Other Research Resources
Nagano platform for research ethics at the McGill University Health Centre - Training site
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Classification of neurodevelopmental outcomes in extreme premature newborns
Canadian Neonatal Network manuals with definitions
Important definitions used in neonatal research
Bronchopulmonary dysplasia (BPD)
Necrotizing Enterocolitis (NEC)
From: Tepas JJ 3rd, Sharma R, Leaphart CL, Celso BG, Pieper P, Esquivia-Lee V. Timing of surgical intervention in necrotizing enterocolitis can be determined by trajectory of metabolic derangement. J Pediatr Surg. 2010 Feb;45(2):310-3; discussion 313-4. doi: 10.1016/j.jpedsurg.2009.10.069. PMID: 20152342.
Other important definitions (IVH, ROP, Chorioamnionitis, SGA, Growth failure, etc.)
Pulmonary Hypertension (PH): The European Society of Cardiology and the European Respiratory Society established a definition of PH considering all ages. When the mean pulmonary artery pressure at rest is ≥ 20 mmHg or when estimated systolic pulmonary artery pressure is ≥ 40 mm Hg by echocardiography, PH is diagnosed 1, 2. The presence of PH at echocardiography is often established established if any of the following is present: an estimated systolic PAP (sPAP) ≥ 40 mmHg or a LV end-systolic eccentricity index (EI) ≥ 1.3. EI quantifies the degree of septal flattening, and premature newborns with a value ≥ 1.3 were previously described to have impaired RV systolic function 3. Maximal estimated sPAP is usually established as the highest value obtained from either a tricuspid regurgitant jet (TRJ) (plus expected right atrial pressure of 5 mmHg), or a PDA peak systolic velocity gradient (when present) 2. A ratio of the estimated sPAP to the systemic systolic blood pressure (sBP) at the time of the echocardiography is often calculated. Further, a RV systolic pressure to systemic systolic blood pressure of greater than 0.5, any cardiac shunt with bidirectional or right to left flow, or any degree of ventricular septal wall flattening are indirect indicators of potential PH. The presence of significant (or severe) PH, defined as being 2/3 systemic or more, has been advocated as a marker of concern in the premature population4.
Bronchopulmonary dysplasia (BPD): BPD and its severity is often defined as per the National Institute of Child Health and Disease (NICHD) workshop on BPD 5. For preterm infants born less than 32 weeks of gestational age and requiring oxygen or respiratory support at 28 days of life, BPD is classified according to the support needed at 36 weeks of post-menstrual age. BPD is considered severe when the patient still requires mechanical ventilation, continuous positive airway pressure or oxygen supplementation above 30%, moderate if the patient has oxygen requirements below 30%, or mild if the patient is breathing in room air. In 2018 – refinement of the definition: BPD is defined at 36 weeks of post-menstrual age or discharge6 according to Higgins et al7: grade I (nasal flow cannula < 1L/min with FiO2 ≤ 70%; nasal cannula with flow of 1 to 3L/min and FiO2 between 22 to 29%; CPAP, non-invasive positive pressure ventilation [NIPPV] or nasal cannula with flow > 3 L/min with FiO2 of 21%), grade II (nasal flow cannula less than 1L/min with FiO2 > 70%; nasal cannula with flow of 1 to 3L/min and FiO2 ≥ 30%; CPAP, NIPPV or nasal cannula with flow > 3L/min with FiO2 between 22-29%; invasive mechanical ventilation [IMV] with FiO2 of 21%), grade III (NIMV, NIPPV or nasal cannula with flow > 3L/min with FiO2 ≥ 30%, IMV with FiO2 > 21%).
Chorioamnionitis is often defined as having clinical signs of uterine infection or inflammation (maternal fever, uterine sensitivity, white blood cells above 15,000) or suspected or confirmed diagnosis written in mother’s chart as per obstetrical team or confirmed diagnosis on placental pathology.
Small for gestational age (SGA) is often diagnosed if birth weight is below the 10th percentile. At the Neocardiolab, we use the Fenton growth chart 8.
Early (EOS) and late onset sepsis (LOS): Early onset sepsis is defined by a positive bacterial or fungal culture in blood and/or cerebrospinal fluid, in the first two days after birth. Late onset sepsis is defined with the same criteria beyond two days of life.
Necrotizing enterocolitis (NEC): NEC is often defined when established as a stage 2 and above according to the Bell’s classification 9, 10. Another classification is the MD7 criteria11. (MD7: Positive blood culture, acidosis, bandemia, thrombocytopenia, hyponatremia, hypotension, or neutropenia).
Intra-ventricular hemorrhage (IVH): IVH is often graded according to the Papile’s classification 12. Grade I – Germinal matrix alone; Grade II – IVH without ventricular dilatation; Grade III - IVH with ventricular dilatation; Grade IV – IVH with intraparenchymal hemorrhage.
Retinopathy of prematurity (ROP) is defined according to the International Classification for Retinopathy of Prematurity 13. Significant ROP is defined as ROP requiring treatment with laser photocoagulation or intra-ocular injection of bevacizumab.
Length of hospitalization is defined as the number of days from birth to discharge from the neonatal intensive care unit, for those who survived initial hospitalization.
Length of invasive ventilation is defined as the number of days from initial intubation to final extubation for those who survived without a tracheostomy.
Length of positive pressure ventilation is defined from initial respiratory support with continuous positive airway pressure, intubation, high flow nasal cannula above 2 liters per minute or non-invasive positive pressure ventilation, to the last day requiring any of these modalities for respiratory support.
Pulmonary hemorrhage is defined as presence of frank blood in the endotracheal tube, or leading to intubation, with an associated increased in oxygen/respiratory support and a confirmatory chest radiography 14.
Score for Neonatal Acute Physiology (SNAP score), will be recorded and is defined as “an illness severity scoring system which sums up the worst physiological derangement in each organ system in the first 12 hours of admission to the NICU (…) SNAP provides a numeric score that reflects how sick each infant is.” 15, 16
Late-onset sepsis - positive bacterial or fungal culture in blood and/or cerebrospinal fluid following the first 3 days after birth
Early-onset sepsis - positive bacterial or fungal culture in blood and/or cerebrospinal fluid in the first 3 days after birth
Growth failure: Weight, length or head circumference below 3th percentile for corrected age as per Fenton or WHO growth curves (when term corrected-age).
Prematurity: Birth before 37 completed weeks of gestation. This is further subdivided on the basis of gestational age into extremely preterm (<28 weeks of gestation), very preterm (28–32 weeks of gestation) and moderate or late preterm (32–37 weeks of gestation).
Very low birth weight (VLBW): Infants who weigh <1,500 g at birth. Most VLBW infants are born at <30 weeks gestational age.
Extremely low birth weight (ELBW): Infants who weigh <1,000 g at birth. Most ELBW infants are born at <28 weeks gestational age.
Extremely low gestational age newborn: Infants born at <28 weeks gestational age.
Post-menstrual age: A measure of the age of an infant that combines gestational and postnatal age, both in weeks. For example, a 23-week gestational age infant at 9 weeks after birth has a postmenstrual age of 32 weeks.
Intrauterine growth restriction (IUGR): Also known as fetal growth restriction, IUGR usually refers to infants whose weight is below the tenth percentile for infants of that gestational age or less than two standard deviations below the average weight for infants of that gestational age.
References for "other important definitions"
 Galie N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J. 2009;30:2493-537.
 Altit G, Dancea A, Renaud C, Perreault T, Lands LC, Sant'Anna G. Pathophysiology, screening and diagnosis of pulmonary hypertension in infants with bronchopulmonary dysplasia - A review of the literature. Paediatric respiratory reviews. 2017;23:16-26.
 Abraham S, Weismann CG. Left Ventricular End-Systolic Eccentricity Index for Assessment of Pulmonary Hypertension in Infants. Echocardiography. 2016;33:910-5.
 Krishnan U, Feinstein JA, Adatia I, Austin ED, Mullen MP, Hopper RK, et al. Evaluation and Management of Pulmonary Hypertension in Children with Bronchopulmonary Dysplasia. J Pediatr. 2017;188:24-34 e1.
 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. American journal of respiratory and critical care medicine. 2001;163:1723-9.  (CNN) TCNN. Postnatal use of steroids for treatment of Chronic Lung Disease in GA<29 weeks. Annual Report by the Canadian Neonatal Network (CNN). 2019:145.
 Higgins RD, Jobe AH, Koso-Thomas M, Bancalari E, Viscardi RM, Hartert TV, et al. Bronchopulmonary Dysplasia: Executive Summary of a Workshop. Journal of Pediatrics. 2018;197:300-8.
 Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC pediatrics. 2013;13:59.
 Neu J. Necrotizing enterocolitis: the search for a unifying pathogenic theory leading to prevention. Pediatric clinics of North America. 1996;43:409-32.
 Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Annals of surgery. 1978;187:1.
 Tepas JJ, 3rd, Sharma R, Leaphart CL, Celso BG, Pieper P, Esquivia-Lee V. Timing of surgical intervention in necrotizing enterocolitis can be determined by trajectory of metabolic derangement. Journal of pediatric surgery. 2010;45:310-3; discussion 3-4.
 Papile L-A, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. The Journal of pediatrics. 1978;92:529-34.
 Prematurity ICftCoRo. The international classification of retinopathy of prematurity revisited. Archives of ophthalmology. 2005;123:991.
 Kluckow M, Jeffery M, Gill A, Evans N. A randomised placebo-controlled trial of early treatment of the patent ductus arteriosus. Archives of Disease in Childhood: Fetal and Neonatal Edition. 2014;99.
 Richardson DK, Corcoran JD, Escobar GJ, Lee SK. SNAP-II and SNAPPE-II: simplified newborn illness severity and mortality risk scores. The Journal of pediatrics. 2001;138:92-100.
 CNN. Patient log - Admission screen definitions - Canadian Neonatal Network - Abstractor’s Manual. 2012. p. 1-93.
Vasoactive Index Score
Stages of Lung Development
Standard Research Echocardiography Protocol at the NeoCardioLab
TnECHO Report at the Montreal Children's Hospital developed by Dr. G. Altit
Echocardiography research definitions at NeoCardioLab
References for Echocardiography definitions
1. Mertens LL, Ganame J, Eyskens B. Echocardiographic Evaluation of Systolic Function. Echocardiography in Pediatric and Congenital Heart Disease: From Fetus to Adult. 2009:76-94.