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Incidence and risk factors of hospitalization for bronchiolitis in preterm children: a retrospective longitudinal study in Italy
Patrizio Pezzotti, Jessica Mantovani, Nicoletta Benincori, Eleonora Mucchino, Domenico Di Lallo
BMC Pediatrics , 2009, DOI: 10.1186/1471-2431-9-56
Abstract: Retrospective cohort study that linked data from four health administrative databases in the Lazio region (a region of central Italy): the birth register, the hospital discharge register, and two ad-hoc databases that record the doses of Palivizumab administered at two local health units.Among 2407 preterm infants, 137 had at least one hospitalization for bronchiolitis in the first 18 months of life, an overall incidence rate of 4.70 per 100 person-years (95%CI: 3.98-5.56); similar incidence rates were observed by calendar year. A multiple Poisson model showed that the following characteristics were associated with higher incidence: younger age of the infant, the period between October-April, male gender, low Apgar score at birth, low birth weight, and low maternal educational level. At least one dose of Palivizumab was administered to 324 (13.5%) children; a dramatic increase from 2000 (2.8%) to 2006 (19.1%) (p < 0.01) was observed. Other factors independently associated with more frequent Palivizumab use were older maternal age, Italian-born mothers, female gender, low Apgar score, low birth weight, shorter gestational age, a diagnosis of broncho-dysplasia, and the month of birth. It is of note that none of the 34 children with congenital heart disease were prescribed Palivizumab. Performing several multiple Poisson models that also considered Palivizumab use as covariate, although the point estimates were in agreement with previous clinical trial results, we did not find in most of them a significant reduction for immunized children to be hospitalized for bronchiolitis.In Italy the incidence of hospitalization for bronchiolitis, and its associated risk factors, are similar to that found in other countries. Although Palivizumab use is associated with the most important characteristics of severe prematurity, other aspects of its non-use in children with congenital heart disease, the age and the birth country of the mother suggest the need for public health measures
Local interleukin-10 production during respiratory syncytial virus bronchiolitis is associated with post-bronchiolitis wheeze
Annemieke Schuurhof, Riny Janssen, Hanneke de Groot, Hennie M Hodemaekers, Arja de Klerk, Jan LL Kimpen, Louis Bont
Respiratory Research , 2011, DOI: 10.1186/1465-9921-12-121
Abstract: This study aimed to determine the in vivo role of IL-10 in RSV pathogenesis and recurrent wheeze in a new cohort of 235 infants hospitalized for RSV bronchiolitis. IL-10 levels in nasopharyngeal aspirates (NPAs) were measured at the time of hospitalization and the IL10 SNP rs1800872 genotype was determined. Follow-up data were available for 185 children (79%).Local IL-10 levels during RSV infection turned out to be higher in infants that later developed physician diagnosed PBW as compared to infants without PBW in the first year after RSV infection (958 vs 692 pg/ml, p = 0.02). The IL10 promoter SNP rs1800872 was not associated with IL-10 concentration in NPAs.The relationship between high local IL-10 levels during the initial RSV infection and physician diagnosed PBW provides further evidence of the importance of the IL-10 response during RSV bronchiolitis.Respiratory syncytial virus (RSV) is a negative-sense, single-stranded RNA virus and a member of the Paramyxoviridae, subfamily Pneumovirinae. RSV causes a wide range of clinical symptoms, varying from mild upper respiratory tract infection to severe bronchiolitis and pneumonia [1,2]. It is the most common cause of severe lower respiratory tract infection in children aged less than 1 year, and approximately 1-3% require hospitalization [3,4]. High-risk groups for severe RSV infection include infants with preterm birth, chronic lung disease of prematurity, congenital heart disease, cystic fibrosis, immunodeficiency disorders, and Down's syndrome [5,6]. Besides infants, specific adult populations are also at risk to develop severe RSV infection [7-10]. However, most infants hospitalized for RSV infection are previously healthy infants and do not fit the profile of a high risk patient [11]. RSV bronchiolitis is often followed by recurrent episodes of wheeze, in about 50% of cases, also referred to as post-bronchiolitis wheeze (PBW) [12-16]. PBW causes significant healthcare costs, and influences quality of life [17,
Rethinking Stress in Parents of Preterm Infants: A Meta-Analysis  [PDF]
Renske Schappin, Lex Wijnroks, Monica M. A. T. Uniken Venema, Marian J. Jongmans
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0054992
Abstract: Background With improved medical outcome in preterm infants, the psychosocial situation of their families is receiving increasing attention. For parents, the birth of a preterm infant is generally regarded as a stressful experience, and therefore many interventions are based on reducing parental stress. Nevertheless, it remains unclear whether parents of children born preterm experience more stress than parents of term-born children, which would justify these interventions. This meta-analysis provides a comprehensive account of parental stress in parents of preterm infants, from birth of the infant through to their adolescence. Mean levels of stress in specific domains of family functioning were investigated, and stress levels in parents of preterm and term infants, and fathers and mothers of preterm infants, were compared. Furthermore, we investigated moderators of parental stress. Methods and Findings A random-effects meta-analysis was conducted including 38 studies describing 3025 parents of preterm (<37 wk) and low birth weight (<2500 g) infants. Parental stress was measured with two parent-reported questionnaires, the Parenting Stress Index and the Parental Stressor Scale: Neonatal Intensive Care Unit. The results indicate that parents of preterm-born children experience only slightly more stress than parents of term-born children, with small effect sizes. Furthermore, mothers have slightly more stress than fathers, but these effect sizes are also small. Parents report more stress for infants with lower gestational ages and lower birth weights. There is a strong effect for infant birth year, with decreasing parental stress from the 1980s onward, probably due to increased quality of care for preterm infants. Conclusions Based on our findings we argue that prematurity can best be regarded as one of the possible complications of birth, and not as a source of stress in itself.
Prospective Validation of a Prognostic Model for Respiratory Syncytial Virus Bronchiolitis in Late Preterm Infants: A Multicenter Birth Cohort Study  [PDF]
Maarten O. Blanken, Hendrik Koffijberg, Elisabeth E. Nibbelke, Maroeska M. Rovers, Louis Bont, on behalf of the Dutch RSV Neonatal Network
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0059161
Abstract: Objectives This study aimed to update and validate a prediction rule for respiratory syncytial virus (RSV) hospitalization in preterm infants 33–35 weeks gestational age (WGA). Study Design The RISK study consisted of 2 multicenter prospective birth cohorts in 41 hospitals. Risk factors were assessed at birth among healthy preterm infants 33–35 WGA. All hospitalizations for respiratory tract infection were screened for proven RSV infection by immunofluorescence or polymerase chain reaction. Multivariate logistic regression analysis was used to update an existing prediction model in the derivation cohort (n = 1,227). In the validation cohort (n = 1,194), predicted versus actual RSV hospitalization rates were compared to determine validity of the model. Results RSV hospitalization risk in both cohorts was comparable (5.7% versus 4.9%). In the derivation cohort, a prediction rule to determine probability of RSV hospitalization was developed using 4 predictors: family atopy (OR 1.9; 95%CI, 1.1–3.2), birth period (OR 2.6; 1.6–4.2), breastfeeding (OR 1.7; 1.0–2.7) and siblings or daycare attendance (OR 4.7; 1.7–13.1). The model showed good discrimination (c-statistic 0.703; 0.64–0.76, 0.702 after bootstrapping). External validation showed good discrimination and calibration (c-statistic 0.678; 0.61–0.74). Conclusions Our prospectively validated prediction rule identifies infants at increased RSV hospitalization risk, who may benefit from targeted preventive interventions. This prediction rule can facilitate country-specific, cost-effective use of RSV prophylaxis in late preterm infants.
Parents’ lived experience of providing kangaroo care to their preterm infants
Angela Leonard,Pat Mayers
Health SA Gesondheid , 2008, DOI: 10.4102/hsag.v13i4.401
Abstract: Premature and low birthweight infants pose particular challenges to health services in South Africa. While there is good evidence to demonstrate the benefits of kangaroo care in low birthweight infants, limited research has been conducted locally on the experiences of parents who provide kangaroo care to their preterm infants. This phenomenological study explores the lived experience of parents who provided their preterm infants with kangaroo care at a tertiary-level maternity centre in the Western Cape. In-depth interviews were conducted with six parents: four mothers and two fathers. Data was analysed using an adaptation of the approaches described by Colaizzi (1978:48-71) and Hycner (1985:280-294). To ensure trustworthiness, the trustworthiness criteria described by Guba and Lincoln (1989:242-243) were applied. Kangaroo care is a phased process, each phase bringing a unique set of experiences. The eight themes that emerged are described: unforeseen, unprepared and uncertain - the experience of birth; anxiety and barriers; an intimate connection; adjustments, roles and responsibilities; measuring success; a network of encouragement and support; living-in challenges; and living with the infant outside of hospital. Challenges facing health care providers are described and recommendations for information about kangaroo care and support for parents are made. Opsomming Vroeggebore babas en babas met ’n lae geboortegewig stel besondere uitdagings vir Suid-Afrikaanse gesondhiedsdienste. Daar bestaan goeie bewyse dat die kangaroesorgmetode voordelig is vir babas met ’n laegeboortegewig, dog is minimale plaaslike navorsing gedoen oor die ondervindinge van ouers wat hierdie metode gebruik om vir hul vroeggebore babas te sorg. Hierdie fenomenologiese studie verken die geleefde ervaringe van ouers wat vir hulle vroeggebore babas deur middel van die kangaroesorgmetode in ’n tersiêre kraamsentrum in die Weskaap gesorg het. Data is ingesamel deur in-diepte onderhoude met ses ouers te voer: vier moeders and twee vaders van vroeggebore babas. Data is ontleed volgens ’n verwerking van die metodes soos deur Colaizzi (1978:48-71) en Hycner (1985:280-294) beskryf. Om betroubaarheid te verseker, is die betroubaarheidskriteria van Guba en Lincoln (1989:242-243) toegepas. Kangaroesorg is ’n geleidelike proses; elke fase lei tot ‘n unieke stel ondervindinge. Agt temas is uit die data ge dentifiseer: Onverwags, onvoorbereid en onseker - die geboorte-ervaring; angstigheid and hindernisse; ’n intieme verband; aanpassings, rolle en verantwoordelikhede; die meting van sukses; ’n n
The Agreement Rate about Unintended Pregnancy and Its Relationship with Postpartum Depression in Parents of Preterm and Term Infants  [PDF]
Maryam Ghorbani, Mahrokh Dolatian, Jamal Shams, Hamid Alavi-Majd
Open Journal of Nursing (OJN) , 2015, DOI: 10.4236/ojn.2015.59084
Abstract: Introduction: Postpartum depression (PPD) affects women’s health and self-confidence, and infant’s social, emotional, cognitive and even physical development. Studies show that parents of preterm infants frequently experience symptoms of depression and anxiety. Women with unintended pregnancy are subjected to more risk of depression than women with planned pregnancy. Unintended pregnancy may lead to increased maternal exposure to psychosocial stressors, reduced social support by the spouse, increased levels of depressive symptoms and decreased life satisfaction. Findings: No significant difference was observed between term and preterm infants’ mothers (p = 0.85) in terms of postpartum depression. However, two groups of fathers in terms of depression showed a significant difference (p = 0.045). McNemar’s test showed that parents of term infants (K = 0.322, p = 0.077), and parents of preterm infants (k = 0.17, p = 0.144) agreed with each other on unintended pregnancy. Conclusion: Fathers of preterm infants are at higher risk for mental disorders than fathers of term infants and they need more attention in future studies.
Key components of early intervention programs for preterm infants and their parents: a systematic review and meta-analysis  [cached]
Benzies Karen M,Magill-Evans Joyce E,Hayden K,Ballantyne Marilyn
BMC Pregnancy and Childbirth , 2013, DOI: 10.1186/1471-2393-13-s1-s10
Abstract: Background Preterm infants are at greater risk for neurodevelopmental disabilities than full term infants. Interventions supporting parents to improve the quality of the infant’s environment should improve developmental outcomes for preterm infants. Many interventions that involve parents do not measure parental change, nor is it clear which intervention components are associated with improved parental outcomes. The aim of this review was to categorize the key components of early intervention programs and determine the direct effects of components on parents, as well as their preterm infants. Methods MEDLINE, EMBASE, CINAHL, ERIC, and Cochrane Database of Systematic Reviews were searched between 1990 and December 2011. Eligible randomized controlled trials (RCTs) included an early intervention for preterm infants, involved parents, and had a community component. Of 2465 titles and abstracts identified, 254 full text articles were screened, and 18 met inclusion criteria. Eleven of these studies reported maternal outcomes of stress, anxiety, depressive symptoms, self-efficacy, and sensitivity/responsiveness in interactions with the infant. Meta-analyses using a random effects model were conducted with these 11 studies. Results Interventions employed multiple components categorized as (a) psychosocial support, (b) parent education, and/or (c) therapeutic developmental interventions targeting the infant. All interventions used some form of parenting education. The reporting quality of most trials was adequate, and the risk of bias was low based on the Cochrane Collaboration tool. Meta-analyses demonstrated limited effects of interventions on maternal stress (Z = 0.40, p = 0.69) and sensitivity/responsiveness (Z = 1.84, p = 0.07). There were positive pooled effects of interventions on maternal anxiety (Z = 2.54, p = 0.01), depressive symptoms (Z = 4.04, p <.0001), and self-efficacy (Z = 2.05, p = 0.04). Conclusions Positive and clinically meaningful effects of early interventions were seen in some psychosocial aspects of mothers of preterm infants. This review was limited by the heterogeneity of outcome measures and inadequate reporting of statistics. Implications of key findings Interventions for preterm infants and their mothers should consider including psychosocial support for mothers. If the intervention involves mothers, outcomes for both mothers and preterm infants should be measured to better understand the mechanisms for change.
Computerized acoustic assessment of treatment efficacy of nebulized epinephrine and albuterol in RSV bronchiolitis
Raphael Beck, Nael Elias, Shay Shoval, Naveh Tov, Gil Talmon, Simon Godfrey, Lea Bentur
BMC Pediatrics , 2007, DOI: 10.1186/1471-2431-7-22
Abstract: Computerized lung sounds analysis with quantification of wheezing and crackles and a clinical score were used during a double blind, randomized, controlled nebulized treatment pilot study. Infants were randomized to receive a single dose of 1 mgr nebulized l-epinephrine or 2.5 mgr nebulized albuterol. Computerized quantification of wheezing and crackles (PulmoTrack?) and a clinical score were performed prior to, 10 minutes post and 30 minutes post treatment. Results were analyzed with Student's t-test for independent samples, Mann-Whitney U test and Wilcoxon test.15 children received albuterol, 12 received epinephrine. The groups were identical at baseline. Satisfactory lung sounds recording and analysis was achieved in all subjects. There was no significant change in objective quantification of wheezes and crackles or in the total clinical scores either within the groups or between the groups. There was also no difference in oxygen saturation and respiratory distress.Computerized lung sound analysis is feasible in young infants with RSV bronchiolitis and provides a non-invasive, quantitative measure of wheezing and crackles in these infants.Trial registration number: ClinicalTrials.gov NCT00361452Bronchiolitis is the most common cause of hospitalization for respiratory infection in infants under one year of age. Respiratory syncytial virus (RSV) is the most common etiology of acute bronchiolitis in infants. About 1–2% of infants with bronchiolitis need to be hospitalized and approximately 8% of these children require intensive care. Of high risk patients, such as those with bronchopulmonary dysplasia or congenital heart disease, about 30% require intensive care [1-3].Treatment for most infants with bronchiolitis is usually supportive, including oxygen, hydration and antipyretics. The use of bronchodilator therapy remains controversial [4,5], since the main tool used to measure response (clinical score) is subjective and inaccurate. Thus different studies showed dif
Cost-utility analysis of palivizumab in Italy: results from a simulation model in the prophylaxis of respiratory syncytial virus infection (RSV) among high-risk preterm infants
Gaetano Chirico, Roberto Ravasio, Urbano Sbarigia
Italian Journal of Pediatrics , 2009, DOI: 10.1186/1824-7288-35-4
Abstract: We used and adapted a pre-existent model in which two cohorts of patients received palivizumab or no prophylaxis. The patients were followed for their expected lifetimes. The economic evaluation was conducted from the perspective of the Italian National Health Service. We considered Life-Years Gained (LYGs), Quality-Adjusted Life-Years (QALYs) and direct medical costs (pharmacological treatment, hospitalization, recurrences for wheezing, etc.). LYGs and QALYs were based on the results of a double blind cohort study with prospective follow-up and direct medical costs were based on Italian treatment patterns. Benefits and costs were discounted at 3%. Costs were assessed in 2007 Euros. Sensitivity and threshold analysis on key clinical and economic parameters were performed.For the two cohorts, the expected life-years (per patient) with palivizumab versus no prophylaxis were 29.842 and 29.754 years, respectively. Quality-adjusted life years (per patient) with palivizumab were 29.202, and for no prophylaxis were 29.043. The expected cost (per patient) was € 6,244.20 with palivizumab and € 4,867.70 with no prophylaxis. We calculated for palivizumab versus no prophylaxis the incremental cost per LYG and per QALY gained. It was € 15,568.65 and € 8,676.74, respectively.This study suggests that, compared with no prophylaxis, palivizumab is cost-effective in the prevention of respiratory syncytial virus infection among high risk preterm infants.Respiratory Syncytial Virus (RSV) is the most common cause of viral respiratory tract infections in infancy. [1] The common presentation of RSV on infants are lower respiratory tract infections such as pneumonias and bronchiolitis occurring usually during the first two years of life. [2-6]In Italy about 4–5,000 RSV-infected, high-risk, preterm infants (gestational age < 36 weeks, with or without bronchopulmonary dysplasia [BPD]) are hospitalized every year. A proportion of these infants require admission to intensive care units due to
Bronchiolitis  [cached]
Ener ?a?r? Dinleyici
Cocuk Enfeksiyon Dergisi , 2009,
Abstract: Bronchiolitis is a potentially life-threatening respiratory condition and the commonest reason for hospital admission in infancy. Up to 3% of all children in their first year of life are hospitalized with bronchiolitis. The respiratory syncytial virus accounts for most cases of bronchiolitis, however, new virus isolation techniques have led to the discovery of previously unrecognized viruses, including the human metapneumovirus. Bronchiolitis is associated with significant morbidity among healthy young children. Infants with underlying medical conditions, such as immunodeficiency, bronchopulmonary dysplasia and congenital heart disease, are at risk of severe progress and death. Diagnosis of acute bronchiolitis based on history and clinical findings. Diagnostic interventions have little effect on clinical outcome including routine viral tests. Supportive therapy (hydration and oxygenization) remains the mainstay of management with limited or no evidence of benefit for most other pharmacological treatments including bronchodilatators, corticosteroids, and rasemic epinephrine. Further, larger, high quality randomized controlled clinical studies are needed to clarify assessment of disease severity, criteria for hospital admission, and therapeutic options. Prevention of severe RSV-associated bronchiolitis has been achieved in high-risk infants by passive administration of the humanized monoclonal anti-RSV-F antibody, palivizumab. Recent studies showed potential efficacy of palivizumab prophylaxis in infants which was born at ≤32 weeks and required mechanical ventilation as well as children with congenital heart disease. Development of more potent anti-RSV neutralizing antibodies like motavizumab, is underway, and vaccine development continues to progress
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