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Evaluation of an improved tool for non-invasive prediction of neonatal respiratory morbidity based on fully automated fetal lung ultrasound analysis. Sci Rep 2019; 9:1950. [PMID: 30760806 PMCID: PMC6374419 DOI: 10.1038/s41598-019-38576-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/02/2019] [Indexed: 11/22/2022] Open
Abstract
The objective of this study was to evaluate the performance of a new version of quantusFLM®, a software tool for prediction of neonatal respiratory morbidity (NRM) by ultrasound, which incorporates a fully automated fetal lung delineation based on Deep Learning techniques. A set of 790 fetal lung ultrasound images obtained at 24 + 0–38 + 6 weeks’ gestation was evaluated. Perinatal outcomes and the occurrence of NRM were recorded. quantusFLM® version 3.0 was applied to all images to automatically delineate the fetal lung and predict NRM risk. The test was compared with the same technology but using a manual delineation of the fetal lung, and with a scenario where only gestational age was available. The software predicted NRM with a sensitivity, specificity, and positive and negative predictive value of 71.0%, 94.7%, 67.9%, and 95.4%, respectively, with an accuracy of 91.5%. The accuracy for predicting NRM obtained with the same texture analysis but using a manual delineation of the lung was 90.3%, and using only gestational age was 75.6%. To sum up, automated and non-invasive software predicted NRM with a performance similar to that reported for tests based on amniotic fluid analysis and much greater than that of gestational age alone.
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102
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Mariani GL, Vain NE. The rising incidence and impact of non-medically indicated pre-labour cesarean section in Latin America. Semin Fetal Neonatal Med 2019; 24:11-17. [PMID: 30291045 DOI: 10.1016/j.siny.2018.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In the poorest populations of the world the difficulties of performing a surgical procedure lead to extremely low cesarean section rates associated with very high perinatal mortality. Meanwhile the proportion of births by cesarean section has been increasing for several decades in many areas of the world, reaching alarmingly high rates especially in Latin America. This review aims to describe this secular trend. The causes of the increase in cesarean deliveries are analyzed with a multidimensional approach, trying to recognize the reasons behind the choice of the route of delivery. We are facing a shift in the guiding paradigm, leaving the classical biomedical one. Advantages and disadvantages of non-medically indicated cesarean section are being sought, comparing it with the results of vaginal delivery, with special emphasis on the short- and long-term morbidity of the newborn. Several variables involved in this controversial topic are considered, with the objective of stimulating critical thoughts about the medical, bioethical and social aspects of the increasing trend in the cesarean section rate.
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Affiliation(s)
- Gonzalo L Mariani
- Division of Neonatology, Italian Hospital, Buenos Aires, Argentina; Neonatology Training Program, University Institute Italian Hospital, Buenos Aires, Argentina.
| | - Nestor E Vain
- School of Medicine, University of Buenos Aires, Buenos Aires, Argentina; Departments of Pediatrics and Newborn Medicine, Hospital Sanatorio Trinidad, Buenos Aires, Argentina; Fundasamin, Foundation for Maternal Infant Health, Buenos Aires, Argentina
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103
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Chawanpaiboon S, Vogel JP, Moller AB, Lumbiganon P, Petzold M, Hogan D, Landoulsi S, Jampathong N, Kongwattanakul K, Laopaiboon M, Lewis C, Rattanakanokchai S, Teng DN, Thinkhamrop J, Watananirun K, Zhang J, Zhou W, Gülmezoglu AM. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob Health 2019; 7:e37-e46. [PMID: 30389451 PMCID: PMC6293055 DOI: 10.1016/s2214-109x(18)30451-0] [Citation(s) in RCA: 1662] [Impact Index Per Article: 332.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 08/08/2018] [Accepted: 09/19/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Preterm birth is the leading cause of death in children younger than 5 years worldwide. Although preterm survival rates have increased in high-income countries, preterm newborns still die because of a lack of adequate newborn care in many low-income and middle-income countries. We estimated global, regional, and national rates of preterm birth in 2014, with trends over time for some selected countries. METHODS We systematically searched for data on preterm birth for 194 WHO Member States from 1990 to 2014 in databases of national civil registration and vital statistics (CRVS). We also searched for population-representative surveys and research studies for countries with no or limited CRVS data. For 38 countries with high-quality data for preterm births in 2014, data are reported directly. For countries with at least three data points between 1990 and 2014, we used a linear mixed regression model to estimate preterm birth rates. We also calculated regional and global estimates of preterm birth for 2014. FINDINGS We identified 1241 data points across 107 countries. The estimated global preterm birth rate for 2014 was 10·6% (uncertainty interval 9·0-12·0), equating to an estimated 14·84 million (12·65 million-16·73 million) live preterm births in 2014. 12· 0 million (81·1%) of these preterm births occurred in Asia and sub-Saharan Africa. Regional preterm birth rates for 2014 ranged from 13·4% (6·3-30·9) in North Africa to 8·7% (6·3-13·3) in Europe. India, China, Nigeria, Bangladesh, and Indonesia accounted for 57·9 million (41×4%) of 139·9 million livebirths and 6·6 million (44×6%) of preterm births globally in 2014. Of the 38 countries with high-quality data, preterm birth rates have increased since 2000 in 26 countries and decreased in 12 countries. Globally, we estimated that the preterm birth rate was 9×8% (8×3-10×9) in 2000, and 10×6% (9×0-12×0) in 2014. INTERPRETATION Preterm birth remains a crucial issue in child mortality and improving quality of maternal and newborn care. To better understand the epidemiology of preterm birth, the quality and volume of data needs to be improved, including standardisation of definitions, measurement, and reporting. FUNDING WHO and the March of Dimes.
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Affiliation(s)
- Saifon Chawanpaiboon
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Joshua P Vogel
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland.
| | - Ann-Beth Moller
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Pisake Lumbiganon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Max Petzold
- Health Metrics Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Daniel Hogan
- Department of Information, Evidence and Research, WHO, Geneva, Switzerland
| | - Sihem Landoulsi
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Nampet Jampathong
- Department of Epidemiology and Biostatistics, Khon Kaen University, Khon Kaen, Thailand
| | - Kiattisak Kongwattanakul
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Malinee Laopaiboon
- Department of Epidemiology and Biostatistics, Khon Kaen University, Khon Kaen, Thailand
| | - Cameron Lewis
- Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | | | - Ditza N Teng
- Joondalup Health Campus, Joondalup, WA, Australia
| | - Jadsada Thinkhamrop
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kanokwaroon Watananirun
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jun Zhang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Zhou
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - A Metin Gülmezoglu
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland
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104
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van Wyk L, Boers KE, van Wassenaer-Leemhuis AG, van der Post JAM, Bremer HA, Delemarre FMC, Gordijn SJ, Bloemenkamp KWM, Roumen FJME, Porath M, van Lith JMM, Mol BWJ, le Cessie S, Scherjon SA. Postnatal Catch-Up Growth After Suspected Fetal Growth Restriction at Term. Front Endocrinol (Lausanne) 2019; 10:274. [PMID: 31293512 PMCID: PMC6598620 DOI: 10.3389/fendo.2019.00274] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 04/15/2019] [Indexed: 01/21/2023] Open
Abstract
Objective: The aim of this study was to study growth patterns of children born after suspected fetal growth restriction (FGR) at term and to compare the effect of induction of labor (IoL) and expectant management (EM), also in relation to neurodevelopmental and behavioral outcome at age 2. Methods: We performed a 2 years' follow-up of growth of children included in the Disproportionate Intrauterine Growth Restriction Trial at Term (DIGITAT) study, a Randomized Controlled Trial (RCT) comparing IoL with EM in pregnancies with suspected FGR at term. We collected data on child growth until the age of 2 years. Standard deviation scores (SDSs) for height and weight were calculated at different ages. We assessed the effects of IoL compared with EM and the effects of a birth weight below or above the 3rd or 10th centile on catch-up growth. Target height SDSs were calculated using the height of both parents. Results: We found a significant increase in SDS in the first 2 years. Children born after EM showed more catch-up growth in the first month [height: mean difference -0.7 (95% CI: 0.2; 1.3)] and weight [mean difference -0.5 (95% CI: 0.3; 0.7)]. Children born with a birth weight below the 3rd and 10th centiles showed more catch-up growth after 1 year [mean difference -0.8 SDS (95% CI: -1.1; -0.5)] and after 2 years [mean difference -0.7 SDS (95% CI: -1.2; -0.2)] as compared to children with a birth weight above the 3rd and 10th centiles. SDS at birth had the strongest effect on adverse neurodevelopmental outcome at 2 years of age. Conclusion: After FGR at term, postnatal catch-up growth is generally present and associated with the degree of FGR. Obstetric management in FGR influences postnatal growth. Longer-term follow-up is therefore needed and should be directed at growth and physical health. Clinical Trial Registration: www.ClinicalTrials.gov, identifier SRCTN10363217.
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Affiliation(s)
- Linda van Wyk
- Departments of Obstetrics, Leiden University Medical Centre, Leiden, Netherlands
- Department of Obstetrics, University Medical Centre Groningen, Groningen, Netherlands
- *Correspondence: Linda van Wyk
| | - Kim E. Boers
- Haaglanden Medical Centre, The Hague, Netherlands
| | | | | | | | | | - Sanne J. Gordijn
- Department of Obstetrics, University Medical Centre Groningen, Groningen, Netherlands
| | | | | | | | - Jan M. M. van Lith
- Departments of Obstetrics, Leiden University Medical Centre, Leiden, Netherlands
| | - Ben W. J. Mol
- Department of Obstetrics, Monash University Medical Centre, Clayton, VIC, Australia
| | - Saskia le Cessie
- Department of Clinical Epidimiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Sicco A. Scherjon
- Department of Obstetrics, University Medical Centre Groningen, Groningen, Netherlands
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Abstract
Late preterm infants (LPIs) are born between 34 0/7 and 36 6/7 weeks' gestation and account for 72% of all preterm births in the United States. Born as much as 6 weeks early, the LPI misses the critical growth and development specific to the third trimester. The loss of this critical period leaves the LPI physiologically and metabolically immature and prone to various morbidities. Common morbidities include respiratory complications, feeding difficulty, hypoglycemia, temperature instability, hyperbilirubinemia, and neurodevelopmental delays.
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Affiliation(s)
- Julie E Williams
- Department of Neonatology, The Johns Hopkins Hospital, The Charlotte R. Bloomberg Children Center Building, 1800 Orleans Street, Baltimore, MD 21287, USA.
| | - Yvette Pugh
- Department of Pediatrics, Community Neonatal Associates, Holy Cross Hospital, 1500 Forest Glen Road, Silver Spring, MD 20910, USA
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106
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Palumbi R, Peschechera A, Margari M, Craig F, Cristella A, Petruzzelli MG, Margari L. Neurodevelopmental and emotional-behavioral outcomes in late-preterm infants: an observational descriptive case study. BMC Pediatr 2018; 18:318. [PMID: 30296934 PMCID: PMC6176499 DOI: 10.1186/s12887-018-1293-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/27/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Over the last decade, several studies investigated the outcomes in children born very preterm. Only recently there has been an increasing interest in the late preterm infants (born between 34 + 0 and 36 + 6 weeks). This population is at high risk of morbidity and mortality in the first years of life. Other studies reported that they are also at risk of long-term developmental problem. Therefore, the aim of this study is to describe the neurodevelopmental and emotional-behavioral outcome in a sample of late preterm patients. METHODS The study included late preterm children and adolescents who had neuropsychiatric and/or neurological symptoms. They underwent a general, neurocognitive and an emotional-behavioral assessment. Exclusion criteria included: patients affected by Central Nervous System congenital abnormalities, neurodegenerative diseases, genetic disorders, epilepsy, or in pharmacological treatment, or adopted children. A descriptive statistics analysis was performed to describe the sociodemographic and clinical characteristics of patients. Risk factors related to late preterm birth, prevalence of neurodevelopmental disorders, and cognitive functioning were recorded and analyzed. RESULTS The sample included 68 LPI (45 males and 23 females) aged from 2 to 16.3 years (mean age 7,5 years), who were affected by one or more neurodevelopmental disorder, including Language Disorder, Attention Deficit Hyperactivity Disorder, Specific Learning Disorder, Developmental Coordination Disorder, Intellectual Disability and Autism Spectrum Disorder. Moreover, in 30.8% of patients, internalizing problems (affective and social skills problem) were detected. CONCLUSIONS Our results support the importance of a long-term surveillance of late preterm and the great need for more longitudinal large population studies in order to collect data on the neurodevelopmental outcomes of this population.
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Affiliation(s)
- Roberto Palumbi
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”; piazza Giulio Cesare, 1170124 Bari, Italy
| | - Antonia Peschechera
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”; piazza Giulio Cesare, 1170124 Bari, Italy
| | - Mariella Margari
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”; piazza Giulio Cesare, 1170124 Bari, Italy
| | - Francesco Craig
- Scientific Institute, IRCCS E. Medea, Unit for Severe disabilities in developmental age and young adults, Developmental Neurology and Neurorehabilitation, Brindisi, Italy
| | - Arcangelo Cristella
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”; piazza Giulio Cesare, 1170124 Bari, Italy
| | - Maria Giuseppina Petruzzelli
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”; piazza Giulio Cesare, 1170124 Bari, Italy
| | - Lucia Margari
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”; piazza Giulio Cesare, 1170124 Bari, Italy
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107
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The global epidemiology of preterm birth. Best Pract Res Clin Obstet Gynaecol 2018; 52:3-12. [DOI: 10.1016/j.bpobgyn.2018.04.003] [Citation(s) in RCA: 313] [Impact Index Per Article: 52.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 04/23/2018] [Indexed: 02/07/2023]
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108
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Abstract
Predelivery diagnosis of placenta accreta, increta, and percreta (from here referred to as placenta accreta, unless otherwise noted) has increasingly created opportunities to optimize antenatal management. Despite the increased frequency of placenta accreta today, occurring in as many as 1 in 533 to 1 in 272 deliveries, high-quality data are lacking for many aspects of antenatal management. This chapter will discuss antenatal management of, and risks faced by, women with suspected placenta accreta, a condition that most frequently requires a potentially morbid cesarean hysterectomy.
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109
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Wennerstrom A, Haywood C, Wallace M, Sugarman M, Walker A, Bonner T, Sutton Y, Keller BL, Lewis M, Springgate B, Theall K. Creating Safe Spaces: A Community Health Worker-Academic Partnered Approach to Addressing Intimate Partner Violence. Ethn Dis 2018; 28:317-324. [PMID: 30202184 DOI: 10.18865/ed.28.s2.317] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Intimate partner violence (IPV) is a persistent public health problem in the United States, with an estimated one in three women experiencing rape, physical violence, and/or stalking by an intimate partner within her lifetime. Non-Hispanic Black women disproportionately experience IPV, but there has been limited success in implementing culturally appropriate prevention programs and services for members of this population. Community health workers (CHWs) are trusted members of under-resourced communities who provide reliable health information and improve the cultural appropriateness of service delivery and may be a vital resource for developing new IPV interventions. Guided by the principles of community partnered participatory research, we developed the CHW-led Safe Spaces project, which aimed to establish a strong academic-community partnership to focus on issues related to experiences of IPV and the prevention of IPV in New Orleans. In this article, we describe the development of our partnership including the formation of an advisory board, creation of a broad-based stakeholder coalition, offering a community partnered participatory research training, conducting IPV education and outreach, and establishing a research agenda. Our processes are replicable and lessons learned may be relevant to other groups seeking to address IPV by leveraging the strengths of community-academic collaborations and CHWs.
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Affiliation(s)
| | | | - Maeve Wallace
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | | | - Ashlee Walker
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | | | - Yana Sutton
- Kali Red's Initiative: Take Back Your Life Foundation, New Orleans, LA
| | | | - Marva Lewis
- Tulane University School of Social Work, New Orleans, LA
| | | | - Katherine Theall
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
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Bonnevier A, Brodszki J, Björklund LJ, Källén K. Underlying maternal and pregnancy-related conditions account for a substantial proportion of neonatal morbidity in late preterm infants. Acta Paediatr 2018; 107:1521-1528. [PMID: 29575302 DOI: 10.1111/apa.14321] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/12/2018] [Indexed: 11/29/2022]
Abstract
AIM We studied the impact of maternal and pregnancy-related conditions and the effect of gestational age itself, on the health of infants born late preterm. METHODS Singletons born in gestational weeks 34 + 0 to 41 + 6 in 1995-2013 in the southern region of Sweden were identified from a perinatal register. We found 14 030 infants born late preterm and 294 814 born at term. A hierarchical system was developed to examine the impact of pregnancy complications. The outcomes studied were as follows: neonatal death, central nervous system (CNS) or respiratory disease, infection, neonatal admission and respiratory support. Odds ratios (OR) and 95% confidence intervals (95% CI) were obtained using logistic regression analyses. RESULTS Late preterm infants were at increased risk for all outcomes compared to term infants, with adjusted ORs from 13.1 (95% CI: 12.7-13.6) for neonatal admission to 2.3 (95% CI: 1.8-2.9) for infections. Late preterm birth after preterm prelabour rupture of membranes was associated with an overall lower risk compared to late preterm births due to other causes. Exposure to antepartum haemorrhage or maternal diabetes increased the risk for CNS and respiratory morbidity. CONCLUSION Morbidity decreased in late preterm infants with increasing gestational age. Underlying conditions accounted for a substantial part of the morbidity.
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Affiliation(s)
- Anna Bonnevier
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Jana Brodszki
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Lars J Björklund
- Department of Pediatric Surgery and Neonatology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Karin Källén
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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111
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Chatziioannidis I, Kyriakidou M, Exadaktylou S, Antoniou E, Zafeiriou D, Nikolaidis N. Neurological outcome at 6 and 12 months corrected age in hospitalised late preterm infants -a prospective study. Eur J Paediatr Neurol 2018; 22:602-609. [PMID: 29571948 DOI: 10.1016/j.ejpn.2018.02.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 02/08/2018] [Accepted: 02/27/2018] [Indexed: 11/28/2022]
Abstract
Late preterm infants (34-0/7 to 36-6/7 weeks" gestation) account for 10-20% of NICU admissions and are at increased risk for morbidity and mortality. Although they are prone to developmental delays, reports on neurological outcome during the first 2 years of life are scarce. The aim of the study was to assess neurological/neuromotor outcome in high risk late preterm infants at 6 and 12 months corrected age and the change in neurological scores over time, and to identify factors associated with the neurological outcome. The Hammersmith Infant Neurological Examination was performed in a cohort of 157 late preterm infants admitted in the NICU. The infants were examined at 6 and 12 months corrected age respectively and scored with the optimality score system including 26 items assessing cranial nerve function, posture, movements, tone and reflexes. Also parents reported neurological milestones in the follow up visit. Infants at 6 months had a global score of 59 (47-76) and optimal scores achieved in 25.4%. At 12 months they had a global score of 70 (58-78) and achieved optimal scores in 63.2%. The subscores of posture, tone and reflexes gradually increased from 6 to 12 months corrected age. Being born small for gestational age was the only factor that adversely influenced HINE score at 6 and 12 months. At 12 months 58.5% achieved independent walking. High risk late preterm infants have suboptimal HINE scores at 6 and 12 months of age, suggesting a need for closer follow up and early intervention programs.
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Affiliation(s)
- Ilias Chatziioannidis
- 2nd NICU and Νeonatology Department of Aristotle University of Thessaloniki, G. Papageorgiou Hospital, Thessaloniki, Greece.
| | - Maria Kyriakidou
- Department of Physiotherapy, G. Papageorgiou Hospital, Thessaloniki, Greece.
| | - Sotiria Exadaktylou
- 2nd NICU and Νeonatology Department of Aristotle University of Thessaloniki, G. Papageorgiou Hospital, Thessaloniki, Greece.
| | - Evangelia Antoniou
- 2nd NICU and Νeonatology Department of Aristotle University of Thessaloniki, G. Papageorgiou Hospital, Thessaloniki, Greece.
| | - Dimitrios Zafeiriou
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, G. Hippokration Hospital, Thessaloniki, Greece.
| | - Nikolaos Nikolaidis
- 2nd NICU and Νeonatology Department of Aristotle University of Thessaloniki, G. Papageorgiou Hospital, Thessaloniki, Greece.
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112
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Pratcorona L, Goya M, Merced C, Rodó C, Llurba E, Higueras T, Cabero L, Carreras E, Arévalo S, Avilés M, Calero I, Casellas M, Folch M, Gascón A, Mendoza M, Sanchez MA, Suy A. Cervical pessary to reduce preterm birth <34 weeks of gestation after an episode of preterm labor and a short cervix: a randomized controlled trial. Am J Obstet Gynecol 2018; 219:99.e1-99.e16. [PMID: 29704487 DOI: 10.1016/j.ajog.2018.04.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 04/04/2018] [Accepted: 04/18/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND To date, no intervention has proved effective in reducing the spontaneous preterm birth rate in singleton pregnancies following an episode of threatened preterm labor and short cervix remaining. OBJECTIVE This study was designed to ascertain whether cervical pessaries could be useful in preventing spontaneous preterm birth in women with singleton pregnancies and a short cervix after a threatened preterm labor episode. STUDY DESIGN This open randomized controlled trial was conducted in 357 pregnant women (between 240-336 weeks) who had not delivered 48 hours after a threatened preterm labor episode and had a short cervix remaining (≤25 mm at 240-296 weeks; ≤15 mm at 300-336 weeks). Patients were randomly assigned to cervical pessary (179) or routine management (178). The primary outcome was the spontaneous preterm birth rate <34 weeks. Spontaneous preterm birth <28 and 37 weeks and neonatal morbidity and mortality were also evaluated in an intention-to-treat analysis. RESULTS No significant differences between the pessary and routine management groups were observed in the spontaneous preterm birth rate <34 weeks (19/177 [10.7%] in the pessary group vs 24/175 [13.7%] in the control group; relative risk, 0.78; 95% confidence interval, 0.45-1.38). Spontaneous preterm birth <37 weeks occurred less frequently in the pessary group (26/175 [14.7%] vs 44/175 [25.1%]; relative risk, 0.58; 95% confidence interval, 0.38-0.90; P = .01). Preterm premature rupture of membranes rate was significantly lower in pessary carriers (4/177 [2.3%] vs 14/175 [8.0%]; relative risk, 0.28; 95% confidence interval, 0.09-0.84; P = .01). The pessary group less frequently required readmission for new threatened preterm labor episodes (8/177 [4.5%] vs 35/175 [20.0%]; relative risk, 0.23; 95% confidence interval, 0.11-0.47; P < .0001). No serious adverse maternal events occurred; neonatal morbidity and mortality were similar in both groups. CONCLUSION Pessary use did not significantly lower the spontaneous preterm birth rate <34 weeks in women with a short cervix remaining after a threatened preterm labor episode but did significantly reduce the spontaneous preterm birth rate <37 weeks, threatened preterm labor recurrence, and the preterm premature rupture of membranes rate.
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114
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Yoneda S, Yoneda N, Shiozaki A, Yoshino O, Ueno T, Niimi H, Kitajima I, Tamura K, Kawasaki Y, Makimoto M, Yoshida T, Saito S. 17OHP-C in patients with spontaneous preterm labor and intact membranes: is there an effect according to the presence of intra-amniotic inflammation? Am J Reprod Immunol 2018; 80:e12867. [PMID: 29709096 DOI: 10.1111/aji.12867] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 04/04/2018] [Indexed: 01/22/2023] Open
Abstract
PROBLEM It is not known whether 17-alpha-hydroxyprogesterone caproate (17OHP-C) is effective for preventing preterm delivery with an episode of preterm labor (PTL) with or without intra-amniotic inflammation/infection. METHODS OF STUDY This was a retrospective cohort study. One hundred and seven PTL patients were selected and divided into a 17OHP-C group (use of 17OHP-C: n = 53) and a no-treatment group (no use of 17OHP-C: n = 54). Moreover, the patients were divided into three subgroups (subgroup A: without intra-amniotic inflammation, B: with mild intra-amniotic inflammation, and C: with severe intra-amniotic inflammation) according to their level of amniotic interleukin (IL)-8, and perinatal prognosis was analyzed. RESULTS Interval from admission to delivery (days) in the 17OHP-C group (76 [13-126], n = 34) was significantly longer than that in the no-treatment group (50 [8-104], n = 33; P = .012) in subgroup B. In cases without intra-amniotic microbes in subgroup B, a significant prolongation of gestational days was associated with the 17OHP-C group (79 [13-126], n = 25) compared with the no-treatment group (50 [8-104], n = 29; P = .029). However, there were no significant differences in subgroups A or C. CONCLUSION 17OHP-C could prolong gestational period in limited PTL cases with sterile mild intra-amniotic inflammation.
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Affiliation(s)
- Satoshi Yoneda
- Department of Obstetrics and Gynecology, University of Toyama, Sugitani, Toyama, Japan
| | - Noriko Yoneda
- Department of Obstetrics and Gynecology, University of Toyama, Sugitani, Toyama, Japan
| | - Arihiro Shiozaki
- Department of Obstetrics and Gynecology, University of Toyama, Sugitani, Toyama, Japan
| | - Osamu Yoshino
- Department of Obstetrics and Gynecology, University of Toyama, Sugitani, Toyama, Japan
| | - Tomohiro Ueno
- Clinical Laboratory Center, University of Toyama, Sugitani, Toyama, Japan
| | - Hideki Niimi
- Clinical Laboratory Center, University of Toyama, Sugitani, Toyama, Japan
| | - Isao Kitajima
- Clinical Laboratory Center, University of Toyama, Sugitani, Toyama, Japan
| | - Kentaro Tamura
- Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital, Sugitani, Toyama, Japan
| | - Yukako Kawasaki
- Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital, Sugitani, Toyama, Japan
| | - Masami Makimoto
- Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital, Sugitani, Toyama, Japan
| | - Taketoshi Yoshida
- Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital, Sugitani, Toyama, Japan
| | - Shigeru Saito
- Department of Obstetrics and Gynecology, University of Toyama, Sugitani, Toyama, Japan
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Pels A, Mol BWJ, Singer J, Lee T, von Dadelszen P, Ganzevoort W, Asztalos E, Magee LA. Influence of Gestational Age at Initiation of Antihypertensive Therapy: Secondary Analysis of CHIPS Trial Data (Control of Hypertension in Pregnancy Study). Hypertension 2018; 71:1170-1177. [PMID: 29686009 PMCID: PMC5959211 DOI: 10.1161/hypertensionaha.117.10689] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 12/27/2017] [Accepted: 03/13/2018] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. For hypertensive women in CHIPS (Control of Hypertension in Pregnancy Study), we assessed whether the maternal benefits of tight control could be achieved, while minimizing any potentially negative effect on fetal growth, by delaying initiation of antihypertensive therapy until later in pregnancy. For the 981 women with nonsevere, chronic or gestational hypertension randomized to less-tight (target diastolic blood pressure, 100 mm Hg), or tight (target, 85 mm Hg) control, we used mixed-effects logistic regression to examine whether the effect of less-tight (versus tight) control on major outcomes was dependent on gestational age at randomization, adjusting for baseline factors as in the primary analysis and including an interaction term between gestational age at randomization and treatment allocation. Gestational age was considered categorically (quartiles) and continuously (linear or quadratic form), and the optimal functional form selected to provide the best fit to the data based on the Akaike information criterion. Randomization before (but not after) 24 weeks to less-tight (versus tight) control was associated with fewer babies with birth weight <10th centile (Pinteraction=0.005), but more preterm birth (Pinteraction=0.043), and no effect on perinatal death or high-level neonatal care >48 hours (Pinteraction=0.354). For the mother, less-tight (versus tight) control was associated with more severe hypertension at all gestational ages but particularly so before 28 weeks (Pinteraction=0.076). In women with nonsevere, chronic, or gestational hypertension, there seems to be no gestational age at which less-tight (versus tight) control is the preferred management strategy to optimize maternal or perinatal outcomes.
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Affiliation(s)
- Anouk Pels
- From the Department of Obstetrics and Gynecology, Academisch Medisch Centrum, Amsterdam, The Netherlands (A.P., W.G.)
| | - Ben Willem J Mol
- Department of Medicine, Robinson Institute, School of Pediatrics and Reproductive Health, University of Adelaide, Australia (B.W.J.M.).,South Australian Health and Medical Research Institute, Adelaide, Australia (B.W.J.M.)
| | - Joel Singer
- School of Public and Population Health (J.S., T.L.).,Department of Obstetrics and Gynecology (J.S., T.L.), University of British Columbia, Vancouver, Canada
| | - Terry Lee
- School of Public and Population Health (J.S., T.L.).,Department of Obstetrics and Gynecology (J.S., T.L.), University of British Columbia, Vancouver, Canada
| | - Peter von Dadelszen
- School of Life Course Sciences, King's College London, United Kingdom (P.v.D., L.A.M.)
| | - Wessel Ganzevoort
- From the Department of Obstetrics and Gynecology, Academisch Medisch Centrum, Amsterdam, The Netherlands (A.P., W.G.)
| | - Elizabeth Asztalos
- Department of Pediatrics, Obstetrics, and Gynecology, University of Toronto, Canada (E.A.).,Department of Pediatrics, Sunnybrook Health Sciences, Toronto, Canada (E.A.)
| | - Laura A Magee
- School of Life Course Sciences, King's College London, United Kingdom (P.v.D., L.A.M.)
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Mrocki MM, Nguyen VB, Lombardo P, Sutherland MR, Bensley JG, Nitsos I, Allison BJ, Harding R, De Matteo R, Schneider M, Polglase GR, Black MJ. Moderate preterm birth affects right ventricular structure and function and pulmonary artery blood flow in adult sheep. J Physiol 2018; 596:5965-5975. [PMID: 29508407 DOI: 10.1113/jp275654] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 02/26/2018] [Indexed: 12/25/2022] Open
Abstract
KEY POINTS Preterm birth occurs when the heart muscle is immature and ill-prepared for the changes in heart and lung function at birth. MRI imaging studies show differences in the growth and function of the heart of young adults born preterm, with the effects more pronounced in the right ventricle. The findings of this study, conducted in sheep, showed that following moderate preterm birth the right ventricular wall was thinner in adulthood, with a reduction in the number and size of the heart muscle cells; in addition, there was impaired blood flow in the main artery leading from the right ventricle to the lungs. The findings indicate that being born only a few weeks early adversely affects the cellular structure of the right ventricle and blood flow to the lungs in adulthood. The reduced number of heart muscle cells has the potential to deleteriously affect right ventricular growth potential and function. ABSTRACT Preterm birth prematurely exposes the immature heart to the haemodynamic transition at birth, which has the potential to induce abnormal cardiac remodelling. Magnetic resonance imaging studies in young adults born preterm have shown abnormalities in the gross structure of the ventricles (particularly the right ventricle; RV), but the cellular basis of these alterations is unknown. The aim of this study, conducted in sheep, was to determine the effect of moderate preterm birth on RV cellular structure and function in early adulthood. Male singleton lambs were delivered moderately preterm (132 ± 1 days; n = 7) or at term (147 ± 1 days; n = 7). At 14.5 months of age, intra-arterial blood pressure and heart rate were measured. Pulmonary artery diameter and peak systolic blood flow were determined using ultrasound imaging, and RV stroke volume and output calculated. Cardiomyocyte number, size, nuclearity and levels of cardiac fibrosis were subsequently assessed in perfusion-fixed hearts using image analysis and stereological methods. Blood pressure (systolic, diastolic and mean), heart rate, levels of myocardial fibrosis and RV stroke volume and output were not different between groups. There was, however, a significant reduction in RV wall thickness in preterm sheep, and this was accompanied by a significant reduction in peak systolic blood flow in the pulmonary artery and in RV cardiomyocyte number. Cellular changes in the RV wall and reduced pulmonary artery blood flow following preterm birth have the potential to adversely affect cardiac and respiratory haemodynamics, especially when the cardiovascular system is physiologically or pathologically challenged.
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Affiliation(s)
- Marshall M Mrocki
- Biomedicine Discovery Institute and the Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
| | - Vivian B Nguyen
- Biomedicine Discovery Institute and the Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
| | - Paul Lombardo
- Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, Victoria, Australia
| | - Megan R Sutherland
- Biomedicine Discovery Institute and the Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
| | - Jonathan G Bensley
- Biomedicine Discovery Institute and the Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
| | - Ilias Nitsos
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Clayton, Victoria, Australia
| | - Beth J Allison
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Clayton, Victoria, Australia
| | - Richard Harding
- Biomedicine Discovery Institute and the Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
| | - Robert De Matteo
- Biomedicine Discovery Institute and the Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
| | - Michal Schneider
- Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, Victoria, Australia
| | - Graeme R Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - M Jane Black
- Biomedicine Discovery Institute and the Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
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Bouchet N, Gayet-Ageron A, Lumbreras Areta M, Pfister RE, Martinez de Tejada B. Avoiding late preterm deliveries to reduce neonatal complications: an 11-year cohort study. BMC Pregnancy Childbirth 2018; 18:17. [PMID: 29310615 PMCID: PMC5759878 DOI: 10.1186/s12884-017-1650-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 12/28/2017] [Indexed: 02/02/2023] Open
Abstract
Background Late preterm (LPT) newborns, defined as those born between 34 0/7 and 36 6/7 gestational weeks, have higher short- and long-term morbidity and mortality than term infants (≥37 weeks). A categorization to justify a non-spontaneous LPT delivery has been proposed to distinguish evidence-based from non-evidence-based criteria. This study aims to describe rates and temporal trends of non-spontaneous LPT neonates delivered according to evidence-based or non-evidence-based criteria and to evaluate the number of avoidable LPT deliveries, including severe neonatal morbidity rates and associated risk factors. Methods Retrospective cohort study including all LPT neonates born at a Swiss university maternity unit between January 1, 2002 and December 31, 2012. Trends of LPT neonates and neonatal complications were assessed across time using Poisson regression and risk factors for neonatal complications by logistic regression. Results Among 40,609 singleton live births, 4223 (10.5%) were preterm and 2017 (4.9%) LPT. In the latter group, 26.2% were non-spontaneous (evidence-based: 12.0%; non-evidence-based: 14.2%). The most frequent indications for evidence-based non-spontaneous LPT delivery were severe preeclampsia (51.8%) and abnormal fetal tracing (24.7%). Indications for non-evidence-based non-spontaneous LPT deliveries were hemorrhage (36.2%) and mild preeclampsia (15.7%). LPT birth rates remained stable over time. The rate of neonatal complications after non-evidence-based LPT birth remained high over time (43.8% vs. 43.5% in 2002 and 2012, respectively; P = 0.645), whereas the annual proportion of neonatal complications overall showed a decreasing trend (from 38.0% in 2002 to 33.5% in 2012; P = 0.051). Conclusions LPT birth rates were stable over time, but neonatal complications remained high, particularly after non-evidence-indicated LPT birth. A total of 287 LPT births could have been potentially avoided if an evidence-based protocol for delivery indications had been used. Efforts should be made to avoid non-spontaneous LPT births in order to reduce neonatal complications.
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Affiliation(s)
- Noémie Bouchet
- Obstetrics Unit, Department of Obstetrics and Gynecology, Geneva University Hospitals and Faculty of Medicine, 30 Boulevard de la Cluse, 1205, Geneva, Switzerland
| | - Angèle Gayet-Ageron
- Clinical Research Centre and Division of Clinical Epidemiology, Department of Community Health and Medicine, Geneva University Hospitals and Faculty of Medicine, 6 rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland
| | - Marina Lumbreras Areta
- Obstetrics Unit, Department of Obstetrics and Gynecology, Geneva University Hospitals and Faculty of Medicine, 30 Boulevard de la Cluse, 1205, Geneva, Switzerland
| | - Riccardo Erennio Pfister
- Neonatology Unit, Department of Pediatrics, Geneva University Hospitals and Faculty of Medicine, 30 Boulevard de la Cluse, 1205, Geneva, Switzerland
| | - Begoña Martinez de Tejada
- Obstetrics Unit, Department of Obstetrics and Gynecology, Geneva University Hospitals and Faculty of Medicine, 30 Boulevard de la Cluse, 1205, Geneva, Switzerland.
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Abstract
Preterm delivery occurs in approximately 12% of all births in the United States and is a major factor that contributes to perinatal morbidity and mortality (1, 2). Preterm prelabor rupture of membranes (also referred to as premature rupture of membranes) (PROM) complicates approximately 3% of all pregnancies in the United States (3). The optimal approach to clinical assessment and treatment of women with term and preterm PROM remains controversial. Management hinges on knowledge of gestational age and evaluation of the relative risks of delivery versus the risks of expectant management (eg, infection, abruptio placentae, and umbilical cord accident). The purpose of this document is to review the current understanding of this condition and to provide management guidelines that have been validated by appropriately conducted outcome-based research when available. Additional guidelines on the basis of consensus and expert opinion also are presented.
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119
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Impact of neonatal morbidity on the risk of developmental delay in late preterm infants. Early Hum Dev 2018; 116:40-46. [PMID: 29136541 DOI: 10.1016/j.earlhumdev.2017.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 09/25/2017] [Accepted: 11/04/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Late preterm infants (LPI) have a higher risk of developmental delay (DD) than term-born infants. The association of perinatal complications with specific morbidity is not clear. AIM (1) To compare the risk of DD at 4years of age between LPI who have presence or absence of any morbidity associated with the prematurity at birth, called complicated (cLPI) or uncomplicated (uLPI), and term-born infants, (2) to determine maternal and perinatal factors associated with risk of DD, and (3) to analyze, in LPI, the association between perinatal morbidity and risk of DD. METHODS A retrospective cohort study including 163 LPI - 47 cLPI and 116 uLPI - and 158 term-born infants (Terms) was conducted. Parents completed the Ages & Stages Questionnaires®3rd Spanish version (ASQ3). Risk of DD was defined as the presence of any ASQ3 domain scoring below the mean minus 2 SD. Association between risk of DD and maternal and perinatal factors was analysed using a multivariate logistic model. Incidence of risk of DD was analysed according to specific morbidity. RESULTS Compared to Terms, cLPI have a higher risk of DD in the communication domain. Respiratory pathology was associated with a higher risk in the communication domain. Caesarean delivery was the only maternal perinatal risk factor for DD, especially in gross motor domain. CONCLUSIONS At the age of 4years cLPI, especially those with respiratory morbidity, had a higher risk of communication delay. Caesarean delivery was the only perinatal risk factor associated with risk of DD.
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120
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Yoneda S, Yoneda N, Fukuta K, Shima T, Nakashima A, Shiozaki A, Yoshino O, Kigawa M, Yoshida T, Saito S. In which preterm labor-patients is intravenous maintenance tocolysis effective? J Obstet Gynaecol Res 2017; 44:397-407. [DOI: 10.1111/jog.13547] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 10/08/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Satoshi Yoneda
- Department of Obstetrics and Gynecology; University of Toyama; Toyama Japan
| | - Noriko Yoneda
- Department of Obstetrics and Gynecology; University of Toyama; Toyama Japan
| | - Kaori Fukuta
- Department of Obstetrics and Gynecology; University of Toyama; Toyama Japan
| | - Tomoko Shima
- Department of Obstetrics and Gynecology; University of Toyama; Toyama Japan
| | - Akitoshi Nakashima
- Department of Obstetrics and Gynecology; University of Toyama; Toyama Japan
| | - Arihiro Shiozaki
- Department of Obstetrics and Gynecology; University of Toyama; Toyama Japan
| | - Osamu Yoshino
- Department of Obstetrics and Gynecology; University of Toyama; Toyama Japan
| | - Mika Kigawa
- Faculty of Health and Social Services; Kanagawa University of Human Services; Yokosuka Japan
| | - Taketoshi Yoshida
- Division of Neonatology Maternal and Perinatal Center; Toyama University Hospital; Toyama Japan
| | - Shigeru Saito
- Department of Obstetrics and Gynecology; University of Toyama; Toyama Japan
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121
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Polić B, Bubić A, Meštrović J, Markić J, Kovačević T, Antončić Furlan I, Utrobičić I, Kolčić I. Emotional and behavioral outcomes and quality of life in school-age children born as late preterm: retrospective cohort study. Croat Med J 2017; 58:332-341. [PMID: 29094811 PMCID: PMC5733375 DOI: 10.3325/cmj.2017.58.332] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aim To determine the effect of late preterm birth and treatment at the intensive care unit (ICU) on school-age children’s emotional and behavioral problems and quality of life (QoL). Methods Emotional and behavioral problems and QoL were investigated in 6-12-year-olds who were born late preterm at the University Hospital Center Split in the period from January 2002 to March 2008. The study included 126 late preterm children treated in ICU (LP-ICU group), 127 late preterm children not treated in ICU (LP-non-ICU group), and 131 full-term children treated in ICU (FT-ICU group). Emotional and behavioral difficulties were assessed using the Child Behavior Checklist. QoL was evaluated with the Royal Alexandra Hospital for Children Measure of Function questionnaire. The data was collected via telephone interview with mothers during 2014. Results Late preterm children had a nearly 5-fold risk for internalizing problems in comparison with FT-ICU children (OR 4.76, 95% confidence interval [CI] 2.37-9.56 and OR 4.82, 95% CI 2.25-10.37 in LP-ICU and LP-non-ICU children, respectively). They also had a greater risk for externalizing problems (OR 3.08, 95% CI 1.44-6.61 and OR 2.68, 95% CI 1.14-6.28, respectively) and total problems (OR 6.29, 95% CI 2.86-13.83 and OR 7.38, 95% CI 3.08-17.69, respectively) and a considerably increased risk for lower QoL (OR 12.79, 95% CI 5.56-29.41 and OR 5.05, 95% CI 2.04-12.48, respectively). Conclusion Children born late preterm had a greater risk for emotional and behavioral problems and lower QoL during childhood than their full-term born peers and they experienced serious health problems upon birth.
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Affiliation(s)
- Branka Polić
- Branka Polić, Department of Pediatrics, PICU, University Hospital Center Split, Spinčićeva 1, 21000 Split, Croatia,
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Ko HS, Jang YR, Yun H, Wie J, Choi SK, Park IY, Shin JC. Late-preterm infants, early-term infants, and timing of elective deliveries; current status in a Korean medical center. J Matern Fetal Neonatal Med 2017; 32:1267-1274. [PMID: 29130825 DOI: 10.1080/14767058.2017.1404564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this study was to examine the current perinatal outcomes among infants born late-preterm and early-term compared to those born full-term and evaluate the optimal gestational age for delivery. METHODS We performed a retrospective cohort study for births occurred at Seoul St. Mary's Hospital over the past 7 years. Statistical comparison was performed using χ2 test and multivariable logistic regression models. RESULTS A total of 7580 women met the study criteria. Compared to 39 weeks, delivery at late-preterm and early-term had higher risk of composite morbidity, including respiratory morbidities, intracranial hemorrhage (ICH), and admission to neonatal intensive care unit (NICU) (34 weeks adjusted odds ratio [aOR]: 132.54; 95% confidence interval (CI): 74.00-240.10; 37 weeks aOR: 2.14; 95%CI: 1.65-2.77). The risks of sepsis and necrotizing enterocolitis in deliveries before 36 weeks and the risk of feeding difficulty in deliveries before 37 weeks were significantly higher than those of 39 weeks. Neonatal morbidity at deliveries was not significantly different between 38 and 39 weeks. CONCLUSIONS Neonatal morbidities at late-preterm births are significant and surveillance for them seems increasing. Obstetricians should recognize the risk of respiratory morbidity, ICH, and NICU admission for deliveries before 38 weeks' gestation.
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Affiliation(s)
- Hyun Sun Ko
- a Department of Obstetrics and Gynecology, College of Medicine , The Catholic University of Korea , Seoul , Republic of Korea
| | - Yu-Ri Jang
- a Department of Obstetrics and Gynecology, College of Medicine , The Catholic University of Korea , Seoul , Republic of Korea
| | - Hanggoo Yun
- a Department of Obstetrics and Gynecology, College of Medicine , The Catholic University of Korea , Seoul , Republic of Korea
| | - JeongHa Wie
- a Department of Obstetrics and Gynecology, College of Medicine , The Catholic University of Korea , Seoul , Republic of Korea
| | - Sae Kyung Choi
- a Department of Obstetrics and Gynecology, College of Medicine , The Catholic University of Korea , Seoul , Republic of Korea
| | - In Yang Park
- a Department of Obstetrics and Gynecology, College of Medicine , The Catholic University of Korea , Seoul , Republic of Korea
| | - Jong Chul Shin
- a Department of Obstetrics and Gynecology, College of Medicine , The Catholic University of Korea , Seoul , Republic of Korea
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Soltani H, Lipoeto NI, Fair FJ, Kilner K, Yusrawati Y. Pre-pregnancy body mass index and gestational weight gain and their effects on pregnancy and birth outcomes: a cohort study in West Sumatra, Indonesia. BMC Womens Health 2017; 17:102. [PMID: 29121896 PMCID: PMC5679340 DOI: 10.1186/s12905-017-0455-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 10/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Indonesia has a considerably high incidence of maternal and infant mortality. The country has however been experiencing a social and economic transition, influencing its general population demographics and nutritional status including the state of health and nutrition of pregnant women. This study aimed to explore body mass index (BMI) and gestational weight gain (GWG), and their relationship with pregnancy outcomes in a sample of Indonesian pregnant women. METHODS This observational cohort study included a total of 607 pregnant women who were recruited in 2010 from maternity clinics in Western Sumatra, Indonesia. Multiple logistic and regression analyses were undertaken to compare pregnancy and birth outcomes for different BMI and GWG, using normal weight women and women with a recommended weight gain as the referent groups. RESULTS The prevalence of underweight (BMI < 18.5 kg/m2) in pregnancy was high at 20.1%; while 21.7% of women were overweight (BMI: 23.0-27.4 kg/m2) and 5.3% obese (BMI ≥ 27.5 kg/m2) using the Asian BMI classifications. The incidence of overweight (BMI: 25.0-29.9 kg/m2) and obese (BMI ≥ 30.0 kg/m2) according to the international BMI classifications were 13.5% and 1.1% respectively. The majority of women gained inadequate weight in pregnancy compared to the Institute of Medicine (IOM) recommendations, especially those who had a normal BMI. Birthweight adjusted mean difference aMD (95% confidence interval) 205 (46,365) and the odds of macrosomia adjusted odds ratio aOR 13.46 (2.32-77.99) significantly increased in obese women compared to those with a normal BMI. Birthweight aMD -139 (-215, -64) significantly decreased in women with inadequate GWG compared to those with recommended GWG, while SGA aOR 5.44 (1.36, 21.77) and prematurity aOR 3.55 (1.23, 10.21) increased. CONCLUSIONS Low nutritional status and inadequate GWG remain a cause for concern in these women. The higher odds of macrosomia with increasing maternal BMI and higher odds of prematurity and small for gestational age infants with inadequate weight gain also require attention. Research and practice recommendations: Urgent attention is required by researchers, policy makers and decision-makers to facilitate development of culturally sensitive interventions to enhance nutritional status and health of mothers and babies, in an area known for its high incidence of maternal and neonatal mortality.
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Affiliation(s)
- Hora Soltani
- Centre for Health and Social Care Research, Sheffield Hallam University, Mundella House, 34 Collegiate Crescent, Collegiate Campus, Sheffield, S10 2BP England
| | - Nur I. Lipoeto
- Faculty of Medicine, Andalas University, Padang, West Sumatra Indonesia
| | - Frankie J. Fair
- Centre for Health and Social Care Research, Sheffield Hallam University, Mundella House, 34 Collegiate Crescent, Collegiate Campus, Sheffield, S10 2BP England
| | - Karen Kilner
- Centre for Health and Social Care Research, Sheffield Hallam University, Mundella House, 34 Collegiate Crescent, Collegiate Campus, Sheffield, S10 2BP England
| | - Y. Yusrawati
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Andalas University, Padang, West Sumatra Indonesia
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Rodriguez-Martinez CE, Acuña-Cordero R, Sossa-Briceño MP. Predictors of prolonged length of hospital stay or readmissions for acute viral lower respiratory tract infections among infants with a history of bronchopulmonary dysplasia. J Med Virol 2017; 90:405-411. [PMID: 28975628 DOI: 10.1002/jmv.24962] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 09/07/2017] [Indexed: 11/08/2022]
Abstract
Length of hospital stay and readmissions are outcome measures that have been largely overlooked in many studies that have evaluated the clinical evolution of pediatric patients with bronchopulmonary dysplasia (BPD). The aim of the present study was to identify predictors of prolonged hospitalizations or readmissions for acute lower respiratory infections (ALRIs) in infants with BPD. In a prospective cohort study, we determined independent predictors of prolonged hospitalizations or readmissions for ALRIs during the first 2 years of life in a population of infants with BPD living in Bogota, Colombia. Of a total of 138 patients included in the study, 83 (60.1%) had at least one hospitalization for ALRI during the follow-up period. After controlling for potential confounders, we found that independent predictors of prolonged hospitalizations or readmissions for ALRIs included male gender (OR = 3.09; CI 95% 1.27-7.52; P = 0.013), ambulatory oxygen therapy between 90 and 119 days (OR = 3.21; CI 95% 1.00-10.24; P = 0.049), ambulatory oxygen therapy equal to or greater than 120 days (OR = 5.73; CI 95% 2.01-16.32; P = 0.001), gestational age at birth (OR = 1.35; CI 95% 1.03-1.76; P = 0.026), birth weight (OR = 0.997; CI 95% 0.996-0.999; P = 0.010), and duration of breastfeeding equal to or greater than 6 months (OR = 0.39; CI 95% 0.16-0.96; P = 0.039). The factors identified can be taken into account when planning policies to reduce duration of hospital stay and readmissions in infants with BPD.
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Affiliation(s)
- Carlos E Rodriguez-Martinez
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia.,Department of Pediatric Pulmonology and Pediatric Critical Care Medicine, School of Medicine, Universidad El Bosque, Bogota, Colombia
| | - Ranniery Acuña-Cordero
- Department of Pediatric Pulmonology, Hospital Militar Central, Department of Pediatrics, School of Medicine, Universidad Militar Nueva Granada, Bogota, Colombia
| | - Monica P Sossa-Briceño
- Department of Internal Medicine, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia
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125
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[Late preterm infants in Spain: Experience of the 34-36 Neonatal Group]. An Pediatr (Barc) 2017; 88:246-252. [PMID: 29100893 DOI: 10.1016/j.anpedi.2017.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/25/2017] [Accepted: 05/22/2017] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Late preterm (LP) infants (34 -36 weeks of gestation) are the largest group of preterm infants and also the least studied so far. In order to improve their care and reduce the impact of their increased morbidity and mortality, it is essential to know the current situation in Spain. POPULATION AND METHOD Clinical-epidemiological variables of the LP population of 34 participating hospitals were prospectively collected from 1 April 2011 to 31 March 2016, and were then compared with the Minimum Perinatal Data Set for term births in the database. RESULTS Of the 9,121 LP studied, 21.7% of 34, 30.8% of 35, and 47.5% of 36 weeks of gestation. The mortality rate was 2.8%. More than one-quarter (27.7%) were multiple pregnancies. Maternal disease were identified in 47.1% and 41.4% were pathological gestation. Just under half (47.9%) were by Caesarean section and 18.8% were of unknown origin or unjustified. No known cause of prematurity was found in 29%, and 3.1% were recognized as unjustified?caesarean?. Just under half (47%) of the LP were breastfed, and 58.6% required admission to neonatology, with 15.2% to Neonatal Intensive Care Unit. Coded diagnoses were recorded in 46.2%, with the most frequent being jaundice, 43.5%, hypoglycaemia, 30%, and respiratory disorders with 28.7%. CONCLUSIONS The large sample of LP studied helps us to highlight the higher neonatal mortality and morbidity that this population suffers and the unavoidable relationship of its incidence with multiparity, maternal aging, and the still numerous inductions of labour and unjustified elective caesareans.
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Stewart B, Karahalios A, Pszczola R, Said J. Moderate to late preterm intrauterine growth restriction: A restrospective, observational study of the indications for delivery and outcomes in an Australian perinatal centre. Aust N Z J Obstet Gynaecol 2017; 58:306-314. [DOI: 10.1111/ajo.12721] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 08/29/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Bridie Stewart
- Sunshine Hospital, Western Health; Melbourne Victoria Australia
- University of Melbourne; Melbourne Victoria Australia
| | - Amalia Karahalios
- Sunshine Hospital, Western Health; Melbourne Victoria Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health; University of Melbourne; Melbourne Victoria Australia
| | | | - Joanne Said
- Sunshine Hospital, Western Health; Melbourne Victoria Australia
- University of Melbourne; Melbourne Victoria Australia
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127
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Murray SR, Shenkin SD, McIntosh K, Lim J, Grove B, Pell JP, Norman JE, Stock SJ. Long term cognitive outcomes of early term (37-38 weeks) and late preterm (34-36 weeks) births: A systematic review. Wellcome Open Res 2017; 2:101. [PMID: 29387801 PMCID: PMC5721566 DOI: 10.12688/wellcomeopenres.12783.1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2017] [Indexed: 01/25/2023] Open
Abstract
Background: There is a paucity of evidence regarding long-term outcomes of late preterm (34-36 weeks) and early term (37-38 weeks) delivery. The objective of this systematic review was to assess long-term cognitive outcomes of children born at these gestations. Methods: Four electronic databases (Medline, Embase, clinicaltrials.gov and PsycINFO) were searched. Last search was 5
th August 2016.
Studies were included if they reported gestational age, IQ measure and the ages assessed. The protocol was registered with the International prospective register of systematic reviews (PROSPERO Record
CRD42015015472). Two independent reviewers assessed the studies. Data were abstracted and critical appraisal performed of eligible papers. Results: Of 11,905 potential articles, seven studies reporting on 41,344 children were included. For early term births, four studies (n = 35,711) consistently showed an increase in cognitive scores for infants born at full term (39-41 weeks) compared to those born at early term (37-38 weeks) with increases for each week of term (difference between 37 and 40 weeks of around 3 IQ points), despite differences in age of testing and method of IQ/cognitive testing. Four studies (n = 5644) reporting childhood cognitive outcomes of late preterm births (34 – 36 weeks) also differed in study design (cohort and case control); age of testing; and method of IQ testing, and found no differences in outcomes between late preterm and term births, although risk of bias was high in included studies. Conclusion: Children born at 39-41 weeks have higher cognitive outcome scores compared to those born at early term (37-38 weeks). This should be considered when discussing timing of delivery. For children born late preterm, the data is scarce and when compared to full term (37-42 weeks) did not show any difference in IQ scores.
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Affiliation(s)
- Sarah R Murray
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh Queen's Medical Research Institute, Edinburgh, EH16 4TJ, UK
| | - Susan D Shenkin
- Geriatric Medicine Unit, Royal Infirmary of Edinburgh and Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Kirsten McIntosh
- Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Jane Lim
- Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Benjamin Grove
- Department of Psychology, University of Edinburgh, Edinburgh, EH16 4T, UK
| | - Jill P Pell
- Section of Public Health, University of Glasgow, Glasgow, G12 8RZ, UK
| | - Jane E Norman
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh Queen's Medical Research Institute, Edinburgh, EH16 4TJ, UK
| | - Sarah J Stock
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh Queen's Medical Research Institute, Edinburgh, EH16 4TJ, UK
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128
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Dundar B, Dincgez Cakmak B, Ozgen G, Tasgoz FN, Guclu T, Ocakoglu G. Platelet indices in preterm premature rupture of membranes and their relation with adverse neonatal outcomes. J Obstet Gynaecol Res 2017; 44:67-73. [DOI: 10.1111/jog.13484] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 07/23/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Betul Dundar
- Department of Obstetrics and Gynecology; Bursa Yuksek Ihtisas Research and Training Hospital; Bursa Turkey
| | - Burcu Dincgez Cakmak
- Department of Obstetrics and Gynecology; Bursa Yuksek Ihtisas Research and Training Hospital; Bursa Turkey
| | - Gulten Ozgen
- Department of Obstetrics and Gynecology; Bursa Yuksek Ihtisas Research and Training Hospital; Bursa Turkey
| | - Fatma Nurgul Tasgoz
- Department of Obstetrics and Gynecology; Bursa Yuksek Ihtisas Research and Training Hospital; Bursa Turkey
| | - Tugberk Guclu
- Department of Obstetrics and Gynecology; Bursa Yuksek Ihtisas Research and Training Hospital; Bursa Turkey
| | - Gokhan Ocakoglu
- Department of Biostatistics; Uludag University Medical Faculty; Bursa Turkey
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Vogel JP, Oladapo OT, Pileggi-Castro C, Adejuyigbe EA, Althabe F, Ariff S, Ayede AI, Baqui AH, Costello A, Chikamata DM, Crowther C, Fawole B, Gibbons L, Jobe AH, Kapasa ML, Kinuthia J, Kriplani A, Kuti O, Neilson J, Patterson J, Piaggio G, Qureshi R, Qureshi Z, Sankar MJ, Stringer JSA, Temmerman M, Yunis K, Bahl R, Metin Gülmezoglu A. Antenatal corticosteroids for women at risk of imminent preterm birth in low-resource countries: the case for equipoise and the need for efficacy trials. BMJ Glob Health 2017; 2:e000398. [PMID: 29082019 PMCID: PMC5656119 DOI: 10.1136/bmjgh-2017-000398] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/21/2017] [Accepted: 06/23/2017] [Indexed: 11/13/2022] Open
Abstract
The scientific basis for antenatal corticosteroids (ACS) for women at risk of preterm birth has rapidly changed in recent years. Two landmark trials—the Antenatal Corticosteroid Trial and the Antenatal Late Preterm Steroids Trial—have challenged the long-held assumptions on the comparative health benefits and harms regarding the use of ACS for preterm birth across all levels of care and contexts, including resource-limited settings. Researchers, clinicians, programme managers, policymakers and donors working in low-income and middle-income countries now face challenging questions of whether, where and how ACS can be used to optimise outcomes for both women and preterm newborns. In this article, we briefly present an appraisal of the current evidence around ACS, how these findings informed WHO’s current recommendations on ACS use, and the knowledge gaps that have emerged in the light of new trial evidence. Critical considerations in the generalisability of the available evidence demonstrate that a true state of clinical equipoise exists for this treatment option in low-resource settings. An expert group convened by WHO concluded that there is a clear need for more efficacy trials of ACS in these settings to inform clinical practice.
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Affiliation(s)
- Joshua P Vogel
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Olufemi T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Cynthia Pileggi-Castro
- Department of Maternal Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | | | - Fernando Althabe
- Department of Mother and Child Health Research for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Shabina Ariff
- Department of Pediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | - Adejumoke Idowu Ayede
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Abdullah H Baqui
- International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anthony Costello
- Department of Maternal Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Davy M Chikamata
- Ministry of Community Development, Mother & Child Health, Lusaka, Zambia
| | - Caroline Crowther
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Bukola Fawole
- Department of Obstetrics & Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Luz Gibbons
- Department of Mother and Child Health Research for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Alan H Jobe
- Department of Pediatrics, Cincinnati Childrens Hospital, Cincinnati, Ohio, USA
| | | | - John Kinuthia
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Alka Kriplani
- All India Institute of Medical Sciences, New Delhi, India
| | - Oluwafemi Kuti
- Department of Obstetrics, Gynaecology and Perinatology, College of Health Sciences, Obafemi Awolowo University, Ife, Nigeria
| | - James Neilson
- Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK
| | - Janna Patterson
- Maternal, Newborn, and Child Health, Bill and Melinda Gates Foundation, Geneva, Switzerland
| | - Gilda Piaggio
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Rahat Qureshi
- Department of Obstetrics and Gynecology, Aga Khan University, Karachi, Pakistan
| | - Zahida Qureshi
- Department of Obstetrics and Gynaecology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Mari Jeeva Sankar
- Department of Pediatrics, WHO Collaborating Centre for Training and Research in Newborn Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Jeffrey S A Stringer
- University of North Carolina, School of Medicine, Chapel Hill, North Carolina, USA
| | - Marleen Temmerman
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Khalid Yunis
- National Collaborative Perinatal Neonatal Network, American University of Beirut, Beirut, Lebanon
| | - Rajiv Bahl
- Department of Maternal Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - A Metin Gülmezoglu
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Kocvarova L, Mackovicova L, Matasova K, Zibolen M. The early postnatal blood flow characteristics in the superior mesenteric and coeliac arteries in late preterm neonates. J Matern Fetal Neonatal Med 2017; 31:3027-3032. [PMID: 28760069 DOI: 10.1080/14767058.2017.1362553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Lenka Kocvarova
- Jessenius Faculty of Medicine in Martin, Clinic of Neonatology, Comenius University, Bratislava, Slovakia
| | - Lenka Mackovicova
- Institute of Mathematics and Informatics, Matej Bel University, Banska Bystrica, Slovakia
| | - Katarina Matasova
- Jessenius Faculty of Medicine in Martin, Clinic of Neonatology, Comenius University, Bratislava, Slovakia
| | - Mirko Zibolen
- Jessenius Faculty of Medicine in Martin, Clinic of Neonatology, Comenius University, Bratislava, Slovakia
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131
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Children born at 32 to 35 weeks with birth asphyxia and later cerebral palsy are different from those born after 35 weeks. J Perinatol 2017; 37:963-968. [PMID: 28300820 DOI: 10.1038/jp.2017.23] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/19/2017] [Accepted: 02/07/2017] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The objectives of this study were to (1) establish the proportion of cerebral palsy (CP) that occurs with a history suggestive of birth asphyxia in children born at 32 to 35 weeks and (2) evaluate their characteristics in comparison with children with CP born at ⩾36 weeks with such a history. STUDY DESIGN Using the Canadian CP Registry, children born at 32 to 35 weeks of gestation with CP with a history suggestive of birth asphyxia were compared with corresponding ⩾36 weeks of gestation children. RESULTS Of the 163 children with CP born at 32 to 35 weeks and 738 born at ⩾36 weeks, 26 (16%) and 105 (14%) had a history suggestive of birth asphyxia, respectively. The children born at 32 to 35 weeks had more frequent abruptio placenta (35% vs 12%; odds ratio (OR) 4.1, 95% confidence interval (CI) 1.5 to 11.2), less frequent neonatal seizures (35% vs 72%; OR 0.20, 95% CI 0.08 to 0.52), more frequent white matter injury (47% vs 17%; OR 4.3, 95% CI 1.3 to 14.0), more frequent intraventricular hemorrhage (IVH) (40% vs 6%; OR 11.2, 95% CI 3.4 to 37.4) and more frequent spastic diplegia (24% vs 8%; OR 1.8, 95% CI 1.2 to 12.2) than the corresponding ⩾36 weeks of gestation children. CONCLUSIONS Approximately 1 in 7 children with CP born at 32 to 35 weeks had a history suggestive of birth asphyxia. They had different magnetic resonance imaging patterns of injury from those born at ⩾36 weeks and a higher frequency of IVH. Importantly, when considering hypothermia in preterm neonates with suspected birth asphyxia, prospective surveillance for IVH will be essential.
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132
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Palacio M, Bonet-Carne E, Cobo T, Perez-Moreno A, Sabrià J, Richter J, Kacerovsky M, Jacobsson B, García-Posada RA, Bugatto F, Santisteve R, Vives À, Parra-Cordero M, Hernandez-Andrade E, Bartha JL, Carretero-Lucena P, Tan KL, Cruz-Martínez R, Burke M, Vavilala S, Iruretagoyena I, Delgado JL, Schenone M, Vilanova J, Botet F, Yeo GSH, Hyett J, Deprest J, Romero R, Gratacos E. Prediction of neonatal respiratory morbidity by quantitative ultrasound lung texture analysis: a multicenter study. Am J Obstet Gynecol 2017; 217:196.e1-196.e14. [PMID: 28342715 PMCID: PMC5625293 DOI: 10.1016/j.ajog.2017.03.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/23/2017] [Accepted: 03/15/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Prediction of neonatal respiratory morbidity may be useful to plan delivery in complicated pregnancies. The limited predictive performance of the current diagnostic tests together with the risks of an invasive procedure restricts the use of fetal lung maturity assessment. OBJECTIVE The objective of the study was to evaluate the performance of quantitative ultrasound texture analysis of the fetal lung (quantusFLM) to predict neonatal respiratory morbidity in preterm and early-term (<39.0 weeks) deliveries. STUDY DESIGN This was a prospective multicenter study conducted in 20 centers worldwide. Fetal lung ultrasound images were obtained at 25.0-38.6 weeks of gestation within 48 hours of delivery, stored in Digital Imaging and Communication in Medicine format, and analyzed with quantusFLM. Physicians were blinded to the analysis. At delivery, perinatal outcomes and the occurrence of neonatal respiratory morbidity, defined as either respiratory distress syndrome or transient tachypnea of the newborn, were registered. The performance of the ultrasound texture analysis test to predict neonatal respiratory morbidity was evaluated. RESULTS A total of 883 images were collected, but 17.3% were discarded because of poor image quality or exclusion criteria, leaving 730 observations for the final analysis. The prevalence of neonatal respiratory morbidity was 13.8% (101 of 730). The quantusFLM predicted neonatal respiratory morbidity with a sensitivity, specificity, positive and negative predictive values of 74.3% (75 of 101), 88.6% (557 of 629), 51.0% (75 of 147), and 95.5% (557 of 583), respectively. Accuracy was 86.5% (632 of 730) and positive and negative likelihood ratios were 6.5 and 0.3, respectively. CONCLUSION The quantusFLM predicted neonatal respiratory morbidity with an accuracy similar to that previously reported for other tests with the advantage of being a noninvasive technique.
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Affiliation(s)
- Montse Palacio
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Barcelona, Spain; Centre for Biomedical Research on Rare Diseases (Centro de Investigación Biomédica en Red Enfermedades Raras), Barcelona, Spain.
| | | | - Teresa Cobo
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Barcelona, Spain; Centre for Biomedical Research on Rare Diseases (Centro de Investigación Biomédica en Red Enfermedades Raras), Barcelona, Spain
| | | | - Joan Sabrià
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jute Richter
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, and Academic Department of Development and Regeneration, Organ System Cluster, KU Leuven, Leuven, Belgium
| | - Marian Kacerovsky
- Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, and Charles University in Prague, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital/Ostra, Gothenburg University, Gothenburg, Sweden; Department of Genetics and Bioinformatics, Area of Health Data and Digitalization, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Fernando Bugatto
- Division of Fetal-Maternal Medicine, Department of Obstetrics and Gynecology, University Hospital Puerta del Mar, Cadiz, Spain
| | - Ramon Santisteve
- Althaia Xarxa Assistencial Universitària de Manresa, Hospital de Sant Joan de Déu, Manresa, Spain
| | - Àngels Vives
- Department of Obstetrics and Gynaecology, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Mauro Parra-Cordero
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Chile Hospital, Santiago de Chile, Chile
| | - Edgar Hernandez-Andrade
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Wayne State University Detroit, MI
| | - José Luis Bartha
- Division of Maternal and Fetal Medicine, University Hospital La Paz, Madrid, Spain
| | - Pilar Carretero-Lucena
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Hospital of Granada (CHUG), Granada, Spain
| | - Kai Lit Tan
- Department of Maternal-Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Rogelio Cruz-Martínez
- Fetal Medicine Research Unit, Children's and Women's Specialty Hospital of Queretaro, Unidad de Investigación en Neurodesarrollo, Instituto de Neurobiología, UNAM-Juriquilla, Queretaro, Mexico
| | - Minke Burke
- Royal Prince Alfred Hospital Sydney, University of Sydney, Sydney, New South Wales, Australia
| | | | - Igor Iruretagoyena
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, University of Wisconsin, Madison, WI
| | - Juan Luis Delgado
- Fetal Medicine Unit, Clinic University Hospital, Virgen de la Arrixaca, Murcia, Spain
| | - Mauro Schenone
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN
| | - Josep Vilanova
- Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra
| | - Francesc Botet
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Barcelona, Spain; Centre for Biomedical Research on Rare Diseases (Centro de Investigación Biomédica en Red Enfermedades Raras), Barcelona, Spain
| | - George S H Yeo
- Department of Maternal-Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Jon Hyett
- Royal Prince Alfred Hospital Sydney, University of Sydney, Sydney, New South Wales, Australia
| | - Jan Deprest
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, and Academic Department of Development and Regeneration, Organ System Cluster, KU Leuven, Leuven, Belgium
| | - Roberto Romero
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI; Center for Molecular Medicine and Genetics, Wayne State University Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI
| | - Eduard Gratacos
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Barcelona, Spain; Centre for Biomedical Research on Rare Diseases (Centro de Investigación Biomédica en Red Enfermedades Raras), Barcelona, Spain
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Mughal MK, Ginn CS, Magill-Evans J, Benzies KM. Parenting stress and development of late preterm infants at 4 months corrected age. Res Nurs Health 2017; 40:414-423. [DOI: 10.1002/nur.21809] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 06/06/2017] [Indexed: 01/13/2023]
Affiliation(s)
| | | | - Joyce Magill-Evans
- Department of Occupational Therapy; University of Alberta; Edmonton Alberta Canada
| | - Karen M. Benzies
- Faculty of Nursing, Department of Paediatrics; University of Calgary; Calgary Alberta Canada
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Ghorayeb SR, Bracero LA, Blitz MJ, Rahman Z, Lesser ML. Quantitative Ultrasound Texture Analysis for Differentiating Preterm From Term Fetal Lungs. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1437-1443. [PMID: 28339127 DOI: 10.7863/ultra.16.06069] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/29/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To differentiate preterm (<37 weeks' gestation) from term (≥37 weeks' gestation) fetal lungs by using quantitative texture analysis of ultrasound images. METHODS This study retrospectively evaluated singleton gestations with valid dating at 20 weeks' gestational age (GA) or later between January 2015 and December 2015. Images were obtained from Voluson E8 ultrasound systems (GE Healthcare, Milwaukee, WI). A region of interest was selected in each fetal lung image at the level of the 4 heart chambers from an area that appeared most representative of the overall lung tissue and had the least shadow. Ultrasonic tissue heterogeneity (heterogeneity index) based on dynamic range calculation was determined for all lung images. This quantification was performed with a custom-made software program that used a dithering technique based on the Floyd-Steinberg algorithm, in which the pixels are transformed into a binary map. Regression analysis was used to determine the correlation and functional association between the heterogeneity index and GA. A receiver operating characteristic curve was used to identify the optimal heterogeneity index cutoff point for differentiating preterm from term fetal lungs. RESULTS A total of 425 fetal lung ultrasound images (313 preterm and 112 term) were analyzed. Quantitative texture analysis predicted GA with sensitivity and specificity of 87.9% and 92.0%, respectively, based on the optimal receiver operating characteristic cutoff point. CONCLUSIONS Quantitative ultrasound texture analysis of fetal lung tissue can differentiate preterm fetal lungs from term fetal lungs. Our data suggest that decreased fetal lung heterogeneity on ultrasound imaging is associated with preterm fetuses.
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Affiliation(s)
- Sleiman R Ghorayeb
- School of Engineering and Applied Sciences, Ultrasound Research Laboratory, Hofstra University, Hempstead, New York, USA
- Departments of Radiology and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York, USA
- Center for Immunology and Inflammation, Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Luis A Bracero
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hofstra Northwell School of Medicine, Southside Hospital, Bay Shore, New York, USA
| | - Matthew J Blitz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hofstra Northwell School of Medicine, North Shore University Hospital, Manhasset, New York, USA
| | - Zara Rahman
- School of Engineering and Applied Sciences, Ultrasound Research Laboratory, Hofstra University, Hempstead, New York, USA
| | - Martin L Lesser
- Biostatistics Unit, Feinstein Institute for Medical Research, Hofstra Northwell School of Medicine, Manhasset, New York, USA
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135
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Isayama T, Lewis-Mikhael AM, O'Reilly D, Beyene J, McDonald SD. Health Services Use by Late Preterm and Term Infants From Infancy to Adulthood: A Meta-analysis. Pediatrics 2017; 140:peds.2017-0266. [PMID: 28759410 DOI: 10.1542/peds.2017-0266] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Late-preterm infants born at 34 to 36 weeks' gestation have increased risks of various health problems. Health service utilization (HSU) of late-preterm infants has not been systematically summarized before. OBJECTIVES To summarize the published literature on short- and long-term HSU by late-preterm infants versus term infants from infancy to adulthood after initial discharge from the hospital. DATA SOURCES We searched Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature, and PsycINFO. STUDY SELECTION Cohort and case-control studies that compared HSU (admissions, emergency department visits, etc) between late-preterm infants and term infants were included. DATA EXTRACTION Data extracted included study design, setting, population, HSU, covariates, and effect estimates. RESULTS Fifty-two articles were included (50 cohort and 2 case-control studies). Meta-analyses with random effect models that used the inverse-variance method found that late-preterm infants had higher chances of all-cause admissions than term infants during all the time periods. The magnitude of the differences decreased with age from the neonatal period through adolescence, with adjusted odds ratios from 2.34 (95% confidence intervals 1.19-4.61) to 1.09 (1.05-1.13) and adjusted incidence rate ratios from 2.62 (2.52-2.72) to 1.14 (1.11-1.18). Late-preterm infants had higher rates of various cause-specific HSU than term infants for jaundice, infection, respiratory problems, asthma, and neurologic and/or mental health problems during certain periods, including adulthood. LIMITATIONS Considerable heterogeneity existed and was partially explained by the variations in the adjustment for multiple births and gestational age ranges of the term infants. CONCLUSIONS Late-preterm infants had higher risks for all-cause admissions as well as for various cause-specific HSU during the neonatal period through adolescence.
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Affiliation(s)
- Tetsuya Isayama
- Departments of Health Research Methods, Evidence, and Impact, .,Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; and
| | | | - Daria O'Reilly
- Departments of Health Research Methods, Evidence, and Impact.,Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Joseph Beyene
- Departments of Health Research Methods, Evidence, and Impact
| | - Sarah D McDonald
- Departments of Health Research Methods, Evidence, and Impact.,Obstetrics and Gynecology, and.,Radiology, McMaster University, Hamilton, Ontario, Canada
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Abstract
Preterm delivery occurs in approximately 12% of all births in the United States and is a major factor that contributes to perinatal morbidity and mortality (1, 2). Preterm premature rupture of membranes (PROM) complicates approximately 3% of all pregnancies in the United States (3). The optimal approach to clinical assessment and treatment of women with term and preterm PROM remains controversial. Management hinges on knowledge of gestational age and evaluation of the relative risks of delivery versus the risks of expectant management (eg, infection, abruptio placentae, and umbilical cord accident). The purpose of this document is to review the current understanding of this condition and to provide management guidelines that have been validated by appropriately conducted outcome-based research when available. Additional guidelines on the basis of consensus and expert opinion also are presented.
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137
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Physical Growth, Morbidity Profile and Mortality Among Healthy Late Preterm Neonates. Indian Pediatr 2017; 54:629-634. [PMID: 28607209 DOI: 10.1007/s13312-017-1123-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the physical growth outcomes, morbidity profile and mortality at an age of 12 months among late preterm (34 0/7to 36 6/7) neonates to term (37 0/7to 41 6/7) neonates. STUDY DESIGN Prospective cohort study. SETTING A tertiary care center of Northern India during 2014-2015. PARTICIPANTS 200 apparently healthy late preterms and term infants, followed up to 12 months of age. MAIN OUTCOME MEASURES Physical growth parameters, morbidity profile and mortality. RESULTS At mean age of 12 months, mean (SD) weight, length and head circumference of late preterms were 7.4 (0.8) kg, 69.2 (2.5) cm and 43.0 (1.1) cm, respectively; which were significantly lower than that of the full term infants [8.7 (1.6) kg, 72.2 (3.1) cm and 44.2 (1.1) cm] (P< 0.001). On univariate analysis, late preterm group was associated with higher odds (95% CI) of being underweight [5.6 (3.4, 5.5)], stunted [3.5 (2.1, 5.8)] and wasted [3.6 (1.9, 6.9)]. On multivariate analysis, only adjusted odds of late preterms becoming underweight by one year was significant [OR 4.1; 95% CI (1.6, 10.4)]. Feeding difficulties, jaundice and re-hospitalization rates were significantly higher in the late preterm group. The median (IQR) episodes per baby for late preterms as compared to terms for diarrhea [1.84 (0,3) vs 1.14 (0,2) (P <0.001)], and fever [1.33 (0,2) vs. 0.95 (0,2) (P = 0.01)] were higher. CONCLUSION Healthy late preterms are at significantly higher risk of being underweight in the first year of life, in addition to having significantly higher morbidity.
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138
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Olivier F, Nadeau S, Bélanger S, Julien AS, Massé E, Ali N, Caouette G, Piedboeuf B. Efficacy of minimally invasive surfactant therapy in moderate and late preterm infants: A multicentre randomized control trial. Paediatr Child Health 2017; 22:120-124. [PMID: 29479196 PMCID: PMC5804903 DOI: 10.1093/pch/pxx033] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Minimally invasive surfactant therapy (MIST) is a new strategy to avoid mechanical ventilation (MV) in respiratory distress syndrome. The primary aim of this study was to test MIST as a means of avoiding MV exposure and pneumothorax occurrence in moderate and late preterm infants (32 to 36 weeks' gestational age). METHODS This was a randomized controlled trial including three Canadian centres. Patients were randomized to standard management or to the intervention if they required nasal continuous positive airway pressure of 6 cm H2O and 35% FiO2 in the first 24 hours of life. Patients from the intervention group received MIST immediately after inclusion. The primary outcome was either need for MV or development of a pneumothorax requiring a chest tube. To ensure that clinicians were not biased toward delaying intubation in the intervention group, clinical failure criteria were also used as a primary outcome. The primary outcome was analyzed using bivariate and multivariate logistic regressions. RESULTS Among 45 randomized patients, 24 were assigned to MIST and 21 to standard management. Eight infants (33%) from the intervention group met the primary outcome criteria versus 19 (90%) in the control group (absolute risk reduction 0.57, 95% confidence interval 0.54 to 0.60). One patient in each group reached the primary outcome because of pneumothorax occurrence. The other patients were exposed to MV. None of the patients reached the clinical failure criteria. CONCLUSION MIST for respiratory distress syndrome management in moderate and late preterm infants was associated with a significant reduction of MV exposure and pneumothorax occurrence.
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Affiliation(s)
- François Olivier
- Department of Pediatrics, CHU de Québec - Université Laval, Québec City, Québec
| | - Sophie Nadeau
- Department of Pediatrics, CHU de Québec - Université Laval, Québec City, Québec
| | - Sylvie Bélanger
- Department of Pediatrics, CHU de Québec - Université Laval, Québec City, Québec
| | - Anne-Sophie Julien
- Plateforme de la recherche clinique, Centre de recherche du CHU de Québec - Université Laval, Hôpital Saint-François d'Assise, Québec City, Québec
| | - Edith Massé
- Department of Pediatrics, Université de Sherbrooke, Hôpital Fleurimont, Sherbrooke, Québec
| | - Nabeel Ali
- Department of Pediatrics, Université de Montréal, Hôpital Maisonneuve-Rosemont, Montréal, Québec
| | - Georges Caouette
- Department of Pediatrics, CHU de Québec - Université Laval, Québec City, Québec
| | - Bruno Piedboeuf
- Department of Pediatrics, CHU de Québec - Université Laval, Québec City, Québec
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139
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Ramadan MK, Hussein G, Saheb W, Rajab M, Mirza FG. Antenatal corticosteroids in the late preterm period: A prospective cohort study. J Neonatal Perinatal Med 2017; 9:15-22. [PMID: 27002271 DOI: 10.3233/npm-16915086] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The study objective was to examine the effect of antenatal corticosteroids on the incidence of short-term neonatal morbidities in singletons born during the late preterm period. STUDY DESIGN This was a prospective cohort study of singleton gestations at risk of imminent delivery between 34 0/7 and 36 6/7 weeks. Short-term neonatal morbidities were compared between the corticosteroid exposed and non-exposed groups. The rates of Neonatal Morbidity Composite and Any Adverse Neonatal Morbidity were then compared between the two groups. RESULTS During the two-year study period, a total of 295 subjects were included. Of those, 74 were exposed to antenatal corticosteroids, while 221 cases constituted the non-exposed group. There was no statistically significant difference in the rate of Any Adverse Neonatal Morbidity (47.3% vs. 40.7% , p = 0.32) or the rate of Neonatal Morbidity Composite (34.4% vs. 37.8% , p = 0.59) between the two groups. Additionally, there was no statistically significant difference in the rates of neonatal intensive care unit admission, respiratory distress syndrome, transient tachypnea of the newborn, hypothermia, and need for phototherapy. CONCLUSION Administration of antenatal corticosteroids to parturients at risk of imminent delivery during the late preterm period does not appear to reduce short-term neonatal morbidities.
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Affiliation(s)
- M K Ramadan
- Makassed General Hospital, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Beirut, Lebanon
| | - G Hussein
- Makassed General Hospital, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Beirut, Lebanon
| | - W Saheb
- Makassed General Hospital, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Beirut, Lebanon
| | - M Rajab
- Makassed General Hospital, Department of Pediatrics, Division of Neonatology, Beirut, Lebanon
| | - F G Mirza
- American University of Beirut Medical Center, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Beirut, Lebanon.,Columbia University College of Physicians and Surgeons, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, New York, NY, USA
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140
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Abstract
BACKGROUND Approximately 500,000 infants are born prematurely each year in the United States. Immunization of infants in a neonatal intensive care unit (NICU) set a precedence for future immunizations. PURPOSES The objectives of this study were to determine the current rates of immunization and identify variables associated with immunizations of NICU graduates who were aged 60 days or older at time of discharge. METHODS This descriptive pilot study utilized retrospective paper medical record review in one tertiary children's hospital. The relationships between immunization status and study variables were examined using t tests and logistic regression. RESULTS Of 43 infants discharged at least 60 days of age or older from the NICU, 74.4% were fully immunized in accordance with American Academy of Pediatrics (AAP) recommendations. Significant predictors were age at discharge for immunization and steroid use for nonimmunization. IMPLICATIONS FOR PRACTICE Immunization needs to be a priority in order to give NICU infants every advantage regarding their future health status. Nurses need to implement hospital policies ensuring immunizations of NICU graduates. IMPLICATIONS FOR RESEARCH Future studies should focus on samples from diverse hospitals and levels of NICUs. Qualitative studies exploring and describing parent and provider knowledge of current AAP guidelines will strengthen our understanding of potential barriers to immunization.
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141
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Tickell KD, Lokken EM, Schaafsma TT, Goldberg J, Lannon SMR. Lower respiratory tract disorder hospitalizations among children born via elective early-term delivery. J Matern Fetal Neonatal Med 2017; 29:1871-6. [PMID: 26302650 DOI: 10.3109/14767058.2015.1066774] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We evaluated the hypothesis that elective early-term delivery increases the risk of childhood lower respiratory tract disorder hospitalization. METHODS Children born via early-term elective inductions were compared to full- or late-term elective inductions in a retrospective cohort study using Washington State birth certificate and hospital discharge data. Outcomes were the odds of lower respiratory disorder hospitalization before age five and cause specific odds ratios for asthma, bronchiolitis, bronchitis, and pneumonia. In addition, a subgroup analysis excluding infants with perinatal complications was conducted. RESULTS Electively induced early-term children were at significantly increased risk of hospitalization before age five for lower respiratory disorders compared to similar full- or late-term children (adjusted OR: 1.31, 95% CI: 1.11-1.55). Bronchiolitis was the only cause-specific outcome with a statistically significant increase in odds of hospitalization, though comparable increases were found for the less common diagnoses of asthma (adjusted OR: 1.39, 95% CI: 0.93-2.08) and pneumonia (adjusted OR: 1.27, 95% CI: 0.99-1.64). Excluding infants with perinatal complications did not alter the results. CONCLUSIONS There was an association between electively induced early-term delivery and hospitalization for lower respiratory tract disorders before age five. This reinforces policies discouraging elective early-term delivery.
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142
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Zwertbroek EF, Broekhuijsen K, Langenveld J, van Baaren GJ, van den Berg PP, Bremer HA, Ganzevoort W, van Loon AJ, Mol BW, van Pampus MG, Perquin DA, Rijnders RJ, Scheepers HC, Sikkema MJ, Woiski MD, Groen H, Franssen MT. Prediction of progression to severe disease in women with late preterm hypertensive disorders of pregnancy. Acta Obstet Gynecol Scand 2016; 96:96-105. [DOI: 10.1111/aogs.13051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 10/16/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Eva F. Zwertbroek
- Department of Obstetrics and Gynecology; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Kim Broekhuijsen
- Department of Obstetrics and Gynecology; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Josje Langenveld
- Department of Obstetrics and Gynecology; Atrium Medical Center Parkstad; Heerlen The Netherlands
| | - Gert-Jan van Baaren
- Department of Obstetrics and Gynecology; Academic Medical Center; Amsterdam The Netherlands
| | - Paul P. van den Berg
- Department of Obstetrics and Gynecology; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Henk A. Bremer
- Department of Obstetrics and Gynecology; Reinier de Graaf Gasthuis; Delft The Netherlands
| | - Wessel Ganzevoort
- Department of Obstetrics and Gynecology; Academic Medical Center; Amsterdam The Netherlands
| | - Aren J. van Loon
- Department of Obstetrics and Gynecology; Martini Hospital; Groningen The Netherlands
| | - Ben W.J. Mol
- The Robinson Research Institute; School of Pediatrics and Reproductive Health; University of Adelaide; Adelaide SA Australia
| | - Maria G. van Pampus
- Department of Obstetrics and Gynecology; Onze Lieve Vrouwe Gasthuis; Amsterdam The Netherlands
| | - Denise A.M. Perquin
- Department of Obstetrics and Gynecology; Medical Center Leeuwarden; Leeuwarden The Netherlands
| | - Robbert J.P. Rijnders
- Department of Obstetrics and Gynecology; Jeroen Bosch Hospital; ‘s-Hertogenbosch The Netherlands
| | - Hubertina C.J. Scheepers
- Department of Obstetrics and Gynecology; Grow, School for Oncology and Developmental Biology; Maastricht University Medical Center; Maastricht The Netherlands
| | - Marko J. Sikkema
- Department of Obstetrics and Gynecology; ZGT Almelo; Amelo The Netherlands
| | - Mallory D. Woiski
- Department of Obstetrics and Gynecology; Radboud University Medical Center; Nijmegen The Netherlands
| | - Henk Groen
- Department of Epidemiology-HPC FA40; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Maureen T.M. Franssen
- Department of Obstetrics and Gynecology; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
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143
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Early developmental outcomes predicted by gestational age from 35 to 41weeks. Early Hum Dev 2016; 103:85-90. [PMID: 27536852 DOI: 10.1016/j.earlhumdev.2016.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 06/30/2016] [Accepted: 07/17/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND Recent studies have indicated that children born only a few weeks earlier than their due date experience more health and cognitive problems than previously realized. AIMS Our study investigated whether gestational age (GA) at birth (35-41weeks) predicted developmental outcomes at 8, 12, 20, or 24months of age. STUDY DESIGN Archival records of developmental screening scores collected between 2006 and 2012 were analyzed using negative binomial and logistic regressions models. SUBJECTS Eight-month (N=3319), 12-month (N=2303), 20-month (N=1461) and 24-month (N=1222) old children were assessed in a county-wide developmental screening program. OUTCOME MEASURES Ages and Stage Questionnaires (ASQs) scores. RESULTS After controlling for demographic covariates, from 35weeks of gestation on, each additional week of gestation (through 41) significantly reduced the overall risk for developmental delay at 8,12, 20 and 24-months of age. Gestational age also uniquely predicted specific risk for delay in the domains of communication, personal-social, fine-motor, and problem solving at various time-points during the first two years of life. CONCLUSIONS With each additional week of gestation past 35weeks there was a graded decrease in the overall risk of developmental delay as well as in specific domains such as communication across the first two years of life. This evidence for the "dose-response" effect of GA on later development suggests that close monitoring of developmental outcomes for children born before 40weeks is warranted.
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Veit L, Amberson M, Freiberger C, Montenegro B, Mukhopadhyay S, Rhein LM. Diagnostic Evaluation and Home Monitor Use in Late Preterm to Term Infants With Apnea, Bradycardia, and Desaturations. Clin Pediatr (Phila) 2016; 55:1210-1218. [PMID: 26957524 DOI: 10.1177/0009922816635808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Apnea, bradycardia, and oxygen desaturation events are a common in neonatal intensive care units, with relevant literature to date largely focusing on very low birth weight and extremely low birth weight infants. We conducted a retrospective review of infants born at ≥34 weeks gestational age at 2 tertiary neonatal intensive care units in Boston, MA, between January 2009 and December 2013. Our objectives included (1) describing the diagnostic evaluations performed in late preterm to term infants with discharge-delaying apnea, bradycardia, or oxygen desaturation events and (2) identifying variables associated with home monitor use. Of the 741 eligible infants identified, diagnostic evaluations were variable and infrequent with blood culture, blood glucose, and head ultrasound performed most commonly. The likelihood of home monitor use was greater in infants with either a prolonged inpatient stay or greater gestational age at birth.
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145
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Torchin H, Ancel PY. [Epidemiology and risk factors of preterm birth]. ACTA ACUST UNITED AC 2016; 45:1213-1230. [PMID: 27789055 DOI: 10.1016/j.jgyn.2016.09.013] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 09/14/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To synthesize the available evidence regarding the incidence and several risk factors of preterm birth. To describe neonatal outcomes according to gestational age and to the context of delivery. MATERIALS AND METHODS Consultation of the Medline database. RESULTS In 2010, 11% of live births (15 million babies) occurred before 37 completed weeks of gestation worldwide. About 85% of these births were moderate to late preterm babies (32-36 weeks), 10% were very preterm babies (28-31 weeks) and 5% were extremely preterm babies (<28 weeks). In France, premature birth concerns 60,000 neonates every year, 12,000 of whom are born before 32 completed weeks of gestation. Half of them are delivered after spontaneous onset of labor or preterm premature rupture of the membranes, and the other half are provider-initiated preterm births. Several maternal factors are associated with preterm birth, including sociodemographic, obstetrical, psychological, and genetic factors; paternal and environmental factors are also involved. Gestational age is highly associated with neonatal mortality and with short- and long-term morbidities. Pregnancy complications and the context of delivery also have an impact on neonatal outcomes. CONCLUSION Preterm birth is one of the leading cause of the under-five mortality and of neurodevelopmental impairment worldwide; it remains a major public health issue.
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Affiliation(s)
- H Torchin
- Inserm U1153, DHU risques et grossesse, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique, centre de recherche épidémiologie et statistique Sorbonne Paris Cité, bâtiment Port-Royal, 53, avenue de l'Observatoire, 75014 Paris, France; Université Paris Descartes, Paris, France.
| | - P-Y Ancel
- Inserm U1153, DHU risques et grossesse, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique, centre de recherche épidémiologie et statistique Sorbonne Paris Cité, bâtiment Port-Royal, 53, avenue de l'Observatoire, 75014 Paris, France; URC - CIC P1419, groupe hospitalier Cochin Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 75014 Paris, France; Université Paris Descartes, Paris, France
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146
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Nijman TAJ, van Vliet EOG, Benders MJN, Mol BWJ, Franx A, Nikkels PGJ, Oudijk MA. Placental histology in spontaneous and indicated preterm birth: A case control study. Placenta 2016; 48:56-62. [PMID: 27871473 DOI: 10.1016/j.placenta.2016.10.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/06/2016] [Accepted: 10/11/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Placental pathology is an important contributor in preterm birth, both spontaneous and indicated. The aim of this study was to describe and compare placental histological features of spontaneous preterm birth versus indicated preterm birth. METHODS A case control study was performed at the University Medical Center Utrecht. Women with spontaneous or indicated preterm birth (17-37 weeks of gestation) delivered in 2009 were included. Women with a pregnancy complicated by congenital and/or chromosomal abnormalities were excluded. Placentas were systematically examined by an expert pathologist blinded for pregnancy outcome, except for gestational age. Placental histological abnormalities were classified into infectious inflammatory lesions and maternal vascular malperfusion lesions and compared between spontaneous and indicated preterm birth. Analysis was stratified for immature (17-23+6 weeks), extremely (24-27+6 weeks), very (28-31+6 weeks) and moderate/late (32-36+6 weeks) preterm birth. RESULTS We included 233 women, 121 women with spontaneous preterm birth and 112 women with indicated preterm birth. Among women with spontaneous extremely preterm birth, higher rates of severe chorioamnionitis were found (56.0% vs. 0%). Furthermore, a shift from infectious-inflammatory lesions to maternal vascular malperfusion lesions was seen after 28 weeks; in women with spontaneous very and moderate/late preterm birth, maternal vascular malperfusion lesions were the main finding (46.8% and 47.7% respectively). In women with indicated preterm birth, maternal vascular malperfusion lesions were most often contributing through all gestational age categories. CONCLUSION Maternal vascular malperfusion lesions are most frequent in both spontaneous and indicated very and moderate/late preterm birth. In spontaneous extreme preterm birth chorioamnionitis is the main finding.
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Affiliation(s)
- Tobias A J Nijman
- Department of Obstetrics and Gynecology, Division Woman & Baby, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Elvira O G van Vliet
- Department of Obstetrics and Gynecology, Division Woman & Baby, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Manon J N Benders
- Department of Neonatology, Division Woman & Baby, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Ben Willem J Mol
- The Robinson Research Institute, School of Pediatrics and Reproductive Health, Adelaide, Australia; The South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia.
| | - Arie Franx
- Department of Obstetrics and Gynecology, Division Woman & Baby, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Peter G J Nikkels
- Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Martijn A Oudijk
- Department of Obstetrics and Gynecology, Division Woman & Baby, University Medical Centre Utrecht, Utrecht, The Netherlands; Departments of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands.
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147
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Simchen MJ, Okrent Smolar AL, Dulitzky M, Sivan E, Morag I. Neonatal morbidities and need for intervention in twins and singletons born at 34-35 weeks of gestation. J Perinat Med 2016; 44:887-892. [PMID: 26677882 DOI: 10.1515/jpm-2015-0113] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 11/17/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare indications for delivery and neonatal morbidities between twins and singletons born between 34 and 35 weeks of gestation. STUDY DESIGN A prospective observational study was performed in which all infants born between January and August 2008, at Sheba Medical Center at 34 0/7-35 6/7 weeks of gestational age were included. Indications for delivery, infants' morbidities and medical interventions were documented. Twins and singletons were compared for antenatal maternal characteristics, risks of short-term neonatal complications and interventions. RESULTS One hundred and seventy-three mothers and 229 neonates (114 twins and 115 singletons) were included. Background maternal characteristics as well as the use of antenatal steroids and MgSO4 were similar between the groups. Only 44% of all deliveries were spontaneous, while the rest were indicated deliveries. Twins were born lighter and 31.9% of them were SGA. Nevertheless, singletons were significantly more likely to receive medical interventions such as prolonged oxygen use (>1 day) and phototherapy. All late preterm infants (n=5) needing surfactant administration were singletons. Overall, the risk of needing any medical intervention was significantly higher for singletons compared with twins (OR 1.8, 95% CI 1.02-3.2). CONCLUSIONS A significant proportion of late preterm births is iatrogenic. Twins and singletons are dissimilar with regards to risks of short-term complications. Despite being born smaller and more SGA, twins are at lower risk of requiring medical intervention in the immediate neonatal period compared with singletons.
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148
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Ballantyne M, Benzies KM, McDonald S, Magill-Evans J, Tough S. Risk of developmental delay: Comparison of late preterm and full term Canadian infants at age 12 months. Early Hum Dev 2016; 101:27-32. [PMID: 27405053 DOI: 10.1016/j.earlhumdev.2016.04.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 04/09/2016] [Accepted: 04/11/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Late preterm (34(0/7) to 36(6/7)weeks gestation) infants may experience developmental delays greater than those found in term (≥ 37(0/7)weeks gestation) infants. AIM The aim of this study was to compare the risk of developmental delay between late preterm and full-term Canadian born infants at age 12months, and to determine infant and maternal factors associated with risk of delay. METHODS A descriptive comparative study was conducted from data available from the All Our Babies community-based, prospective, pregnancy cohort in Calgary, Alberta. Participants were a sample of mothers of 52 infants born late preterm and 156 randomly selected mothers of term infants, matched for infant sex; eligible infants were singleton births. Mothers completed a developmental screening tool, the Ages and Stages Questionnaire, version 3 (ASQ-3), when their infant was age 12months. Corrected age (CA) was used for preterm infants. RESULTS Both late preterm and term infants who required neonatal intensive care (NICU) were more likely to demonstrate risk of developmental delay. Compared to term infants, there was a trend for late preterm infants to be at risk of communication and gross motor delay at age 12months CA that was attenuated to the null when adjustments were made for NICU admission and other covariates. CONCLUSIONS Infants born between 34 and 41weeks who are admitted to NICU are at increased risk of developmental delay. Early identification of risk provides an opportunity for referral for developmental assessment and early intervention programming.
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Affiliation(s)
- Marilyn Ballantyne
- Holland Bloorview Kids Rehabilitation Hospital, 2W305, 150 Kilgour Road, Toronto, Ontario, M4G 1R8, Canada.
| | - Karen M Benzies
- Faculty of Nursing, University of Calgary, PF2222, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada; Department of Paediatrics, Cumming School of Medicine, University of Calgary, 2888 Shaganappi Trail NW, Calgary, Alberta, T2N 4N1, Canada.
| | - Sheila McDonald
- Alberta Health Services, Calgary Zone, 10301 Southport Lane, SW, Calgary, Alberta, T2W 1S7, Canada.
| | - Joyce Magill-Evans
- Department of Occupational Therapy, 8205 - 114 Street, University of Alberta, Edmonton, Alberta, T6G 2G4, Canada.
| | - Suzanne Tough
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, 2888 Shaganappi Trail NW, Calgary, Alberta, T2N 4N1, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 2888 Shaganappi Trail NW, Calgary, Alberta, T2N 4N1, Canada.
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149
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Villamizar-Carvajal B, Vargas-Porras C, Gómez-ortega OR. Metaanálisis: efecto de las intervenciones para disminuir el nivel de estrés en padres de prematuros. AQUICHAN 2016. [DOI: 10.5294/aqui.2016.16.3.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introducción: El nacimiento prematuro de un bebé genera estrés en los padres, por el riesgo de aumento en la morbimortalidadque esto conlleva. Existen intervenciones que disminuyen el nivel de estrés en los padres beneficiando a su vez el neurodesarrollo delrecién nacido. Objetivo: Categorizar los principales componentes de los programas de intervención temprana y determinar el efecto deestas intervenciones en la disminución del nivel de estrés en padres de prematuros hospitalizados. Método: Meta-análisis con 9 ensayosclínicos controlados, que cumplieron los criterios de rigurosidad metodológica. Resultados: las intervenciones aplicadas a los padresde prematuros hospitalizados, mostraron efecto de intensidad media-baja sobre el nivel de estrés percibido (d=0,36 IC [-0.68, -0,05]).Sin embargo, las pruebas de heterogeneidad indican alta variabilidad inter-estudio (Q(df=8) = p-val: <0,00001), I2=85% ), explicadaparcialmente por las características moderadoras codificadas para los estudios. Conclusiones: aunque las intervenciones mostraronefectos positivos en la disminución del nivel de estrés en los padres, se evidencia que la educación y el apoyo emocional en conjunto logranun mejor efecto. Las futuras investigaciones deben analizar aspectos como calidad de los estudios, intervenciones con apoyo emocional,edad de los padres y diversidad en los contextos de aplicación.
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150
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Haller S, Deindl P, Cassini A, Suetens C, Zingg W, Abu Sin M, Velasco E, Weiss B, Ducomble T, Sixtensson M, Eckmanns T, Harder T. Neurological sequelae of healthcare-associated sepsis in very-low-birthweight infants: Umbrella review and evidence-based outcome tree. ACTA ACUST UNITED AC 2016; 21:30143. [PMID: 26940884 DOI: 10.2807/1560-7917.es.2016.21.8.30143] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 09/30/2015] [Indexed: 01/08/2023]
Abstract
Sepsis is a frequent cause of death in very-low-birthweight infants and often results in neurological impairment. Its attributable risk of sequelae has not been systematically assessed. To establish an outcome tree for mapping the burden of neonatal sepsis, we performed systematic literature searches to identify systematic reviews addressing sequelae of neonatal sepsis. We included cohort studies and performed meta-analyses of attributable risks. Evidence quality was assessed using GRADE. Two systematic reviews met inclusion criteria. The first included nine cohort studies with 5,620 participants and five outcomes (neurodevelopmental impairment, cerebral palsy, vision impairment, hearing impairment, death). Pooled risk differences varied between 4% (95% confidence interval (CI):2-10) and 13% (95% CI:5-20). From the second review we analysed four studies with 472 infants. Positive predictive value of neurodevelopmental impairment for later cognitive impairment ranged between 67% (95% CI:22-96) and 83% (95% CI:36-100). Neonatal sepsis increases risk of permanent neurological impairment. Effect size varies by outcome, with evidence quality being low to very low. Data were used to construct an outcome tree for neonatal sepsis. Attributable risk estimates for sequelae following neonatal sepsis are suitable for burden estimation and may serve as outcome parameters in interventional studies.
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Affiliation(s)
- Sebastian Haller
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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