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Dassios T, Jenkinson A, Bhat R, Greenough A. Racial Differences in Respiratory Morbidity in Late Preterm Infants: A Retrospective Cohort Study. Glob Pediatr Health 2024; 11:2333794X241273151. [PMID: 39329161 PMCID: PMC11425724 DOI: 10.1177/2333794x241273151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/10/2024] [Accepted: 07/10/2024] [Indexed: 09/28/2024] Open
Abstract
Objectives. The role of race in late preterm respiratory morbidity has not been adequately described. We aimed to determine whether neonatal respiratory morbidity differs between Black and White late preterm infants. Methods. Single-centre retrospective cohort study at King's College Hospital NHS Foundation Trust, London, UK of infants born at 34 to <37 weeks of gestational age. The incidence of invasive ventilation was used as the main outcome. Results. In the study period 354 Black and 673 White late preterm infants were admitted. Black, compared to white infants, had a lower incidence of invasive ventilation (19% vs 27%, P < .001) and a lower incidence of non-invasive ventilation (22% vs 34%, P < .001). Black infants had a shorter duration and cost of stay compared to White infants (P = .011 and <0.001 respectively). Conclusion. Black late preterm infants needed less frequently invasive and non-invasive ventilation and had a shorter duration and cost of stay compared to White late preterm infants.
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Affiliation(s)
- Theodore Dassios
- King's College London, London, UK
- University of Patras, Patras, Greece
| | | | - Ravindra Bhat
- King's College Hospital NHS Foundation Trust, London, UK
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2
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Svenvik M, Jenmalm MC, Brudin L, Raffetseder J, Hellberg S, Axelsson D, Lindell G, Blomberg M, Ernerudh J. Chemokine and cytokine profiles in preterm and term labor, in preterm prelabor rupture of the membranes, and in normal pregnancy. J Reprod Immunol 2024; 164:104278. [PMID: 38901109 DOI: 10.1016/j.jri.2024.104278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/27/2024] [Accepted: 06/07/2024] [Indexed: 06/22/2024]
Abstract
The objective of this study was to investigate the immune mechanisms involved in preterm labor (PTL), preterm prelabor rupture of the membranes (PPROM), and normal pregnancies. The second objective was to explore immune profiles in PTL for association with early ( < 34 gestational weeks (gw)) or instant ( < 48 h) delivery. This prospective observational multi-center study included women with singleton pregnancies with PTL (n = 80) or PPROM (n = 40) before 34 gw, women with normal pregnancies scheduled for antenatal visits (n = 44), and women with normal pregnancies in active labor at term (n = 40). Plasma samples obtained at admission were analyzed for cytokine and chemokine quantification using a multiplex bead assay in order to compare the immune profiles between PTL, PPROM, and normal pregnancies. In PTL, CXCL1 and CCL17 were significantly higher compared to gestational age-matched women at antenatal visits, whereas for PPROM, CXCL1 and IL-6 were increased. Women in term labor had a more pronounced inflammatory pattern with higher levels of CXCL1, CXCL8, and IL-6 compared with PTL (p = 0.007, 0.003, and 0.013, respectively), as well as higher levels of CCL17, CXCL1 and IL-6 (all p < 0.001) compared with the women at antenatal visits. In PTL, CXCL8 was higher in women with delivery before 34 gw, whereas CXCL8, GM-CSF, and IL-6 were significantly higher in women with delivery within 48 h. To conclude, PTL and PPROM were associated with a complex pattern of inflammation, both involving Th17 (CXCL1) responses. Although further studies are needed, CXCL8, GM-CSF, and IL-6 may be potential candidates for predicting preterm birth in PTL.
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Affiliation(s)
- Maria Svenvik
- Department of Obstetrics and Gynecology, Region Kalmar County, Kalmar, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Maria C Jenmalm
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Lars Brudin
- Department of Clinical Physiology, Region Kalmar County, Kalmar, Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Johanna Raffetseder
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Sandra Hellberg
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Daniel Axelsson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Obstetrics and Gynecology, Ryhov County Hospital, Jönköping, Sweden
| | - Gunnel Lindell
- Department of Obstetrics and Gynecology, Region Kalmar County, Kalmar, Sweden
| | - Marie Blomberg
- Department of Obstetrics and Gynecology, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Jan Ernerudh
- Department of Clinical Immunology and Transfusion Medicine, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Tekeba B, Techane MA, Workneh BS, Zegeye AF, Gonete AT, Alemu TG, Wassie M, Kassie AT, Ali MS, Mekonen EG, Tamir TT. Mortality of neonates born to mothers of extreme reproductive age in Ethiopia; multilevel mixed effect analysis of Ethiopian demographic and health survey data of 2016. Front Pediatr 2024; 12:1390952. [PMID: 39005505 PMCID: PMC11240850 DOI: 10.3389/fped.2024.1390952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 06/12/2024] [Indexed: 07/16/2024] Open
Abstract
Introduction Neonatal mortality is still a major public health problem in middle- and low-income countries like Ethiopia. Despite strategies and efforts made to reduce neonatal death, the mortality rate declines at a slower pace in the country. Though there are studies conducted on neonatal mortality and its determinants, our searches of the literature have found no study on the extent of mortality of neonates born to mothers of extreme reproductive age in the study area. Therefore, this study aimed to assess the magnitude and factors associated with the mortality of neonates born to mothers of extreme reproductive age in Ethiopia. Methods Secondary data analysis was conducted using 2016 Ethiopian Demographic and Health Survey data. The final study contained an overall weighted sample of 2,269 live births. To determine the significant factors in newborn deaths, a multilevel binary logistic regression was fitted. For measuring the clustering impact, the intra-cluster correlation coefficient, median odds ratio, proportional change in variance, and deviation were employed for model comparison. The adjusted odds ratio with a 95% confidence interval was presented in the multivariable multilevel logistic regression analysis to identify statistically significant factors in neonatal mortality. A P-value of less than 0.05 was declared statistically significant. Results The neonatal mortality rate of babies born to extreme aged reproductive women in Ethiopia was 34 (95% Cl, 22.2%-42.23%) per 1,000 live birth. Being twin pregnancy (AOR = 10; 95% Cl: 8.61-20.21), being from pastoralist region (AOR = 3.9; 95% Cl: 1.71-8.09), having larger baby size (AOR = 2.93; 95% Cl: 1.4-9.12) increase the odds of neonatal mortality. On the other hand, individual level media exposure (AOR = 0.3; 95% Cl: 0.09-0.91) and community level media exposure (AOR = 0.24; 95% Cl: 0.07-0.83), being term gestation (AOR = 0.14; 95% Cl: 0.01-0.81) decreases the odds of neonatal mortality born to mothers of extreme reproductive age. Conclusion Ethiopia had a greater rate of neonatal death among babies born at the extremes of reproductive age than overall reproductive life. Multiple pregnancies, larger baby sizes, emerging regions, term gestation, and media exposure were found to be significant factors associated with the mortality of neonates born to mothers of extreme reproductive age. Therefore, the concerned bodies should give emphasis to mothers giving birth before the age of 20 and above 35, access to media, healthy pregnancy, and special attention to pastoralists to reduce the burden of neonatal mortality.
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Affiliation(s)
- Berhan Tekeba
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Masresha Asmare Techane
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belayneh Shetie Workneh
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alebachew Ferede Zegeye
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Almaz Tefera Gonete
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Getaneh Alemu
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Wassie
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemneh Tadesse Kassie
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mohammed Seid Ali
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Enyew Getaneh Mekonen
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Tarik Tamir
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Xu ZM, Lin D, Zhang J, Zheng YJ, Liu J, Zhang L, Pan M. A comparison of Mersilene tape versus braided suture in transvaginal cervical cerclage: A retrospective case-control study. Int J Gynaecol Obstet 2024. [PMID: 38822723 DOI: 10.1002/ijgo.15715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 05/13/2024] [Accepted: 05/18/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVE Previous studies have indicated that there is an association between cervical cerclage and type of suture material. However, it is still unclear which suture material can provide the greatest benefit to patients who have undergone cerclage. This study investigated the effect of two different suture materials (Mersilene tape vs braided suture) used for transvaginal cervical cerclage placement on maternal outcomes of women with cervical insufficiency. METHODS In this retrospective case-control study, 170 women who underwent history-, ultrasound-, or physical examination-indicated transvaginal cervical cerclage were categorized according to suture materials used for cerclage: a total of 96 received Mersilene tape and 74 received braided suture. Study participants received a transvaginal cervical cerclage before 28 weeks and were followed up until delivery to assess pregnancy and neonatal outcomes. The primary outcome was gestational age at delivery. Secondary outcomes included preterm premature rupture of membranes (PPROM), premature rupture of membranes (PROM), chorioamnionitis, neonatal survival rate, and neonatal morbidity. RESULTS Out of 170 eligible women, 74 (43.5%) received braided suture while 96 (56.5%) received Mersilene tape. Baseline characteristics were similar between the two groups. The group that received braided suture had a lower incidence of gestational age at delivery <37 weeks (29.2% vs 54.2%, P = 0.046), PPROM (9.5% vs 21.9%, P = 0.029) and PROM (17.6% vs 32.3%, P = 0.028) compared to the group that received Mersilene tape. However, there were no significant differences between the two groups in average gestational age at delivery, the rate of gestational age at delivery <24, <28, <32, and < 34 weeks, chorioamnionitis, and neonatal survival rate, as well as neonatal morbidity. CONCLUSION Compared to Mersilene tape, the utilization of braided suture has been significantly associated with a reduction in the incidence of gestational age at delivery <37 weeks, as well as a decreased risk of PPROM and PROM. However, the use of braided sutures did not result in discernible differences in the rates of chorioamnionitis or adverse neonatal outcomes.
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Affiliation(s)
- Zhi-Min Xu
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fujian, People's Republic of China
| | - Dan Lin
- Nursing Department and Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fujian, People's Republic of China
| | - Jun Zhang
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fujian, People's Republic of China
| | - Yi-Jing Zheng
- College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fujian, People's Republic of China
| | - Jing Liu
- College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fujian, People's Republic of China
| | - Lin Zhang
- College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fujian, People's Republic of China
| | - Mian Pan
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fujian, People's Republic of China
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Gyamfi-Bannerman C. Antenatal Late Preterm Steroids: The Evolution of the ALPS Trial. Clin Obstet Gynecol 2024; 67:399-410. [PMID: 38688083 PMCID: PMC11068095 DOI: 10.1097/grf.0000000000000865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
The Antenatal Late Preterm Steroids (ALPS) trial was designed to address respiratory morbidity common in infants born late preterm. The study was published in April, 2016 and, shortly thereafter, changed clinical practice in obstetrics in the United States. The following chapter describes the ALPS trial study design in detail, including the background leading to the trial, the study outcomes, and the initial findings of the long-term follow-up study. The ALPS story would not be complete without Elizabeth Thom, PhD, who died before her time. Her brilliance largely contributed to the design of the ALPS trial.
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Affiliation(s)
- Cynthia Gyamfi-Bannerman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of California, La Jolla, California
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Rundell MR, Bailey RA, Wagner AJ, Warner BB, Miller LE. Long-Term Neurodevelopmental Outcomes in Children with Gastroschisis: A Review of the Literature. Am J Perinatol 2024. [PMID: 38810899 DOI: 10.1055/s-0044-1787173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
This study aimed to investigate and present a review of the literature on long-term neurodevelopmental outcomes in children with gastroschisis. Gastroschisis is the most common abdominal wall defect. Children with gastroschisis are at high risk for premature birth, intestinal failure, sepsis, and repeated anesthesia exposure, which collectively increase the risk for adverse long-term neurodevelopmental outcomes. The existing literature on neurodevelopmental outcomes is limited in number, quality, and generalizability, creating a gap in clinical knowledge and care. Five internet databases were searched by a professional research librarian: Ovid MEDLINE, Scopus, Web of Science, PsycINFO, and Cochrane Library. Included articles were (1) published in English, (2) included postneonatal hospital discharge neurodevelopmental outcomes of children with gastroschisis, and (3) included patients under the age of 18 years. No date parameters were applied. The paucity of literature on long-term neurodevelopmental outcomes in gastroschisis children has left large gaps in the body of knowledge on post-hospital care of such children. In this review, 37 articles were found evaluating neurodevelopmental outcomes in gastroschisis and, while conclusions were contradictory, the literature broadly indicated the potential for neurodevelopmental deficits in the gastroschisis pediatric population. A significant limitation of this review was the heterogeneous samples included in available literature, which confounded the ability to determine cognitive risk of gastroschisis independent of other abdominal wall defects. Findings of this review demonstrate potential risk for neurodevelopmental deficits in the pediatric gastroschisis population exist, yet additional research is needed to definitively predict the significance, type, onset, and trajectory of neurodevelopmental impairment in this population. The significant gaps in long-term outcomes data have elucidated the need for prospective, longitudinal investigation of various cognitive domains in homogenous gastroschisis populations to properly evaluate prevalence of neurodevelopmental deficits and guide recommendations for long-term clinical care. KEY POINTS: · Limited literature exists regarding long-term neurodevelopmental outcomes in gastroschisis.. · There is some evidence to suggest worse cognitive behavioral outcomes in gastroschisis over time.. · Developmental surveillance, screening, and evaluation may be beneficial for gastroschisis patients..
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Affiliation(s)
- Maddie R Rundell
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rachel A Bailey
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Amy J Wagner
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Barbara B Warner
- Department of Pediatrics, Washington University, St. Louis, Missouri
| | - Lauren E Miller
- Division of Neuropsychology, Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Gavra-Shlissel H, Porat S, Tadmor O, Bitton E, Lipschuetz M, Kabiri D. Validating staging criteria for sonographic and physical examination for cervical changes at <24 weeks' gestation to predict preterm birth. Am J Obstet Gynecol MFM 2024; 6:101211. [PMID: 37926146 DOI: 10.1016/j.ajogmf.2023.101211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/21/2023] [Accepted: 10/31/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Preterm birth represents a significant clinical challenge, and the ability to predict it effectively is a priority in obstetrics. The cervix undergoes specific changes during pregnancy, and staging these changes may offer a valuable predictive model for preterm birth, particularly among women with a midtrimester short cervical length. OBJECTIVE The study aimed to validate a proposed staging model for asymptomatic women with midtrimester short cervical length and to evaluate its potential for predicting preterm birth. The integration of cervical examination and inspection with cervical length measurement was a novel approach to be assessed. STUDY DESIGN This was a multicenter, retrospective cohort study that included 925 pregnant women with a singleton fetus and a midtrimester cervical length measurement of ≤25 mm. Cervical conditions were assessed using ultrasonography, a speculum, and a physical examination and were classified into 1 of 5 cervical stages to correlate with the likelihood of preterm birth. Statistical analyses included Kaplan-Meier survival analysis to illustrate the time-to-event characteristics across the 5 stages and density plot evaluation to visualize the distribution of the gestational ages within the stages. RESULTS The staging model included 5 stages based on cervical length, appearance, and dilatation. Among the 925 participants, 649 were classified as being stage 1, 245 as stage 2, 18 as stage 3, 10 as stage 4, and 3 as stage 5. The observed rates of preterm birth before 37 weeks for individuals classified in stages 1, 2, 3, 4, and 5 were 22.3%, 26.5%, 44.4%, 60%, and 66.7%, respectively (P=.005). The overall observed rates of preterm birth before 28, 32, 34, and 37 weeks' gestation were 5.5%, 9.9%, 12.2%, and 24.1%, respectively (P=.005). CONCLUSION This study validated the proposed staging criteria as an effective predictor of preterm birth caused by cervical insufficiency. The results demonstrate a significant increase in the preterm birth rate with advancing stage classification, indicating that the staging effectively stratified women based on their risk for preterm birth and highlighting the potential use for targeted interventions. Implementing these staging criteria can potentially improve the counseling and management of pregnant women at risk for preterm birth.
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Affiliation(s)
- Hadar Gavra-Shlissel
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (Drs Gavra-Shlissel, Porat, Bitton, Lipschuetz, and Kabiri)
| | - Shay Porat
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (Drs Gavra-Shlissel, Porat, Bitton, Lipschuetz, and Kabiri)
| | - Offer Tadmor
- Maccabi Health Services, Jerusalem, Israel (Dr Tadmor)
| | - Elyasaf Bitton
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (Drs Gavra-Shlissel, Porat, Bitton, Lipschuetz, and Kabiri)
| | - Michal Lipschuetz
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (Drs Gavra-Shlissel, Porat, Bitton, Lipschuetz, and Kabiri)
| | - Doron Kabiri
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (Drs Gavra-Shlissel, Porat, Bitton, Lipschuetz, and Kabiri).
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Monson MA, Chmait RH, Einerson B. Fetoscopic Laser Ablation of Type II Vasa Previa: A Cost Benefit Analysis. Am J Perinatol 2024; 41:e2454-e2462. [PMID: 37494587 DOI: 10.1055/s-0043-1771262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVE We aimed to compare costs of two strategies for third-trimester type II vasa previa management: (1) fetoscopic laser ablation surgery (FLS) referral and (2) standard management (SM). STUDY DESIGN A decision analytic model and cost-benefit analysis from a health care perspective were performed. The population included patients with type II vasa previa at approximately 32 weeks. SM entailed 32-week antepartum admission and cesarean at approximately 35 weeks. FLS referral included consultation and possible laser surgery at 32 weeks for willing/eligible candidates. Successful laser surgery allowed the possibility of term vaginal delivery. Outcomes included antepartum admission, preterm birth, cesarean, neonatal transfusion, and death. Sensitivity analyses were performed. RESULTS In base case analysis, FLS referral was cost saving compared with SM (total cost per patient $65,717.10 vs. 71,628.16). FLS referrals yielded fewer antepartum admissions, cesareans, premature births, neonatal transfusions, and deaths. Eligible referred patients choosing FLS incurred a total cost of $41,702.46, a >40% decrease compared with SM. FLS referral was cost saving in all one-way sensitivity analyses except when antepartum admission costs were low. In threshold analyses, FLS referral was cost saving unless laser surgery cost was >$39,892 (2.75x expected cost), antepartum admission cost for monitoring of vasa previa or ruptured membranes was <$7,455, <11% patients were eligible for laser surgery, and when <12% of eligible patients chose laser surgery. In two-way sensitivity analysis, FLS referral was cost saving except at very high laser surgery costs and extremely low antepartum admission costs. CONCLUSION Referral for FLS for type II vasa previa was cost saving and improved outcomes compared with SM, despite upfront costs, fetoscopy-related risks, and many patients being ineligible or not opting for surgery after referral. KEY POINTS · Vasa previa rupture may lead to fetal exsanguination and death.. · Late preterm cesarean is common practice for prenatally diagnosed vasa previa.. · Successful fetoscopic laser ablation for type II vasa previa has been described.. · Laser ablation of vasa previa allows for a safe-term vaginal delivery.. · Referral for laser surgery is cost saving and is associated with improved outcomes..
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Affiliation(s)
- Martha A Monson
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Health, Salt Lake City, Utah
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| | - Ramen H Chmait
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Brett Einerson
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Health, Salt Lake City, Utah
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
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Wylie BJ, Ali SA. Late-Preterm Corticosteroids in Low-Resource Settings. Obstet Gynecol 2024; 143:465-467. [PMID: 38330408 DOI: 10.1097/aog.0000000000005539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Affiliation(s)
- Blair J Wylie
- Blair J. Wylie is from Columbia University Medical Center, New York, New York. Syed Asad Ali is from the Department of Community Health Sciences at Aga Khan University, Karachi, Pakistan
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Min J, Lee W, Oh J, Kwag Y, Kim E, Kim JM, Lee KA, Ha E. Disparities in the association between ambient temperature and preterm birth according to individual and regional characteristics: a nationwide time-stratified case-crossover study. Environ Health 2024; 23:23. [PMID: 38389085 PMCID: PMC10882820 DOI: 10.1186/s12940-024-01062-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/06/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Several studies have reported that climate change elevates heat exposure in pregnant women and high temperatures during pregnancy are associated with preterm births (PTBs). Although the association might be disproportionate, related evidence remains sparse. We evaluated the disproportionate risk of PTB associated with ambient temperature during pregnancy by individual and regional characteristics in South Korea. METHODS We collected data on birth certificates and daily mean temperatures during the period from 2011 to 2019. A time-stratified case-crossover design was used to investigate the association between temperature and PTB and stratified analyses were conducted to examine the effect modification of individual and regional characteristics. RESULTS A total of 160,067 singleton PTBs were recorded in Korea from 2011 to 2019. A 5℃ increase in the mean temperature during the last four weeks before delivery was associated with an increased risk of PTB with an odds ratio (OR) of 1.03 (95% confidence interval [CI]: 1.02, 1.05), and the association was more evident in mothers aged ≥35 years (OR: 1.06 [95% CI: 1.03, 1.10]) and with low education levels (OR: 1.04 [95% CI: 1.02, 1.05]). Additionally, the estimated risk was evident in districts with lower medical resources and more prominent disparities were shown by individual and regional characteristics in rural areas than in urban areas. CONCLUSIONS This study provides evidence that the risk of PTB related to ambient temperature is disproportionate by individual and regional characteristics and suggests the need for public health policies to alleviate the disparities, especially in rural areas.
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Affiliation(s)
- Jieun Min
- Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
- Graduate Program in System Health Science and Engineering, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Whanhee Lee
- School of Biomedical Convergence Engineering, College of Information and Biomedical Engineering, Pusan National University, Yangsan, Republic of Korea
| | - Jongmin Oh
- Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
- Institute of Ewha-SCL for Environmental Health (IESEH), SCL for Environmental Health (IESEH), Ewha Womans University College of MedicineEwha Womans University College of Medicine, Seoul, Republic of Korea
- Department of Human Systems Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Youngrin Kwag
- Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Eunji Kim
- Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
- Graduate Program in System Health Science and Engineering, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Joyce Mary Kim
- Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
- Graduate Program in System Health Science and Engineering, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Kyung A Lee
- Department of Obstetrics and Gynecology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
| | - Eunhee Ha
- Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
- Graduate Program in System Health Science and Engineering, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
- Institute of Ewha-SCL for Environmental Health (IESEH), SCL for Environmental Health (IESEH), Ewha Womans University College of MedicineEwha Womans University College of Medicine, Seoul, Republic of Korea.
- Department of Medical Science, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Republic of Korea.
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Nelson DB, Fomina YY. Challenges in Using Progestin to Prevent Singleton Preterm Births: Current Knowledge and Clinical Advice. Int J Womens Health 2024; 16:119-130. [PMID: 38283999 PMCID: PMC10812715 DOI: 10.2147/ijwh.s394305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/23/2023] [Indexed: 01/30/2024] Open
Abstract
Preterm birth is the leading cause of infant morbidity and mortality in children younger than 5 years old and accounts for approximately 35% of newborn deaths worldwide. The use of progestogen therapy for prevention of preterm birth has been one of the most controversial topics in modern obstetrics. Progestogens can be classified as natural or synthetic. Progesterone is a natural progestogen while progestins such as 17-alpha-hydroxyprogesterone caproate (17OHP-C) are synthetic steroid hormones. Evidence supporting the use of progestogens varies by formulation and populations studied. After more than a decade, the US Food and Drug Administration has withdrawn accelerated approval of 17OHP-C for the prevention of recurrent preterm birth in pregnant individuals with a singleton gestation. With this decision, there is no current FDA-approved treatment for prevention of spontaneous preterm birth. In this review, we provide a historical context behind the rise and fall of 17OHP-C clinical application, highlight the challenges behind the data supporting progestogen use, and offer suggestions on how to make an impact on preterm birth moving forward.
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Affiliation(s)
- David B Nelson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yevgenia Y Fomina
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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12
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Wu BA, Chand KK, Bell A, Miller SL, Colditz PB, Malhotra A, Wixey JA. Effects of fetal growth restriction on the perinatal neurovascular unit and possible treatment targets. Pediatr Res 2024; 95:59-69. [PMID: 37674023 PMCID: PMC10798895 DOI: 10.1038/s41390-023-02805-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/04/2023] [Accepted: 08/16/2023] [Indexed: 09/08/2023]
Abstract
The neurovascular unit (NVU) within the brain is a multicellular unit that synergistically acts to maintain blood-brain barrier function and meet cerebral metabolic demand. Recent studies have indicated disruption to the NVU is associated with neuropathology in the perinatal brain. Infants with fetal growth restriction (FGR) are known to be at increased risk of neurodevelopmental conditions including motor, learning, and behavioural deficits. There are currently no neuroprotective treatments for these conditions. In this review, we analyse large animal studies examining the effects of FGR on the perinatal NVU. These studies show altered vascularity in the FGR brain as well as blood-brain barrier dysfunction due to underlying cellular changes, mediated by neuroinflammation. Neuroinflammation is a key mechanism associated with pathological effects in the FGR brain. Hence, targeting inflammation may be key to preserving the multicellular NVU and providing neuroprotection in FGR. A number of maternal and postnatal therapies with anti-inflammatory components have been investigated in FGR animal models examining targets for amelioration of NVU disruption. Each therapy showed promise by uniquely ameliorating the adverse effects of FGR on multiple aspects of the NVU. The successful implementation of a clinically viable neuroprotective treatment has the potential to improve outcomes for neonates affected by FGR. IMPACT: Disruption to the neurovascular unit is associated with neuropathology in fetal growth restriction. Inflammation is a key mechanism associated with neurovascular unit disruption in the growth-restricted brain. Anti-inflammatory treatments ameliorate adverse effects on the neurovascular unit and may provide neuroprotection.
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Affiliation(s)
- Bing Anthony Wu
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Kirat K Chand
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Alexander Bell
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - Suzanne L Miller
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - Paul B Colditz
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Perinatal Research Centre, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Atul Malhotra
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Monash Newborn, Monash Children's Hospital, Melbourne, VIC, Australia
| | - Julie A Wixey
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
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13
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Manno JM, Marzan MB, Rolnik DL, Potenza S, Pritchard N, Said JM, Palmer KR, Whitehead CL, Sheehan PM, Ford J, Mol BW, Walker SP, Hui L. Reduction in spontaneous and iatrogenic preterm births in twin pregnancies during COVID-19 lockdown in Melbourne, Australia: a multicenter cohort study. BMC Pregnancy Childbirth 2023; 23:846. [PMID: 38082241 PMCID: PMC10712149 DOI: 10.1186/s12884-023-06137-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Melbourne, Australia, recorded one of the longest and most stringent pandemic lockdowns in 2020, which was associated with an increase in preterm stillbirths among singleton pregnancies. Twin pregnancies may be particularly susceptible to the impacts of pandemic disruptions to maternity care due to their higher background risk of adverse perinatal outcomes. METHODS Multicenter retrospective cohort study of all twin pregnancies birthing in public maternity hospitals in Melbourne. Multivariable log-binomial regression models were used to compare perinatal outcomes between a pre-pandemic group to women in whom weeks 20+0 to 40+0 of gestation occurred entirely during one of two lockdown-exposure periods: exposure 1 from 22 March 2020 to 21 March 2021 and exposure 2 from 22 March 2021 to 27 March 2022. RESULTS Total preterm births < 37 weeks were significantly lower in exposure 1 compared with the pre-pandemic period (63.1% vs 68.3%; adjusted risk ratio 0.92 95% CI 0.87-0.98, p = 0.01). This was mainly driven by fewer spontaneous preterm births (18.9% vs 20.3%; adjusted risk ratio 0.95 95% CI 0.90-0.99, p = 0.04). There were also lower rates of preterm birth < 34 weeks (19.9% vs 23.0%, adjusted risk ratio 0.93 95% CI 0.89-0.98 p = 0.01) and total iatrogenic births for fetal compromise (13.4% vs 20.4%; adjusted risk ratio 0.94 95% CI 0.89-0.98, p = 0.01). There were fewer special care nursery admissions (38.5% vs 43.4%; adjusted risk ratio 0.91 95% CI 0.87-0.95, p < 0.001) but no significant changes in stillbirth (1.5% vs 1.6%; adjusted risk ratio 1.00 95% CI 0.99-1.01, p = 0.82). Compared with the pre-pandemic period, there were more preterm births < 28 weeks and neonatal intensive care unit admissions in exposure 2. CONCLUSIONS Melbourne's first lockdown-exposure period was associated with lower preterm births in twins without significant differences in adverse newborn outcomes. Our findings provide insights into the influences on preterm birth and the optimal timing of delivery for twins.
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Affiliation(s)
- Juliana M Manno
- Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | - Melvin B Marzan
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Mercy Health, Heidelberg, Australia
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville, Australia
| | - Daniel L Rolnik
- Department of Obstetrics and Gynaecology, Monash Health, Clayton, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Stephanie Potenza
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Mercy Health, Heidelberg, Australia
| | - Natasha Pritchard
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Mercy Health, Heidelberg, Australia
| | - Joanne M Said
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- Maternal-Fetal Medicine Department, Joan Kirner Women's and Children's Hospital, Western Health, St Albans, Australia
| | - Kirsten R Palmer
- Department of Obstetrics and Gynaecology, Monash Health, Clayton, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Clare L Whitehead
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Parkville, Australia
| | - Penelope M Sheehan
- Department of Obstetrics and Gynaecology, Monash Health, Clayton, Australia
- Department of Obstetrics and Gynaecology, Eastern Health, Box Hill, Australia
| | - Jolyon Ford
- Department of Obstetrics and Gynaecology, Peninsula Health, Frankston, Australia
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash Health, Clayton, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Susan P Walker
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Mercy Health, Heidelberg, Australia
| | - Lisa Hui
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Parkville, Australia.
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Mercy Health, Heidelberg, Australia.
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville, Australia.
- Department of Obstetrics and Gynaecology, The Northern Hospital, Northern Health, Epping, Australia.
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14
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Falconer O, Ivy S, Le Carpentier D, Gavlak J, Liddle N, Senior E, Lowe P, Crowley P, Young A, Johnson MJ, Beattie RM, Evans HJ. Longitudinal pilot study of oxygen saturation indices in healthy preterm infants. Pediatr Res 2023; 94:2062-2069. [PMID: 37542167 PMCID: PMC10665185 DOI: 10.1038/s41390-023-02741-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 06/25/2023] [Accepted: 07/09/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND This study aimed to determine patterns of nocturnal pulse oximetry indices in moderate to late preterm infants, and investigate the relationship between oxygen desaturations, the apnoea hypopnoea index, and both corrected gestational and postnatal age. METHODS 21 healthy infants born at 32 + 0 - 36 + 6 weeks gestation underwent serial nocturnal pulse oximetry studies and respiratory polygraphy studies until 40 weeks corrected gestational age (CGA). The main outcome measures were number of >3% oxygen desaturations/hour (ODI3), mean oxygen saturations, and number of apnoeas and hypopnoeas/hour. RESULTS Median ODI3 increased between weeks 1 and 3 from 49.9 to 85.4/hour (p = 0.017). Mean oxygen saturations reached a corresponding nadir of 96.0% in week 3, then increased to 96.8% in week 6 (p = 0.019). Mixed effects modelling demonstrated that ODI3 and mean saturations were influenced by postnatal age but not CGA (p < 0.05). Desaturations frequently occurred without an apnoea or hypopnoea. CONCLUSION ODI3 rises then falls during the first 8 weeks of life in moderate to late preterm infants, independently of CGA. These interesting preliminary results highlight the importance of further serial data collection to generate age-specific normal ranges, and develop a better understanding of respiratory control in preterm infants. IMPACT The frequency of >3% oxygen desaturations (ODI3) in healthy moderate to late preterm infants rises then falls after birth, peaking in postnatal week 3. There is a corresponding nadir in mean saturations. There were significant non-linear relationships between ODI3/mean saturations and postnatal age, but not corrected gestational age. The majority of brief oxygen desaturations occurred without an apnoea or hypopnoea. Normal ranges for oxygen saturation indices are not known in this population. These results demonstrate the need for further serial data collection to generate age-specific normal ranges and inform oxygen prescribing guidelines.
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Affiliation(s)
- Olivia Falconer
- Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Savannah Ivy
- University of Southampton School of Medicine, Southampton, UK
| | | | - Johanna Gavlak
- Department of Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Natasha Liddle
- Department of Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Emily Senior
- Department of Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Paula Lowe
- Department of Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Philippa Crowley
- Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Aneurin Young
- Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mark J Johnson
- Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Robert Mark Beattie
- Department of Paediatric Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Hazel J Evans
- Department of Paediatric Respiratory Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
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15
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Nehme L, Huang JC, Abuhamad A, Saade G, Kawakita T. Cost-effectiveness of history-indicated cerclage vs cervical length assessment for prevention of preterm birth. Am J Obstet Gynecol 2023; 229:674.e1-674.e9. [PMID: 37352907 DOI: 10.1016/j.ajog.2023.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/16/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Preterm birth is one of the major causes of neonatal morbidity and mortality. Preterm delivery is a large burden to our health care system, and a history of preterm birth is one of the most common risk factors for subsequent preterm birth. OBJECTIVE We sought to examine the cost-effectiveness of the history-indicated cerclage strategy compared with the transvaginal ultrasound cervical length assessment strategy in individuals with a history of preterm birth. STUDY DESIGN We developed a decision analysis model to compare history-indicated cerclage and cervical length assessment. The primary outcome was the net monetary benefit from a maternal and neonatal perspective of both strategies, defined as the value of an intervention with a known willingness to pay threshold for a unit of benefit. The time horizon was set to be a lifetime. Costs (in 2022 USD) included those for the cerclage, serial transvaginal ultrasounds, maternal care for admission, neonatal care, and severe disability. Probabilities, utilities, and costs were derived from the literature. A cost-effectiveness threshold was set at $100,000 per QALY (quality-adjusted life year). We first conducted 1-way sensitivity analyses with associated variables as sensitivity analyses. We then performed a probabilistic sensitivity analysis using Monte Carlo simulation with 1000 trials to test the robustness of the results in the setting of simultaneous changes in probabilities, costs, and utilities. RESULTS In our base-case analysis, the history-indicated cerclage strategy compared to transvaginal ultrasound cervical length assessment was associated with more cost ($85,038 vs $70,155), with slightly less effectiveness from the maternal perspective (26.74 QALY vs 26.78 QALY) and from the neonatal perspective (28.91 QALY vs 29.06 QALY), and with less maternal and neonatal net monetary benefit. Therefore, the history-indicated cerclage strategy was dominated. With the 1000 trials of Monte Carlo simulation, transvaginal ultrasound cervical length assessment was the preferred strategy 84% and 88% of the time from the maternal and neonatal perspectives, respectively. CONCLUSION The history-indicated cerclage strategy was more expensive and slightly less effective than the transvaginal ultrasound cervical length assessment strategy with a lower net monetary benefit.
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Affiliation(s)
- Lea Nehme
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA
| | - Jim C Huang
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Alfred Abuhamad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA
| | - George Saade
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA
| | - Tetsuya Kawakita
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA.
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16
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Ubom AE, Vatish M, Barnea ER. FIGO good practice recommendations for preterm labor and preterm prelabor rupture of membranes: Prep-for-Labor triage to minimize risks and maximize favorable outcomes. Int J Gynaecol Obstet 2023; 163 Suppl 2:40-50. [PMID: 37807588 DOI: 10.1002/ijgo.15113] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Preterm labor occurs in around 10% of pregnancies worldwide. Once diagnosed, significant efforts must be made to reduce the likelihood of morbidity and mortality associated with preterm birth. In high-resource settings, access to hospitals with a neonatal intensive care unit (NICU) is readily available, whereas access to NICU care is limited in low- and middle-income countries (LMICs) and many rural settings. Use of FIGO's Prep-for-Labor triage method rapidly identifies low- and high-risk patients with preterm labor to enable clinicians to decide whether the patient can be managed on site or if transfer to a level II-IV facility is needed. The management steps described in this paper aim to minimize the morbidity and mortality associated with preterm labor and in the setting of preterm labor with preterm premature rupture of membranes (PPROM). The methods for accurate diagnosis of PPROM and chorioamnionitis are described. When the risk of preterm birth is high, antenatal corticosteroids should be administered for lung maturation combined with limited tocolysis for 48 hours to permit the corticosteroid course to be completed. Magnesium sulfate is also administered for fetal neuroprotection. Implementation of FIGO's Prep-for-Labor triage method in an LMIC setting will help improve maternal and neonatal outcomes.
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Affiliation(s)
- Akaninyene Eseme Ubom
- Department of Obstetrics, Gynecology and Perinatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Manu Vatish
- Bill and Melinda Gates Foundation, Seattle, Washington, USA
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Eytan R Barnea
- Society for the Investigation of Early Pregnancy (SIEP), New York, New York, USA
- Obstetrics Gynecology & Reproductive Sciences University of Miami Miller School of Medicine, Miami, Florida, USA
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17
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Vaz MJ, Dongas S, Ratner AJ. Capsule production promotes Group B Streptococcus intestinal colonization. Microbiol Spectr 2023; 11:e0234923. [PMID: 37732775 PMCID: PMC10655599 DOI: 10.1128/spectrum.02349-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/25/2023] [Indexed: 09/22/2023] Open
Abstract
Late-onset disease is the most common clinical presentation of Group B Streptococcus (GBS) infection during infancy, and gastrointestinal (GI) colonization is an important precursor. Previously, we described a murine model of postnatal GBS GI colonization that resulted in sustained colonization and progression to invasive disease. Capsular polysaccharide is an important GBS virulence factor. Vaccines based on a subset of capsular serotypes are in clinical trials. However, little is known regarding the role of specific GBS capsular serotypes in GI colonization. We examined the role of GBS capsule in GI colonization using capsule-producing and acapsular strains derived from GBS strain A909 (serotype Ia) in a murine model. Using isogenic GBS strains differing only in capsular serotypes, we explored the role of specific serotypes in GI colonization by determining competitive indices during cocolonization. We found that GBS A909 colonizes the murine GI tract without causing invasive disease. In monocolonization experiments, there was colonization persistence with the capsule-producing strain (100%) compared to the acapsular mutant strain (13%). In cocolonization experiments, the capsule-producing strain outcompeted its isogenic acapsular mutant, with a geometric mean competitive index of 8, 95% confidence interval (CI) [1.7, 38.9] in the colon at 7 days post-colonization. A909 expressing its native serotype Ia capsule outcompeted an isogenic mutant that expresses serotype III capsule, with a geometric mean competitive index of 2.5, 95% CI [1.2, 5.1] in the colon at 7 days post-colonization. Thus, polysaccharide capsule production enhances GBS GI colonization in vivo. In an A909 genetic background, the production of a serotype Ia capsule provides a competitive advantage over an isogenic strain producing type III capsule. The murine model is a valuable tool to understand the role of GBS capsule types in GI colonization. IMPORTANCE The establishment of GBS intestinal colonization is believed to be a critical precursor to late-onset disease in neonates, which has a significant impact on neurodevelopment outcomes in this population. Our prior work described a murine model of postnatal Group B Streptococcus (GBS) acquisition and invasive disease. Using this model, we explored the importance of GBS polysaccharide capsule production on gastrointestinal colonization. We found that the expression of capsule (compared to isogenic acapsular strains) provides an advantage in intestinal colonization and, importantly, that capsule type Ia has an advantage over capsule type III in a GBS A909 strain background. We speculate that specific serotypes may differ in colonization fitness, which may play a role in serotype distribution in neonatal disease.
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Affiliation(s)
- Michelle J. Vaz
- Department of Pediatrics, NYU School of Medicine, New York, New York, USA
| | - Sophia Dongas
- Department of Pediatrics, NYU School of Medicine, New York, New York, USA
| | - Adam J. Ratner
- Department of Pediatrics, NYU School of Medicine, New York, New York, USA
- Department of Microbiology, NYU School of Medicine, New York, New York, USA
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Shi Y, Kim HJ, Kim SY, Kim GE, Jin HJ. Lack of association between the VEGFA gene polymorphisms and preterm birth in Korean women. Genomics Inform 2023; 21:e29. [PMID: 37813625 PMCID: PMC10584649 DOI: 10.5808/gi.22064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 06/05/2023] [Accepted: 06/24/2023] [Indexed: 10/11/2023] Open
Abstract
Preterm birth (PTB), a pregnancy-related disease, is defined as a birth before 37 weeks of gestation. It is a major cause of maternal mortality and morbidity worldwide, and its incidence rate is steadily increasing. Various genetic factors can contribute to the etiology of PTB. Vascular endothelial growth factor A (VEGFA) gene is an important angiogenic gene and its polymorphisms have been reported to be associated with PTB development. Therefore, we conducted a case-control study to evaluate the association between VEGFA rs699947, rs2010963, and rs3025039 polymorphisms and PTB in Korean women. A total of 271 subjects (116 patients with PTB and 155 women at ≥38 weeks of gestation) were analyzed in this study. The genotyping of VEGFA gene polymorphisms was performed using polymerase chain reaction- restriction fragment length polymorphism. No significant association between the patients with PTB and the control groups was confirmed. In the combination analysis, we found a significant association between PTB and VEGFA rs699947 CC-rs2010963 GG-rs3025039 CC combination (odds ratio, 3.77; 95% confidence interval, 1.091 to 13.032; p = 0.031). The VEGFA rs699947, rs2010963, and rs3025039 polymorphisms might have no genetic association with the pathogenesis of PTB in Korean women. However, the combination analysis indicates the possibility that VEGFA acts in PTB pathophysiology. Therefore, larger sample sets and replication studies are required to further elucidate our findings.
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Affiliation(s)
- Yue Shi
- Department of Biological Sciences, College of Science & Technology, Dankook University, Cheonan 31116, Korea
| | - Hyung Jun Kim
- Department of Biological Sciences, College of Science & Technology, Dankook University, Cheonan 31116, Korea
| | - Seong Yong Kim
- Department of Biological Sciences, College of Science & Technology, Dankook University, Cheonan 31116, Korea
| | - Ga Eun Kim
- Department of Biological Sciences, College of Science & Technology, Dankook University, Cheonan 31116, Korea
| | - Han Jun Jin
- Department of Biological Sciences, College of Science & Technology, Dankook University, Cheonan 31116, Korea
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19
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Mekic N, Selimovic A, Cosickic A, Mehmedovic M, Hadzic D, Zulic E, Mustafic S, Serak A. Predictors of adverse short-term outcomes in late preterm infants. BMC Pediatr 2023; 23:298. [PMID: 37328827 PMCID: PMC10276478 DOI: 10.1186/s12887-023-04112-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/05/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Infants born between 34 weeks and 36 weeks and 6 days of gestation are defined as late preterm infants (LPIs), and they account for approximately 74% of all premature births. Preterm birth (PB) remains the leading cause of infant mortality and morbidity worldwide. AIM To analyse short-term morbidity and mortality and identify predictors of adverse outcomes in late preterm infants. PATIENTS AND METHODS In this retrospective study, we evaluated adverse short-term outcomes of LPIs admitted to the Intensive Care Unit (ICU), Clinic for Children's Diseases, University Clinical Center Tuzla, between 01.01.2020 and 31.12.2022. The analysed data included sex, gestational age, parity, birth weight, Apgar score (i.e., assessment of vitality at birth in the first and fifth minutes after birth), and length of hospitalization in NICU, as well as short-term outcome data. Maternal risk factors we observed were: age of mother, parity, maternal morbidity during pregnancy, complications and treatment during pregnancy. LPIs with major anatomic malformations were excluded from the study. Logistic regression analysis was used to identify risk factors for neonatal morbidity among LPIs. RESULTS We analysed data from 154 late preterm newborns, most of whom were male (60%), delivered by caesarean Sect. (68.2%) and from nulliparous mothers (63.6%). Respiratory complications were the most common outcome among all subgroups, followed by CNS morbidity, infections and jaundice requiring phototherapy. The rate of almost all of the complications in the late-preterm group decreased as gestational age increased from 34 to 36 weeks. Birth weight (OR: 1,2; 95% CI: 0,9 - 2,3; p = 0,0313) and male sex (OR: 2,5; 95% CI: 1,1-5,4; p = 0,0204) were significantly and independently associated with an increased risk for respiratory morbidity, and gestational weeks and male sex were associated with infectious morbidity. None of the risk factors analysed herein were predictors of CNS morbidity in LPIs. CONCLUSION A younger gestational age at birth is associated with a greater risk of short-term complications among LPIs, thus highlighting the need for increased knowledge about the epidemiology of these late preterm births. Understanding the risks of late preterm birth is critical to optimizing clinical decision-making, enhancing the cost-effectiveness of endeavours to delay delivery during the late preterm period, and reducing neonatal morbidity.
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Affiliation(s)
- Nina Mekic
- Pediatric Department, Health and Educational Medical Center Tuzla, Tuzla, Bosnia and Herzegovina.
| | - Amela Selimovic
- Clinic for Children's Diseases Tuzla, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Almira Cosickic
- Clinic for Children's Diseases Tuzla, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Majda Mehmedovic
- Clinic for Internal Medicine, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Devleta Hadzic
- Clinic for Children's Diseases Tuzla, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Evlijana Zulic
- Clinic for Children's Diseases Tuzla, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Sehveta Mustafic
- Polyclinic for Laboratory Diagnostics University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Amra Serak
- Pediatric Department, Health and Educational Medical Center Tuzla, Tuzla, Bosnia and Herzegovina
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Weigelt A, Bleck S, Huebner MJ, Rottermann K, Waellisch W, Morhart P, Abu-Tair T, Dittrich S, Schoeffl I. Impact of premature birth on cardiopulmonary function in later life. Eur J Pediatr 2023:10.1007/s00431-023-04952-y. [PMID: 37147470 DOI: 10.1007/s00431-023-04952-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 05/07/2023]
Abstract
Pulmonary function is reduced in children after preterm birth. The variety of subgroups ranges from early to late preterm births. Limitations in pulmonary function can be observed even after late preterm birth without signs of bronchopulmonary dysplasia and/or history of mechanical ventilation. Whether this reduction in lung function is reflected in the cardiopulmonary capacity of these children is unclear. This study aims to investigate the impact of moderate to late premature birth on cardiopulmonary function. Cardiopulmonary exercise testing on a treadmill was performed by 33 former preterm infants between 8 and 10 years of age who were born between 32 + 0 and 36 + 6 weeks of gestation and compared with a control group of 19 children born in term of comparable age and sex. The former preterm children achieved comparable results to the term-born controls with respect to most of the cardiopulmonary exercise parameters [Formula: see text]. The only differences were in a slightly higher oxygen uptake efficiency slope [Formula: see text] and higher peak minute ventilation [Formula: see text] in the group of children born preterm. With respect to heart rate recovery [Formula: see text] and breathing efficiency [Formula: see text], there were no significant differences. CONCLUSION Children born preterm did not show limitations in cardiopulmonary function in comparison with matched controls. WHAT IS KNOWN • Preterm birth is associated with reduced pulmonary function in later life, this is also true for former late preterms. • As a consequence of being born premature, the lungs have not finished their important embryological development. Cardiopulmonary fitness is an important parameter for overall mortality and morbidity in children and adults and a good pulmonary function is therefore paramount. WHAT IS NEW • Children born prematurely were comparable to an age- and sex-matched control group with regards to almost all cardiopulmonary exercise variables. • A significantly higher OUES, a surrogate parameter for VO2peak was found for the group of former preterm children, most likely reflecting on more physical exercise in this group. Importantly, there were no signs of impaired cardiopulmonary function in the group of former preterm children.
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Affiliation(s)
- Annika Weigelt
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany.
| | - Steffen Bleck
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Matthias Jens Huebner
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Kathrin Rottermann
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Wolfgang Waellisch
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Patrick Morhart
- Department of Neonatology and Intensive Medical Care, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Tariq Abu-Tair
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Sven Dittrich
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Isabelle Schoeffl
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, LS13HE, UK
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21
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Oliphant EA, McKinlay CJ, McNamara D, Cavadino A, Alsweiler JM. Caffeine to prevent intermittent hypoxaemia in late preterm infants: randomised controlled dosage trial. Arch Dis Child Fetal Neonatal Ed 2023; 108:106-113. [PMID: 36038256 PMCID: PMC9985705 DOI: 10.1136/archdischild-2022-324010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/12/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To establish the most effective and best tolerated dose of caffeine citrate for the prevention of intermittent hypoxaemia (IH) in late preterm infants. DESIGN Phase IIB, double-blind, five-arm, parallel, randomised controlled trial. SETTING Neonatal units and postnatal wards of two tertiary maternity hospitals in New Zealand. PARTICIPANTS Late preterm infants born at 34+0-36+6 weeks' gestation, recruited within 72 hours of birth. INTERVENTION Infants were randomly assigned to receive a loading dose (10, 20, 30 or 40 mg/kg) followed by 5, 10, 15 or 20 mg/kg/day equivolume enteral caffeine citrate or placebo daily until term corrected age. PRIMARY OUTCOME IH (events/hour with oxygen saturation concentration ≥10% below baseline for ≤2 min), 2 weeks postrandomisation. RESULTS 132 infants with mean (SD) birth weight 2561 (481) g and gestational age 35.7 (0.8) weeks were randomised (24-28 per group). Caffeine reduced the rate of IH at 2 weeks postrandomisation (geometric mean (GM): 4.6, 4.6, 2.0, 3.8 and 1.7 events/hour for placebo, 5, 10, 15 and 20 mg/kg/day, respectively), with differences statistically significant for 10 mg/kg/day (GM ratio (95% CI] 0.39 (0.20 to 0.76]; p=0.006) and 20 mg/kg/day (GM ratio (95% CI] 0.33 (0.17 to 0.68]; p=0.003) compared with placebo. The 20 mg/kg/day dose increased mean (SD) pulse oximetry oxygen saturation (SpO2) (97.2 (1.0) vs placebo 96.0 (0.8); p<0.001), and reduced median (IQR) percentage of time SpO2 <90% (0.5 (0.2-0.8) vs 1.1 (0.6-2.4); p<0.001) at 2 weeks, without significant adverse effects on growth velocity or sleeping. CONCLUSION Caffeine reduces IH in late preterm infants at 2 weeks of age, with 20 mg/kg/day being the most effective dose. TRIAL REGISTRATION NUMBER ACTRN12618001745235.
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Affiliation(s)
- Elizabeth Anne Oliphant
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
- Starship Child Health, Auckland District Health Board, Auckland, New Zealand
| | - Christopher Jd McKinlay
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
- Kidz First Neonatal Care, Counties Manukau District Health Board, Auckland, New Zealand
| | - David McNamara
- Starship Child Health, Auckland District Health Board, Auckland, New Zealand
| | - Alana Cavadino
- Section of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| | - Jane M Alsweiler
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
- Starship Child Health, Auckland District Health Board, Auckland, New Zealand
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22
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Kaltsogianni O, Dassios T, Lee R, Harris C, Greenough A. Closed-loop automated oxygen control in ventilated infants born at or near term: A crossover trial. Acta Paediatr 2023; 112:246-251. [PMID: 36403205 PMCID: PMC10099764 DOI: 10.1111/apa.16598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/31/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
AIM To determine if the use of closed-loop automated oxygen control (CLAC) reduced the incidence and duration of hypoxemic episodes (SpO2 < 92%) in ventilated infants born at or above 34 weeks of gestation. METHODS Infants were studied on two consecutive days for 6 h each day. They were randomised to receive standard care (manual oxygen control) or standard care with a CLAC system (automated oxygen control) first. RESULTS Sixteen infants with a median (IQR) gestational age of 37.4 (36.6-38.8) weeks were studied at a median (IQR) postmenstrual age of 38.8 (37.4-39.8) weeks. During the automated oxygen control period, infants spent less time in hypoxemia (SpO2 < 92%) (p = 0.033), episodes of desaturation were shorter (p = 0.001), the time spent within target SpO2 range (92%-96%) was increased (p = 0.001), and the FiO2 delivery was lower (p = 0.018). The time spent in hyperoxemia (SpO2 > 96%) was reduced during automated oxygen control (p = 0.011), the episodes of hyperoxemia were of shorter duration (p = 0.008) and fewer manual adjustments were made to the FiO2 (p = 0.005). CONCLUSIONS Closed-loop automated oxygen control in ventilated infants born at or near term was associated with a reduction in the incidence and duration of hypoxemic episodes with more time spent in the target oxygen range.
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Affiliation(s)
- Ourania Kaltsogianni
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Theodore Dassios
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Rebecca Lee
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Christopher Harris
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Anne Greenough
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
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23
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Exchange blood transfusion for hyperbilirubinaemia: Neonatal characteristics and short-term outcomes. SOUTH AFRICAN JOURNAL OF CHILD HEALTH 2022. [DOI: 10.7196/sajch.2022.v16i4.1794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background. Factors that have been associated with severe hyperbilirubinaemia requiring exchange blood transfusion (EBT) are early discharge, late preterm birth and haemolytic disease. Early discharge is a common practice in neonatal care, so it is important to identify and audit neonates who received EBT, in order to identify modifiable factors.
Objectives. To describe the characteristics and outcomes of infants requiring EBT.
Methods. We reviewed records of infants admitted with severe jaundice requiring EBT from January 2009 to December 2013. Descriptive analysis of characteristics, clinical presentation, laboratory findings and outcome at discharge was performed.
Results. A total of 150 neonates received EBT (30 per year), and 101 were reviewed. Of these, 34 (33.7%) were inpatients and 67 (66.3%) were new admissions (2.34/1 000 new admissions). The majority of neonates requiring EBT were born vaginally (86.1%), were late preterm births (20.8%) and were exclusively breastfed (82.2%). The median postnatal age at presentation was 5 days. Clinical signs suggestive of acute bilirubin encephalopathy were present in 24.8% of cases. Among mother-infant pairs with known blood groups, 9.3% and 70.4% had rhesus (Rh) and ABO incompatibility, respectively. A Coombs test was positive in 62.5% of those with Rh incompatibility compared with 31.7% of those with ABO incompatibility. A total of 6 patients (5.9%) died, all within 7 days of EBT, but none during EBT.
Conclusion. The majority of neonates requiring EBT presented post discharge after birth and had been born vaginally at term, suggesting early discharge after delivery. More than two-thirds of cases were related to ABO incompatibility. Screening for jaundice before discharge must be prioritised, especially for infants born to mothers who are Rh negative or ABO blood group O.
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24
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Xin Y, Shao Y, Mu W, Li H, Zhou Y, Wang C. Accuracy of the neutrophil-to-lymphocyte ratio for the diagnosis of neonatal sepsis: a systematic review and meta-analysis. BMJ Open 2022; 12:e060391. [PMID: 36517090 PMCID: PMC9756154 DOI: 10.1136/bmjopen-2021-060391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 11/12/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The purpose of this study was systematically and quantitatively to assess the value of the neutrophil-to-lymphocyte ratio (NLR) for the diagnosis of neonatal sepsis by systematic review and meta-analysis. DESIGN Systematic review and meta-analysis. METHODS Eight major databases, including The Cochrane, PubMed, Embase, Web of Science, CNKI, Wanfang, China Biomedical Literature Database and VIP Database, were systematically searched for NLR diagnoses of neonatal sepsis from inception to June 2022. Two investigators independently conducted the literature search, screening, data extraction and quality evaluation with the Quality Assessment of Diagnostic Accuracy Studies-2 checklist. Statistical analysis was performed using Review Manager V.5.3, Stata V.16.0, R (V.3.6.0) and Meta-DISC V.1.4. RESULTS A total of 14 studies comprising 1499 newborns were included in this meta-analysis. With a cut-off value ranging from 0.1 to 9.4, the pooled sensitivity of the NLR in the diagnosis of neonatal sepsis was 0.74 (95% CI: 0.61 to 0.83), the pooled specificity was 0.88 (95% CI: 0.73 to 0.95), the positive likelihood ratio (LR+) was 6.35 (95% CI: 2.6 to 15.47), the negative likelihood ratio (LR-) was 0.30 (95% CI: 0.19 to 0.46), the diagnostic OR (DOR) was 12.88 (95% CI: 4.47 to 37.08), area under the curve (AUC) was 0.87 (95% CI: 0.84 to 0.89). In the subgroup analysis of early-onset neonatal sepsis, the pooled sensitivity was 0.75 (95% CI: 0.47 to 0.91), the pooled specificity was 0.99 (95% CI: 0.88 to 1.00), the LR+ was 63.3 (95% CI: 5.7 to 696.8), the LR- was 0.26 (95% CI: 0.10 to 0.63), the DOR was 247 (95% CI: 16 to 3785) and the AUC was 0.97 (95% CI: 0.95 to 0.98). CONCLUSIONS Our findings suggest that the NLR is a helpful indicator for the diagnosis of early neonatal sepsis, but it still needs to be combined with other laboratory tests and specific clinical manifestations.
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Affiliation(s)
- Yu Xin
- Department of Critical Care Medicine, The First Affifiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
- Department of Critical Care Medicine, Harbin meidcal university cancer hospital, Harbin, Heilongjiang, China
| | - Yunshuang Shao
- Department of Cardiovascular Medicine, Qilu Hospital of Shandong University Qingdao, Qingdao, Shandong, China
| | - Wenjing Mu
- Department of Critical Care Medicine, Harbin meidcal university cancer hospital, Harbin, Heilongjiang, China
| | - Hongxu Li
- Department of Critical Care Medicine, The First Affifiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
- Department of Critical Care Medicine, Harbin meidcal university cancer hospital, Harbin, Heilongjiang, China
| | - Yuxin Zhou
- Department of Critical Care Medicine, The First Affifiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
- Department of Critical Care Medicine, Harbin meidcal university cancer hospital, Harbin, Heilongjiang, China
| | - Changsong Wang
- Department of Critical Care Medicine, The First Affifiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
- Department of Critical Care Medicine, Harbin meidcal university cancer hospital, Harbin, Heilongjiang, China
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25
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Fayed A, Wahabi HA, Esmaeil S, Elmorshedy H, AlAniezy H. Preterm, early term, and post-term infants from Riyadh mother and baby multicenter cohort study: The cohort profile. Front Public Health 2022; 10:928037. [PMID: 36187618 PMCID: PMC9516634 DOI: 10.3389/fpubh.2022.928037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/09/2022] [Indexed: 01/24/2023] Open
Abstract
Background Birth before 37 or beyond 42 gestational weeks is associated with adverse neonatal and maternal outcomes. Studies investigating determinants and outcomes of these deliveries are scarce. The objective of this study was to determine the neonatal birth profile in relation to the gestational age at delivery and to evaluate its influence on the immediate maternal and neonatal outcomes. Methods This is a multicenter cohort study of 13,403 women conducted in three hospitals in Riyadh. Collected data included sociodemographic characteristics, obstetric history, and physical and laboratory measurements. Regression models were developed to estimate the adjusted odds ratio (OR) and confidence intervals (CI) to determine factors associated with preterm, early term, and post-term births and to evaluate common maternal and neonatal risks imposed by deliveries outside the full term. Results The incidence of preterm, early term, and post-term delivery was 8.4%, 29.8%, and 1.4%, respectively. Hypertensive events during pregnancy consistently increased the risk of all grades of preterm births, from more than 3-fold for late preterm (OR = 3.40, 95% CI = 2.21-5.23) to nearly 7-fold for extremely early preterm (OR = 7.11, 95% CI = 2.24-22.60). Early term was more likely to occur in older mothers (OR = 1.30, 95% CI = 1.13-1.49), grand multiparous (OR = 1.21, 95% CI = 1.06-1.38), pregestational diabetes (OR = 1.91, 95% CI = 1.49-2.44), and gestational diabetes women (OR = 1.18, 95% CI = 1.05-1.33). The risk of post-term birth was higher in primiparous. In preterm births, the adverse outcome of neonates having an APGAR score of <7 at 5 min and admission to neonatal intensive care units increased progressively as the gestational age decreased. Post-term births are 2-fold more likely to need induction of labor; meanwhile, preterm births were more likely to deliver by cesarean section. Conclusion This large cohort study was the first in Saudi Arabia to assess the delivery profile across a continuum of gestational age and the associated maternal and neonatal adverse outcomes of deliveries outside the full-term period. The study showed that the prevalence of preterm and post-term birth in Saudi Arabia is similar to the prevalence in other high-income countries. The immediate adverse pregnancy outcomes inversely increased with the decrease in gestational age at delivery. In addition, maternal age, hypertension, diabetes, and parity influenced the gestational age at delivery.
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Affiliation(s)
- Amel Fayed
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Hayfaa A. Wahabi
- Research Chair of Evidence-Based Healthcare and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia,Department of Family and Community Medicine, King Saud University Medical City and College of Medicine, Riyadh, Saudi Arabia
| | - Samia Esmaeil
- Research Chair of Evidence-Based Healthcare and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia,*Correspondence: Samia Esmaeil
| | - Hala Elmorshedy
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Hilala AlAniezy
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
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26
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Elucidating the Effect of Antenatal Corticosteroids in the Late Preterm Period. J Obstet Gynaecol India 2022; 73:107-112. [PMID: 37073231 PMCID: PMC10105809 DOI: 10.1007/s13224-022-01664-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 05/12/2022] [Indexed: 10/15/2022] Open
Abstract
Abstract
Aim and Objective
To determine the efficacy of antenatal corticosteroids given in the late preterm period.
Methodology
We conducted a retrospective case–control study on patients with singleton pregnancies who were at a risk of delivering in the late preterm period (34 weeks to 36 weeks 6 days). A total of 126 patients who had received antenatal corticosteroids (prenatal administration of either betamethasone or dexamethasone, minimum one dose) during the late preterm period were taken as cases, and 135 patients who had not received steroids antenatally due to various reasons, for example, who were clinically unstable, presented with active bleeding, non-reassuring foetal status that obligated an imminent delivery and those in active labour were included as controls. The various neonatal outcomes like APGAR score at one and five minutes, incidence of admission and duration of stay in neonatal intensive care unit (NICU), respiratory morbidity, requirement of assisted ventilation, intraventricular haemorrhage (IVH) necrotizing enterocolitis, transient tachypnea of the newborn, respiratory distress syndrome, use of surfactant, neonatal hypoglycaemia, hyperbilirubinemia requiring phototherapy, sepsis and neonatal mortality were compared between the two groups.
Results
The baseline characteristics of both groups were comparable. There was a lower incidence of admissions to neonatal intensive care unit (NICU) (15% vs. 26%, p = 0.05), respiratory distress syndrome (5% vs. 13%, p = 0.04), requirement of invasive ventilation (0% vs. 4%, p = 0.04) and hyperbilirubinemia requiring phototherapy (24% vs. 39%, p = 0.02) in the babies of the group that received steroids compared to the control group. The rate of overall respiratory morbidity in the neonates was lowered after giving steroids (16% vs. 28%, p = 0.04). The incidence of neonatal necrotizing enterocolitis, hypoglycaemia, IVH, TTN, sepsis and mortality between the two groups was not significant (p > 0.05).
Conclusion
Antenatal corticosteroids administered to patients between 34 and 36 weeks 6 days of gestation reduce respiratory morbidity, requirement of invasive ventilation, respiratory distress syndrome, hyperbilirubinemia requiring phototherapy and the incidence of NICU admissions in the newborns.
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Amsalu R, Oltman SP, Baer RJ, Medvedev MM, Rogers EE, Jelliffe-Pawlowski L. Incidence, Risk Factors, and Reasons for 30-Day Hospital Readmission Among Healthy Late Preterm Infants. Hosp Pediatr 2022; 12:639-649. [PMID: 35694876 PMCID: PMC9997672 DOI: 10.1542/hpeds.2021-006215] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Late preterm infants have an increased risk of morbidity relative to term infants. We sought to determine the rate, temporal trend, risk factors, and reasons for 30-day readmission. METHODS This is a retrospective cohort study of infants born at 34 to 42 weeks' gestation in California between January 1, 2011, and December 31, 2017. Birth certificates maintained by California Vital Statistics were linked to discharge records maintained by the California Office of Statewide Health Planning and Development. Multivariable logistic regression was used to identify risk factors and derive a predictive model. RESULTS Late preterm infants represented 4.3% (n = 122 014) of the study cohort (n = 2 824 963), of which 5.9% (n = 7243) were readmitted within 30 days. Compared to term infants, late preterm infants had greater odds of readmission (odds ratio [OR]: 2.34 [95% confidence interval (CI): 2.28-2.40]). The temporal trend indicated increases in all-cause and jaundice-specific readmission infants (P < .001). The common diagnoses at readmission were jaundice (58.9%), infections (10.8%), and respiratory complications (3.5%). In the adjusted model, factors that were associated with greater odds of readmission included assisted vaginal birth, maternal age ≥34 years, diabetes, chorioamnionitis, and primiparity. The model had predictive ability of 60% (c-statistic 0.603 [95% CI: 0.596-0.610]) in late preterm infants who had <5 days length of stay at birth. CONCLUSION The findings contribute important information on what factors increase or decrease the risk of readmission. Longitudinal studies are needed to examine promising hospital predischarge and follow-up care practices.
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Affiliation(s)
| | - Scott P Oltman
- California Preterm Birth Initiative
- Departments of Epidemiology & Biostatistics
| | - Rebecca J Baer
- California Preterm Birth Initiative
- Department of Pediatrics, University of California San Diego, La Jolla, California
| | - Melissa M Medvedev
- Pediatrics, University of California San Francisco, San Francisco, California
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Elizabeth E Rogers
- Pediatrics, University of California San Francisco, San Francisco, California
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Goldstein MJ, Bailer JM, Gonzalez-Brown VM. Preterm vs term delivery in antenatally diagnosed gastroschisis: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2022; 4:100651. [PMID: 35462060 DOI: 10.1016/j.ajogmf.2022.100651] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To review the evidence regarding gestational age at birth, length of stay, sepsis incidence, days on mechanical ventilation, and mortality between preterm and term deliveries in pregnancies complicated by gastroschisis. DATA SOURCES We conducted database searches of PubMed, Cochrane Central Register of Controlled Trials, Embase, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov without language restrictions through August 16, 2021. References of all relevant articles were reviewed. STUDY ELIGIBILITY CRITERIA Randomized controlled trials, nonrandomized controlled trials, and observational studies were evaluated comparing length of stay, sepsis, days on mechanical ventilation, and mortality between either elective preterm delivery and expectant management (Group 1) or preterm gestational age and term gestational age (Group 2). METHODS Two researchers independently selected studies and evaluated risk of bias with the Risk of Bias 2 tool for randomized controlled trials and the Newcastle-Ottawa Scale for cohort studies. Mean differences and odds ratios were calculated using a random-effects model for inclusion and methodological quality. The primary outcome was length of stay. Secondary outcomes were incidence of sepsis, mortality, days on mechanical ventilation, and gestational age. RESULTS Thirty studies with a total of 7409 patients were included in the systematic review, of which 25 were included in the analysis. Group 1 studies found no difference in length of stay or mortality and a trend toward fewer days on mechanical ventilation (mean difference, -0.40; 95% confidence interval, -0.89 to -0.10; P=.12; I2=35%). Subgroup analysis excluding premature delivery demonstrated lower sepsis incidence in elective preterm delivery (odds ratio, 0.46; 95% confidence interval, 0.25-0.84; P=.01; I2=0%). Group 2 studies found increased length of stay (mean difference, 15.44; 95% confidence interval, 8.44-21.83; P<.00001; I2=94%), sepsis (odds ratio, 1.69; 95% confidence interval, 1.15-2.50; P=.008; I2=51%), days on mechanical ventilation (mean difference, 1.38; 95% confidence interval, 0.10-2.66; P=.03; I2=66%), and mortality (odds ratio, 2.97; 95% confidence interval, 1.59-5.55; P=.0007; I2=0%). Gestational age was significantly lower in Group 2 studies than in Group 1 studies. CONCLUSION Data continue to be conflicting, but subgroup analysis suggested a possible reduction in sepsis incidence and mean days on mechanical ventilation with elective early term delivery.
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Affiliation(s)
| | - Jessica Marie Bailer
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Veronica Mayela Gonzalez-Brown
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX
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Battarbee AN, Ye Y, Szychowski JM, Casey BM, Tita AT, Boggess KA. Euglycemia after antenatal late preterm steroids: a multicenter, randomized controlled trial. Am J Obstet Gynecol MFM 2022; 4:100625. [PMID: 35346889 DOI: 10.1016/j.ajogmf.2022.100625] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Late preterm steroid administration can induce transient maternal and thus fetal hyperglycemia, which can increase production of fetal insulin and C-peptide. Infants delivered in this setting are subsequently at increased risk for hypoglycemia. Although maternal glycemic control before delivery is a key component of care for parturients with diabetes, this intervention has not been studied in the setting of late preterm steroid administration. OBJECTIVE This study aimed to determine the effect of maternal screening for and treatment of hyperglycemia after late preterm steroid administration on fetal C-peptide levels and other metabolic markers. STUDY DESIGN This was a multicenter, randomized trial (NCT03076775) of nondiabetic parturients with a singleton gestation receiving betamethasone at 34 0/7 weeks to 36 5/7 weeks for anticipated preterm birth. Participants randomized to maternal glycemic control received fasting and 1-hour postprandial or serial intrapartum capillary blood glucose screening with insulin treatment as indicated. Those randomized to expectant management did not receive any glucose screening or treatment. The primary outcome was fetal C-peptide level measured from umbilical cord blood at delivery. Secondary outcomes included other fetal metabolic markers and neonatal hypoglycemia (glucose level <40 mg/dL). Baseline characteristics and outcomes were compared between the groups. We estimated that we would need a sample size of 144 to provide >90% power to show a 1 ng/mL decrease in C-peptide concentration (±1.5 ng/mL) at ⍺=0.05 using a 2-sample t test and 1 interim analysis. After the interim analysis, the trial was stopped for futility. RESULTS Of 491 screened parturients, 163 (33%) were deemed eligible and 86 (53%) were randomized to 1 of the treatment groups (June 2017 to February 2021). One person was lost to follow-up because of delivery at another hospital. Baseline characteristics were similar between groups. The median interval from betamethasone administration to delivery was 24 hours (interquartile range, 13-96 hours) and did not differ between groups (P=.82). Most (82%) randomized to maternal glycemic control had hyperglycemia: 80% had at least 1 fasting glucose level >95 mg/dL, 75% had at least one 1-hour postprandial glucose level >140 mg/dL, and 80% had at least 1 intrapartum glucose level >110 mg/dL. In addition, 15% had at least 1 glucose level >180 mg/dL. None had maternal hypoglycemia after insulin treatment. Compared with expectant management, maternal glycemic control did not affect the median fetal C-peptide level (1.02; interquartile range, 0.52-1.85 vs 1.09; interquartile range, 0.61-1.65; P=.97) or other metabolic markers. Maternal glycemic control also did not affect neonatal hypoglycemia (49% vs 51%; P=.83) or other secondary neonatal or maternal outcomes. There was no evidence of effect modification by gestational age or body mass index at randomization, indication for betamethasone, duration from betamethasone to delivery, maternal race or ethnicity, or neonatal sex. In addition, the results were unchanged in a sensitivity analysis using a per-protocol approach. CONCLUSION Maternal hyperglycemia was observed in most nondiabetic parturients after receiving late preterm betamethasone. However, there was no improvement in fetal metabolic status, neonatal hypoglycemia, or other neonatal or maternal outcomes with maternal glycemic control. Therefore, maternal glucose surveillance and treatment does not seem to be beneficial in nondiabetic parturients receiving late preterm steroids.
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Affiliation(s)
- Ashley N Battarbee
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Battarbee, Ye, Szychowski, Casey, and Tita); Departments of Obstetrics and Gynecology (Drs Battarbee, Ye, Szychowski, Casey, and Tita) and Biostatistics (Dr Szychowski), The University of Alabama at Birmingham, Birmingham, AL.
| | - Yuanfan Ye
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Battarbee, Ye, Szychowski, Casey, and Tita); Departments of Obstetrics and Gynecology (Drs Battarbee, Ye, Szychowski, Casey, and Tita) and Biostatistics (Dr Szychowski), The University of Alabama at Birmingham, Birmingham, AL
| | - Jeff M Szychowski
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Battarbee, Ye, Szychowski, Casey, and Tita); Departments of Obstetrics and Gynecology (Drs Battarbee, Ye, Szychowski, Casey, and Tita) and Biostatistics (Dr Szychowski), The University of Alabama at Birmingham, Birmingham, AL
| | - Brian M Casey
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Battarbee, Ye, Szychowski, Casey, and Tita); Departments of Obstetrics and Gynecology (Drs Battarbee, Ye, Szychowski, Casey, and Tita) and Biostatistics (Dr Szychowski), The University of Alabama at Birmingham, Birmingham, AL
| | - Alan T Tita
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Battarbee, Ye, Szychowski, Casey, and Tita); Departments of Obstetrics and Gynecology (Drs Battarbee, Ye, Szychowski, Casey, and Tita) and Biostatistics (Dr Szychowski), The University of Alabama at Birmingham, Birmingham, AL
| | - Kim A Boggess
- Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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Weimer KED, Bidegain M, Shaikh SK, Couchet P, Tanaka DT, Athavale K. Comparison of short-term outcomes of 35-weeks' gestation infants cared for in a level II NICU vs mother-baby, a retrospective study. J Neonatal Perinatal Med 2022; 15:643-651. [PMID: 35661024 DOI: 10.3233/npm-221015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Late preterm infants are at high risk for medical complications and represent a growing NICU population. While 34-weeks' gestation infants are generally admitted to the NICU and 36-weeks'gestation infants stay in mother-baby, there is wide practice variation for 35-weeks'gestation infants. The objective of this study was to compare short-term outcomes of 35-weeks' gestation infants born at two hospitals within the same health system (DUHS), where one (DRH) admits all 35-weeks' gestation infants to their level II NICU and the other (DUH) admits all 35-weeks' gestation infants to mother-baby, unless clinical concern. METHODS We conducted a retrospective cohort analysis of 35-weeks' gestation infants born at DUHS from 2014-2019. Infant specific data were collected for birth, demographics, medications, medical therapies, LOS, ED visits and readmissions. 35-weeks' gestation infants at each hospital (DRH vs DUH) that met inclusion criteria were compared, regardless of unit(s) of care. RESULTS 726 infants of 35-weeks' gestation were identified, 591 met our inclusion criteria (DUH -462, DRH -129). Infants discharged from DRH were more likely to receive medical therapies (caffeine, antibiotics, blood culture, phototherapy, NGT), had a 4 day longer LOS, but were more likely to feed exclusively MBM at discharge. There were no differences in ED visits; however, more infants from DUH were readmitted within 30 days of discharge. CONCLUSIONS Our findings suggest admitting 35-weeks' gestation infants directly to the NICU increases medical interventions and LOS, but might reduce hospital readmissions.
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Affiliation(s)
- K E D Weimer
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - M Bidegain
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - S K Shaikh
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - P Couchet
- Department of Pediatrics, Duke University, Durham, NC, USA.,Hospital de Clínicas, Departamento de Neonatología, UDELAR, Montevideo, Uruguay
| | - D T Tanaka
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - K Athavale
- Department of Pediatrics, Duke University, Durham, NC, USA
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Clapp MA, Melamed A, Freret TS, James KE, Gyamfi-Bannerman C, Kaimal AJ. US Incidence of Late-Preterm Steroid Use and Associated Neonatal Respiratory Morbidity After Publication of the Antenatal Late Preterm Steroids Trial, 2015-2017. JAMA Netw Open 2022; 5:e2212702. [PMID: 35583868 PMCID: PMC9118048 DOI: 10.1001/jamanetworkopen.2022.12702] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/30/2022] [Indexed: 12/12/2022] Open
Abstract
Importance The Antenatal Late Preterm Steroids (ALPS) trial demonstrated a 20% reduction in the risk of respiratory complications in neonates at risk for a late-preterm birth who were exposed to antenatal corticosteroids compared with those who were not. Objective To assess whether new evidence of steroid administration for neonatal respiratory benefit in the late-preterm period is associated with changes in obstetric practice and the use of assisted ventilation for the neonate after delivery. Design, Setting, and Participants This cross-sectional study of US births from February 1, 2015, to October 31, 2017, as ascertained from US natality data, included live-born, singleton neonates born between 34 and 36 completed weeks of gestation to people without pregestational diabetes. An interrupted time series analysis using Poisson regression models was conducted. Data were analyzed from July 11, 2022, to November 9, 2022. Exposures Public dissemination of the ALPS trial results, which occurred during a 9-month period from February 1, 2016 (first published online), to October 31, 2016 (time of the last major professional society's guideline update in the months after the trial's publication). Main Outcomes and Measures Steroid use, any assisted ventilation use, and assisted ventilation use for more than 6 hours immediately after the dissemination period. Results A total of 707 862 births were included, divided among the 12-month predissemination period (n = 250 643), dissemination period (n = 195 736), and 12-month postdissemination period (n = 261 493). Most births were at 36 weeks of gestation (53.9% in the predissemination and postdissemination period; P = .10). Small but significant differences were found between the predissemination and postdissemination period cohorts: there were more individuals 35 years or older (19.5% vs 17.9%), fewer White individuals (67.8% vs 69.8%), and more publicly insured individuals (50.5% vs 50.1%) in the postdissemination period compared with the predissemination period, respectively (P < .001 for all). Compared with what rates were expected based on the predissemination trends, the adjusted rate of steroid use increased from 5.0% to 11.7% (adjusted incidence rate ratio [IRR], 2.34; 95% CI, 2.13-2.57), and assisted ventilation use decreased from 8.9% to 8.2% (adjusted IRR, 0.91; 95% CI, 0.85-0.98) after the dissemination period. No change was observed in assisted ventilation use for more than 6 hours (adjusted IRR, 0.98; 95% CI, 0.87-1.10). Conclusions and Relevance These findings suggest that there was an immediate change in practice of administering antenatal steroids and a reduction in neonatal morbidity among late-preterm births associated with the dissemination of the ALPS trial, suggesting that this evidence may be translating into a reduction in immediate respiratory morbidity outside the context of a clinical trial.
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Affiliation(s)
- Mark A. Clapp
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Alexander Melamed
- New York–Presbyterian Hospital, Herbert Irving Comprehensive Cancer Center, Columbia University Vagelos College of Physicians and Surgeons, New York
| | - Taylor S. Freret
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Kaitlyn E. James
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | | | - Anjali J. Kaimal
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
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Management of Preterm Premature Rupture of Membranes in the Late Preterm Period. Obstet Gynecol Surv 2022; 77:283-292. [PMID: 35522430 DOI: 10.1097/ogx.0000000000001024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Importance For patients who present with prelabor rupture of membrane (PROM) in the late preterm period (34 to 36 6/7 weeks), management remains unclear due to lack of consensus. However, recent guidelines have suggested that shared decision-making may be used and expectant management can be considered up to 37 0/7 weeks. Objective In this article, we review the contemporary studies comparing the risks and benefits of immediate delivery versus expectant management for patients with late preterm prelabor rupture of membranes (PPROM). Evidence Acquisition Original research articles, review articles, and guidelines on management of late PPROM. Results Three randomized clinical trials and 2 meta-analyses comparing expectant management and immediate delivery outcomes in late PPROM showed no significant difference in neonatal sepsis rates between groups. Expectant management increased the likelihood that pregnancies reached term while decreasing the rate of cesarean delivery. However, data suggest an increased risk of antepartum hemorrhage among patients in the expectant management groups, as well as higher rates of histologic chorioamnionitis. Conclusions and Relevance We recommend that clinicians offer expectant management as an alternative to immediate delivery in the setting of late PPROM through a shared decision-making process that clearly outlines the risks and benefits.
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Kim YS, Kang M, Choe YJ, Sung J, Lee JY, Choe SA. Child mortality of twins and singletons among late preterm and term birth: a study of national linked birth and under-five mortality data of Korea. Eur J Pediatr 2022; 181:2109-2116. [PMID: 35166933 DOI: 10.1007/s00431-022-04410-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/10/2022] [Accepted: 02/06/2022] [Indexed: 11/03/2022]
Abstract
Twins involve a higher risk of perinatal complications compared to singletons. We compared the risk of under five mortality between twins and singletons among late preterm and term births. The national birth data of South Korea pertaining to the years 2010-2014 linked with the mortality record of children aged under 5 years in 2010-2019 was analyzed. The final study population was 2,199,632 singletons and 62,351 twins. We conducted a survival analysis of under-five mortality with adjustment for neonatal and familial factors. Overall under-five mortality rates during the study period were 3.6 and 2.0 for twins and singletons, respectively. Although the unadjusted overall under-five mortality was higher in twins (hazard ratio [HR] = 1.80, 95% confidence interval [CI]: 1.57, 2.06, overall risk), twin birth was associated with comparable or lower risk (HR = 0.70, 95% CI: 0.58, 0.85, overall; 0.70, 95% CI: 0.56, 0.87, excluding neonatal mortality; 0.59, 95% CI: 0.40, 0.86, excluding infant mortality) after controlling for both neonatal and familial factors. Twins born at a gestational age of 34-35 weeks showed a generally lower risk of under-five mortality than their singleton counterparts, regardless of model specification.Conclusion: Among late preterm and term birth, under-5-year mortalities for twins were lower than singleton births when adjusted for neonatal and familial risk factors. This highlights the differential implication of gestational age at birth between twin and singleton in the child mortality.
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Affiliation(s)
- Young Shin Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, 02841, South Korea
| | - Minku Kang
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, 02841, South Korea
| | - Young June Choe
- Department of Pediatrics, Korea University Anam Hospital, Seoul, 02841, South Korea
| | - Joohon Sung
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, 08826, Korea
| | - Ji Yeon Lee
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Seung-Ah Choe
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, 02841, South Korea. .,Division of Life Sciences, Korea University, 02841, Seoul, South Korea.
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Pregnancy outcomes in twin pregnancies over 10 years. Obstet Gynecol Sci 2022; 66:20-25. [PMID: 36444516 PMCID: PMC9877468 DOI: 10.5468/ogs.22232] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/06/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the changes in twin pregnancy outcomes between 2007 and 2016 in a Korean population. METHODS The data for this nationwide population-based study was obtained from the national birth registry of the Korean National Statistical Office and the Health Insurance Review & Assessment Service of Korea. Women with twin pregnancies who gave birth between 2007 and 2016 were included. RESULTS From 2007 to 2016, the rate of twin pregnancies increased (1.37% vs. 1.91%, respectively, P<0.0001). The risk of preterm birth (adjusted odds ratio [aOR], 1.77; 95% confidence interval [CI], 1.66-1.89) also increased; however, the risk of twin growth discordance (aOR, 0.90; 95% CI, 0.82-0.99) decreased. The risks of cesarean section (aOR, 1.16; 95% CI, 1.03-1.29), gestational diabetes mellitus (aOR, 2.10; 95% CI, 1.83-2.39), and postpartum hemorrhage (aOR, 1.27; 95% CI, 1.14-1.41) all increased from 2007 to 2016. CONCLUSION Twin pregnancy outcomes have changed significantly in Korea over a recent 10-year period.
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Outcome and management in neonates with gastroschisis in the third millennium-a single-centre observational study. Eur J Pediatr 2022; 181:2291-2298. [PMID: 35226141 PMCID: PMC9110488 DOI: 10.1007/s00431-022-04416-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 02/02/2023]
Abstract
UNLABELLED Gastroschisis is one of the most common congenital malformations in paediatric surgery. However, there is no consensus regarding the optimal management. The aims of this study were to investigate the management and outcome and to identify predictors of outcome in gastroschisis. A retrospective observational study of neonates with gastroschisis born between 1999 and 2020 was undertaken. Data was extracted from the medical records and Cox regression analysis was used to identify predictors of outcome measured by length of hospital stay (LOS) and duration of parenteral nutrition (PN). In total, 114 patients were included. Caesarean section was performed in 105 (92.1%) at a median gestational age (GA) of 36 weeks (range 29-38) whereof (46) 43.8% were urgent. Primary closure was achieved in 82% of the neonates. Overall survival was 98.2%. One of the deaths was caused by abdominal compartment syndrome and one patient with intestinal failure-associated liver disease died from sepsis. None of the deceased patients was born after 2005. Median time on mechanical ventilation was 22 h. Low GA, staged closure, intestinal atresia, and sepsis were independent predictors of longer LOS and duration on PN. In addition, male sex was an independent predictor of longer LOS. CONCLUSION Management of gastroschisis according to our protocol was successful with a high survival rate, no deaths in neonates born after 2005, and favourable results in LOS, duration on PN, and time on mechanical ventilation compared to other reports. Multicentre registry with long-term follow-up is required to establish the best management of gastroschisis. WHAT IS KNOWN • Gastroschisis is one of the most common congenital malformations in paediatric surgery with increasing incidence. • There is no consensus among clinicians regarding the optimal management of gastroschisis. WHAT IS NEW • Although primary closure was achieved in 82% of the patients, mortality rate was very low (1.8%) with no deaths in neonates born after 2005 following the introduction of measurement of intraabdominal pressure at closure. • Low gestational age, staged closure, intestinal atresia, sepsis, and male sex were independent predictors of longer length of hospital stay.
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Girma B, Berhe H, Mekonnen F, Nigussie J. Survival and predictors of mortality among preterm neonates in Northern Ethiopia: A retrospective follow-up study. Front Pediatr 2022; 10:1083749. [PMID: 36714659 PMCID: PMC9880159 DOI: 10.3389/fped.2022.1083749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 12/19/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND In the year 2015, more than one-third of neonatal deaths caused by prematurity was recorded worldwide. Despite different kinds of efforts taken at the global and local levels to reduce neonatal mortality, it remains high with low reduction rates, especially in low- and middle-income countries like sub-Saharan Africa and South Asia. Therefore, this study aims to assess the survival status and predictors of mortality among preterm neonates. METHODS A retrospective follow-up study was conducted on randomly selected 561 preterm neonates. Data were extracted from patient records using a pretested checklist. Data entry and analysis were done using Epi-Data Version 4.4.2.1 and Stata version 14, respectively. The Cox proportional hazard regression model was fitted to identify the predictors of mortality. A hazard ratio with a 95% confidence interval (CI) was estimated and p-values < 0.05 were considered statistically significant. RESULT The proportion of preterm neonatal deaths was 32.1% (180) with an incidence of 36.6 (95% CI: 31.6-42.4) per 1,000 person days. The mean survival time was 18.7 (95% CI: 17.7-19.9) days. Significant predictors for time to death of preterm neonates were respiratory distress syndrome [adjusted hazard ratio (AHR): 2.04; 95% CI: 1.48-2.82], perinatal asphyxia (AHR: 2.13; 95% CI: 1.32-3.47), kangaroo mother care (AHR: 0.14; 95% CI: 0.08-0.24), and gestational age (AHR: 0.85; 95% CI: 0.80-0.90). CONCLUSION Preterm neonatal death is still a major public health concern. Respiratory distress syndrome, perinatal asphyxia, kangaroo mother care, and gestational age were independent significant predictors for time to death, as found in this study. Hence, priority must be given to neonates with the above illnesses and strengthen the management and care of preterm neonates.
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Affiliation(s)
- Bekahegn Girma
- Department of Nursing, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Hailemariam Berhe
- School of Nursing, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Furtuna Mekonnen
- School of Nursing, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Jemberu Nigussie
- Department of Nursing, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
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Ustun N, Hocaoğlu M, Turgut A, Arslanoğlu S, Ovalı F. Does antenatal corticosteroid therapy improve neonatal outcomes in late preterm birth? J Matern Fetal Neonatal Med 2021; 35:9105-9111. [PMID: 34895004 DOI: 10.1080/14767058.2021.2015576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Infants who are born at 34°/7 to 366/7 weeks of gestation (late preterm) are at greater risk for respiratory and other neonatal morbidities. The objective of this study was to examine the effects of the administration of antenatal corticosteroids (ACS) to women at risk for late preterm delivery on the incidence of neonatal outcomes. METHOD This was a prospective cohort study of singleton gestations at risk of imminent delivery between 34°/7 and 366/7 weeks. Neonatal outcomes were compared between mothers who received ACS and those who did not. The primary outcome was the rate of composite respiratory morbidity defined as the need for treatment within 72 h of life (continuous positive airway pressure or high flow nasal cannula for least 2 h or supplemental oxygen with a fraction of inspired oxygen of at least 0.30 for at least four continuous hours or mechanical ventilation). RESULTS During the 3-year study period, 595 subjects were included in this study, comprising 234 subjects that received ACS and 361 that did not. Administration of ACS significantly reduced the rates of composite respiratory morbidity (aOR 0.63 95% CI 0.40-0.99), the use of CPAP or HFNC for at least 2 h (aOR 0.57 95% CI 0.35-0.94), and transient tachypnea of the newborn (aOR 0.48 95% CI 0.28-0.82). Neonatal hypoglycemia was more significantly increased in the ACS group compared with controls (aOR 1.64 95% CI 1.04-2.59). We found no significant between-group differences in the rate of respiratory distress syndrome, surfactant use, need for resuscitation, jaundice requiring phototherapy, admission to neonatal intensive care or special care nursery, and duration of hospitalization. CONCLUSION Administration of ACS during the late preterm period decreased neonatal respiratory complications, however, increased the rate of hypoglycemia.
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Affiliation(s)
- Nuran Ustun
- Division of Neonatology, Department of Paediatrics, Istanbul Medeniyet University, Göztepe Training and Research Hospital, Istanbul, Turkey
| | - Meryem Hocaoğlu
- Department of Obstetrics and Gynecology, Istanbul Medeniyet University, Göztepe Training and Research Hospital, Istanbul, Turkey
| | - Abdülkadir Turgut
- Department of Obstetrics and Gynecology, Istanbul Medeniyet University, Göztepe Training and Research Hospital, Istanbul, Turkey
| | - Sertaç Arslanoğlu
- Division of Neonatology, Department of Paediatrics, Istanbul Medeniyet University, Göztepe Training and Research Hospital, Istanbul, Turkey
| | - Fahri Ovalı
- Division of Neonatology, Department of Paediatrics, Istanbul Medeniyet University, Göztepe Training and Research Hospital, Istanbul, Turkey
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Girma B, Nigussie J. Magnitude of preterm hospital neonatal mortality and associated factors in northern Ethiopia: a cross-sectional study. BMJ Open 2021; 11:e051161. [PMID: 34862286 PMCID: PMC8647539 DOI: 10.1136/bmjopen-2021-051161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE This study aimed to assess the magnitude of preterm neonatal mortality in hospitals and associated factors in northern Ethiopia. DESIGN Institutional-based cross-sectional study. SETTING Comprehensive specialised hospitals in the Tigray region, northern Ethiopia. PARTICIPANTS Preterm neonates admitted in Ayder and Aksum comprehensive specialised hospitals PRIMARY OUTCOME: Magnitude of preterm neonatal mortality. SECONDARY OUTCOME Factors associated with preterm neonatal mortality RESULT: This study was conducted from 1 April 2019 to 15 May 2019 among 336 participants with a response rate of 96.8%. The magnitude of preterm neonatal mortality was 28.6% (95% CI: 24.0 to 33.7). In multivariable logistic regression, respiratory distress syndrome (adjusted odd ratio (AOR)=2.85; 95% CI: 1.35 to 6.00), apnoea of prematurity (AOR=5.45; 95% CI: 1.32 to 22.5), nulli parity (AOR=3.63; 95% CI: 1.59 to 8.24) and grand parity (AOR=3.21; 95% CI: 1.04 to 9.94) were significant factors associated with preterm neonatal mortality. However, receiving Kangaroo mother care (AOR=0.08; 95% CI: 0.03 to 0.20) and feeding initiated during hospitalisation (AOR=0.07; 95% CI: 0.03 to 0.15) were protective against preterm neonatal mortality. CONCLUSIONS The magnitude of preterm neonatal mortality in hospitals was still high. Interventions geared towards curbing preterm in-hospital neonatal mortality should strengthen early diagnosis and treatment of preterm newborns with respiratory distress syndrome and apnoea of prematurity; while concomitantly reinforcing the implementation of kangaroo care and early feeding initiation is important.
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Affiliation(s)
- Bekahegn Girma
- Department of Nursing, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Jemberu Nigussie
- Department of Nursing, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
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Desta M, Getaneh T, Memiah P, Akalu TY, Shiferaw WS, Yimer NB, Asmare B, Black KI. Is preterm birth associated with intimate partner violence and maternal malnutrition during pregnancy in Ethiopia? A systematic review and meta analysis. Heliyon 2021; 7:e08103. [PMID: 34926844 PMCID: PMC8648551 DOI: 10.1016/j.heliyon.2021.e08103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/08/2021] [Accepted: 09/28/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Despite remarkable progress in the reduction of under-five mortality, preterm birth associated mortality and morbidity remains a major public health problem in Sub-saharan Africa. In Ethiopia, study findings on the association of preterm birth with intimate partner violence and maternal malnutrition have been inconsistent. Therefore, this systematic review and meta-analysis estimates the pooled effect of intimate partner violence and maternal malnutrition on preterm birth. METHODS International databases including PubMed, Web of Science, SCOPUS, CINAHL, PsycINFO, Google Scholar, Science Direct, and the Cochrane Library, were systematically searched. All identified observational studies and/or predictors were included. I2 statistics and Egger's test were used to assess the heterogeneity and publication biases of the studies. A random-effects model was computed to estimate the prevalence and its determinants of preterm birth. RESULTS The random effects meta-analysis showed that a pooled national prevalence of preterm birth was 13% (95% CI: 10.0%, 16.0%). The highest prevalence of preterm birth was 25% (95% CI: 21.0%, 30.0%) in Harar, and the lowest prevalence was 8% in Southern Nations Nationalities People of Representatives. The meta-analysis suggested a decrease in preterm birth of up to 61% among women receiving antenatal care [POR = 0.39 (95% CI: 0.21, 0.72)]. Women who experienced intimate partner violence [POR = 2.52 (95% CI: 1.68, 3.78)], malnutrition during pregnancy [POR = 2.00 (95% CI: 1.16, 3.46)], and previous preterm birth [POR = 3.73 (95% CI: 2.37, 5.88)] had significantly higher odds of preterm birth. CONCLUSION One in every eight live births in Ethiopia were preterm. Women who experienced intimate partner violence, malnutrition, and had previous preterm exposure were significantly associated with preterm birth. Thus, improving antenatal care visits and screening women who experience previous preterm birth are key interventions. The Federal Ministry of Health could be instrumental in preventing intimate partner violence and improving the nutritional status of pregnant women through proper and widespread implementation of programs to reduce preterm birth.
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Affiliation(s)
- Melaku Desta
- Department of Midwifery, College of Health Sciences, Debre Markos University, Ethiopia
| | - Temesgen Getaneh
- Department of Midwifery, College of Health Sciences, Debre Markos University, Ethiopia
| | - Peter Memiah
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland, School of Medicine, Baltimore, Maryland, USA
| | - Tadesse Yirga Akalu
- Department of Nursing, College of Health Sciences, Debre Markos University, Ethiopia
| | | | - Nigus Bililign Yimer
- Department of Midwifery, College of Health Sciences, Woldia University, Ethiopia
| | - Biachew Asmare
- Department of Human Nutrition and Food Science, College of Health Sciences, Debre Markos University, Ethiopia
| | - Kirsten I. Black
- Professor, Speciality Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health The University of Sydney, Australia
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Gupta J, Care A, Goodfellow L, Alfirevic Z, Lian LY, Müller-Myhsok B, Alfirevic A, Phelan M. Metabolic profiling of maternal serum of women at high-risk of spontaneous preterm birth using NMR and MGWAS approach. Biosci Rep 2021; 41:BSR20210759. [PMID: 34402867 PMCID: PMC8415214 DOI: 10.1042/bsr20210759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/28/2021] [Accepted: 08/17/2021] [Indexed: 12/26/2022] Open
Abstract
Preterm birth (PTB) is a leading global cause of infant mortality. Risk factors include genetics, lifestyle choices and infection. Understanding the mechanism of PTB could aid the development of novel approaches to prevent PTB. This study aimed to investigate the metabolic biomarkers of PTB in early pregnancy and the association of significant metabolites with participant genotypes. Maternal sera collected at 16 and 20 weeks of gestation, from women who previously experienced PTB (high-risk) and women who did not (low-risk controls), were analysed using 1H nuclear magnetic resonance (NMR) metabolomics and genome-wide screening microarray. ANOVA and probabilistic neural network (PNN) modelling were performed on the spectral bins. Metabolomics genome-wide association (MGWAS) of the spectral bins and genotype data from the same participants was applied to determine potential metabolite-gene pathways. Phenylalanine, acetate and lactate metabolite differences between PTB cases and controls were obtained by ANOVA and PNN showed strong prediction at week 20 (AUC = 0.89). MGWAS identified several metabolite bins with strong genetic associations. Cis-eQTL analysis highlighted TRAF1 (involved in the inflammatory pathway) local to a non-coding SNP associated with lactate at week 20 of gestation. MGWAS of a well-defined cohort of participants highlighted a lactate-TRAF1 relationship that could potentially contribute to PTB.
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Affiliation(s)
- Juhi K. Gupta
- Wolfson Centre for Personalised Medicine, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, L69 3GL, UK
- Harris-Wellbeing Research Centre, University Department, Liverpool Women’s Hospital, Liverpool, L8 7SS, UK
| | - Angharad Care
- Harris-Wellbeing Research Centre, University Department, Liverpool Women’s Hospital, Liverpool, L8 7SS, UK
| | - Laura Goodfellow
- Harris-Wellbeing Research Centre, University Department, Liverpool Women’s Hospital, Liverpool, L8 7SS, UK
| | - Zarko Alfirevic
- Harris-Wellbeing Research Centre, University Department, Liverpool Women’s Hospital, Liverpool, L8 7SS, UK
| | - Lu-Yun Lian
- NMR Centre for Structural Biology, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, L69 7ZB, UK
| | - Bertram Müller-Myhsok
- Wolfson Centre for Personalised Medicine, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, L69 3GL, UK
- Max Planck Institute of Psychiatry, Munich 80804, Germany
| | - Ana Alfirevic
- Wolfson Centre for Personalised Medicine, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, L69 3GL, UK
- Harris-Wellbeing Research Centre, University Department, Liverpool Women’s Hospital, Liverpool, L8 7SS, UK
| | - Marie M. Phelan
- NMR Centre for Structural Biology, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, L69 7ZB, UK
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Khalifa YEA, Aboulghar MM, Hamed ST, Tomerak RH, Asfour AM, Kamal EF. Prenatal prediction of respiratory distress syndrome by multimodality approach using 3D lung ultrasound, lung-to-liver intensity ratio tissue histogram and pulmonary artery Doppler assessment of fetal lung maturity. Br J Radiol 2021; 94:20210577. [PMID: 34538070 DOI: 10.1259/bjr.20210577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Studying the correlation of different lung parameters, using three-dimensional ultrasound (3D US) with fetal lung maturity (FLM) to predict the development of neonatal respiratory distress syndrome (RDS). METHODS Three-dimensional ultrasound was done to record the fetal lung volume (FLV), fetal lung-to-liver intensity ratio (FLLIR) and the main pulmonary artery (MPA) blood flow parameters; pulsatility index (PI), resistive index (RI) and acceleration time-to-ejection time ratio (At/Et), to 218 women between 32 and 40 weeks gestational age within 24 h from labor. RESULTS Of 218 fetuses examined, final analysis was done for 143 fetuses. Thirty eight (26.5%) were diagnosed with RDS. The MPA PI and RI were significantly higher in fetuses diagnosed with RDS compared with those without (2.51 ± 0.33 and 0.90 ± 0.03 cm/s versus 1.96 ± 0.20 and 0.84 ± 0.01 cm/s; p value < 0.001 and <0.001 respectively). MPA At/Et was significantly lower (0.24 ± 0.04 vs 0.35 ± 0.04; p value < 0.001). FLLIR was significantly lower (1.04 ± 0.07 vs 1.18 ± 0.11; p value < 0.001), and the mean FLV was significantly smaller (28.23 ± 5.63, vs 38.87 ± 4.68 cm3; p value < 0.001). CONCLUSION Main pulmonary artery (PI, RI, At/Et ratio), FLIIR, and mean FLV can be used as reliable predictors of neonatal RDS. ADVANCES IN KNOWLEDGE 3D ultrasound VOCAL technique, ultrasound tissue histogram and pulmonary artery Doppler are reliable tools for prenatal prediction of fetal lung maturity.
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Affiliation(s)
| | | | - Soha T Hamed
- Radiology department, Women imaging unit, Cairo University, Cairo, Egypt
| | | | - Ahmed M Asfour
- Cardiovascular Medicine department, Cairo University, Cairo, Egypt
| | - Eman F Kamal
- Radiology department, Women imaging unit, Cairo University, Cairo, Egypt
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Care AG, Gupta JK, Goodfellow L, Zhang G, Monangi N, Belling E, Landero J, Chappell J, Sharp A, Alfirevic A, Müller-Myhsok B, Muglia LJ, Alfirevic Z. Maternal selenium levels and whole genome screen in recurrent spontaneous preterm birth population: A nested case control study. Eur J Obstet Gynecol Reprod Biol 2021; 265:203-211. [PMID: 34534736 DOI: 10.1016/j.ejogrb.2021.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To establish if low maternal selenium (Se) was associated with sPTB in women with recurrent sPTB and identify genetic link with maternal Se levels. DESIGN Nested case-control study. SETTING Tertiary Maternity Hospital. POPULATION Plasma and whole blood from pregnant women with history of early sPTB/PPROM < 34+0 and European ancestry were obtained at 20 weeks (range 15-24 weeks). 'Cases' were recurrent PTB/PPROM < 34+0 weeks and term (≥37+0) deliveries were classified as 'high-risk controls.' Women with previous term births and index birth ≥ 39 weeks were 'low-risk controls'. METHODS Maternal plasma Se measured by ICP-MS was used as a continuous phenotype in a GWAS analysis. Se was added to a logistic regression model using PTB predictor variables. MAIN OUTCOME MEASURES Maternal Se concentration, recurrent early sPTB/PPROM. RESULTS 53/177 high-risk women had a recurrent sPTB/PPROM < 34+0weeks and were 2.7 times more likely to have a Se level < 83.3 ppm at 20weeks of pregnancy compared with low-risk term controls (n = 179), (RR 2.7, 95%CI 1.5-4.8; p = .001). One SNP from a non-coding region (FOXN3 intron variant, rs55793422) reached genome-wide significance level (p = 3.73E-08). Targeted analysis of Se gene variant did not show difference between preterm and term births. (χ2 test, OR = 0.95; 95%CI = 0.59-1.56; p = 0.82). When Se levels were added to a clinical prediction model, only an additional 5% of cases (n = 3) and 0.6% (n = 1) of controls were correctly identified. CONCLUSIONS Low plasma Se is associated with sPTB risk but is not sufficiently predictive at individual patient level. We did not find a genetic association between maternal Se levels and Se-related genes.
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Affiliation(s)
- Angharad G Care
- Harris Wellbeing Preterm Birth Research Centre, Department of Women's and Children's Health, University of Liverpool, Liverpool Women's Hospital, Liverpool, United Kingdom.
| | - Juhi K Gupta
- Harris Wellbeing Preterm Birth Research Centre, Department of Women's and Children's Health, University of Liverpool, Liverpool Women's Hospital, Liverpool, United Kingdom; Wolfson Centre for Personalised Medicine, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - Laura Goodfellow
- Harris Wellbeing Preterm Birth Research Centre, Department of Women's and Children's Health, University of Liverpool, Liverpool Women's Hospital, Liverpool, United Kingdom
| | - Ge Zhang
- Division of Human Genetics, Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics and University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Nagendra Monangi
- Division of Human Genetics, Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics and University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Elizabeth Belling
- Division of Human Genetics, Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics and University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Julio Landero
- Department of Chemistry, University of Cincinnati, Cincinnati, OH, United States
| | - Joanne Chappell
- Division of Human Genetics, Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics and University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Andrew Sharp
- Harris Wellbeing Preterm Birth Research Centre, Department of Women's and Children's Health, University of Liverpool, Liverpool Women's Hospital, Liverpool, United Kingdom
| | - Ana Alfirevic
- Harris Wellbeing Preterm Birth Research Centre, Department of Women's and Children's Health, University of Liverpool, Liverpool Women's Hospital, Liverpool, United Kingdom; Wolfson Centre for Personalised Medicine, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - Bertram Müller-Myhsok
- Waterhouse Building, University of Liverpool, Liverpool, United Kingdom; Max Plank Institute of Psychiatry, Munich, Germany
| | - Louis J Muglia
- Division of Human Genetics, Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics and University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Zarko Alfirevic
- Harris Wellbeing Preterm Birth Research Centre, Department of Women's and Children's Health, University of Liverpool, Liverpool Women's Hospital, Liverpool, United Kingdom
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Two-port, exteriorized uterus, fetoscopic meningomyelocele closure has fewer adverse neonatal outcomes than open hysterotomy closure. Am J Obstet Gynecol 2021; 225:327.e1-327.e9. [PMID: 33957114 DOI: 10.1016/j.ajog.2021.04.252] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/23/2021] [Accepted: 04/28/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND In utero closure of meningomyelocele using an open hysterotomy approach is associated with preterm delivery and adverse neonatal outcomes. OBJECTIVE This study compared the neonatal outcomes in in utero meningomyelocele closure using a 2-port, exteriorized uterus, fetoscopic approach vs the conventional open hysterotomy approach. STUDY DESIGN This retrospective cohort study included all consecutive patients who underwent in utero meningomyelocele closure using open hysterotomy (n=44) or a 2-port, exteriorized uterus, fetoscopic approach (n=46) at a single institution between 2012 and 2020. The 2-port, exteriorized uterus, fetoscopic closure was composed of the following 3 layers: a bovine collagen patch, a myofascial layer, and a skin. The frequency of respiratory distress syndrome and a composite of other adverse neonatal outcomes, including retinopathy of prematurity, periventricular leukomalacia, and perinatal death, were compared between the study groups. Regression analyses were performed to determine any association between the fetoscopic closure and adverse neonatal outcomes, adjusted for several confounders, including gestational age of <37 weeks at delivery. RESULTS The fetoscopic closure was associated with a lower rate of respiratory distress syndrome than the open hysterotomy closure (11.5% [5 of 45] vs 29.5% [13 of 44]; P=.037). The proportion of neonates with a composite of other adverse neonatal outcomes in the fetoscopic group was half of that observed patients in the open hysterotomy group; however, this difference did not reach statistical significance (4.3% [2 of 46] vs 9.1% [4 of 44]; P=.429). Here, regression analysis has demonstrated that fetoscopic meningomyelocele closure was associated with a lower risk of respiratory distress syndrome (adjusted odds ratio, 0.23; 95% confidence interval, 0.06-0.84; P=.026) than open hysterotomy closure. CONCLUSION In utero meningomyelocele closure using a 2-port, exteriorized uterus, fetoscopic approach was associated with a lower risk of respiratory distress syndrome than the conventional open hysterotomy meningomyelocele closure.
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Van Winsen KD, Savvidou MD, Steer PJ. The effect of mode of delivery and duration of labour on subsequent pregnancy outcomes: a retrospective cohort study. BJOG 2021; 128:2132-2139. [PMID: 34396678 DOI: 10.1111/1471-0528.16864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess whether delivery mode and duration of labour in a first labour of spontaneous onset is associated with gestational length, delivery mode and neonatal outcome in the subsequent pregnancy. STUDY DESIGN Retrospective analysis of prospectively collected data. SETTING 15 Maternity units in North West London (1988-2000). POPULATION 30 840 women with spontaneous onset of labour in pregnancy 1 and a subsequent birth reported in the same database. METHODS Assessment of outcomes by mode of delivery in pregnancy 1, restricting the analysis to the difference in the gestational length between pregnancy 1 and 2. MAIN OUTCOME MEASURES Gestational length, mode of delivery and neonatal unit admission in pregnancy 2. RESULTS Caesarean section (CS) in the first or second stage of labour in pregnancy 1 was associated with pregnancy 2 being a median of 5 and 8 days shorter and a preterm birth rate of 6.0% and 10.1%, respectively, whereas following a normal or instrumental vaginal birth in pregnancy 1, the median duration was similar, with preterm delivery rates of 4.5% and 3.9%. In all, 56.2% of women with a CS in pregnancy 1 had a repeat CS and 12.5% of their babies were admitted to a neonatal unit, compared with 5.3% of women with vaginal birth. Longer labours were associated with shorter gestations in pregnancy 2. CONCLUSIONS Compared with vaginal birth, an emergency CS in the first-term pregnancy is associated with a shorter gestational length, increased rate of repeat CS and increased risk of NNU admission in the next pregnancy. TWEETABLE ABSTRACT An emergency caesarean section in the first-term pregnancy affects the duration and outcome of the next pregnancy.
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Affiliation(s)
- K D Van Winsen
- Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, UK
| | - M D Savvidou
- Academic Department of Obstetrics and Gynaecology, Department of Metabolism, Digestion and Reproduction, Imperial College London, Chelsea & Westminster Hospital, London, UK.,Fetal Medicine Unit, Chelsea & Westminster Hospital, London, UK
| | - P J Steer
- Academic Department of Obstetrics and Gynaecology, Department of Metabolism, Digestion and Reproduction, Imperial College London, Chelsea & Westminster Hospital, London, UK
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Gulersen M, Gyamfi-Bannerman C, Greenman M, Lenchner E, Rochelson B, Bornstein E. Practice patterns in the administration of late preterm antenatal corticosteroids. AJOG GLOBAL REPORTS 2021; 1:100014. [PMID: 36277253 PMCID: PMC9563817 DOI: 10.1016/j.xagr.2021.100014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Given the unpredictable nature of preterm birth and the short-term impact of antenatal corticosteroids on neonatal outcomes, optimal timing of antenatal corticosteroid administration (2–7 days from expected birth) remains challenging. OBJECTIVE We set out to evaluate the likelihood of delivery between 2 and 7 days after antenatal corticosteroid administration in the late preterm period and whether this differs based on the indication for corticosteroid administration. STUDY DESIGN Retrospective cohort of all singletons that received antenatal corticosteroids in the late preterm period (34 0/7 to 36 6/7 weeks’ gestation) and delivered within a large health system between November 2017 and March 2020. Women who received antenatal corticosteroids before the late preterm period, major fetal structural malformations, and cases with missing data were excluded. Cases were stratified on the basis of the indication for antenatal corticosteroid administration, that is, anticipated spontaneous late preterm birth or medically indicated late preterm birth. The primary outcome was delivery between 2 and 7 days after the administration of the first dose of antenatal corticosteroids. Secondary outcomes included time interval from antenatal corticosteroid administration to delivery and delivery during the first 2 days or later than 7 days after antenatal corticosteroid administration. Multivariable logistic regression was performed to evaluate factors associated with optimal timing while adjusting for potential confounders. RESULTS Of the 1238 patients included in the study, 656 (53%) delivered within the first day after antenatal corticosteroid administration and thus received only the first of 2 doses. Regardless of the indication for late preterm antenatal corticosteroid administration, the likelihood of delivery between 2 and 7 days later was 13.3% (165 of 1238). Moreover, it was more common (23.4% vs 5.0%; P≤.001) (Table 2) and more likely (adjusted odds ratio, 5.88; 95% confidence interval, 4.00–9.09) in women at risk of medically indicated preterm birth than in those with anticipated spontaneous preterm birth. Furthermore, women with anticipated spontaneous preterm birth had a shorter time interval from antenatal corticosteroid administration to delivery (10.7 vs 49.71 hour; P≤.001). CONCLUSION Regardless of the indication for late preterm antenatal corticosteroid administration, the likelihood of delivery between 2 and 7 days later was low. Nevertheless, our data suggested that delivery within the desired time interval of antenatal corticosteroid administration is more common in women at risk of medically indicated late preterm birth compared with those at risk of spontaneous late preterm birth.
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Gulersen M, Bornstein E, Domney A, Blitz MJ, Rafael TJ, Li X, Krantz D, Rochelson B. Cerclage in singleton gestations with an extremely short cervix (≤10 mm) and no history of spontaneous preterm birth. Am J Obstet Gynecol MFM 2021; 3:100430. [PMID: 34271252 DOI: 10.1016/j.ajogmf.2021.100430] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/20/2021] [Accepted: 06/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Data regarding the efficacy of a cervical cerclage for preterm birth prevention in patients with a short cervix and no history of spontaneous preterm birth are limited and inconclusive. OBJECTIVE This study aimed to determine whether cervical cerclage is associated with an increased time interval to delivery in asymptomatic patients with singleton pregnancies with an extremely short cervical length (≤10 mm) and no history of spontaneous preterm birth. STUDY DESIGN This was a multicenter retrospective cohort study of asymptomatic patients with singleton pregnancies with a cervical length of ≤10 mm between 16 and 23 weeks' gestation from January 2014 to December 2019. Patients with previous spontaneous preterm birth, symptoms of preterm labor, cervical dilation of >1 cm, pessary, major fetal structural malformations, or missing data were excluded from the study. The primary outcome of time interval from diagnosis to delivery was compared between those who had a cervical cerclage after diagnosis and those who did not. The secondary outcomes included gestational age at delivery and adverse neonatal outcomes. Moreover, a subgroup analysis of all outcomes in patients already being treated with vaginal progesterone in each group was performed. Statistical analysis included chi-square and Wilcoxon rank-sum tests and a multivariate Cox proportional hazard regression for time interval to delivery. RESULTS Of the 90 patients included in the study, 52 (57.8%) had cervical cerclage, of which 35 (67.3%) were already being treated with progesterone. Moreover, 38 patients (42.2%) did not have cervical cerclage, of which 21 (55.3%) were already being treated with progesterone. Patients in the cervical cerclage group had an earlier gestational age (21.0 vs 22.0 weeks' gestation; P≤.001) and shorter cervical length (5 vs 7 mm; P=.002) at the diagnosis of a short cervix (cervical length≤10 mm) than those who did not have a cerclage. Cervical cerclage was associated with a longer time interval to delivery (17.0 vs 15.0 weeks; P=.02) and lower hazard of earlier delivery after diagnosis (adjusted hazard ratio, 0.61; 95% confidence interval, 0.38-0.99; P=.04) than no cerclage, after accounting for gestational age and cervical length at diagnosis. In patients already treated with progesterone, cervical cerclage was also associated with a longer time interval to delivery (17.0 vs 13.1 weeks; P=.01) and a lower hazard of earlier delivery after diagnosis (adjusted hazard ratio, 0.49; 95% confidence interval, 0.27-0.87; P=.02) compared to those with no cerclage. Late preterm birth was less common in patients with a cervical cerclage compared with those with no cervical cerclage (11.5% vs 31.6%; P=.03). CONCLUSION Cervical cerclage should be considered in asymptomatic patients with an extremely short cervical length (≤10 mm) and no history of spontaneous preterm birth.
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Affiliation(s)
- Moti Gulersen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY (Drs Gulersen, Domney, Rafael, and Rochelson).
| | - Eran Bornstein
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY (Dr Bornstein)
| | - Alixandra Domney
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY (Drs Gulersen, Domney, Rafael, and Rochelson)
| | - Matthew J Blitz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, South Shore University Hospital, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Bay Shore, NY (Dr Blitz)
| | - Timothy J Rafael
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY (Drs Gulersen, Domney, Rafael, and Rochelson)
| | - Xueying Li
- Eurofins NTD, Melville, NY (Ms Li and Mr Krantz)
| | - David Krantz
- Eurofins NTD, Melville, NY (Ms Li and Mr Krantz)
| | - Burton Rochelson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY (Drs Gulersen, Domney, Rafael, and Rochelson)
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O'Connor KM, Ashoori M, Dias ML, Dempsey EM, O'Halloran KD, McDonald FB. Influence of innate immune activation on endocrine and metabolic pathways in infancy. Am J Physiol Endocrinol Metab 2021; 321:E24-E46. [PMID: 33900849 DOI: 10.1152/ajpendo.00542.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Prematurity is the leading cause of neonatal morbidity and mortality worldwide. Premature infants often require extended hospital stays, with increased risk of developing infection compared with term infants. A picture is emerging of wide-ranging deleterious consequences resulting from innate immune system activation in the newborn infant. Those who survive infection have been exposed to a stimulus that can impose long-lasting alterations into later life. In this review, we discuss sepsis-driven alterations in integrated neuroendocrine and metabolic pathways and highlight current knowledge gaps in respect of neonatal sepsis. We review established biomarkers for sepsis and extend the discussion to examine emerging findings from human and animal models of neonatal sepsis that propose novel biomarkers for early identification of sepsis. Future research in this area is required to establish a greater understanding of the distinct neonatal signature of early and late-stage infection, to improve diagnosis, curtail inappropriate antibiotic use, and promote precision medicine through a biomarker-guided empirical and adjunctive treatment approach for neonatal sepsis. There is an unmet clinical need to decrease sepsis-induced morbidity in neonates, to limit and prevent adverse consequences in later life and decrease mortality.
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Affiliation(s)
- K M O'Connor
- Department of Physiology, School of Medicine, College of Medicine and Health, University College Cork, Cork, Ireland
| | - M Ashoori
- Department of Physiology, School of Medicine, College of Medicine and Health, University College Cork, Cork, Ireland
- Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland
| | - M L Dias
- Department of Physiology, School of Medicine, College of Medicine and Health, University College Cork, Cork, Ireland
| | - E M Dempsey
- Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, School of Medicine, College of Medicine and Health, Cork University Hospital, Wilton, Cork, Ireland
| | - K D O'Halloran
- Department of Physiology, School of Medicine, College of Medicine and Health, University College Cork, Cork, Ireland
- Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland
| | - F B McDonald
- Department of Physiology, School of Medicine, College of Medicine and Health, University College Cork, Cork, Ireland
- Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland
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Ward C, Caughey AB. Late preterm births: neonatal mortality and morbidity in twins vs. singletons. J Matern Fetal Neonatal Med 2021; 35:7962-7967. [PMID: 34154507 DOI: 10.1080/14767058.2021.1939303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the outcomes of twins and singletons in the late preterm period. MATERIALS AND METHODS This is a retrospective cohort study of data obtained for 165,894 births in California who delivered between 34 + 0 and 36 + 6 weeks. The primary outcome was neonatal and infant mortality. The secondary outcomes included the following neonatal morbidities: respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), seizure, and sepsis. Univariate analysis was performed using chi-square test and multivariable logistic regression was used to adjust for potential confounders. RESULTS There were 143,891 singleton and 22,003 twin gestations included in the study. There was no difference in the primary outcome, neonatal and infant mortality between twins and singletons delivered at 34 and 36 weeks. After controlling for multiple potential confounders, significant differences in secondary outcomes of neonatal morbidity were identified. At 34 weeks, twins had significantly higher rates of IVH (aOR 2.47 (95%CI 1.08-5.64)), NEC (aOR 2.46 (95%CI 1.42-4.29)), RDS (aOR 1.60 (95%CI 1.45-1.77)), and sepsis (aOR 1.19 (95%CI 1.05-1.34)) compared to singletons. By 36 weeks, only an increased risk of RDS persisted among twins. CONCLUSIONS While there was no difference in mortality among twins and singletons in the late preterm period, twins may have significantly increased neonatal morbidity compared to singletons delivered between 34 + 0 and 36 + 6 weeks.
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Affiliation(s)
- Clara Ward
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of Texas Health Science Center, Houston, TX, USA
| | - Aaron B Caughey
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Oregon Health and Science University, Portland, OR, USA
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Gulersen M, Gyamfi-Bannerman C, Greenman M, Lenchner E, Rochelson B, Bornstein E. Time interval from late preterm antenatal corticosteroid administration to delivery and the impact on neonatal outcomes. Am J Obstet Gynecol MFM 2021; 3:100426. [PMID: 34153514 DOI: 10.1016/j.ajogmf.2021.100426] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/30/2021] [Accepted: 06/15/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although administration of antenatal corticosteroids has been shown to decrease neonatal respiratory morbidity when given to women at risk for late preterm birth, the time interval from antenatal corticosteroid administration to delivery that is associated with the greatest neonatal benefit remains unknown. OBJECTIVE This study aimed to evaluate whether the time interval from administration of late preterm antenatal corticosteroids to delivery is associated with a change in the likelihood of transient tachypnea of the newborn, respiratory distress syndrome, and hypoglycemia. STUDY DESIGN This was a retrospective cohort study of all singleton neonates who were exposed to 1 or 2 doses of antenatal corticosteroids in the late preterm period (34+0 to 36+6 weeks' gestation) within a large healthcare system between November 2017 and March 2020. Neonates exposed to antenatal corticosteroids before 34 weeks' gestation and those with major fetal structural malformations and chromosomal disorders were excluded. Cases were stratified into the following groups based on the time interval from the first dose of antenatal corticosteroid administration to delivery: <2 days, 2 to 7 days, and >7 days. The primary outcome of transient tachypnea of the newborn was compared among the 3 groups. Secondary outcomes included respiratory distress syndrome and hypoglycemia. A multivariable logistic regression was performed to evaluate the association between the time interval and neonatal outcomes while adjusting for potential confounders. For each outcome, delivery within 2 to 7 days from the first dose of betamethasone administration was defined as the reference group. Data were presented as adjusted odds ratios with 95% confidence intervals, and statistical significance was defined as P < .05. RESULTS The study cohort comprised 1248 neonates. Of those, 649 (52%) were exposed to 1 dose of antenatal corticosteroids. There were statistically significant differences in the maternal characteristics such as nulliparity, pregnancies complicated by hypertensive disorders and fetal growth restriction, gestational age at antenatal corticosteroid administration, gestational age at delivery, and mode of delivery among the 3 groups. There was a significantly increased risk for transient tachypnea of the newborn (adjusted odds ratio, 4.81; 95% confidence interval, 1.72-12.92) and respiratory distress syndrome (adjusted odds ratio, 9.86; 95% confidence interval, 1.15-84.24) associated with delivery <2 days of antenatal corticosteroid administration. The risk for hypoglycemia was highest in the delivery <2 days group (adjusted odds ratio, 3.44; 95% confidence interval, 2.10-5.63) and decreased as the time interval from antenatal corticosteroid administration to delivery increased (adjusted odds ratio, 0.32; 95% confidence interval, 0.20-0.51 for delivery >7 days). CONCLUSION Adverse neonatal outcomes such as transient tachypnea of the newborn, respiratory distress syndrome, and hypoglycemia are more common when late preterm birth occurs <2 days after antenatal corticosteroid administration when compared with birth 2 to 7 days after administration. In addition, delivery >7 days after antenatal corticosteroid administration is associated with a decreased risk for hypoglycemia. Understanding the impact of antenatal corticosteroid timing on neonatal outcomes is essential in caring for patients at risk for late preterm birth.
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Affiliation(s)
- Moti Gulersen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY (Drs Gulersen, Greenman, and Rochelson); Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA (Dr Gyamfi-Bannerman); Biostatistics and Data Management, New York University Rory Meyers College of Nursing, New York, NY (Dr Lenchner); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, NY (Dr Bornstein).
| | - Cynthia Gyamfi-Bannerman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY (Drs Gulersen, Greenman, and Rochelson); Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA (Dr Gyamfi-Bannerman); Biostatistics and Data Management, New York University Rory Meyers College of Nursing, New York, NY (Dr Lenchner); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, NY (Dr Bornstein)
| | - Michelle Greenman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY (Drs Gulersen, Greenman, and Rochelson); Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA (Dr Gyamfi-Bannerman); Biostatistics and Data Management, New York University Rory Meyers College of Nursing, New York, NY (Dr Lenchner); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, NY (Dr Bornstein)
| | - Erez Lenchner
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY (Drs Gulersen, Greenman, and Rochelson); Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA (Dr Gyamfi-Bannerman); Biostatistics and Data Management, New York University Rory Meyers College of Nursing, New York, NY (Dr Lenchner); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, NY (Dr Bornstein)
| | - Burton Rochelson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY (Drs Gulersen, Greenman, and Rochelson); Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA (Dr Gyamfi-Bannerman); Biostatistics and Data Management, New York University Rory Meyers College of Nursing, New York, NY (Dr Lenchner); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, NY (Dr Bornstein)
| | - Eran Bornstein
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY (Drs Gulersen, Greenman, and Rochelson); Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA (Dr Gyamfi-Bannerman); Biostatistics and Data Management, New York University Rory Meyers College of Nursing, New York, NY (Dr Lenchner); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, NY (Dr Bornstein)
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Mitha A, Chen R, Altman M, Johansson S, Stephansson O, Bolk J. Neonatal Morbidities in Infants Born Late Preterm at 35-36 Weeks of Gestation: A Swedish Nationwide Population-based Study. J Pediatr 2021; 233:43-50.e5. [PMID: 33662344 DOI: 10.1016/j.jpeds.2021.02.066] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/27/2021] [Accepted: 02/24/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess risk for neonatal morbidities among infants born late preterm at 35-36 gestational weeks, early term (37-38 weeks), and late-term (41 weeks) infants, compared with full-term (39-40 weeks) infants. STUDY DESIGN This nationwide population-based cohort study included 1 650 450 non-malformed liveborn singleton infants born at 35-41 weeks between 1998 and 2016 in Sweden. The relative risks for low Apgar score (0-3) at 5 minutes; respiratory, metabolic, infectious, and neurologic morbidities; and severe neonatal morbidity (composite outcome) were adjusted for maternal, pregnancy, delivery, and infant characteristics. RESULTS Compared with infants born at 39-40 weeks, the adjusted relative risks and proportions of infants born at 35-36 weeks were higher for metabolic morbidity 7.79 (95%, 7.61 to 7.97; 33.75% vs 3.11%), respiratory morbidity 5.54 (95% CI, 5.24 to 5.85; 5.49% vs 0.75%), severe neonatal morbidity 2.42 (95% CI, 2.27 to 2.59; 3.40% versus 1.03%), infectious morbidity 1.98 (95% CI, 1.83 to 2.14; 2.53% vs 0.95%), neurologic morbidity 1.74 (95% CI, 1.48 to 2.03; 0.54% vs 0.23%), and low Apgar score 2.07 (95% CI, 1.72 to 2.51; 0.42% vs 0.12%). The risks for respiratory, severe neonatal morbidity, infectious, neurologic morbidities, and low Apgar score were highest at 35 weeks, gradually decreased until 39 weeks, and increased during 39-41 weeks. CONCLUSIONS Infants born late preterm at 35-36 weeks of gestation are at increased risk of neonatal morbidities, although the absolute risks for severe neonatal morbidities are low. Our findings reinforce the need of preventing late preterm delivery to decrease the burden of neonatal morbidity and help professionals and families with a better risk assessment.
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Affiliation(s)
- Ayoub Mitha
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden; University Hospital Center Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France; University of de Paris, Epidemiology and Statistics Research Center/CRESS, French Institute of Health and Medical Research (U1153 - Obstetrical, Perinatal and Pediatric Epidemiology Research Team), National Institute for Agricultural Research, Hospital Tenon, Paris, France
| | - Ruoqing Chen
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
| | - Maria Altman
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Stefan Johansson
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden; Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Olof Stephansson
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Jenny Bolk
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden; Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
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