Marmienė, Vitalija

In clinical practice, it is crucial to identify diagnostic methods that can forecast the neurodevelopmental outcomes of very preterm neonates. Our study aimed to assess the predictive significance of amplitude-integrated electroencephalography (aEEG) for the neurodevelopmental outcomes of preterm infants at 12 months corrected age and to establish the cut-off score that could indicate potential neurodevelopmental impairments.

Background: Very low birth weight (VLBW) infants tend to have slower postnatal growth than the fetuses of the same gestational age (GA)1. Higher nutrient intake and better early growth are associated with better neurocognitive outcomes; excessive nutrient intakes may lead to metabolic consequences. Nutrient intakes for optimal growth, body composition and neurodevelopment are not known. Objectives: To assess growth and neurodevelopment of VLBW infants during the first year of life and its relationship with early nutrition. Methods: 120 VLBW infants were divided into 2 groups: extremely preterm (EP, <28 weeks) and very/moderately preterm (VP). 92 infants completed 12 months follow-up. Nutrient intake was calculated for the first 4 weeks. Growth (weight, length, and head circumference (HC)) was measured weekly until discharge, and at 3,6,9,12 months corrected GA (CGA) and related to healthy infants2. Body composition was assessed at discharge by dual X-ray absorptiometry (DXA). Neurodevelopment was assessed at 12 months using Bayley-II. Results: At birth, weightSDS and lengthSDS were higher in EP than VP (p<0.001, and p=0.019, respectively), HCSDS did not differ (p=0.137). There was no difference in weightSDS, lengthSDS and HCSDS at discharge or at 12 months CGA. EP infants had higher BMI and body fat at discharge (p<0.001), but BMI did not differ at 12 months (p=0.545). Acceleration of weight gain and HC growth occurred between 4 weeks and discharge in EP and between discharge and 3 months CGA in VP, while length growth accelerated most between discharge and 3 months in both groups. Nutrient intake during first 4 weeks and neurodevelopment scores at 12 months did not differ between groups. Higher nutrient intake was associated with better in-hospital growth and neurodevelopment scores in EP, but not in VP. In EP higher nutrient intake was not associated with higher BMI or DXA fat mass at discharge, but carbohydrates and fat intake was positively associated with BMI at 12 months CGA (p=0.003 and p=0.013, respectively). In VP group, protein intake correlated positively with BMI at discharge (p=0.029), fat intake - with DXA fat mass (p=0.021) but no correlation was found between nutrient intake and BMI at 12 months CGA. Conclusion: Weight, length, and HC growth patterns are different in GA groups and should be considered when choosing feeding strategies. Nutrient intake should be balanced between improving neurodevelopmental outcomes and potential risk of metabolic syndromes.

Optimal nutrient intake ensuring better neurodevelopment for very low birth weight (VLBW) infants remains unknown. The aim of this study was to assess the relationship between early (first 28 days) nutritional intake, first year growth, and neurodevelopment. In total, 120 VLBW infants were included into the study. A group of 95 infants completed follow-up to 12 months of corrected gestational age (CGA). Nutrient intake was assessed, and weight, length, and head circumference (HC) were measured weekly until discharge and at 3, 6, 9, and 12 months of CGA. Neurodevelopment was assessed at 12 months of CGA. Two groups-extremely preterm (EP) and very/moderately preterm (VP)-were compared. Growth before discharge was slower in the EP group than the VP group. At 12 months, there was no difference in anthropometric characteristics or neurodevelopmental scores between the groups. Higher carbohydrate intake during the first 28 days was the single significant predictor for better cognitive scores only in the EP group (βs = 0.60, p = 0.017). Other nutrients and growth before discharge were not significant for cognitive and motor scores in either group in multivariable models, whereas post-discharge HC growth was associated with both cognitive and motor scores in the VP group. Monitoring intake of all nutrients and both pre-discharge and post-discharge growth is essential for gaining knowledge about individualized nutrition for optimal neurodevelopment.

Neurosonography (NSG) is a readily available non-invasive radiological examination technique that assesses brain damage in neonates who experienced perinatal hypoxia. The aim of the study was to determine the relationship between hypoxic-ischemic (HI)brain injuries in full-term neonates detected during ultrasonography and mental and neuromotor development outcomes at an early school age. We evaluated 8–9-yearoldchildren (n = 32) who had experienced hypoxia at birth with mild to moderate hypoxic-ischemic encephalopathy (HIE) and hadn’t undergone therapeutic hypothermia. The control group consisted of 8–9-year-old children (n = 16) who were born healthy. During the first five days of life, the newborns underwent cerebral ultrasonography. The HIE stage was evaluated according to the Sarnat and Sarnat scale. Neuromotor and neurological outcomes were assessed using the Gross Motor Function Classification System, the Health Utilities Index (HUI) questionnaire, the Wechsler Intelligence Scale for Children WISC-III, and structured neurological examination. In the case of moderate brain edema and/or thalamus and/or basal ganglion injuries along with cerebellum and brainstem (E/T/BG/C/B) injuries compared to other injuries, the following abnormalities were statistically significantly more common: hearing disorders (100%, p = 0.03),cerebellar dysfunction (60%, p = 0.02), epilepsy (60%, p = 0.01), a lower Working Memory Index (median, 82.0, p = 0.015). In case of moderate brain swelling (edema)and thalamus and/or basal ganglion (E/T/BG) injuries, the sensitivity and specificity of the ultrasound examination when predicting epilepsy, hearing disorders, lower full IQ, and the Perceptual Organization Index were 100%. Neurosonography helps predict the outcomes of mental and neuromotor development at an early school age in full term neonates who experienced perinatal asphyxia/hypoxia. Moderate hypoxic-ischemic brain changes detected during ultrasonography were statistically significantly associated with hearing disorders, cerebellar dysfunction, epilepsy, and a lower Working Memory Index in children at an early school age.

Background and Objectives: Late long-term outcomes of perinatal asphyxia (PA) in school-age are often unclear. To assess long-term outcomes at an early school age in children who had experienced perinatal hypoxia or asphyxia, where therapeutic hypothermia was not applied. Materials and Methods: The case group children were 8–9-year-old children (n=32) who were born at full term and experienced hypoxia or asphyxia at birth, where therapeutic hypothermia (TH) was not applied. The control group consisted of 8–9-year-old children (n=16) born without hypoxia. A structured neurological examination was performed at an early school age. The neuromotor function was assessed using the Gross Motor Function Classification System (GMFCS). Health-related quality-of-life was assessed using the Health Utilities Index (HUI) questionnaire. Intellectual abilities were assessed using the Wechsler Intelligence Scale for Children (WISC). Results: The case group, compared with controls, had significantly (p=0.002) lower mean [SD] full-scale IQ (87(16.86) vs. 107(12.15)), verbal-scale IQ (89(17.45) vs. 105(11.55)), verbal comprehension index (89(17.36) vs. 105(10.74)), working memory index (89(15.68) vs. 104(11.84)), performance IQ (87(16.51) vs. 108(15.48)) and perceptual organization index (85(15.71) vs. 105 (15.93)). We did not find any significant differences in the incidence of disorders of neurological examination, movement abilities and health-related quality of life at an early school age between the case and the control group children. Conclusion: In children who experienced perinatal asphyxia but did not have cerebral paralysis (CP), where therapeutic hypothermia was not applied, cognitive assessment scores at an early school age were significantly lower compared to those in the group of healthy children, and were at a low average level.

Introduction: Perinatal asphyxia (PA) remains one of the most pressing problems in the world. Late-onset outcomes in neonates who have experienced asphyxia are unclear. Objectives: The aim of the study was to evaluate long-term outcomes of early school age (ESA) children with PA. Methods: The case group includes children of ESA (8-9 years) (n = 32), who had hypoxia/asphyxia at birth, the control group - ESA children who didn‘t experience hypoxia/asphyxia at birth (n = 16). Clinical neurological examination and assessment of psychomotor development in ESA were accomplished using the Wechsler Intelligence Scale for Children (WISC-III). Results: We have found 62.5% (n=20) of neurological disorders (p=0,004) and 40.6% (n=13) of psychomotor disorders (p=0,048) in the case group: increased deep tendon reflexes of the lower extremities (21.9%), epilepsy (12.5%), hearing impairments - 3.1%, visual disturbances - 12.5%. Attention deficit disorders - 31.3%, learning difficulties - 21.9%, mental disorders - 12.5%, language disorders - 9.4%. Low general IQ (< 79) was found in 15.6% of children in the case group. The children with psychomotor disorders had a statistically significant increase in neurological problems (p = 0.000). 84.4 percent (n = 27) hypoxic-ischemic encephalopathy (HIE) was diagnosed in the case group. In ESA 55.6% neurological disorders, 25.9% – attention deficit disorders, 22.2% - learning difficulties, 18.5%. - low general IQ, 14.8% - epilepsy, 11.1% - mental disorders, 7.4% – language disorders. Conclusion: In the children who experienced PA, more than half of them had neurological disorders at ESA and less than half of them had psychomotor disorders.

In very low birth weight (VLBW) newborns, parenteral nutrition (PN) is delivered via a peripheral venous catheter (PVC), a central venous catheter (CVC), or a peripherally inserted central venous catheter (PICC). Up to 45% of PICCs are accompanied by complications, the most common being sepsis. A PVC is an unstable PN delivery technique requiring frequent change. The growth and neurodevelopment of VLBW newborns may be disturbed because of catheters used for early PN delivery and complications thereof. The aim of the conducted study was to evaluate the effect of two PN delivery techniques (PICC and PVC) on anthropometric parameters and neurodevelopment of VLBW newborns. A prospective randomized clinical trial was conducted at the Department of Neonatology of the Hospital of the Lithuanian University of Health Sciences Kauno klinikos between 1 January 2014 and 31 March 2017. Low birth weight (≥750 - <1500 g) newborns that met the inclusion criteria were randomized into two groups: PICC and PVC. For the entire period of treatment, PN was delivered via a catheter chosen during the randomization. In the trial, we assessed short-term outcomes, i.e., anthropometric parameters (weight, length, and head circumference) from birth until CA 36 weeks or upon discharge, and long-term outcomes, i.e., anthropometric parameters (weight, length, and head circumference) from 3 months to CA 12 months as well as neurodevelopment at CA 12 months according to Bayley II. In total, 108 newborns (57 in the PICC group and 51 in the PVC group) underwent randomization. Short-term outcomes were assessed in 47 PICC and 38 PVC subjects. Long-term outcomes were assessed in 38 and 33 subjects of PICC and PVC groups, respectively. There were no differences observed in anthropometric parameters between the subjects of two groups in the short and long term. Delayed mental performance (MDI <85) was observed in 26.3% and 21.2% (p=0.781), and dela[...].

Background and Objectives: In very low birth weight (VLBW) newborns, parenteral nutrition (PN) is delivered via a peripheral venous catheter (PVC), a central venous catheter (CVC), or a peripherally inserted central venous catheter (PICC). Up to 45% of PICCs are accompanied by complications, the most common being sepsis. A PVC is an unstable PN delivery technique requiring frequent change. The growth and neurodevelopment of VLBW newborns may be disturbed because of catheters used for early PN delivery and complications thereof. The aim of the conducted study was to evaluate the effect of two PN delivery techniques (PICC and PVC) on anthropometric parameters and neurodevelopment of VLBW newborns. Materials and Methods: A prospective randomized clinical trial was conducted in VLBW (≥750–<1500 g) newborns that met the inclusion criteria and were randomized into two groups: PICC and PVC. We assessed short-term outcomes (i.e., anthropometric parameters from birth until corrected age (CA) 36 weeks) and long-term outcomes (i.e., anthropometric parameters from CA 3 months to 12 months as well as neurodevelopment at CA 12 months according to the Bayley II scale). Results: In total, 108 newborns (57 in the PICC group and 51 in the PVC group) were randomized. Short-term outcomes were assessed in 47 and 38 subjects, and long-term outcomes and neurodevelopment were assessed in 38 and 33 subjects of PICC and PVC groups, respectively. There were no differences observed in anthropometric parameters between the subjects of the two groups in the short- and long-term. Mental development index (MDI) < 85 was observed in 26.3% and 21.2% (p = 0.781), and psychomotor development index (PDI) < 85 was observed in 39.5% and 54.5% (p = 0.239) of PICC and PVC subjects, respectively. Conclusions: In the short- and long-term, no differences were observed in the anthropometric parameters of newborns in both groups. [...].

Purpose of study: The umbilical artery blood pH, base deficit (BE), bicarbonate, and lactate levels–the main indicators of fetal distress. The aim of the study was to evaluate the significance of following indicators for cerebral blood circulation changes, and hypoxic-ischemic encephalopathy (HIE) in full-term infants. Materials and methods: The prospective cross-sectional study was performed at the Department of Neonatology, Lithuanian University of Health Sciences. The studied group consisted of 58 full-term neonates who experienced perinatal asphyxia or hypoxia. Immediately after birth was analysed umbilical artery blood pH, BE, bicarbonate, and lactate levels. During the first five days of life blood circulation in the anterior cerebral arteries was measured, and evaluated clinical signs of HIE using the modified Sarnat and Sarnat scale. The comparison between the HIE groups was performed by applying the parametric and nonparametric ANOVA analysis and the non-parametric Kruskal–Wallis (χ2 – chi square) criterion and Kendal (r) criterions. Correlation analysis was applied to determine the correlation of blood circulation parameters with pH, BE, bicarbonate and lactate levels. Results: Mean Vs values in ACA on day 2 were significantly (p = 0.02) lower when umbilical artery blood BE was ≤−12 mmol/L, and bicarbonate levels were <19 mmol/L. We did not find any statistically significant differences in mean Vd and RI values in ACA between pathological index groups of umbilical artery blood pH, BE, bicarbonate and lactate levels. Significantly lower pH values were detected in the umbilical artery blood of neonates with more severe stages of HIE (r = 0.5; p < 0.001). Conclusions: Umbilical artery blood pH correlated with the stage of HIE. Bicarbonate and BE levels in full-term infants influenced changes in cerebral blood circulation