Active clinical trials for "Premature Birth"

The purpose of this study is to determine whether antenatal model in vaginosis are effective in preventing vaginal infection and preterm delivery

In the US, every year approximately 30,000 infants are born very prematurely, with birth weight less than 1000 grams. These infants usually require ventilators to help them breath normally during the first few weeks of life. Although the ventilator is lifesaving, it can also injure the very fragile lungs of these infants. Thus, a ventilation strategy, called permissive hypercapnia (high carbon dioxide), is widely used to prevent lung injury. Importantly, there is new research showing that high carbon dioxide may cause brain injury. In our proposed research, we will use magnetic resonance imaging methods to evaluate the brain in 40 very premature infants at term-equivalent age (Half of them had permissive hypercapnia ventilation, the other half did not) to see if permissive hypercapnia has adverse effect on brain development.

The prevalence of preterm birth is rising in most western countries. The causes of preterm birth is not fully understood and seem to be multifactorial. The endocrine and metabolic aspects are scarcely investigated.The main purpose of this study is to test the hypothesis that endocrine and metabolic factors associate to preterm births.

The main objective is to assess the nutritional benefit of probiotics supplementation on premature infants growth. As secondary objectives, different parameters related to probiotics tolerance will be measured.

Transient hypothyroxinemia of prematurity (THOP) is a typical entity of the preterm infant, affecting the majority of preterm infants, born less than 30 weeks of gestational age. It is defined as a temporary postnatal reduction from cord values in serum levels of T4 and FT4, but with normal thyroid-stimulating hormone (TSH) levels.The etiology of THOP is complex and multifactorial. Loss of maternal T4, limited postnatal thermogenesis, hypothalamic-pituitary immaturity, limited thyroid gland reserve, persistent fetal thyroid hormone metabolism and predisposition to nonthyroidal illness syndrome are several factors that contribute in less or more intensity to THOP.The association between THOP and poor neurodevelopmental outcome is well established and several therapeutic clinical trials have been set up. However, there is currently no evidence for prophylactic or therapeutic supplementation with thyroxine (T4) for premature infants with THOP. One study of van Wassenaer et al. showed a beneficial effect of treatment of THOP in a subgroup of preterm infants with gestational age less than 28 weeks, but a reverse effect in the group with a gestational age of 29 weeks. This is an illustration of the limited comprehension of the pathophysiology of THOP. Although studies about THOP usually involves the preterm infants born at 33 weeks or earlier, one study of Paul et al. showed a decreased thyroid function in late preterm and term infants with respiratory distress syndrome as function of severity of illness. Unpublished data of our center showed also the presence of THOP, although less frequent, in the group of late preterm infants. Other data about this group of preterm infants are scarce. During the first half of pregnancy, the fetus is completely dependent of maternal thyroid hormone supply and the fetal thyroid gland starts thyroid hormone secretion from about 17-19 weeks of gestational age. Conditions of maternal (sub)clinical hypothyroidism are associated with complications like hypertension, preterm birth, low birth weight, placental abruption, and fetal death. One can wonder if there are compensating mechanisms in the placenta, providing the fetus with sufficient thyroid hormone in cases of compromised thyroid supply. One study showed that total placenta deiodinase type 3 (D3) activity in pregnancies with severely hypothyroid fetuses was not significantly lower than in euthyroid controls. Two studies showed increased monocarboxylate transporter 8 (MCT8) and decreased MCT10 expression within placentae of pregnancies complicated by IUGR. As far as we know, nothing is known about possible compensating effects in placentae of mothers with subclinical hypothyroidism and the possible influence on the development of THOP. Maternal subclinical hypothyroidism during pregnancy is a predisposition for the development of overt hypothyroidism. The influence of maternal thyroid antibodies during pregnancy towards thyroid hormone function of the fetus and consequently neurodevelopmental outcome is still not clear. One single study of Negro et al. showed that euthyroid pregnant women who are positive for thyroid peroxidase antibodies (TPOAb) develop impaired thyroid function, which is associated with an increased risk of miscarriage and premature deliveries. They also showed that substitutive treatment with levothyroxine (LT4) is able to lower the chance of miscarriage and premature delivery.A study of Pop et al. concluded that children of pregnant women who had elevated titers of TPO-Ab but normal thyroid function are at risk for impaired development.Nothing is known about the possible influence of maternal thyroid antibodies towards the development of THOP, although a theoretical link is possible. The investigators want to investigate whether there are compensatory mechanisms in placentas of premature born infants and whether the maternal thyroid hormone condition is a prediction of the development of THOP in the premature infant. The investigators want to investigate the differences between several groups of preterm infants: 24-28 weeks, 28-32 weeks and 32-36 weeks. The further aim of this study is to investigate the impact of maternal thyroid hormone condition during pregnancy on neurodevelopmental outcome of the neonate. In Belgium, 8% of the newborns are born preterm. There are about 2000 deliveries each year in the University Hospitals Leuven. Between 2 and 5% of all pregnant women are considered to have subclinical hypothyroidism and preterm birth is almost 2-fold higher in women with subclinical hypothyroidism.The incidence of THOP is 30 %. We performed a statistical power calculation with a confidence level of 95%. Given the above data and with the assumption that 50% of the premature babies born to a hypothyroid mothers will develop THOP, we need to include 320 patients who give premature birth to obtain a statistical power of 80%. Therefore, the inclusion time will be 2 years.

Racism and health care system distrust are potent stressors and may be associated with preterm birth (PTB). Additionally, cervical shortening is a common pathway leading to PTB. This study is enrolling a prospective cohort of pregnant women. The study assesses racial discrimination, health care system distrust, and cervical change using 2 questionnaires, exam, and protein levels in cervical vaginal fluid and maternal serum.

Prematurely born infants with ductal-dependent congenital heart disease (CHD) are at increased risk to develop necrotizing enterocolitis (NEC). Abnormal left to right blood flow through a patent ductus arteriosus can cause intestinal ischemia and compromise the gastrointestinal tract as a barrier to infection. In some infants, bacterial translocation leads to NEC which may result in death, intestinal perforation, cholestasis and, at the very least, feeding problems. Predicting which infants with CHD will develop NEC will potentially decrease the severity of disease if interventions were started earlier. Near-infrared spectroscopy (NIRS) allows determination of regional oxygen saturation levels in tissues such as brain, kidney, and as recently reported, intestine. This study will test whether or not decreasing intestinal oxygen saturations can predict the development of NEC in this at risk population before the symptoms become severe. NIRS probes will be placed on the forehead, flank and abdomen of eligible infants and regional oxygen saturations will be recorded prospectively and continuously with the clinical care team blinded to the data. The development of NEC and significant feeding problems will then be correlated with the regional oxygen saturations to determine whether decreased intestinal oxygen saturations predicted early signs and symptoms of NEC. We anticipate generating pilot data in 30 infants who meet inclusion criteria. Support of this research will be provided partially by Somanetics, the manufacturer of the INVOS regional oxygen saturation monitors. They will, however, have no control over the data generated by this study.

The purpose of this study is to test the feasibility of measuring body composition by air displacement plethysmography (ADP) in rapidly growing, medically stable late gestation [32-35 weeks post-menstrual age (PMA)] premature infants.

Purpose of the study: To evaluate the effect of prematurity on renal function in 5 years old children To compare former premature children treated by ibuprofen in the neonatal period to controls

To see if infant outcomes will improve when mothers are helped to hold their preterm infants skin-to-skin as soon as possible after birth and as often as possible and for as long as possible each time during the next five days.