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di Pasquo E, Fieni S, Chandraharan E, Dall'Asta A, Morganelli G, Spinelli M, Bettinelli ML, Aloe R, Russo A, Galli L, Perrone S, Ghi T. Correlation between intrapartum CTG findings and interleukin-6 levels in the umbilical cord arterial blood: A prospective cohort study. Eur J Obstet Gynecol Reprod Biol 2024; 294:128-134. [PMID: 38237311 DOI: 10.1016/j.ejogrb.2024.01.018] [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: 09/21/2023] [Revised: 12/28/2023] [Accepted: 01/12/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE to investigate the correlation between the intrapartum CardioTocoGraphic (CTG) findings "suggestive of fetal inflammation" ("SOFI") and the interleukin (IL)-6 level in the umbilical arterial blood. STUDY DESIGN prospective cohort study conducted at a tertiary maternity unit and including 447 neonates born at term. METHODS IL-6 levels were systematically measured at birth from a sample of blood taken from the umbilical artery. The intrapartum CTG traces were retrospectively reviewed by two experts who were blinded to the postnatal umbilical arterial IL-6 values as well as to the neonatal outcomes. The CTG traces were classified into "suggestive of fetal inflammation (SOFI)" and "no evidence of fetal inflammation (NEFI) according to the principles of physiologic interpretation the CTG traces. The CTG was classified as "SOFI" if there was a persistent fetal heart rate (FHR) increase > 10 % compared with the observed baseline FHR observed at the admission or at the onset of labor without any preceding repetitive decelerations. The occurrence of Composite Adverse Outcome (CAO) was defined as Neonatal Intensive Care Unit (NICU) or Special Care Baby Unit (SCBU) admission due to one or more of the following: metabolic acidaemia, Apgar score at 5 min ≤ 7, need of neonatal resuscitation, respiratory distress, tachypnoea/polypnea, jaundice requiring phototherapy, hypotension, body temperature instability, poor perinatal adaptation, suspected or confirmed early neonatal sepsis. MAIN OUTCOME MEASURES To compare the umbilical IL-6 values between the cases with intrapartum CTG traces classified as "SOFI" and those classified as "NEFI"; to assess the correlation of umbilical IL-6 values with the neonatal outcome. RESULTS 43 (9.6 %) CTG traces were categorized as "SOFI"; IL-6 levels were significantly higher in this group compared with the "NEFI" group (82.0[43.4-325.0] pg/ml vs. 14.5[6.8-32.6] pg/mL; p <.001). The mean FHR baseline assessed 1 h before delivery and the total labor length showed an independent and direct association with the IL-6 levels in the umbilical arterial blood (p <.001 and p = 0.005, respectively). CAO occurred in 33(7.4 %) cases; IL-6 yielded a good prediction of the occurrence of the CAO with an AUC of 0.72 (95 % CI 0.61-0.81). CONCLUSION Intrapartum CTG findings classified as "SOFI" are associated with higher levels of IL-6 in the umbilical arterial blood.
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Affiliation(s)
- Elvira di Pasquo
- Unit of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
| | - Stefania Fieni
- Unit of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
| | | | - Andrea Dall'Asta
- Unit of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy; Unit of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giovanni Morganelli
- Unit of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
| | - Marta Spinelli
- Unit of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Maria Laura Bettinelli
- Unit of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Rosalia Aloe
- Unit of Blood Chemistry Diagnostics, Diagnostic Department, University Hospital of Parma, Parma, Italy
| | - Annalisa Russo
- Unit of Blood Chemistry Diagnostics, Diagnostic Department, University Hospital of Parma, Parma, Italy
| | - Letizia Galli
- Unit of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
| | - Serafina Perrone
- Unit of Neonatology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Tullio Ghi
- Unit of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy; Unit of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Parma, Parma, Italy.
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A predictive model for prognosis in very low birth weight infants with late-onset sepsis. Pediatr Res 2023:10.1038/s41390-023-02480-x. [PMID: 36725910 DOI: 10.1038/s41390-023-02480-x] [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] [Received: 08/10/2022] [Revised: 12/28/2022] [Accepted: 01/04/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This study aims to develop a predictive model to assess the probability of poor prognosis in very low birth weight infants (VLBWI) with late-onset sepsis (LOS). METHODS A total of 309 eligible VLBWI with LOS were included in the study. Logistic regression was used to determine prognostic factors for VLBWI with LOS. A nomogram incorporating these factors was created to predict the probability of poor prognosis. Poor prognosis includes death and survival with severe complications. RESULTS In the developmental cohort, the incidence of poor prognosis was 59.5% (147/247). Forward stepwise logistic regression analysis showed that HCO3, albumin (ALB), ionized calcium (iCa), blood urea nitrogen (BUN), gestational age (GA), and birth weight (BW) were independent predictors of poor prognosis in VLBWI with LOS. The predictive model showed good discrimination and calibration. In the developmental cohort, the prediction model had a sensitivity of 83.7%, a specificity of 74.0%, and a C-index of 0.845 (95% confidence interval: 0.795-0.894). CONCLUSION Our study identified independent predictors of poor prognosis in VLBWI with LOS and used them to construct a predictive model. This model can help clinicians to identify high-risk groups with poor prognosis early and provide important clinical reference information. IMPACT This article highlights the development of a predictive model to assess the probability of poor prognosis in very low birth weight infants with late-onset sepsis (LOS). The model constructed in this manuscript was the first model to predict the poor prognosis of VLBWI with LOS. We mean a poor prognosis that includes death and some severe complications that may lead to long-term disability. Clinicians can use the model's scoring results to assess a patient's condition and accurately identify the occurrence of poor prognosis.
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Hasegawa J, Nakao M, Ikeda T, Toyokawa S, Jojima E, Satoh S, Ichizuka K, Tamiya N, Nakai A, Fujimori K, Maeda T, Takeda S, Suzuki H, Ueda S, Iwashita M, Ikenoue T. Fetal heart rate evolution patterns in cerebral palsy associated with umbilical cord complications: a nationwide study. BMC Pregnancy Childbirth 2022; 22:177. [PMID: 35241026 PMCID: PMC8896380 DOI: 10.1186/s12884-022-04508-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 02/21/2022] [Indexed: 11/22/2022] Open
Abstract
Background The aim of the present study was to clarify fetal heart rate (FHR) evolution patterns in infants with cerebral palsy (CP) according to different types of umbilical cord complications. Methods This case–control study included children born: with a birth weight ≥2000 g, at gestational age ≥33 weeks, with disability due to CP, and between 2009 and 2014. Obstetric characteristics and FHR patterns were compared among patients with CP associated with (126 cases) and without (594 controls) umbilical cord complications. Results There were 32 umbilical cord prolapse cases and 94 cases with coexistent antenatal umbilical cord complications. Compared with the control group, the persistent non-reassuring pattern was more frequent in cases with coexistent antenatal umbilical cord complications (p = 0.012). A reassuring FHR pattern was observed on admission, but resulted in prolonged deceleration, especially during the first stage of labor, and was significantly identified in 69% of cases with umbilical cord prolapse and 35% of cases with antenatal cord complications, compared to 17% of control cases (p < 0.001). Conclusion Hypercoiled cord and abnormal placental umbilical cord insertion, may be associated with CP due to acute hypoxic-ischemic injury as well as sub-acute or chronic adverse events during pregnancy, while umbilical cord prolapse may be characterized by acute hypoxic-ischemic injury during delivery. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04508-2.
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Affiliation(s)
- Junichi Hasegawa
- Visiting Researcher, Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan. .,Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
| | - Masahiro Nakao
- Visiting Researcher, Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Mie, Japan.,Department of Obstetrics and Gynecology, Sakakibara Heart Institute, Tokyo, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Mie, Japan.,The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan
| | - Satoshi Toyokawa
- Visiting Researcher, Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan.,Department of Public Health, The University of Tokyo, Tokyo, Japan
| | - Emi Jojima
- Department of the Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan
| | - Shoji Satoh
- The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan.,Maternal and Perinatal Care Center, Oita Prefectural Hospital, Oita, Japan
| | - Kiyotake Ichizuka
- The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan.,Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Nanako Tamiya
- The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Akihito Nakai
- The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan.,Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
| | - Keiya Fujimori
- The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima, Japan
| | - Tsugio Maeda
- The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan.,Maeda Clinic, Incorporated Association Anzu-kai, Shizuoka, Japan
| | - Satoru Takeda
- The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan.,Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hideaki Suzuki
- Department of the Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan
| | - Shigeru Ueda
- Department of the Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan
| | - Mitsutoshi Iwashita
- The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan.,Kugayama Hospital, Tokyo, Japan
| | - Tsuyomu Ikenoue
- The Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy, Tokyo, Japan.,Miyazaki University, Miyazaki, Japan
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Battin M, Sadler L. Neonatal encephalopathy: How can we improve clinical outcomes? J Paediatr Child Health 2018; 54:1180-1183. [PMID: 29873135 DOI: 10.1111/jpc.14081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 04/26/2018] [Accepted: 05/03/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Malcolm Battin
- Newborn Services, Auckland City Hospital, Auckland, New Zealand
| | - Lynn Sadler
- Newborn Services, Auckland City Hospital, Auckland, New Zealand
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Malmqvist O, Ohlin A, Ågren J, Jonsson M. Seizures in newborn infants without hypoxic ischemic encephalopathy - antenatal and labor-related risk factors: a case-control study. J Matern Fetal Neonatal Med 2018; 33:799-805. [PMID: 30373414 DOI: 10.1080/14767058.2018.1505853] [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: 10/28/2022]
Abstract
Objective: To identify antepartum and intrapartum risk factors for neonatal seizures in the absence of hypoxic ischemic encephalopathy (HIE).Methods: Population-based case-control study. Of 98 484 births, 40 newborns at 34 gestational weeks or later had seizures within the first 7 days of life. Cases (n = 40) and controls (n = 160) were retrieved from the University hospitals of Örebro for 1994-2013 and Uppsala for 2003-2013. Demographics and characteristics of pregnancy, labor, delivery, and neonatal data were analyzed. Crude odds ratio (OR) and adjusted odds ratios (AOR) with 95% confidence intervals (CIs) for antenatal and intrapartum factors were calculated using logistic regression analysis. Main outcome measure was neonatal seizures within the first 7 days of life.Results: The incidence of neonatal seizures without HIE was 0.41/1000 live births. Antenatal risk factors for neonatal seizures were as follows: short maternal stature (AOR: 5.4; 1.8-16.5); previous caesarean section (AOR: 4.8; 1.5-15.0); and assisted fertilization (AOR: 6.8; 1.3-35.2). Intrapartum risk factors were as follows: induction of labor (AOR: 5.7; 1.8-17.7); preterm birth (AOR: 13.5; 3.7-48.9); and head circumference >37 cm (AOR: 6.9; 1.4-34.8).Conclusions: Preterm birth was the strongest risk factor for neonatal seizures in the absence of HIE. The results also indicate that feto-pelvic disproportion is associated with the occurrence of seizures.Rationale: Antepartum and intrapartum risk factors for newborn seizures in the absence of HIE were investigated in a case-control study. Out of 98 484 births at 34 gestational weeks or more, 40 newborns had seizures without HIE. All had a normal Apgar score although they later presented with seizures. Preterm birth was the strongest risk factor (OR: 13.5; 95% CI: 3.7-48.9). Our results also indicate that feto-pelvic disproportion is of importance. Furthermore, a history of prior caesarean was associated with seizures. This is the first study to assess obstetric risk factors for newborn seizures separate from those with seizures and concomitant HIE. The distinction is of importance due to different etiologies, treatments, and preventive strategies.
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Affiliation(s)
- Olle Malmqvist
- Department of Pediatrics, Faculty of Medicine and Health, Örebro Universitet, Örebro, Sweden
| | - Andreas Ohlin
- Department of Pediatrics, Faculty of Medicine and Health, Örebro Universitet, Örebro, Sweden
| | - Johan Ågren
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Maria Jonsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Wretler S, Nordström L, Graner S, Holzmann M. Risk factors for intrapartum acidemia - a cohort study. J Matern Fetal Neonatal Med 2017; 31:3232-3237. [PMID: 28812454 DOI: 10.1080/14767058.2017.1368074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Birth acidemia is associated with short- and long-term morbidity in the child. Optimal intrapartum surveillance and timely interventions may reduce the incidence of these outcomes. Knowledge about conditions which increase the risks might be beneficial for optimal care. The aim with this study was to identify factors which increased the risk for lactacidemia in fetal scalp blood. MATERIALS AND METHODS A secondary analysis of a cohort study performed at Karolinska University Hospital Stockholm Sweden between February 2009 and February 2011. The study population included 1070 women in labor where fetal scalp blood sampling (FBS) was performed. RESULTS In a univariate logistic regression analysis for lactate >4.8 mmol/L at FBS, minor language barriers (OR 2.54; 95%CI 1.26-5.11), active bearing down (OR 2.46; 95%CI 1.12-5.39) and maternal height <155 cm (OR 2.15; 95%CI 1.08-4.26) were found as risk factors. In a multivariate logistic regression analysis, minor language barriers (OR 2.21; 95%CI 1.05-4.67) and active pushing (OR 2.68; 95%CI 1.20-6.00) remained significant. CONCLUSIONS Language barriers, active pushing and short stature were found to be significant risk factors for intrapartum lactacidemia. In the group with minor language problems better use of interpreters might be beneficial.
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Affiliation(s)
- Stina Wretler
- a Department of Women's and Children's Health , Karolinska Institutet , Stockholm , Sweden.,b Department of Obstetrics and Gynecology , Karolinska University Hospital , Stockholm , Sweden
| | - Lennart Nordström
- a Department of Women's and Children's Health , Karolinska Institutet , Stockholm , Sweden.,b Department of Obstetrics and Gynecology , Karolinska University Hospital , Stockholm , Sweden
| | - Sophie Graner
- c Centre for Pharmacoepidemiology, Department of Medicine , Karolinska Institutet , Stockholm , Sweden
| | - Malin Holzmann
- a Department of Women's and Children's Health , Karolinska Institutet , Stockholm , Sweden.,b Department of Obstetrics and Gynecology , Karolinska University Hospital , Stockholm , Sweden
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Dupont C, Winer N, Rabilloud M, Touzet S, Branger B, Lansac J, Gaucher L, Duclos A, Huissoud C, Boutitie F, Rudigoz RC, Colin C. Multifaceted intervention to improve obstetric practices: The OPERA cluster-randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2017. [PMID: 28649035 DOI: 10.1016/j.ejogrb.2017.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Suboptimal care contributes to perinatal morbidity and mortality. We investigated the effects of a multifaceted program designed to improve obstetric practices and outcomes. STUDY DESIGN A cluster-randomized trial was conducted from October 2008 to November 2010 in 95 French maternity units randomized either to receive an information intervention about published guidelines or left to apply them freely. The intervention combined an outreach visit with a morbidity/mortality conference (MMC) to review perinatal morbidity/mortality cases. Within the intervention group, the units were randomized to have MMCs with or without clinical psychologists. The primary outcome was the rate of suboptimal care among perinatal morbidity/mortality cases. The secondary outcomes included the rate of suboptimal care among cases of morbidity, the rate of suboptimal care among cases of mortality, the rate of avoidable morbidity and/or mortality cases, and the incidence of, morbidity and/or mortality. A mixed logistic regression model with random intercept was used to quantify the effect of the intervention on the main outcome. RESULTS The study reviewed 2459 cases of morbidity or mortality among 165,353 births. The rate of suboptimal care among morbidity plus mortality cases was not significantly lower in the intervention than in the control group (8.1% vs. 10.6%, OR [95% CI]: 0.75 [0.50-1.12], p=0.15. However, the cases of suboptimal care among morbidity cases were significantly lower in the intervention group (7.6% vs. 11.5%, 0.62 [0.40-0.94], p=0.02); the incidence of perinatal morbidity was also lower (7.0 vs. 8.1‰, p=0.01). No differences were found between psychologist-backed and the other units. CONCLUSIONS The intervention reduced the rate of suboptimal care mainly in morbidity cases and the incidence of morbidity but did not succeed in improving morbidity plus mortality combined. More clear-cut results regarding mortality require a longer study period and the inclusion of structures that intervene before and after the delivery room. (ClinicalTrials.gov ID: NCT02584166).
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Affiliation(s)
- Corinne Dupont
- Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France; Health Services and Performance Research - HESPER EA 7425, F-69008, Lyon, France.
| | - Norbert Winer
- Service de gynécologie-obstétrique/maternité, Centre Hospitalo-universitaire de Nantes, F-44300, Nantes, France
| | - Muriel Rabilloud
- Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, F-69003, Lyon, France; Université de Lyon, F-69000, Lyon, France; Université Lyon 1, F-69100, Villeurbanne, France; CNRS UMR 5558 Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, F-69100, Villeurbanne, France
| | - Sandrine Touzet
- Health Services and Performance Research - HESPER EA 7425, F-69008, Lyon, France; Pôle IMER, Hospices Civils de Lyon, F-69003, Lyon, France; Université de Lyon, F-69100, Lyon, France
| | - Bernard Branger
- Réseau Sécurité Naissance, Pays-de-la-Loire, F-44000, Nantes, France
| | - Jacques Lansac
- Réseau périnatal de la Région Centre, F-37000, Tours, France
| | - Laurent Gaucher
- Health Services and Performance Research - HESPER EA 7425, F-69008, Lyon, France; Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, F-69500 Lyon, France
| | - Antoine Duclos
- Health Services and Performance Research - HESPER EA 7425, F-69008, Lyon, France; Pôle IMER, Hospices Civils de Lyon, F-69003, Lyon, France; Université de Lyon, F-69100, Lyon, France
| | - Cyril Huissoud
- Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France
| | - Florent Boutitie
- Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, F-69003, Lyon, France; Université de Lyon, F-69000, Lyon, France; Université Lyon 1, F-69100, Villeurbanne, France; CNRS UMR 5558 Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, F-69100, Villeurbanne, France
| | | | - Cyrille Colin
- Health Services and Performance Research - HESPER EA 7425, F-69008, Lyon, France; Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, F-69003, Lyon, France; Université de Lyon, F-69000, Lyon, France; Université Lyon 1, F-69100, Villeurbanne, France; CNRS UMR 5558 Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, F-69100, Villeurbanne, France
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Allanson ER, Waqar T, White C, Tunçalp Ö, Dickinson JE. Umbilical lactate as a measure of acidosis and predictor of neonatal risk: a systematic review. BJOG 2017; 124:584-594. [PMID: 27704703 DOI: 10.1111/1471-0528.14306] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Umbilical cord lactate is one approach to measuring acidosis and intrapartum hypoxia, knowledge of which may be helpful for clinicians involved in the care of women and newborns. OBJECTIVE To synthesise the evidence on accuracy of umbilical cord lactate in measuring acidosis and predicting poor neonatal outcome. SEARCH STRATEGY Studies published and unpublished between 1990 and 2014 from PubMed/Medline, EMBASE, Cochrane Central Register of Controlled Trials, and clinicaltrials.gov were assessed. SELECTION CRITERIA Cross-sectional and randomised studies that assessed fetal acidosis (using lactate as the index test) with or without an assessment of neonatal outcome. DATA COLLECTION AND ANALYSIS Correlations between index and reference test(s) were recorded, as were the raw data to classify the predictive ability of umbilical lactate for neonatal outcomes. Meta-analysis of correlation was performed. We plotted estimates of the studies' observed sensitivities and specificities on Forest plots with 95% confidence intervals (CI). Where possible, we combined data using meta-analysis, applying the hierarchical summary receiver operating characteristics model and a bivariate model. MAIN RESULTS Twelve studies were included. Umbilical lactate correlated with pH [pooled effect size (ES) -0.650; 95% CI -0.663 to -0.637, P < 0.001], base excess (ES -0.710; 95% CI -0.721 to -0.699, P < 0.001), and Apgar scores at 5 minutes (ES 0.300; 95% 0.193-0.407, P < 0.001). Umbilical lactate had pooled sensitivity and specificity for predicting neonatal neurological outcome including hypoxic ischaemic encephalopathy of 69.7% (95% CI 23.8-94.4%) and 93% (95% CI 86.8-96.3%). AUTHORS' CONCLUSION Umbilical cord lactate is a clinically applicable, inexpensive and effective way to measure acidosis and is a tool that may be used in the assessment of neonatal outcome. TWEETABLE ABSTRACT Umbilical cord lactate: a clinically applicable, inexpensive, effective way to measure intrapartum acidosis.
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Affiliation(s)
- E R Allanson
- School of Women's and Infants' Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Crawley, WA, Australia
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - T Waqar
- CMH Medical College, CMH Lahore, Lahore, Pakistan
| | - Crh White
- School of Women's and Infants' Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Ö Tunçalp
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - J E Dickinson
- School of Women's and Infants' Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Crawley, WA, Australia
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Sadler LC, Farquhar CM, Masson VL, Battin MR. Contributory factors and potentially avoidable neonatal encephalopathy associated with perinatal asphyxia. Am J Obstet Gynecol 2016; 214:747.e1-8. [PMID: 26723195 DOI: 10.1016/j.ajog.2015.12.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/09/2015] [Accepted: 12/17/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND The recently published monograph, Neonatal encephalopathy and neurologic outcome, from the American College of Obstetricians and Gynecologists calls for a root cause analysis to identify components of care that contributed to cases of neonatal encephalopathy to design better practices, surveillance mechanisms, and systems. All cases of infants born in New Zealand with moderate and severe neonatal encephalopathy were reported to the New Zealand Perinatal and Maternal Mortality Review Committee from 2010. A national clinical review of these individual cases has not previously been undertaken. OBJECTIVES The objective of the study was to undertake a multidisciplinary structured review of all cases of neonatal encephalopathy that arose following the onset of labor in the absence of acute peripartum events in 2010-2011 to determine the frequency of contributory factors, the proportion of potentially avoidable morbidity and mortality and to identify themes for quality improvement. STUDY DESIGN National identification of, and collection of clinical records on, cases of moderate or severe neonatal encephalopathy occurring after the onset of labor in the absence of an acute peripartum event, excluding those with normal gases and Apgar scores at 1 minute, among all cases of moderate and severe neonatal encephalopathy at term in New Zealand in 2010-2011 was undertaken. Cases were included if they had abnormal gases as defined by any of pH of ≤ 7.2, base excess of ≤ -10, or lactate of ≥ 6 or if there were no cord gases, an Apgar score at 1 minute of ≤ 7. A clinical case review was undertaken by a multidisciplinary team using a structured tool to record contributory factors (organization and/or management, personnel, and barriers to access and/or engagement with care), potentially avoidable morbidity and mortality and to identify themes to guide quality improvement. RESULTS Eighty-three babies fulfilled the inclusion criteria for the review, 56 moderate (67%) and 27 severe (33%), 21 (25%) of whom were deceased prior to hospital discharge. Eighty-four percent of 64 babies with cord gas results had one of pH of ≤ 7.0, base excess of ≤ -12, or lactate of ≥ 6; and 42% (8 of 19) without cord gases had 5 minute Apgar scores < 5. Excluding 5 babies who died within a day of birth, all but 1 baby were admitted to a neonatal unit within 1 day of birth. Contributory factors were identified in 84% of 83 cases, most commonly personnel factors (76%). Fifty-five percent of cases with morbidity or mortality were considered to be potentially avoidable, and 52% of cases were considered potentially avoidable because of personnel factors. The most frequently identified theme related to the use and interpretation of cardiotocography in labor. CONCLUSION A multidisciplinary case review of neonatal encephalopathy following apparently uncomplicated labor identified a high rate of potentially avoidable morbidity and mortality and issues amenable to quality improvement such as multidisciplinary training of staff in fetal surveillance in labor.
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Dose-dependent effects of levetiracetam after hypoxia and hypothermia in the neonatal mouse brain. Brain Res 2016; 1646:116-124. [PMID: 27216570 DOI: 10.1016/j.brainres.2016.05.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/18/2016] [Accepted: 05/19/2016] [Indexed: 10/21/2022]
Abstract
Perinatal asphyxia to the developing brain remains a major cause of morbidity. Hypothermia is currently the only established neuroprotective treatment available for term born infants with hypoxic-ischemic encephalopathy, saving one in seven to eight infants from developing severe neurological deficits. Therefore, additional treatments with clinically applicable drugs are indispensable. This study investigates a potential additive neuroprotective effect of levetiracetam combined with hypothermia after hypoxia-induced brain injury in neonatal mice. 9-day-old C57BL/6-mice (P9) were subjected either to acute hypoxia or room-air. After 90min of systemic hypoxia (6% O2), pups were randomized into six groups: 1) vehicle, 2) low-dose levetiracetam (LEV), 3) high-dose LEV, 4) hypothermia (HT), 5) HT combined with low-dose LEV and 6) HT combined with high-dose LEV. Pro-apoptotic factors, neuronal structures, and myelination were analysed by histology and on protein level at appropriate time points. On P28 to P37 long-term outcome was assessed by neurobehavioral testing. Hypothermia confers acute and long-term neuroprotection by reducing apoptosis and preservation of myelinating oligodendrocytes and neurons in a model of acute hypoxia in the neonatal mouse brain. Low-dose LEV caused no adverse effects after neonatal hypoxic brain damage treated with hypothermia whereas administration of high-dose LEV alone or in combination with hypothermia increased neuronal apoptosis after hypoxic brain injury. LEV in low- dosage had no additive neuroprotective effect following acute hypoxic brain injury.
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The significance of base deficit in acidemic term neonates. Am J Obstet Gynecol 2015; 213:373.e1-7. [PMID: 25827502 DOI: 10.1016/j.ajog.2015.03.051] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 02/20/2015] [Accepted: 03/25/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Much emphasis is placed on the metabolic component of umbilical cord acidemia at birth, with an importance attached to an arterial level of <7.00 accompanied by a base deficit of 12 mmol/L. We hypothesized that in acidemic neonates, the level of arterial base deficit provides no prognostic information beyond that provided by the level of arterial pH. STUDY DESIGN This is a cohort study using a database of deliveries from a major teaching hospital, with additional information from neonatal records. A total of 8797 term, singleton, nonanomalous neonates were identified who had paired and validated cord blood gas analysis. Of these, 520 were acidemic (pH <7.1) and 84 were severely acidemic (pH <7.0). Outcomes examined were encephalopathy grade 2/3 and/or death, Apgar <7 at 5 minutes, neonatal unit admission, and composite outcomes of neurological and systemic involvement. Hierarchical logistic regressions were done using IBM SPSS Statistics 20.0 (Armonk, NY) to assess the predictive value of arterial pH and arterial base deficit. RESULTS For each outcome the median pH and base deficit of those neonates affected by the adverse outcome was significantly lower than for those who were unaffected. Hierarchical logistic regressions showed that pH is a significant predictor of all adverse outcomes studied (P < .001 for all outcomes). When base deficit, and then the cross-product, are added to the model, neither add predictive value. CONCLUSION In acidemic neonates, the metabolic component does not predict those at risk of adverse outcomes once pH is taken into account. The apparently worse outcomes with greater base deficit simply reflect a greater degree of acidemia. The prognostic significance attached to the base deficit among acidemic neonates is questionable.
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Yamada T, Cho K, Morikawa M, Yamada T, Minakami H. Intrapartum risk factors for neonatal encephalopathy leading to cerebral palsy in women without apparent sentinel events. J Obstet Gynaecol Res 2015; 41:1520-5. [DOI: 10.1111/jog.12772] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 04/02/2015] [Accepted: 05/03/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Takahiro Yamada
- Department of Perinatal Medicine; Hokkaido University Hospital; Sapporo Japan
| | - Kazutoshi Cho
- Department of Perinatal Medicine; Hokkaido University Hospital; Sapporo Japan
| | - Mamoru Morikawa
- Department of Perinatal Medicine; Hokkaido University Hospital; Sapporo Japan
| | - Takashi Yamada
- Department of Obstetrics and Gynecology; Japan Community Health Care Organization Hokkaido Hospital; Sapporo Japan
| | - Hisanori Minakami
- Department of Perinatal Medicine; Hokkaido University Hospital; Sapporo Japan
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Jonsson M, Ågren J, Nordén-Lindeberg S, Ohlin A, Hanson U. Neonatal encephalopathy and the association to asphyxia in labor. Am J Obstet Gynecol 2014; 211:667.e1-8. [PMID: 24949542 DOI: 10.1016/j.ajog.2014.06.027] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 04/26/2014] [Accepted: 06/11/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE In cases with moderate and severe neonatal encephalopathy, we aimed to determine the proportion that was attributable to asphyxia during labor and to investigate the association between cardiotocographic (CTG) patterns and neonatal outcome. STUDY DESIGN In a study population of 71,189 births from 2 Swedish university hospitals, 80 cases of neonatal encephalopathy were identified. Cases were categorized by admission CTG patterns (normal or abnormal) and by the presence of asphyxia (cord pH, <7.00; base deficit, ≥12 mmol/L). Cases with normal admission CTG patterns and asphyxia at birth were considered to experience asphyxia related to labor. CTG patterns were assessed for the 2 hours preceding delivery. RESULTS Admission CTG patterns were normal in 51 cases (64%) and abnormal in 29 cases (36%). The rate of cases attributable to asphyxia (ie, hypoxic ischemic encephalopathy) was 48 of 80 cases (60%), most of which evolved during labor (43/80 cases; 54%). Both severe neonatal encephalopathy and neonatal death were more frequent with an abnormal, rather than with a normal, admission CTG pattern (13 [45%] vs 11 [22%]; P = .03), and 6 [21%] vs 3 [6%]; P = .04), respectively. Comparison of cases with an abnormal and a normal admission CTG pattern also revealed more frequently observed decreased variability (12 [60%] and 8 [22%], respectively) and more late decelerations (8 [40%] and 1 [3%], respectively). CONCLUSION Moderate and severe encephalopathy is attributable to asphyxia in 60% of cases, most of which evolve during labor. An abnormal admission CTG pattern indicates a poorer neonatal outcome and more often is associated with pathologic CTG patterns preceding delivery.
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Affiliation(s)
- Maria Jonsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Johan Ågren
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Andreas Ohlin
- Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
| | - Ulf Hanson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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