In preterm infants, ascending intrauterine infection is associated with lower cerebral tissue oxygen saturation and higher oxygen extraction

Maternal HPV Infection: Effects on Pregnancy Outcome

The human papilloma virus (HPV) infection, caused by a ubiquitous virus typically transmitted through the direct contact of infected organs, either through the skin or mucosa, is the most common sexually transmitted infection, placing young women at a high risk of contracting it. Although the vast majority of cases spontaneously clear within 1-2 years, persistent HPV infection remains a serious concern, as it has repeatedly been linked to the development of multiple malignancies, including cervical, anogenital, and oropharyngeal cancers. Additionally, more recent data suggest a harmful effect of HPV infection on pregnancy. As the maternal hormonal environment and immune system undergo significant changes during pregnancy, the persistence of HPV is arguably favored. Various studies have reported an increased risk of adverse pregnancy outcomes among HPV-positive women, with the clinical impact encompassing a range of conditions, including preterm birth, miscarriage, pregnancy-induced hypertensive disorders (PIHD), intrauterine growth restriction (IUGR), low birth weight, the premature rupture of membranes (PROM), and fetal death. Therefore, understanding the mechanisms employed by HPV that negatively impact pregnancy and assessing potential approaches to counteract them would be of interest in the quest to optimize pregnancy outcomes and improve child survival and health.

Randomized control trial comparing physiologic effects in preterm infants during treatment with nasal continuous positive airway pressure (NCPAP) generated by Bubble NCPAP and Ventilator NCPAP: a pilot study

OBJECTIVES

Nasal continuous positive airway pressure (NCPAP) is an accepted form of non-invasive ventilation in preterm infants. Few, if any, studies have shown an advantage of one type of NCPAP over another. It has been theorized that bubble-generated NCPAP may be advantageous for the preterm neonate versus traditionally used ventilator-generated NCPAP. The aim of this study was to examine for any short-term differences in physiologic parameters in preterm subjects receiving these two different methods of NCPAP.

METHODS

We conducted a randomized, prospective, cross-over pilot study of preterm infants being treated with NCPAP in the neonatal intensive care unit. Subjects were continuously monitored for several physiologic parameters including heart rate, respiratory rate, oxygen saturation, cerebral tissue oxygen saturation and cerebral fractional oxygen extraction using routine neonatal monitors and near-infrared spectroscopy (NIRS) while on 2 h of bubble NCPAP and 2 h of ventilator NCPAP. Subjects were randomized to be monitored while either starting on bubble NCPAP and then switching to ventilator NCPAP or starting on ventilator NCPAP and switching to bubble NCPAP.

RESULTS

Eighteen subjects were included. We found no statistically significant difference in any of the physiologic parameters while subjects were receiving bubble NCPAP versus ventilator NCPAP during the monitoring time periods. While on bubble NCPAP, subjects showed a trend toward decreasing respiratory rate and decreasing cerebral fractional oxygen extraction over time, but this did not reach statistical significance.

CONCLUSION

There appears to be no difference in immediate physiologic effects between bubble NCPAP and ventilator NCPAP. This does not preclude the possibility of potential long-term differences, but any differences seen would likely be based on mechanisms that take more time to develop. A larger prospective trial is warranted to confirm our findings.

The Effect of Maternal Antihypertensive Drugs on the Cerebral, Renal and Splanchnic Tissue Oxygen Extraction of Preterm Neonates

BACKGROUND

Drugs with antihypertensive action are frequently used in obstetrics for the treatment of preeclampsia (labetalol) and tocolysis (nifedipine) or for neuroprotection (MgSO4), and may affect the hemodynamics of preterm born neonates.

OBJECTIVE

The aim of this study was to assess whether maternal antihypertensive drugs affect multisite oxygenation levels of the neonate.

METHODS

Eighty preterm neonates of ≤32 weeks of gestational age were monitored using near-infrared spectroscopy. Mean cerebral, renal and splanchnic fractional tissue oxygen extractions (cFTOE, rFTOE and sFTOE) were calculated for the first 5 postnatal days. We determined the effect of various maternal antihypertensive drugs on cFTOE and rFTOE using multilevel analysis, and on sFTOE using Kruskal-Wallis and Mann-Whitney U tests.

RESULTS

Eleven infants were exposed to labetalol ± MgSO4, 7 to nifedipine ± MgSO4, 20 to MgSO4 only, and 42 to no maternal antihypertensive drugs. The infants exposed to labetalol ± MgSO4 had a lower cFTOE on days 1 (0.14, p = 0.031), 2 (0.13, p = 0.035) and 4 (0.18, p = 0.046) than nonexposed infants on the corresponding days (0.22, 0.20 and 0.24, respectively). On day 2, cFTOE was also lower in infants exposed to nifedipine ± MgSO4 (0.11, p = 0.028) and to MgSO4 only (0.15, p = 0.047). sFTOE was higher in infants exposed to labetalol ± MgSO4 on days 1 (µ = 0.71) and 2 (µ = 0.82) than in nonexposed infants (µ = 0.26, p = 0.04 and µ = 0.55, p = 0.007, respectively). Maternal antihypertensive drugs did not affect rFTOE.

CONCLUSIONS

Low neonatal cFTOE found with maternal antihypertensive drug exposure may relate to either increased cerebral perfusion or neurologic depression induced by the medication, or preferential brain perfusion associated with preeclampsia placental insufficiency. Concomitantly high sFTOE found with labetalol exposure supports the latter, while renal autoregulation may explain rFTOE stability.