Fetal intracranial hemorrhage and maternal vitamin K deficiency induced by total parenteral nutrition: A case report

Can small bowel obstruction during pregnancy be treated with conservative management? A review

BACKGROUND

Small bowel obstruction can occur during pregnancy, which, if missed, can lead to dire consequences for both the mother and foetus. Management of this condition usually requires surgical intervention. However, only a small number of patients are treated conservatively.

OBJECTIVE

The objective was to review the literature to determine the feasibility of conservative management for small bowel obstruction.

METHODS

A systematic search of the PubMed and Embase databases was performed using the keywords [small bowel obstruction AND pregnancy]. All original articles were then reviewed and included in this review if deemed suitable.

CONCLUSION

Conservative management of small bowel obstruction in pregnant women is feasible if the patient is clinically stable and after ruling out bowel ischaemia and closed-loop obstruction.

[The prevalence and risk factors of intracranial non-traumatic hemorrhage in newborns]

OBJECTIVE

To assess the prevalence rate of intracranial hemorrhage in newborns and to detect the size of the relative risk for different characteristics of the background of intrauterine development according to the materials of the Republican Prenatal Center.

MATERIAL AND METHODS

The study was conducted on the basis of the Republican Prenatal Center of the Azerbaijan Republic. All newborns (996 children) (birth weight - 500 grams or more, gestational age - over 22 completed weeks) have been examined by a neuropathologist. If there were signs of any neurological abnormalities, an ultrasound examination of the brain was performed.

RESULTS

The prevalence rate of intracranial non-traumatic hemorrhage (INTH) among newborns was 15.66% (4.8% among full-term, 48.8% among premature). Depending on mother's age the prevalence rate of INTH changed from 12.7% (mother's age 20-24 years) to 23.0% (mother's age 35 years or more).

CONCLUSION

The risk of INTH statistically significantly increased with maternal age 35 years or more, with 4 or more births, with the birth of a fetus weighing up to 2500 and more than 4000 grams, with a gestational age of less than 37 weeks, with multiple pregnancies and with vaginal delivery.

Early oral feeding following intestinal anastomosis surgery in infants: a multicenter real world study

Background

To prevent postoperative complications, delayed oral feeding (DOF) remains a common model of care following pediatric intestinal anastomosis surgery; however, early oral feeding (EOF) has been shown to be safe and effective in reducing the incidence of complications and fast recovery after pediatric surgery. Unfortunately, the evidence in support of EOF after intestinal anastomosis (IA) in infants is insufficient. Therefore, this study was primarily designed to evaluate the safety and efficacy of EOF. In addition, the current status of EOF application and associated factors that favor or deter EOF implementation were also assessed.

Methods

A total of 898 infants were divided into two groups (EOF group, n = 182; DOF group, n = 716), and the clinical characteristics were collected to identify the factors associated with EOF in infants. Complications and recovery were also compared to define the safety and efficacy after balancing the baseline data by propensity score matching (PSM) (EOF group, n = 179; DOF group, n = 319).

Results

The total EOF rate in infants with IA was 20.3%. Multivariate logistic regression revealed significant differences in the EOF rates based on IA site and weight at the time of surgery (OR = 0.652, 95% CI: 0.542-0.784, p < 0.001) and (OR = 1.188, 95% CI: 1.036-1.362, p = 0.013), respectively. The duration of total parenteral nutrition (TPN), parenteral nutrition (PN), and postoperative hospital stay were significantly shorter in the EOF group than the DOF group [2.0 (1.0, 2.0) d vs. 5.0 (3.0, 6.0) d; 6.0 (5.0, 8.0) d vs. 8.0 (6.0, 11.0) d; 10.0 (7.0, 14.0) d vs. 12.0 (9.0, 15.0) d, all p < 0.001]. The rates of abdominal distension and vomiting in the EOF group were significantly higher than the DOF group (17.9% vs. 7.2%, p < 0.001; 7.8% vs. 2.5%, p = 0.006); however, no differences were found in failure to initial OF, diarrhea, hematochezia, and anastomotic leakage between the two groups (p > 0.05).

Conclusion

The overall rate of EOF in infants following IA was low, and the sites of anastomosis and weight at surgery were two factors associated with EOF. Nevertheless, performing EOF in infants after IA was safe and effective, reduced PN usage, shortened the hospital stay, and did not increase the rate of severe complications.Clinical Trial Registration: ClinicalTrails.gov, identifier NCT04464057.