea requiring stimulation after a given number of apnea-free days was obtained from chart review of 216 infants, beginning on the day they attained both full feeds and temperature stability in an open crib. Baseline rates of survival or impairment, utilities for calculation of quality-adjusted life years (QALYs), outcomes for respiratory arrest at home, and long-run costs for neurodevelopmental impairment were derived from the literature. Hospital expenditures were obtained from itemized billing records for infants on each of the final 10 days of hospitalization and converted to costs using Medicare cost-to-charge ratios. Costs are reported in 2000 US dollars. RESULTS: For infants born at 24 to 26 weeks' gestation, each additional day of monitoring cost from $41000 per QALY saved for the first day to >$130000 per additional QALY gained for the tenth day. Cost-effectiveness was poorer for infants who were born at gestational ages >30 weeks. Results were sensitive to the proportion of charted apneas requiring stimulation that would actually progress, without intervention, to respiratory arrest. CONCLUSIONS: In this model, the cost-effectiveness of predischarge monitoring for apnea of prematurity declined significantly as the duration of monitoring was increased. Consideration should be given to alternative uses for resources in formulating neonatal discharge guidelines.

Apnea↗