1
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Starke V, Diderholm B, Heyman M, Blomqvist YT. Being parents of extremely preterm children, from a long-term perspective: A qualitative study of parents' experiences. Early Hum Dev 2023; 183:105819. [PMID: 37393662 DOI: 10.1016/j.earlhumdev.2023.105819] [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: 05/15/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND In recent decades, modern neonatal intensive care has improved, increasing the survival of extremely preterm children. Few studies have examined the experiences of parents of extremely preterm children from a long-term perspective. AIM To describe parents' experiences of parenting extremely preterm children during their childhood and transition to adulthood. STUDY DESIGN A qualitative interview study with a descriptive design. SUBJECTS Thirteen parents of eleven children born at 24 gestational weeks in Sweden, 1990-1992, participated in individual semi-structured interviews. OUTCOME MEASURES Data were analyzed using qualitative reflexive thematic analysis. RESULT Five themes forming a timeline were created in the analytic process: parenthood, at the NICU, young childhood, adolescence, and adulthood. Various aspects affecting parenthood were described throughout the timeline, and occasionally the parents experienced difficulties dealing with their children's special physical and/or mental needs. Today, some families have established a functioning situation despite their children's physical and/or mental difficulties, while some still struggle with their children's everyday life. CONCLUSION Having an extremely preterm family member profoundly affects the whole family for various lengths of time. Parents expressed a need for support from both healthcare and school throughout their children's childhood and in their transition to adulthood, although the need varies between parent-child pairs. By studying the parents' experiences, their need for support can be further recognized and understood, and developed and improved accordingly.
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Affiliation(s)
- Veronica Starke
- Department of Women's and Children's Health, Uppsala University, Sweden.
| | - Barbro Diderholm
- Department of Women's and Children's Health, Uppsala University, Sweden
| | - Maria Heyman
- Department of Women's and Children's Health, Uppsala University, Sweden
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2
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The First 1000 Days of Infant. Healthcare (Basel) 2022; 10:healthcare10010106. [PMID: 35052270 PMCID: PMC8775982 DOI: 10.3390/healthcare10010106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/31/2021] [Accepted: 01/03/2022] [Indexed: 11/24/2022] Open
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3
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Boland RA, Cheong JLY, Doyle LW. Changes in long-term survival and neurodevelopmental disability in infants born extremely preterm in the post-surfactant era. Semin Perinatol 2021; 45:151479. [PMID: 34493405 DOI: 10.1016/j.semperi.2021.151479] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Extremely preterm birth before 28 weeks' gestation accounts for less than 1% of births in high-income countries but is associated with high rates of perinatal and infant mortality, and of neurodevelopmental disability in surviving children. Survival rates have increased over time, both overall, and within each week of gestational age since the introduction of exogenous surfactant into clinical care in the early 1990s. However, rates of major neurodevelopmental disability in survivors, whether they be in early childhood or at school-age, have not clearly improved in parallel with the increases in survival. An important strategy to improve survival free of major neurodevelopmental disability is to birth extremely preterm infants in a tertiary perinatal center, where specialist obstetric care for the mother and ongoing intensive care for the infant can both be provided without the potential morbidities associated with postnatal transfer.
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Affiliation(s)
- Rosemarie A Boland
- Clinical Sciences, Murdoch Children's Research, 50 Flemington Road, Parkville, VIC 3052, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia; Paediatric Infant Perinatal Emergency Retrieval, Royal Children's Hospital, Parkville, VIC, Australia.
| | - Jeanie L Y Cheong
- Clinical Sciences, Murdoch Children's Research, 50 Flemington Road, Parkville, VIC 3052, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia; Neonatal Services, Royal Women's Hospital, Parkville, VIC, Australia
| | - Lex W Doyle
- Clinical Sciences, Murdoch Children's Research, 50 Flemington Road, Parkville, VIC 3052, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia; Neonatal Services, Royal Women's Hospital, Parkville, VIC, Australia
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4
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Watson H, McLaren J, Carlisle N, Ratnavel N, Watts T, Zaima A, Tribe RM, Shennan AH. All the right moves: why in utero transfer is both important for the baby and difficult to achieve and new strategies for change. F1000Res 2020; 9. [PMID: 32913633 PMCID: PMC7429922 DOI: 10.12688/f1000research.25923.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 01/20/2023] Open
Abstract
The best way to ensure that preterm infants benefit from relevant neonatal expertise as soon as they are born is to transfer the mother and baby to an appropriately specialised neonatal facility before birth (“
in utero”). This review explores the evidence surrounding the importance of being born in the right unit, the advantages of
in utero transfers compared to
ex utero transfers, and how to accurately assess which women are at most risk of delivering early and the challenges of
in utero transfers. Accurate identification of the women most at risk of preterm birth is key to prioritising who to transfer antenatally, but the administrative burden and pathway variation of
in utero transfer in the UK are likely to compromise optimal clinical care. Women reported the impact that
in utero transfers have on them, including the emotional and financial burdens of being transferred and the anxiety surrounding domestic and logistical concerns related to being away from home. The final section of the review explores new approaches to reforming the
in utero transfer process, including learning from outside the UK and changing policy and guidelines. Examples of collaborative regional guidance include the recent Pan-London guidance on
in utero transfers. Reforming the transfer process can also be aided through technology, such as utilising the CotFinder app. In utero transfer is an unavoidable aspect of maternity and neonatal care, and the burden will increase if preterm birth rates continue to rise in association with increased rates of multiple pregnancy, advancing maternal age, assisted reproductive technologies, and obstetric interventions. As funding and capacity pressures on health services increase because of the COVID-19 pandemic, better prioritisation and sustained multi-disciplinary commitment are essential to maximise better outcomes for babies born too soon.
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Affiliation(s)
- Helena Watson
- Guy's and St Thomas NHS Foundation Trust, London, UK.,Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - James McLaren
- Gosford Hospital, Gosford, New South Wales, Australia
| | - Naomi Carlisle
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | | | - Tim Watts
- Guy's and St Thomas NHS Foundation Trust, London, UK
| | | | - Rachel M Tribe
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Andrew H Shennan
- Guy's and St Thomas NHS Foundation Trust, London, UK.,Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
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5
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Singh N, Bonney E, McElrath T, Lamont RF. Prevention of preterm birth: Proactive and reactive clinical practice-are we on the right track? Placenta 2020; 98:6-12. [PMID: 32800387 DOI: 10.1016/j.placenta.2020.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 11/27/2022]
Abstract
Preterm birth remains the major cause of death and disability among children under the age of five. In developing countries antenatal preterm birth prevention clinics are set up to provide cervical length surveillance and/or treatment modalities such as cerclage or progesterone for those women with identified risk factors such as previous cervical treatment or preterm birth. However, 85% of women have no risk factors for PTB and currently there is no biomarker to screen women early in pregnancy. Women will present unexpectedly in threatened preterm labour and we have no choice but to adopt a re-active approach to their care by using predication and preparation strategies such as fetal fibronectin, tocolytic therapy and steroids. Despite these strategies approximately 15-20% of these women will give birth preterm before 34 weeks. There is a urgent need to re-design primary, secondary and tertiary prevention strategies for spontaneous preterm labour (sPTL) in singleton pregnancies aimed at identifying and addressing key gaps in clinical practice and research.
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Affiliation(s)
- Natasha Singh
- Department of Obstetrics, Chelsea and Westminster Hospital and Imperial College London, UK.
| | - Elizabeth Bonney
- Department of Obstetrics, Gynaecology, and Reproductive Sciences, University of Vermont, Burlington, VT, USA
| | - Tom McElrath
- Brigham and Women's Hospital, Department of Obstetrics and Gynaecology, Boston, MA, USA
| | - Ronald F Lamont
- Division of Surgery, University College London, Northwick Park Institute of Medical Research Campus, London, UK
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6
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Lamont RF, Jørgensen JS. Safety and Efficacy of Tocolytics for the Treatment of Spontaneous Preterm Labour. Curr Pharm Des 2020; 25:577-592. [PMID: 30931850 DOI: 10.2174/1381612825666190329124214] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/25/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Preterm birth is the major cause of perinatal mortality and morbidity worldwide. Attempts to reduce the burden may be proactive using biochemical or biophysical prediction and preventative measures. If these efforts fail, then the approach may have to be reactive using tocolytics to inhibit spontaneous preterm labour. OBJECTIVE We have reviewed the evidence concerning the safety and efficacy of various classes of tocolytic agents. RESULTS The evidence to support the use of magnesium sulfate or nitric oxide donors as a tocolytic is poor. Compared to placebo or no treatment, there is evidence to support the efficacy of calcium channel blockers (mainly nifedipine), prostaglandin synthetase inhibitors (mainly indomethacin and sulindac), oxytocin receptor antagonists (mainly atosiban) and β2-agonists (mainly ritodrine, terbutaline, salbutamol and fenoterol). Maternal safety concerns have reduced the use of β2-agonists. Fetal safety and gestational age restrictions have largely condemned prostaglandin synthetase inhibitors to second-line therapy. First-line therapy in Europe and other parts of the world outside the USA and Australia is limited to calcium channel blockers and oxytocin receptor antagonists. With respect to efficacy, atosiban and nifedipine are similar, but the robustness of the evidence favours atosiban. With respect to safety, atosiban is clearly the safest tocolytic as there are fetomaternal concerns with nifedipine, particularly in high daily doses. CONCLUSION The perfect tocolytic that is uniformly effective and safe does not exist. Cost, licensing and informed consent are considerations involved in the choice. Efforts continue to develop and introduce other or better agents, including novel compounds such as progesterone, PGF2α antagonists and statins.
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Affiliation(s)
- Ronald F Lamont
- Research Unit of Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark.,Division of Surgery, Northwick Park Institute of Medical Research Campus, University College London, London, United Kingdom
| | - Jan S Jørgensen
- Research Unit of Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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7
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Biten H, Redd TK, Moleta C, Campbell JP, Ostmo S, Jonas K, Chan RVP, Chiang MF. Diagnostic Accuracy of Ophthalmoscopy vs Telemedicine in Examinations for Retinopathy of Prematurity. JAMA Ophthalmol 2019; 136:498-504. [PMID: 29621387 DOI: 10.1001/jamaophthalmol.2018.0649] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Examinations for retinopathy of prematurity (ROP) are typically performed using binocular indirect ophthalmoscopy. Telemedicine studies have traditionally assessed the accuracy of telemedicine compared with ophthalmoscopy as a criterion standard. However, it is not known whether ophthalmoscopy is truly more accurate than telemedicine. Objective To directly compare the accuracy and sensitivity of ophthalmoscopy vs telemedicine in diagnosing ROP using a consensus reference standard. Design, Setting, and Participants This multicenter prospective study conducted between July 1, 2011, and November 30, 2014, at 7 neonatal intensive care units and academic ophthalmology departments in the United States and Mexico included 281 premature infants who met the screening criteria for ROP. Exposures Each examination consisted of 1 eye undergoing binocular indirect ophthalmoscopy by an experienced clinician followed by remote image review of wide-angle fundus photographs by 3 independent telemedicine graders. Main Outcomes and Measures Results of both examination methods were combined into a consensus reference standard diagnosis. The agreement of both ophthalmoscopy and telemedicine was compared with this standard, using percentage agreement and weighted κ statistics. Results Among the 281 infants in the study (127 girls and 154 boys; mean [SD] gestational age, 27.1 [2.4] weeks), a total of 1553 eye examinations were classified using both ophthalmoscopy and telemedicine. Ophthalmoscopy and telemedicine each had similar sensitivity for zone I disease (78% [95% CI, 71%-84%] vs 78% [95% CI, 73%-83%]; P > .99 [n = 165]), plus disease (74% [95% CI, 61%-87%] vs 79% [95% CI, 72%-86%]; P = .41 [n = 50]), and type 2 ROP (stage 3, zone I, or plus disease: 86% [95% CI, 80%-92%] vs 79% [95% CI, 75%-83%]; P = .10 [n = 251]), but ophthalmoscopy was slightly more sensitive in identifying stage 3 disease (85% [95% CI, 79%-91%] vs 73% [95% CI, 67%-78%]; P = .004 [n = 136]). Conclusions and Relevance No difference was found in overall accuracy between ophthalmoscopy and telemedicine for the detection of clinically significant ROP, although, on average, ophthalmoscopy had slightly higher accuracy for the diagnosis of zone III and stage 3 ROP. With the caveat that there was variable accuracy between examiners using both modalities, these results support the use of telemedicine for the diagnosis of clinically significant ROP.
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Affiliation(s)
- Hilal Biten
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland
| | - Travis K Redd
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland
| | - Chace Moleta
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland
| | - J Peter Campbell
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland
| | - Susan Ostmo
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland
| | - Karyn Jonas
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago
| | - R V Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago.,Center for Global Health, College of Medicine, University of Illinois at Chicago
| | - Michael F Chiang
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland.,Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
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8
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Lundqvist P, Weis J, Sivberg B. Parents’ journey caring for a preterm infant until discharge from hospital‐based neonatal home care—A challenging process to cope with. J Clin Nurs 2019; 28:2966-2978. [DOI: 10.1111/jocn.14891] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 03/16/2019] [Accepted: 04/14/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Pia Lundqvist
- Department of Health Sciences, Faculty of Medicine Lund University Lund Sweden
| | - Janne Weis
- Neonatal Department and the Research Unit for Women’s and Children’s Health Copenhagen University Hospital Copenhagen Denmark
| | - Bengt Sivberg
- Department of Health Sciences, Faculty of Medicine Lund University Lund Sweden
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9
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Gente M, Aufieri R, Agostino R, Fedeli T, Calevo MG, Massirio P, Bellini C. Nationwide survey of neonatal transportation practices in Italy. Ital J Pediatr 2019; 45:51. [PMID: 30999944 PMCID: PMC6471884 DOI: 10.1186/s13052-019-0640-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite regionalization of perinatal care provides for the "in utero" transfer of high-risk pregnancies, there will always be a number of neonates who undergo acute inter-facility transport. The presence of a well-organized Neonatal Emergency Transport Service (NETS) can prevent and reduce risks of transportation, especially for very preterm infants, and is therefore mandatory for any program of regionalization of perinatal care. Italian National Health System is highly decentralized and Regions are autonomous to structure, plan and delivery their regional health services. Consequently, organization models and resources available vary widely and significant regional differences in access and quality of health services have been reported in the past years. A national survey was conducted in 2015 by the neonatal transport study group of the Italian Society of Neonatology with the aim to describe neonatal transfer practices and to assess the Neonatal Emergency Transport Services (NETS) status in the 20 Italian regions. METHODS A questionnaire regarding neonatal transfer practices and NETS activity for the previous year (2014) was sent to the 44 NETS operating in the 20 Italian regions. Demographic data were obtained from the Italian National Statistical Institute (ISTAT). RESULTS The overall survey response rate was 100%. In 2014, only 12 (60%) of the 20 Italian regions were fully covered by NETS, 3 (15%) regions were partially covered, while neonatal transport was not available in 5 (25%) regions. Overall, in 2014, the 44 NETS operating in Italy transported a total of 6387 infants, including 522 (8.17%) having a gestational age < 28 weeks. CONCLUSIONS The organization of NETS in Italy is devolved on a regional basis, resulting in a large heterogeneity of access and quality to services across the country. Where available, NETS are generally well-equipped and organized but limited volume of activities often cannot guarantee adequate levels of skills of personnel or an appropriate cost-efficiency ratio. The regions reported with lack of NETS have managed, or are trying, to fill the gap, but continuing efforts to reduce regional differences in the availability and quality of services are still needed.
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Affiliation(s)
- Maurizio Gente
- Department of Pediatrics and Infant Neuropsychiatry, Neonatal Emergency Transport Service, Sapienza University of Rome, Rome, Italy
| | - Roberto Aufieri
- Division of Neonatology and Neonatal Intensive Care Unit, ASL Roma 2 - Ospedale Sant'Eugenio, Rome, Italy
| | - Rocco Agostino
- Division of Neonatology, Villa Margherita Private Nursing Home, Rome, Italy
| | - Tiziana Fedeli
- Neonatal Intensive Care Unit, Fondazione MBBM, Monza, Italy
| | - Maria Grazia Calevo
- Department of Epidemiology, Biostatistics and Committees, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Paolo Massirio
- Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, Department Mother&Child, IRCCS Istituto Giannina Gaslini, Largo G. Gaslini, 5, 16147, Genoa, Italy
| | - Carlo Bellini
- Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, Department Mother&Child, IRCCS Istituto Giannina Gaslini, Largo G. Gaslini, 5, 16147, Genoa, Italy.
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10
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Ali AA, Sayed AK, El Sherif L, Loutfi GO, Ahmed AMM, Mohamed HB, Anwar AT, Taha AS, Yahia RM, Elgebaly A, Abdel-Daim MM. Systematic review and meta-analysis of randomized controlled trials of atosiban versus nifedipine for inhibition of preterm labor. Int J Gynaecol Obstet 2019; 145:139-148. [PMID: 30784056 DOI: 10.1002/ijgo.12793] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/11/2018] [Accepted: 02/19/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Two tocolytic drugs-atosiban and nifedipine-are currently used for first-line treatment of preterm labor (PTL). OBJECTIVE To compare the efficacy and safety of atosiban with nifedipine for PTL treatment. SEARCH STRATEGY In May 2017, we searched PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Clinical Trials with search terms including "nifedipine", "atosiban", and "preterm labor". SELECTION CRITERIA Randomized controlled trials of women with PTL. DATA COLLECTION AND ANALYSIS Data were extracted for study design, patient characteristics, risk of bias domains, and study outcomes. A random-effects model was used to generate pooled risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS We included seven studies that enrolled 992 patients. There was no significant difference between atosiban and nifedipine for pregnancy prolongation of 48 hours or more regarding efficacy (RR 1.06, 95% CI 0.92-1.22; P=0.440) or effectiveness (0.93, 0.84-1.03; P=0.177). Pregnancy prolongation for 7 days or more also did not differ between groups for efficacy (RR 1.04, 95% CI 0.89-1.21; P=0.656) or effectiveness (0.91, 0.79-1.05; P=0.177). Atosiban-however-was associated with fewer maternal side-effects than nifedipine. CONCLUSION Atosiban resulted in fewer maternal side-effects than nifedipine, with no difference in pregnancy prolongation. PROSPERO registration: CRD42018090223.
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Affiliation(s)
- Aya Ashraf Ali
- Faculty of Medicine, Minia University, Minia, Egypt.,Minia Medical Research Society (MMRS), Minia University, Minia, Egypt
| | - Ahmed Kamal Sayed
- Faculty of Medicine, Minia University, Minia, Egypt.,Minia Medical Research Society (MMRS), Minia University, Minia, Egypt
| | - Loalo'a El Sherif
- Faculty of Medicine, Minia University, Minia, Egypt.,Minia Medical Research Society (MMRS), Minia University, Minia, Egypt
| | - Gihan Ossam Loutfi
- Faculty of Medicine, Minia University, Minia, Egypt.,Minia Medical Research Society (MMRS), Minia University, Minia, Egypt
| | - Abdullah Mahmoud Mohamed Ahmed
- Faculty of Medicine, Minia University, Minia, Egypt.,Minia Medical Research Society (MMRS), Minia University, Minia, Egypt
| | - Hajer Bassem Mohamed
- Faculty of Medicine, Minia University, Minia, Egypt.,Minia Medical Research Society (MMRS), Minia University, Minia, Egypt
| | - Ahmad Tareq Anwar
- Faculty of Medicine, Minia University, Minia, Egypt.,Minia Medical Research Society (MMRS), Minia University, Minia, Egypt
| | - Abdullah Salah Taha
- Faculty of Medicine, Minia University, Minia, Egypt.,Minia Medical Research Society (MMRS), Minia University, Minia, Egypt
| | - Reem Mohamed Yahia
- Faculty of Medicine, Minia University, Minia, Egypt.,Minia Medical Research Society (MMRS), Minia University, Minia, Egypt
| | - Ahmed Elgebaly
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt.,Medical Research Education and Practice Association (MREP), Cairo, Egypt
| | - Mohamed M Abdel-Daim
- Pharmacology Department, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
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11
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Domellöf M, Jonsson B. The Swedish Approach to Management of Extreme Prematurity at the Borderline of Viability: A Historical and Ethical Perspective. Pediatrics 2018; 142:S533-S538. [PMID: 30171138 DOI: 10.1542/peds.2018-0478c] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2018] [Indexed: 11/24/2022] Open
Abstract
Sweden has a long tradition of being at the forefront of the management of extremely preterm infants. In this article, we explore the historical background, ethical discussions, and evidence from national surveys combined with data from quality registers that form the background of the current Swedish guidelines for the care of extremely preterm infants. The current Swedish national guidelines suggest providing active care for preterm infants from 23 weeks' gestation and considering active care from 22 weeks' gestation. The survival of infants in gestational weeks 22 and 23 has increased and now exceed 50% and 60%, respectively; importantly, the Swedish proactive approach to care at the border of viability has not resulted in an increased proportion of functional impairment among survivors.
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Affiliation(s)
- Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden; and
| | - Baldvin Jonsson
- Department of Women's and Children's Health, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
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12
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Tsikouras P, Anastasopoulos G, Maroulis V, Bothou A, Chalkidou A, Deuteraiou D, Anthoulaki X, Tsatsaris G, Bourazan AH, Iatrakis G, Zervoudis S, Galazios G, Inagamova LK, Csorba R, Teichmann AT. Comparative Evaluation of Arabin Pessary and Cervical Cerclage for the Prevention of Preterm Labor in Asymptomatic Women with High Risk Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040791. [PMID: 29670041 PMCID: PMC5923833 DOI: 10.3390/ijerph15040791] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 11/24/2022]
Abstract
Objective: Preterm labor is one of the most significant obstetric problems associated with high rate of actual and long-term perinatal complications. Despite the creation of scoring systems, uterine activity monitoring, cervical ultrasound and several biochemical markers, the prediction and prevention of preterm labor is still a matter of concern. The aim of this study was to examine cervical findings for the prediction and the comparative use of Arabin pessary or cerclage for the prevention of preterm birth in asymptomatic women with high risk factors for preterm labor. Material and methods: The study group was composed of singleton pregnancies (spontaneously conceived) with high risk factors for preterm labor. Cervical length, dilatation of the internal cervical os and funneling, were estimated with transvaginal ultrasound during the first and the second trimesters of pregnancy. Results: Cervical funneling, during the second trimester of pregnancy, was the most significant factor for the prediction of preterm labor. The use of Arabin cervical pessary was found to be more effective than cerclage in the prolongation of pregnancy. Conclusion: In women at risk for preterm labor, the detection of cervical funneling in the second trimester of pregnancy may help to predict preterm labor and to apply the appropriate treatment for its prevention. Although the use of cervical pessary was found to be more effective than cerclage, more studies are needed to classify the effectiveness of different methods for such prevention.
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Affiliation(s)
- Panagiotis Tsikouras
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece.
| | - George Anastasopoulos
- Medical Informatics Laboratory, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece.
| | - Vasileios Maroulis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece.
| | - Anastasia Bothou
- Department of Obstetrics and Gynecology, Rea Hospital, 17564 Athens, Greece.
| | - Anna Chalkidou
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece.
| | - Dorelia Deuteraiou
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece.
| | - Xanthoula Anthoulaki
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece.
| | - Georgios Tsatsaris
- Medical Informatics Laboratory, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece.
| | - Arzou Halil Bourazan
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece.
| | - George Iatrakis
- Department of Obstetrics and Gynecology, Technological Educational Institute, 17564 Athens, Greece.
| | - Stefanos Zervoudis
- Department of Obstetrics and Gynecology, Rea Hospital, 17564 Athens, Greece.
| | - Georgios Galazios
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece.
| | - Lola-Katerina Inagamova
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece.
| | - Roland Csorba
- Department of Obstetrics and Gynecology, Clinicum Aschaffenburg, Teaching Hospital of University, 97070 Würzburg, Germany.
| | - Alexander-Tobias Teichmann
- Department of Obstetrics and Gynecology, Clinicum Aschaffenburg, Teaching Hospital of University, 97070 Würzburg, Germany.
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Gyamfi-Bannerman C, Menon R, Bonney EA, Dolan SM, Johnson M, Lamont RF, Mesiano S, Murtha AP, Myatt L, Mysorekar I, Williams SM, Zhong N, Helmer H. Novel thoughts on preterm birth research proceedings of the 13th annual preterm birth international collaborative (PREBIC) meeting. Semin Perinatol 2017; 41:438-441. [PMID: 29074002 DOI: 10.1053/j.semperi.2017.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Cynthia Gyamfi-Bannerman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology Columbia University Medical Center, New York, NY.
| | - Ramkumar Menon
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine Perinatal Research, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Elizabeth A Bonney
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Siobhan M Dolan
- Division of Reproductive and Medical Genetics, Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Mark Johnson
- Academic Obstetrics and Gynaecology, Imperial College School of Medicine, Chelsea and Westminster Hospital, 369 Fulham Rd, London SW10 9NH, UK
| | - Ronald F Lamont
- Division of Surgery, University College London, Northwick Park Institute for Medical Research Campus, London, UK; Odense University Hospital, Department of Gynecology and Obstetrics, University of Southern Denmark, Institute of Clinical Research, Research Unit of Gynecology and Obstetrics, Odense, Denmark
| | - Sam Mesiano
- Department of Reproductive Biology, Case Western Reserve University, Cleveland, OH
| | - Amy P Murtha
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Duke University Medical Center, University of Alabama at Birmingham, Birmingham, AL
| | - Leslie Myatt
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
| | - Indira Mysorekar
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 660 South Euclid Ave, St. Louis, MO 63110; Pathology and Immunology, Washington University School of Medicine, 660 South Euclid Ave, St. Louis, MO 63110
| | - Scott M Williams
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, School of Medicine, Cleveland, OH
| | - Nanbert Zhong
- New York State Institute for Basic Research in Developmental disabilities, Staten Island, NY
| | - Hanns Helmer
- Division of Obstetrics and Feto-maternal Medicine, Department of Obstetrics and Gynaecology, Medical University of Vienna, Austria
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14
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Lamont RF, Jørgensen JS. Oxytocin-receptor antagonists in the aetiology of autism spectrum disorder. Early Hum Dev 2017; 112:60-61. [PMID: 28522143 DOI: 10.1016/j.earlhumdev.2017.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 04/17/2017] [Indexed: 01/25/2023]
Affiliation(s)
- Ronald F Lamont
- Department of Obstetrics and Gynaecology, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark; Division of Surgery, University College London, Northwick Park Institute for Medical Research Campus, London, UK.
| | - Jan Stener Jørgensen
- Department of Obstetrics and Gynaecology, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark
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Boland RA, Davis PG, Dawson JA, Stewart MJ, Smith J, Doyle LW. Very preterm birth before arrival at hospital. Aust N Z J Obstet Gynaecol 2017; 58:197-203. [PMID: 28856670 DOI: 10.1111/ajo.12690] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/19/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Our aim was to report perinatal characteristics of very preterm births before arrival (BBAs) at a hospital, and perinatal and infant mortality rates up to one year, comparing BBAs with births in a hospital. MATERIALS AND METHODS A population-based cohort study of 22-31 weeks' gestation births in the state of Victoria, Australia from 1990-2009. BBAs were defined as unintentional births at home or on route to hospital. Perinatal data were obtained from the Department of Health and Human Services, Victoria. Perinatal and infant mortality data comparing BBAs with births in hospitals were analysed by logistic regression, adjusted for gestational age, birthweight and sex. RESULTS One hundred and thirty-three BBAs were recorded: 51 (38%) stillbirths and 82 (62%) livebirths. Compared with births in a hospital, BBAs were less mature (26.3 weeks (SD 2.9) vs 27.7 weeks (SD 2.8), P < 0.001) and a higher proportion were born to teenagers: 13% versus 5% (adjusted odds ratio (aOR) 2.86, P < 0.001). BBAs were significantly more likely to be stillborn (aOR 2.13, 95% confidence interval (CI) 1.41, 3.23, P < 0.001) die within 28 days of livebirth (aOR 2.97, 95% CI 1.54, 5.73, P = 0.001) or die within a year of livebirth (aOR 2.87, 95% CI 1.51, 5.46, P = 0.001) compared with hospital births. Overall, 54 BBAs survived to one year (41% all BBAs, 67% liveborn BBAs), compared with 69% of hospital births (87% of livebirths). CONCLUSIONS Very preterm birth before arrival is more common in teenagers and is associated with significantly increased risks of perinatal and infant mortality compared with birth in a hospital.
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Affiliation(s)
- Rosemarie Anne Boland
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynecology, University of Melbourne, Parkville, Victoria, Australia.,Paediatric Infant Perinatal Emergency Retrieval, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Peter Graham Davis
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynecology, University of Melbourne, Parkville, Victoria, Australia.,Newborn Research Centre, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Jennifer Anne Dawson
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynecology, University of Melbourne, Parkville, Victoria, Australia.,Newborn Research Centre, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Michael J Stewart
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Paediatric Infant Perinatal Emergency Retrieval, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Jacqui Smith
- Paediatric Infant Perinatal Emergency Retrieval, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Lex William Doyle
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynecology, University of Melbourne, Parkville, Victoria, Australia.,Newborn Research Centre, Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
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Stensvold HJ, Klingenberg C, Stoen R, Moster D, Braekke K, Guthe HJ, Astrup H, Rettedal S, Gronn M, Ronnestad AE. Neonatal Morbidity and 1-Year Survival of Extremely Preterm Infants. Pediatrics 2017; 139:peds.2016-1821. [PMID: 28228499 DOI: 10.1542/peds.2016-1821] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine 1-year survival and major neonatal morbidities (intracranial hemorrhage grade >2, cystic periventricular leukomalacia, retinopathy of prematurity grade >2, necrotizing enterocolitis, severe bronchopulmonary dysplasia) among extremely preterm infants in Norway in 2013-2014, and to compare the results to the first Norwegian Extreme Prematurity Study 1999-2000 and similar contemporary European population-based studies. METHODS Population-based study of all infants born at 22 through 26 weeks' gestation in Norway in 2013-2014. Prospectively collected data were obtained by linking data in the Norwegian Neonatal Network to the Medical Birth Registry of Norway. RESULTS Of 420 infants (incidence 3.5 per 1000 births), 145 were stillborn (34.5%), 275 were live-born (82.3% of the 334 fetuses alive at admission for obstetrical care), and 251 (91.3% of live-born infants) were admitted to a neonatal unit. The survival among live-born infants was 18% at 22 weeks, 29% at 23 weeks, 56% at 24 weeks, 84% at 25 weeks and 90% at 26 weeks (for each week increment in gestational age: odds ratio 3.3; 95% confidence interval, 2.4-4.4). Among infants surviving to 1 year of age, major neonatal morbidity was diagnosed in 55%. Decreasing gestational age was moderately associated with rates of major morbidity (odds ratio 1.6; 95% confidence interval, 1.2-2.2). CONCLUSIONS Compared to the previous 1999-2000 cohort, the rate of stillbirth before admission to an obstetrical unit increased, whereas the survival rate among live born infants was similar in our 2013-2014 cohort. Neonatal morbidity rates remain high among extremely preterm infants.
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Affiliation(s)
- Hans Jorgen Stensvold
- Division of Paediatric and Adolescent Medicine, Neonatal Department, and .,Norwegian Neonatal Network, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Claus Klingenberg
- Division of Child and Adolescent Health. University Hospital of North Norway, Tromso, Norway.,Paediatric Research Group, Department of Health Sciences, University of Tromso, Norway
| | - Ragnhild Stoen
- Department of Pediatrics, St Olav Hospital, Trondheim, Norway.,Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Dag Moster
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Norway.,Medical Birth Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
| | - Kristin Braekke
- Division of Paediatric and Adolescent Medicine, Neonatal Department, and
| | - Hans Jorgen Guthe
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Henriette Astrup
- Department of Pediatrics, Sorlandet Hospital Trust, Kristiansand, Norway
| | - Siren Rettedal
- Children's Department, Stavanger University Hospital, Stavanger, Norway; and
| | - Morten Gronn
- Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lorenskog, Norway
| | - Arild E Ronnestad
- Division of Paediatric and Adolescent Medicine, Neonatal Department, and.,Norwegian Neonatal Network, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
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Boland RA, Davis PG, Dawson JA, Doyle LW. Outcomes of infants born at 22-27 weeks' gestation in Victoria according to outborn/inborn birth status. Arch Dis Child Fetal Neonatal Ed 2017; 102:F153-F161. [PMID: 27531224 DOI: 10.1136/archdischild-2015-310313] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 07/18/2016] [Accepted: 07/25/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To compare mortality and serious morbidity rates between outborn and inborn livebirths at 22-27 weeks' gestation. DESIGN Population-based cohort study. SETTING Victoria, Australia. PATIENTS Livebirths at 22-27 weeks' gestation free of major malformations in 2010-2011. INTERVENTIONS Outcome data for outborn (born outside a tertiary perinatal centre) infants compared with inborn (born in a tertiary perinatal centre) infants were analysed by logistic regression, adjusted for gestational age, birth weight and sex. MAIN OUTCOME MEASURES Infant mortality and serious morbidity rates to hospital discharge. RESULTS 541 livebirths free of major malformations were recorded. By 1 year, 49 (58%) outborns and 140 (31%) inborns died (adjusted OR (aOR) 2.78, 95% CI 1.52 to 5.09, p=0.001). In total, 445 infants were admitted to neonatal intensive care unit (NICU); 93 died by 1 year (14/49 outborns and 79/396 inborns), (aOR 1.75, 95% CI 0.87 to 3.55, p=0.12). There were no significant differences in rates of necrotising enterocolitis, intraventricular haemorrhage, retinopathy of prematurity, bronchopulmonary dysplasia (BPD) or the combined outcome of death or BPD in outborn infants compared with inborn infants. Outborns had an increased risk of cystic periventricular leukomalacia (cPVL) compared with inborns (12.2% vs 2.8%, respectively; aOR 5.34, 95% CI 1.84 to 15.54, p=0.002). CONCLUSIONS Mortality rates remained higher for outborn livebirths at 22-27 weeks' gestation compared with inborn peers in 2010-2011. Outborn infants admitted to NICU did not have substantially different rates of mortality or serious morbidity compared with inborns, with the exception of cPVL. Longer-term health consequences of outborn birth before 28 weeks' gestation need to be determined.
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Affiliation(s)
- Rosemarie Anne Boland
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynecology, University of Melbourne, Royal Women's Hospital, Parkville, Victoria, Australia.,Paediatric Infant Perinatal Emergency Retrieval, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Peter Graham Davis
- Department of Obstetrics and Gynecology, University of Melbourne, Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Jennifer Anne Dawson
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynecology, University of Melbourne, Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Lex William Doyle
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynecology, University of Melbourne, Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia
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Lamont RF, Keelan JA, Larsson PG, Jørgensen JS. The treatment of bacterial vaginosis in pregnancy with clindamycin to reduce the risk of infection-related preterm birth: a response to the Danish Society of Obstetrics and Gynecology guideline group's clinical recommendations. Acta Obstet Gynecol Scand 2017; 96:139-143. [DOI: 10.1111/aogs.13065] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 11/10/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Ronald F. Lamont
- Division of Surgery; University College London; Northwick Park Institute for Medical Research Campus; London UK
- Department of Gynecology and Obstetrics; Odense University Hospital; Research Unit of Gynecology and Obstetrics; Institute of Clinical Research; University of Southern Denmark; Odense Denmark
| | - Jeffrey A. Keelan
- School of Women's and Infants’ Health; The University of Western Australia; Perth WA Australia
| | - Per G. Larsson
- Department of Obstetrics and Gynecology; Skaraborg Hospital; University of Linköping; Skövde Sweden
| | - Jan S. Jørgensen
- Department of Gynecology and Obstetrics; Odense University Hospital; Research Unit of Gynecology and Obstetrics; Institute of Clinical Research; University of Southern Denmark; Odense Denmark
- Center for Innovative Medical Technology; Odense University Hospital; Odense Denmark
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Lamont CD, Jørgensen JS, Lamont RF. The safety of tocolytics used for the inhibition of preterm labour. Expert Opin Drug Saf 2016; 15:1163-73. [DOI: 10.1080/14740338.2016.1187128] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Callum D. Lamont
- Department of Medical Education, Lincoln County Hospital, Lincoln, UK
| | - Jan Stener Jørgensen
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, Research Unit of Gynaecology and Obstetrics, University of Southern Denmark, Odense, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Ronald F. Lamont
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, Research Unit of Gynaecology and Obstetrics, University of Southern Denmark, Odense, Denmark
- Division of Surgery, University College London, Northwick Park Institute for Medical Research Campus, London, UK
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20
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Boland RA, Dawson JA, Davis PG, Doyle LW. Why birthplace still matters for infants born before 32 weeks: Infant mortality associated with birth at 22-31 weeks' gestation in non-tertiary hospitals in Victoria over two decades. Aust N Z J Obstet Gynaecol 2016; 55:163-9. [PMID: 25921005 DOI: 10.1111/ajo.12313] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 12/20/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Very preterm infants born in non-tertiary hospitals ('outborn') are known to have higher mortality rates compared with infants 'inborn' in tertiary centres. AIM The aim of this study was to report changes over time in the incidence of outborn livebirths, 22-31 weeks and infant mortality rates for outborn compared with inborn births. METHODS We conducted a population-based cohort study of consecutive livebirths, 22-31 weeks' gestation in Victoria from 1990 to 2009. The relationship between birthplace, gestational age, birthweight, sex and infant mortality were analysed by logistic regression. RESULTS There were 13,760 livebirths, 22-31 weeks: 14% were outborn. The proportion of outborn livebirths fell from 19% in 1991 to a nadir of 9% in 1997, but climbed to 17% by 2009. At all times, outborns had higher mortality rates compared with inborns. The overall infant mortality rate was 250.6 per 1000 outborn compared with 113.3 per 1000 inborn livebirths (adjusted odds ratio (aOR) 2.76 (95% CI 2.32, 3.27, P < 0.001). There were no differences between outborn and inborn mortality risks for 22-week livebirths (OR 7.04, 95% CI 0.87, 56.8, P = 0.067), but there were at 23-27 weeks (aOR 3.16, 95% CI 2.52, 3.96, P < 0.001) and at 28-31 weeks (aOR 1.66, 95% CI 1.19, 2.31, P = 0.003). Over time, mortality rates fell for inborn 23-27 week infants. Mortality rates fell for outborn 23-27 week infants in 1990-2005, but rose in 2006-2009. CONCLUSIONS Outborn livebirths at 22-31 weeks' gestation occur too frequently and are associated with a significantly increased risk of mortality. Strategies to reduce outborn livebirths are required.
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Affiliation(s)
- Rosemarie Anne Boland
- Department of Obstetrics and Gynaecology, University of Melbourne, The Royal Women's Hospital, Parkville, Vic, Australia; Murdoch Childrens Research Institute, Parkville, Vic, Australia; Paediatric Infant Perinatal Emergency Retrieval, Royal Children's Hospital, Parkville, Vic, Australia
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Lamont RF. Advances in the Prevention of Infection-Related Preterm Birth. Front Immunol 2015; 6:566. [PMID: 26635788 PMCID: PMC4644786 DOI: 10.3389/fimmu.2015.00566] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 10/23/2015] [Indexed: 11/17/2022] Open
Abstract
Infection-related preterm birth (PTB) is more common at early gestational ages and is associated with major neonatal mortality and morbidity. Abnormal genital tract microflora in early pregnancy predicts late miscarriage and early PTB. Accordingly, it is logical to consider antibiotics as an intervention. Unfortunately, the conclusions of systematic reviews and meta-analyses (SR&MAs) carried out in an attempt to explain the confusion over the heterogeneity of individual studies are flawed by the fact that undue reliance was placed on studies which: (a) had a suboptimal choice of antibiotic (mainly metronidazole) or used antibiotics not recommended for the treatment of bacterial vaginosis (BV) or BV-related organisms; (b) used antibiotics too late in pregnancy to influence outcome (23–27 weeks); and (c) included women whose risk of PTB was not due to abnormal genital tract colonization and hence unlikely to respond to antibiotics. These risks included: (a) previous PTB of indeterminate etiology; (b) low weight/body mass index; or (c) detection of fetal fibronectin, ureaplasmas, Group B streptococcus or Trichomonas vaginalis). While individual studies have found benefit of antibiotic intervention for the prevention of PTB, in meta-analyses these effects have been negated by large methodologically flawed studies with negative results. As a result, many clinicians think that any antibiotic given at any time in pregnancy to any woman at risk of PTB will cause more harm than good. Recently, a more focused SR&MA has demonstrated that antibiotics active against BV-related organisms, used in women whose risk of PTB is due to abnormal microflora, and used early in pregnancy before irreversible inflammatory damage has occurred, can reduce the rate of PTB. This review presents those data, the background and attempts to explain the confusion using new information from culture-independent molecular-based techniques. It also gives guidance on the structure of putative future antibiotic intervention studies.
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Affiliation(s)
- Ronald F Lamont
- Research Unit of Gynecology and Obstetrics, Department of Gynecology and Obstetrics, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark , Odense , Denmark ; Division of Surgery, University College London , London , UK
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Källén K, Serenius F, Westgren M, Maršál K. Impact of obstetric factors on outcome of extremely preterm births in Sweden: prospective population-based observational study (EXPRESS). Acta Obstet Gynecol Scand 2015; 94:1203-14. [PMID: 26249263 DOI: 10.1111/aogs.12726] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/31/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION A population-based observational study investigated the contribution of obstetric factors to the survival and postnatal development of extremely preterm infants. MATERIAL AND METHODS Mortality up to 1 year and neurodevelopment at 2.5 years (Bayley-III test, cerebral palsy, vision, hearing) were evaluated in infants born before 27 weeks of gestation in Sweden 2004-2007 (n = 1011), using logistic regression analyses of risk factors. RESULTS Of 844 fetuses alive at admission, 8.4% died in utero before labor, 7.8% died intrapartum. Of 707 live-born infants, 15% died within 24 h, 70% survived ≥365 days, 64% were assessed at 2.5 years. The risk of death within 24 h after birth decreased with gestational age [odds ratio (OR) 0.3; 95% CI 0.2-0.4], antenatal corticosteroids (OR 0.3; 95% CI 0.1-0.6), and cesarean section (OR 0.4; 95% CI 0.2-0.9); it increased with multiple birth (OR 3.0; 95% CI 1.5-6.0), vaginal breech delivery (OR 2.3; 95% CI 1.0-5.1), 5-min Apgar score <4 (OR 50.4; 95% CI 28.2-90.2), and birth at a level II hospital (OR 2.6; 95% CI 1.2-5.3). The risk of death between 1 and 365 days remained significantly decreased for gestational age and corticosteroids. The risk of mental developmental delay at 2.5 years decreased with gestational age, birthweight and fetal growth; it increased with vaginal breech delivery (OR 2.0; 95% CI 1.2-7.4), male gender, low Apgar score and high Clinical Risk Index for Babies score. CONCLUSION Several obstetric factors, including abdominal delivery, influenced the risk of death within the first day of life, but not later. Antenatal corticosteroids and gestational age decreased the mortality up to 1 year. Mental developmental delay was related to vaginal breech delivery.
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Affiliation(s)
- Karin Källén
- Centre for Reproductive Epidemiology, Lund University, Lund, Sweden
| | - Fredrik Serenius
- Women's and Children's Health, Section for Pediatrics, Uppsala University, Uppsala, Sweden.,Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Magnus Westgren
- Department of Obstetrics and Gynecology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Karel Maršál
- Department of Obstetrics and Gynecology, Clinical Sciences Lund, Lund University, Lund, Sweden
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Månsson C, Jakobsson U, Lundqvist P. Translation and psychometric evaluation of a Swedish version of the parental stressor scale PSS: NICU. Scand J Caring Sci 2015; 30:193-201. [DOI: 10.1111/scs.12217] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 12/29/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Catrin Månsson
- Department of Neonatology; Skåne University Hospital; Lund Sweden
| | - Ulf Jakobsson
- Center for Primary Health Care Research; Faculty of Medicine; Lund University; Lund Sweden
| | - Pia Lundqvist
- Department of Health Sciences; Faculty of Medicine; Lund University; Lund Sweden
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Preterm prelabor rupture of membranes and outcome of very-low-birth-weight infants in the German Neonatal Network. PLoS One 2015; 10:e0122564. [PMID: 25856083 PMCID: PMC4391753 DOI: 10.1371/journal.pone.0122564] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 02/23/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE It was the aim of our study to evaluate the independent effect of preterm prelabor rupture of membranes (PPROM) as a cause of preterm delivery on mortality during primary hospital stay and significant morbidities in very-low-birth-weight (VLBW) infants < 32 weeks of gestation. DESIGN Observational, epidemiological study design. SETTING Population-based cohort, German Neonatal Network (GNN). POPULATION 6102 VLBW infants were enrolled in GNN from 2009-2012, n=4120 fulfilled criteria for primary analysis (< 32 gestational weeks, no pre-eclampsia, HELLP (highly elevated liver enzymes and low platelets syndrome) or placental abruption as cause of preterm birth). METHODS Multivariable logistic regression analyses included PPROM as potential risk factors for adverse outcomes and well established items such as gestational age in weeks, birth weight, antenatal steroids, center, inborn delivery, multiple birth, gender and being small-for-gestational-age. RESULTS PPROM as cause of preterm delivery had no independent effect on the risk of early-onset sepsis, clinical sepsis and blood-culture proven sepsis, while gestational age proved to be the most important contributor to sepsis risk. The diagnosis of PPROM was associated with an increased risk for bronchopulmonary dysplasia (BPD; OR: 1.25, 95% CI: 1.02-1.55, p=0.03) but not with other major outcomes. CONCLUSIONS The diagnosis of PPROM per se is not associated with adverse outcome in VLBW infants < 32 weeks apart from a moderately increased risk for BPD. Randomized controlled trials with primary neonatal outcomes are needed to determine which subgroup of VLBW infants benefit from expectant or intentional management of PPROM.
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Joergensen JS, Kjær Weile LK, Lamont RF. The early use of appropriate prophylactic antibiotics in susceptible women for the prevention of preterm birth of infectious etiology. Expert Opin Pharmacother 2014; 15:2173-91. [DOI: 10.1517/14656566.2014.950225] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Marlow N, Bennett C, Draper ES, Hennessy EM, Morgan AS, Costeloe KL. Perinatal outcomes for extremely preterm babies in relation to place of birth in England: the EPICure 2 study. Arch Dis Child Fetal Neonatal Ed 2014; 99:F181-8. [PMID: 24604108 PMCID: PMC3995269 DOI: 10.1136/archdischild-2013-305555] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Expertise and resources may be important determinants of outcome for extremely preterm babies. We evaluated the effect of place of birth and perinatal transfer on survival and neonatal morbidity within a prospective cohort of births between 22 and 26 weeks of gestation in England during 2006. METHODS We studied the whole population of 2460 births where the fetus was alive at the admission of the mother to hospital for delivery. Outcomes to discharge were compared between level 3 (most intensive) and level 2 maternity services, with and without transfers, and by activity level of level 3 neonatal unit; ORs were adjusted for gestation at birth and birthweight for gestation (adjusted ORs (aOR)). FINDINGS Of this national birth cohort, 56% were born in maternity services with level 3 and 34% with level 2 neonatal units; 10% were born in a setting without ongoing intensive care facilities (level 1). When compared with level 2 settings, risk of death in level 3 services was reduced (aOR 0.73 (95% CI 0.59 to 0.90)), but the proportion surviving without neonatal morbidity was similar (aOR 1.27 (0.93 to 1.74)). Analysis by intended hospital of birth confirmed reduced mortality in level 3 services. Following antenatal transfer into a level 3 setting, there were fewer intrapartum or labour ward deaths, and overall mortality was higher for those remaining in level 2 services (aOR 1.44 (1.09 to 1.90)). Among level 3 services, those with higher activity had fewer deaths overall (aOR 0.68 (0.52 to 0.89)). INTERPRETATION Despite national policy, only 56% of births between 22 and 26 weeks of gestation occurred in maternity services with a level 3 neonatal facility. Survival was significantly enhanced following birth in level 3 services, particularly those with high activity; this was not at the cost of increased neonatal morbidity.
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Affiliation(s)
- N Marlow
- Academic Neonatology, UCL Institute for Women's Health, London
| | - C Bennett
- Academic Neonatology, UCL Institute for Women's Health, London
| | - E S Draper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - E M Hennessy
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - A S Morgan
- Academic Neonatology, UCL Institute for Women's Health, London
| | - K L Costeloe
- Centre For Paediatrics, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK,Homerton University Hospital, NHS Foundation Trust, London, UK
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Jørgensen JS, Weile LKK, Lamont RF. Preterm labor: current tocolytic options for the treatment of preterm labor. Expert Opin Pharmacother 2014; 15:585-8. [DOI: 10.1517/14656566.2014.880110] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lamont RF, Kam KYR. Atosiban as a tocolytic for the treatment of spontaneous preterm labor. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.3.2.163] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Svedenkrans J, Henckel E, Kowalski J, Norman M, Bohlin K. Long-term impact of preterm birth on exercise capacity in healthy young men: a national population-based cohort study. PLoS One 2013; 8:e80869. [PMID: 24324639 PMCID: PMC3855651 DOI: 10.1371/journal.pone.0080869] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 10/09/2013] [Indexed: 11/18/2022] Open
Abstract
Background Increasing numbers of survivors of preterm birth are growing into adulthood today. Long-term health-effects of prematurity are still poorly understood, but include increased risk for diabetes, obesity and cardiovascular diseases in adult life. To test if reduced physical fitness may be a link in the causal chain of preterm birth and diseases in later life, the association of preterm birth and adult exercise capacity was investigated. The hypothesis was that preterm birth contributes independently of other risk factors to lower physical fitness in adulthood. Methods and Findings Population-based national cohort study of all males conscripting for military service in 1993–2001 and born in Sweden 1973–1983, n = 218,820. Data were retrieved from the Swedish Conscript Register, the Medical Birth Register and the Population and Housing Census 1990. Primary outcome was the results from maximal exercise test (Wmax in Watt) performed at conscription. Association to perinatal and socioeconomic risk factors, other co-variates and confounders were analysed. General linear modelling showed that preterm birth predicted low Wmax in a dose-response related pattern, with 25 Watt reduction in Wmax for the lowest gestational ages, those born ≤27 weeks. Low birth weight for gestational age also independently predicted low Wmax compared to normal and high birth weight (32 Watt reduction for those with a birth weight Standard Deviation Score <2). Low parental education was significantly associated with reduced Wmax (range 17 Watt), as well as both low and high current BMI, with severe obesity resulting in a 16 Watt deficit compared to Wmax top performance. Conclusion Being born preterm as well as being born small for gestational age predicts low exercise capacity in otherwise healthy young men. The effect size of being born preterm equal or exceed that of other known risk factors for unfitness in adults, such as low parental education and overweight.
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Affiliation(s)
- Jenny Svedenkrans
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Ewa Henckel
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Jan Kowalski
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Kajsa Bohlin
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Karolinska University Hospital Huddinge, Stockholm, Sweden
- * E-mail:
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Georgsdottir I, Haraldsson A, Dagbjartsson A. Behavior and well-being of extremely low birth weight teenagers in Iceland. Early Hum Dev 2013; 89:999-1003. [PMID: 24041813 DOI: 10.1016/j.earlhumdev.2013.08.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 08/14/2013] [Accepted: 08/22/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Preterm children are at risk for behavioral and emotional problems. AIMS To evaluate behavior and emotional well-being of extremely low birth weight (ELBW) teenagers born in Iceland in 1991-1995. METHODS Participants, 30 of 35 ELBW survivors (25 girls, 5 boys, mean age 16.8 years), were interviewed, underwent medical examination and answered the Youth Self-Report for ages 11-18 (YSR) of the Achenbach System of Empirically Based Assessment (ASEBA). The ELBW parents answered the ASEBA Child Behavior Checklist for ages 6-18 and the Autism Spectrum Screening Questionnaire (ASSQ). A comparison group of 30 teenagers (23 girls, 7 boys, mean age 16.5 years) answered the YSR questionnaire and their parents answered the CBCL and ASSQ questionnaires. RESULTS ELBW teenagers and parents report more behavior problems than the full term comparison teenagers and parents. They score significantly higher on the YSR and CBCL syndrome scales except for YSR and CBCL rule-breaking behavior and CBCL thought problems. The ELBW teenagers self-report on total competence, activities, social participation and academic performance was not significantly lower than the comparison teenagers. Parents of ELBW teenagers rated total competence, social participation and school performance of their children significantly lower than parents of comparison teenagers. The YSR Positive Qualities Scale was not significantly different between the two teenage groups. Two ELBW teenagers scored above cut-off points on the ASSQ questionnaire and none of the comparison teenagers. Bullying was reported by 20% of ELBW parents compared to none of the comparison group. CONCLUSION ELBW teenagers experience emotional, behavior and social challenges. The teenagers value their positive qualities, activities and academic performance similar to peers.
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Abstract
Confusion in terminology and non-standardized definitions can arguably be classified as the most important characteristics that lead to disparate study findings. While such situations abound in all of perinatal epidemiology, the study of "periviable birth" is a classic case in point. The most common term used to describe periviable birth has been extremely low birthweight (ELBW), often defined as newborns with birthweight below 1000g; yet, we identified 11 other descriptors for periviable birth. Due to the multitude of definitions, the reported incidence of periviable births varies from 0.03% to 1.9% (a relative difference of 7025%). Antecedent risk factors for periviable birth, though geographically heterogeneous, include nulliparity and multiple gestations, each accounting for one-third and one-fourth of all periviable births, respectively. Spontaneous preterm labor precedes 34% of these deliveries and premature rupture of membranes in 25%. The pregnancy was complicated by hypertensive disease in 21% and bleeding and chorioamnionitis in 18% each. Over 50% of these births are cesarean deliveries. Six clinical interventions before delivery that may improve outcomes include transfer of patient to a tertiary center, administration of antenatal corticosteroids, tocolytics, or antibiotics after premature rupture of membranes, assessment of fetal well-being with electronic fetal heart rate monitoring, and willingness to perform a cesarean delivery after the limit of viability is reached. While there is an accessible predictive model for mortality and long-term morbidities for newborns delivered at 22-25 weeks with weights of 400-1000g, it is hampered by the need to know the birthweight. In addition to reaching a consensus regarding what birthweight-gestational age thresholds determine a periviable birth, the acute need to optimize neonatal outcomes remains a paramount target worthy of future research, and efforts to advance obstetrical medicine are needed to minimize the likelihood of its occurrence.
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Affiliation(s)
- Suneet P Chauhan
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, 845 Fairfax Ave, Suite 544, Norfolk, VA 23507.
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Ahle M, Drott P, Andersson RE. Epidemiology and trends of necrotizing enterocolitis in Sweden: 1987-2009. Pediatrics 2013; 132:e443-51. [PMID: 23821702 DOI: 10.1542/peds.2012-3847] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To investigate temporal, seasonal, and geographic variations in the incidence of necrotizing enterocolitis (NEC) and its relation to early infant survival in the Swedish population and in subgroups based on gestational age, birth weight, and gender. METHODS In the Swedish birth cohort of 1987 through 2009 all children with a diagnosis of NEC were identified in the National Patient Register, the Swedish Medical Birth Register, and the National Cause of Death Register. NEC incidence, early mortality, and seasonality were analyzed with descriptive statistics, Poisson regression, and auto regression. RESULTS The overall incidence of NEC was 3.4 in 10,000 live births, higher in boys than in girls (incidence rate ratio 1.22, 95% confidence interval 1.06-1.40, P = .005), with a peak in November and a trough in May, and increased with an average of ~5% a year during the study period. In most subgroups, except the most immature, an initial decrease was followed by a steady increase. Seven-day mortality decreased strongly in all subgroups over the entire study period (annual incidence rate ratio 0.96, 95% confidence interval 0.95-0.96, P < .001). This was especially marked in the most premature and low birth weight infants. CONCLUSIONS After an initial decrease, the incidence of NEC has increased in Sweden during the last decades. An association with the concurrent dramatically improved early survival seems likely.
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Affiliation(s)
- Margareta Ahle
- Department of Radiology, University Hospital, 581 85 Linköping, Sweden.
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Survival and morbidity among two cohorts of extremely low birth weight neonates from a tertiary hospital in northern India. Indian Pediatr 2013; 50:1047-50. [PMID: 23798639 DOI: 10.1007/s13312-013-0278-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 05/14/2013] [Indexed: 10/26/2022]
Abstract
This study was conducted to compare the survival and morbidity of extremely low birth weight neonates born during two different time periods (2009-10 and 2001-02) at a Level III referral neonatal unit in Northern India. All consecutive intramural extremely low birth weight neonates (<1000g), irrespective of gestation, and admitted to Intensive Care were enrolled. 149 and 123 neonates were enrolled during 2009-10 and 2001-02, respectively. The baseline characteristics were comparable except for mean birth weight, which was lower during 2009-10 (843±108g vs 885±126g, P=0.003). Surfactant therapy (54% vs 18%, P<0.001), non-invasive ventilation (28% vs 6%, P<0.001), high frequency ventilation (24% vs 4%, P=0.001), IVH (52% vs 25%, P<0.001) and PDA (34% vs 18%, P=0.004) were significantly more during 2009-10. Culture positive sepsis (33% vs 51%, P=0.003) and ROP rates (7% vs 23%, P=0.042) were significantly higher during 2001-02. Overall survival was similar; however, neonates between 28-30 weeks gestation had better survival (63%) during 2009-10 compared to 2001-02 (38%), P=0.009. Survival in neonates 28-30 weeks improved during this period while overall survival remained the same.
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Lee TC, Chiang MF. Pediatric Retinal Vascular Diseases. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00061-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Affiliation(s)
- Ahizechukwu C Eke
- Washington University School of Medicine; Department of Obstetrics and Gynecology; 4911 Barnes-Jewish Hospital (BJC) Plaza Campus Box 8064 St Louis MO USA 63110
| | - Ifeanyichukwu U Ezebialu
- Faculty of Clinical medicine, College of Medicine, Anambra State University Amaku,; Department of Obstetrics and Gynaecology; Awka Nigeria
| | - George U Eleje
- Nnamdi Azikiwe University Teaching Hospital; Department of Obstetrics and Gynaecology; Nnewi Anambra State Nigeria
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Maastrup R, Bojesen SN, Kronborg H, Hallström I. Breastfeeding support in neonatal intensive care: a national survey. J Hum Lact 2012; 28:370-9. [PMID: 22674965 DOI: 10.1177/0890334412440846] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The incidence of breastfeeding of preterm infants is affected by the support provided at the hospital and in the neonatal intensive care unit (NICU). However, policies and guidelines promoting breastfeeding vary both nationally and internationally. OBJECTIVES The aim of this survey was to describe breastfeeding support in Danish NICUs, where approximately 98% of mothers initiate lactation. METHODS A national survey of all 19 Danish NICUs was conducted in 2009. Four NICUs were at designated Baby-Friendly hospitals, and 5 had a lactation consultant. In all NICUs, it was possible for some parents to stay overnight; 2 units had short restrictions on parents' presence. Five NICUs had integrated postpartum care for mothers. Breastfeeding policies, written guidelines, and systematic breastfeeding training for the staff were common in most NICUs. Seventeen NICUs recommended starting breast milk expression within 6 hours after birth, and mothers were encouraged to double pump. Most NICUs aimed to initiate skin-to-skin contact the first time the parents were in the NICU, and daily skin-to-skin contact was estimated to last for 2-4 hours in 63% and 4-8 hours in 37% of the units. The use of bottle-feeding was restricted. CONCLUSIONS The Danish NICUs described the support of breastfeeding as a high priority, which was reflected in the recommended policies for breast milk pumping, skin-to-skin contact, and the parents' presence in the NICU, as well as in the restricted use of bottle-feeding. However, support varied between units, and not all units supported optimal breastfeeding.
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Affiliation(s)
- Ragnhild Maastrup
- Knowledge Centre for Breastfeeding Infants with Special Needs, Department of Neonatology, Rigshospitalet, Copenhagen, Denmark.
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Jonsdottir GM, Georgsdottir I, Haraldsson A, Hardardottir H, Thorkelsson T, Dagbjartsson A. Survival and neurodevelopmental outcome of ELBW children at 5 years of age: comparison of two cohorts born 10 years apart. Acta Paediatr 2012; 101:714-8. [PMID: 22404100 DOI: 10.1111/j.1651-2227.2012.02645.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To examine survival and outcome of extremely low-birth-weight (ELBW) children (birth weight < 1000 g) in two 5-year periods, 10 years apart. METHODS In a retrospective population-based study, information on all ELBW children born in Iceland in 1991-1995 and in 2001-2005 was obtained from the National Birth Registry, hospital charts and medical records. The two periods were compared. RESULTS In 1991-1995, 102 of 22.261 newborn children (0.5%) were extremely low birth weight compared with 70 of 20.923 newborns (0.33%) in 2001-2005 (p = 0.04). At 5 years of age, 52% (35/67) of live-born children born in 1991-1995 were alive compared with 63% (31/49) of children born in 2001 - 2005 (p = 0.2). Six ELBW children (17%) born 1991-1995 were diagnosed with disabilities at 5 years of age, three with major neurodevelopmental disabilities compared with six (19%) born 2001-2005, thereof one with severe neurodevelopmental disabilities (p = 0.57). CONCLUSION The incidence of childhood disabilities in ELBW children in Iceland remains stable despite an increase in survival rate. The severity of neurodevelopmental disabilities has decreased.
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Affiliation(s)
- Orvar Finnström
- Department of Paediatrics, University Hospital, Linköping, Sweden.
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Georgsdottir I, Erlingsdottir G, Hrafnkelsson B, Haraldsson A, Dagbjartsson A. Disabilities and health of extremely low-birthweight teenagers: a population-based study. Acta Paediatr 2012; 101:518-23. [PMID: 22211629 DOI: 10.1111/j.1651-2227.2011.02576.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Evaluation of long-term outcome of extremely low-birthweight (ELBW) teenagers born in Iceland in 1991-1995. METHOD Participants, 30 of 35 ELBW survivors and 30 full term control teenagers (14-19 years), were assessed for disabilities, health problems and learning difficulties. Results of national standardized tests in mathematics and Icelandic language were compared with results of neurodevelopmental assessment at 5 years of age. RESULTS A quarter of the ELBW teenagers had disabilities. All were initially diagnosed with neurodevelopmental disorders early in life and neurosensory and/or intellectual disabilities were confirmed later in childhood. Chronic lung disorders, neurological problems and psychiatric disorders were most common health problems. Growth parameters were within normal limits for most of the ELBW teenagers. Learning difficulties affected 57% of the ELBW teenagers, 20% attended special education classes and 37% required special teaching. Results of national standardized tests were significantly lower for ELBW survivors and were significantly related to the results of neurodevelopmental assessment at 5 years of age. INTERPRETATION A quarter of ELBW teenagers have disabilities albeit most of them mild. Chronic health problems and learning difficulties affect many ELBW survivors. Changes with time emphasize need of long-term follow-up.
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Danerek M, Maršál K, Cuttini M, Lingman G, Nilstun T, Dykes AK. Attitudes of Swedish midwives towards management of extremely preterm labour and birth. Midwifery 2011; 28:e857-64. [PMID: 22169524 DOI: 10.1016/j.midw.2011.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 10/19/2011] [Accepted: 10/24/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE the aim of the study was to ascertain the attitudes of Swedish midwives towards management of very preterm labour and birth and to compare the attitudes of midwives at university hospitals with those at general hospitals. DESIGN this cross-sectional descriptive and comparative study used an anonymous self-administrated questionnaire for data collection. Descriptive and analytic statistics were carried out for analysis. PARTICIPANTS the answers from midwives (n=259) were collected in a prospective SWEMID study. SETTING the midwives had experience of working on delivery wards in maternity units with neonatal intensive care units (NICU) in Sweden. FINDINGS in the management of very preterm labour and birth, midwives agreed to initiate interventions concerning steroid prophylaxis at 23 gestational weeks (GW), caesarean section for preterm labour only at 25 GW, when to give information to the neonatologist before birth at 23 GW, and when to suggest transfer to NICU at 23 GW. Midwives at university hospitals were prone to start interventions at an earlier gestational age than the midwives at general hospitals. Midwives at university hospitals seemed to be more willing to disclose information to the parents. KEY CONCLUSIONS midwives with experience of handling very preterm births at 21-28 GW develop a positive attitude to interventions at an earlier gestational age as compared to midwives without such experience. IMPLICATIONS FOR PRACTICE based on these results we suggest more communication and transfer of information about the advances in perinatal care and exchange of knowledge between the staff at general and university hospitals. Establishment of platforms for inter-professional discussions about ethically difficult situations in perinatal care, might benefit the management of very preterm labour and birth.
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Affiliation(s)
- Margaretha Danerek
- Department of Health Sciences, Faculty of Medicine, University Lund, Box 157, 221 00 Lund, Sweden.
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Huotilainen M, Lovio R, Kujala T, Tommiska V, Karma K, Fellman V. Could audiovisual training be used to improve cognition in extremely low birth weight children? Acta Paediatr 2011; 100:1489-94. [PMID: 21535135 DOI: 10.1111/j.1651-2227.2011.02345.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To study whether a dyslexia remediation programme, Audilex, improves cognition in extremely low birth (ELBW) children. METHODS Six-year-old ELBW children were allocated to a 5-week training with Audilex or playing control computer games. Before and after intervention, auditory event-related brain potentials (ERP) to sound changes were recorded and reading related skills assessed. Primary outcome was the mismatch negativity (MMN) component of ERP. Secondary outcomes were Audilex Test (ability to perform the Audilex games), the reading skills after the intervention and 2 years later. Of eligible children, 39 (54%) consented and 22 (30%) completed the protocol. RESULTS The MMN responses to the frequency (p = 0.02) and duration deviants (p < 0.01) increased after Audilex training (n = 11), but not after control game playing (n = 11). Audilex Test performance was similar in both groups. The reading skills were similar after intervention and 2 years later; word reading score 59.7, 66.8 and 74.9 and comprehensive reading score 8.1, 8.8 and 9.4 in Audilex, Control and healthy class-mate children, respectively. CONCLUSIONS Although all children did not complete the protocol, the results suggest that training with Audilex dyslexia programme might be beneficial for enhancing neural-level sound discrimation and possibly reading skills in ELBW children. A larger trial is warranted.
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Affiliation(s)
- Minna Huotilainen
- Cognitive Brain Research Unit, Cognitive Science, Institute of Behavioural Sciences, University of Helsinki, Finland
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Neonatal outcomes of very preterm infants admitted to a tertiary center in Lithuania between the years 2003 and 2005. Eur J Pediatr 2011; 170:1293-303. [PMID: 21404102 DOI: 10.1007/s00431-011-1431-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 02/16/2011] [Indexed: 10/18/2022]
Abstract
The objectives of the study are to investigate gestational age-specific mortality and neonatal outcomes in preterm infants admitted to a tertiary center in Lithuania, and to make comparison with tertiary centers in western countries. Three hundred thirty-eight newborns born at ≤ 32 weeks of gestation and with birth weight ≤ 1,500 g between 1 January 2003 and 31 December 2005, admitted to the neonatal intensive care unit at Kaunas Medical University Hospital, were prospectively investigated. Mortality and associations between maternal, perinatal, and neonatal variables and short-term outcomes were examined for two gestational age (GA) groups (group I, extremely preterm, 22-27 weeks GA; group II, very preterm, 28-32 weeks GA). Mortality in group I was 53.5% and 2.9% in group II. GA <28 weeks, Apgar score <5 at 5 min, and birth weight <1,000 g posed the highest risk for death. Overall, 78.2% of the surviving infants were discharged from hospital without adverse short-term outcomes. The incidence of bronchopulmonary dysplasia (BPD) was 6.3%, of retinopathy of prematurity (ROP) requiring treatment 4.2%, of intraventricular hemorrhage (IVH) III-IV 10.9%, and for cystic periventricular leukomalacia (cPVL) 8.0%. In conclusion, a decade after introduction of perinatal programs, mortality in the very preterm group is similar to those reported from cohorts in western countries. In the extremely preterm group, however, mortality is still higher. Neonatal outcomes such as ROP are now similar, and BPD is lower to those in other cohorts, whereas the incidence of brain lesions is still higher. We speculate that differences in outcomes between studies may be explained by differences in resources, definitions, and treatment routines.
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Farooqi A, Hägglöf B, Sedin G, Serenius F. Impact at age 11 years of major neonatal morbidities in children born extremely preterm. Pediatrics 2011; 127:e1247-57. [PMID: 21482612 DOI: 10.1542/peds.2010-0806] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Uncertainty continues regarding the extent to which neonatal morbidities predict poor long-term outcome and functional abilities in extremely preterm infants. OBJECTIVE The goal of this study was to determine the impact of bronchopulmonary dysplasia (BPD), ultrasonographic signs of brain injury, and severe retinopathy of prematurity (ROP) on 11-year outcomes in infants born at <26 weeks' gestation. METHODS A total of 247 infants were born alive before 26 completed weeks of gestation from 1990 through 1992 in all of Sweden, and 98 (40%) survived to a postmenstrual age of 36 weeks. Main outcome measures were (1) poor outcome, defined as combined end point of death after 36 weeks' postmenstrual age or survival with at least 1 major disability at 11 years, and (2) consequences of chronic conditions in the survivors according to a validated instrument administered to parents. RESULTS Brain injury and severe ROP but not BPD correlated independently with poor outcome at 11 years of age. Among children who were free from BPD, brain injury, and severe ROP, 10% had a poor outcome. Corresponding rates with any 1, any 2, and all 3 neonatal morbidities were 19%, 58%, and 80%, respectively. Multivariate analysis revealed that brain injury and severe ROP were associated with high rates of consequences of chronic conditions. CONCLUSIONS In infants born extremely preterm who survive to a postmenstrual age of 36 weeks, severe ROP and brain injury separately predict the risk of death or major disability at 11 years of age. Thus, continued research to determine how to prevent these complications of prematurity is critical.
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Affiliation(s)
- Aijaz Farooqi
- Institute of Clinical Sciences, Department of Pediatrics, University Hospital, SE-901 85 Umeå, Sweden.
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El tractocile como tratamiento de mantenimiento en la amenaza de parto prematuro en casos seleccionados. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2011. [DOI: 10.1016/j.gine.2009.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Danerek M, Maršál K, Cuttini M, Lingman G, Nilstun T, Dykes AK. Attitudes of midwives in Sweden toward a woman's refusal of an emergency cesarean section or a cesarean section on request. Birth 2011; 38:71-9. [PMID: 21332777 DOI: 10.1111/j.1523-536x.2010.00440.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND A woman's refusal or request for a cesarean section can be a problem for midwives and obstetricians working in maternity units. The objective of this study was to describe the attitudes of midwives in Sweden toward the obstetrician's decision making in relation to a woman's refusal of an emergency cesarean section and to a woman's request for a cesarean section without a medical indication. METHODS The study has a cross-sectional multicenter design and used an anonymous, structured, and standardized questionnaire for data collection. The study group comprised midwives who had experience working at a delivery ward at 13 maternity units with neonatal intensive care units in Sweden (n = 259). RESULTS In the case of a woman's refusal to undergo an emergency cesarean section for fetal reasons, most midwives (89%) thought that the obstetrician should try to persuade the woman to agree. Concerning a woman's request for a cesarean section without any medical indications, most midwives thought that the obstetrician should agree if the woman had previous maternal or fetal complications. The reason was to support the woman's decision out of respect for her autonomy; the midwives at six university hospitals were less willing to accept the woman's autonomy in this situation. If the only reason was "her own choice," 77 percent of the midwives responded that the obstetrician should not comply. CONCLUSIONS The main focus of midwives seems to be the baby's health, and therefore they do not always agree with respect to a woman's refusal or request for a cesarean section. The midwives prefer to continue to explain the situation and persuade the woman to agree with the recommendation of the obstetrician.
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Affiliation(s)
- Margaretha Danerek
- Department of Health Sciences, Faculty of Medicine, University Lund, Lund, Sweden
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Pantou K, Drougia A, Krallis N, Hotoura E, Papassava M, Andronikou S. Perinatal and neonatal mortality in Northwest Greece (1996-2004). J Matern Fetal Neonatal Med 2011; 23:1237-43. [PMID: 20082595 DOI: 10.3109/14767050903544769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE An improvement in perinatal mortality is reported in various countries. This is a retrospective analysis of perinatal and neonatal mortality in Northwest (NW) Greece. METHODS Analysis was made of the births and deaths register in NW Greece and records of the regional referral tertiary care center and the National Hospitals at the same area for the period 1996-2004. Perinatal mortality was analysed according to birthweight (BW) and gestational age (GA) for two separate periods, 1996-1999 (I) and 2000-2004 (II), corresponding to an increase in antenatal steroid use from 20% to 63%. RESULTS Neonatal mortality improved between the two periods in infants with very low BW [very low birth weight (VLBW), <1500 g] and the very preterm infants (<28 weeks GA). Severe respiratory distress syndrome (RDS) decreased (p<0.001) for infants with GA≤34 weeks and those with BW 751-1500 g (p<0.02), and perinatal asphyxia is no longer a leading cause of death. Intrauterine transfer increased (p<0.001) for infants with BW≤1500 g. The main cause of death as derived from birth records and neonatal intensive care unit records is prematurity, alone or with complications. CONCLUSIONS With the introduction of antenatal steroids and increase in intrauterine transfer there has been a decrease in neonatal mortality of VLBW infants in NW Greece.
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Affiliation(s)
- K Pantou
- Neonatal Intensive Care Unit, Department of Child Health, School of Medicine, University of Ioannina, Ioannina, Greece
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Abstract
UNLABELLED Ethical dilemmas in neonatology can be analysed using both the theoretical tools of analytic philosophy and the empirical tools of clinical epidemiology and health services research. Both yield important insights into ways to think about the ethical issues that arise in clinical neonatology. In this paper, we review recent empirical research in neonatal bioethics. Studies published in the last 5 years shed light on issues that arise in prenatal consultation, prognostication, outcomes, quality-of-life and cost-effectiveness in neonatal intensive care. These studies show ways in which doctors vary in their decisions from country to country, hospital to hospital and for babies and children with different conditions but similar prognoses. Empirical research in bioethics can answer questions about what doctors and parents think and do. It does not answer questions about what they ought to do. CONCLUSION Good ethics starts with good facts, even if good facts are not sufficient to get us to good ethics.
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Incidence of and risk factors for neonatal morbidity after active perinatal care: extremely preterm infants study in Sweden (EXPRESS). Acta Paediatr 2010; 99:978-92. [PMID: 20456261 DOI: 10.1111/j.1651-2227.2010.01846.x] [Citation(s) in RCA: 170] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS The aim of this study was to determine the incidence of neonatal morbidity in extremely preterm infants and to identify associated risk factors. METHODS Population based study of infants born before 27 gestational weeks and admitted for neonatal intensive care in Sweden during 2004-2007. RESULTS Of 638 admitted infants, 141 died. Among these, life support was withdrawn in 55 infants because of anticipation of poor long-term outcome. Of 497 surviving infants, 10% developed severe intraventricular haemorrhage (IVH), 5.7% cystic periventricular leucomalacia (cPVL), 41% septicaemia and 5.8% necrotizing enterocolitis (NEC); 61% had patent ductus arteriosus (PDA) and 34% developed retinopathy of prematurity (ROP) stage > or =3. Eighty-five per cent needed mechanical ventilation and 25% developed severe bronchopulmonary dysplasia (BPD). Forty-seven per cent survived to one year of age without any severe IVH, cPVL, severe ROP, severe BPD or NEC. Tocolysis increased and prolonged mechanical ventilation decreased the chances of survival without these morbidities. Maternal smoking and higher gestational duration were associated with lower risk of severe ROP, whereas PDA and poor growth increased this risk. CONCLUSION Half of the infants surviving extremely preterm birth suffered from severe neonatal morbidities. Studies on how to reduce these morbidities and on the long-term health of survivors are warranted.
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Abstract
OBJECTIVE To determine the optimal first-line tocolytic agent for treatment of premature labor. METHODS We performed a quantitative analysis of randomized controlled trials of tocolysis, extracting data on maternal and neonatal outcomes, and pooling rates for each outcome across trials by treatment. Outcomes were delay of delivery for 48 hours, 7 days, and until 37 weeks; adverse effects causing discontinuation of therapy; absence of respiratory distress syndrome; and neonatal survival. We used weighted proportions from a random-effects meta-analysis in a decision model to determine the optimal first-line tocolytic therapy. Sensitivity analysis was performed using the standard errors of the weighted proportions. RESULTS Fifty-eight studies satisfied the inclusion criteria. A random-effects meta-analysis showed that all tocolytic agents were superior to placebo or control groups at delaying delivery both for at least 48 hours (53% for placebo compared with 75-93% for tocolytics) and 7 days (39% for placebo compared with 61-78% for tocolytics). No statistically significant differences were found for the other outcomes, including the neonatal outcomes of respiratory distress and neonatal survival. The decision model demonstrated that prostaglandin inhibitors provided the best combination of tolerance and delayed delivery. In a hypothetical cohort of 1,000 women receiving prostaglandin inhibitors, only 80 would deliver within 48 hours, compared with 182 for the next-best treatment. CONCLUSION Although all current tocolytic agents were superior to no treatment at delaying delivery for both 48 hours and 7 days, prostaglandin inhibitors were superior to the other agents and may be considered the optimal first-line agent before 32 weeks of gestation to delay delivery.
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Clerc J, Gaucherand P, Berland M, Dupuis O. [Perinatal transfers: survey to evaluate the satisfaction degree of obstetricians and pediatricians with the Rhône-Alpes regional hotline center]. ACTA ACUST UNITED AC 2009; 37:222-8. [PMID: 19261505 DOI: 10.1016/j.gyobfe.2009.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Accepted: 01/08/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVE In 2006, the Ministry of Health issued a legal text relating to organization of maternal transports: "By the end of the year 2008, transfers of women and new-born babies will have to be treated in a centralized way", have to provide a 24 hours service and can take several forms such as a regional transfer center, working for several perinatal network or a simple hotline within the level 3 maternity hospital of the perinatal network and would be managed by efficiently trained professionals. In order to help professionals to choose between various types of organizations, we considered to evaluate their degree of satisfaction with the Rhône-Alpes regional hotline center. PATIENTS AND METHODS A postal survey was carried out 15 months after the creation of the regional hotline center to the 146 obstetricians and neonatologists of the perinatal network. Eight questions dealt with the following points: organization of in utero transfers and retransfers for obstetricians on the one hand, and the organization of neonatal transfers and retransfers for pediatricians on the other hand.Moreover, several questions relating to the communication quality and the global transport organization were asked to all of these professionals. Finally, practitioners were asked whether the regional hotline center should carry on its activity or not. RESULTS The response rate was 51%. Seventy-two percent of practitioners considered the regional hotline center improved the communication between professionals. 66,7% thought that it improved the organization of transport. Obstetricians get benefits in 91,7% of in utero transfers and in 63,8% of retransfers. Neonatologists get benefits in 92,3% of new born babies' transfers and in 53,8% of retransfers. Finally, 85,3% of the doctors felt that the regional hotline center was time saving and 96% of them felt that this structure should carry on its activity. DISCUSSION AND CONCLUSION In the French Rhône-Alpes region, most obstetricians and pediatricians are satisfied by a regional hotline center dedicated to in utero as well as neonate transfer.
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Affiliation(s)
- J Clerc
- Service de gynécologie-obstétrique, centre hospitalier Lyon-Sud, Pierre-Bénite, France.
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