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Alhasoon M. Survival Rates of Extremely Low-Birth-Weight Infants in a Tertiary Care Center in Saudi Arabia. Cureus 2024; 16:e54462. [PMID: 38510896 PMCID: PMC10951768 DOI: 10.7759/cureus.54462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2024] [Indexed: 03/22/2024] Open
Abstract
Introduction Extremely low birth weight (ELBW) refers to the condition in which an infant is born with a weight of less than one thousand grams (2.2 pounds) at birth. ELBW infants face significant challenges and are at increased risk for various medical complications and developmental issues. ELBW poses unique challenges for infants, families, and healthcare providers. Understanding the causes, consequences, and appropriate management strategies for ELBW is crucial for improving the survival rates of these vulnerable infants. Aim This study aimed to measure the survival rates of ELBW infants in Saudi Arabia and its correlated risk factors. Patients and methods This case-control study was a retrospective chart review analysis of data from King Abdulaziz Medical City (KAMC), a single tertiary care center in Riyadh, Kingdom of Saudi Arabia, and conducted over a four-year period. To estimate the survival rate among all live-birth newborn infants who were born with ELBWs of less than 1000 grams, collected data were tabulated and cleaned in MS Excel, and all data were analyzed using IBM SPSS Statistics for Windows, version 26 (released 2019; IBM Corp., Armonk, New York, United States). Results Two hundred and fifty-six patients were involved. Non-survival rates were 12.9%. In a multivariate regression model, prolonged rupture of membranes (PROM), periventricular leukomalacia (PVL), major intraventricular hemorrhage (IVH), and longer length of stay had increased risks for non-survival, while increasing gestational age, APGAR scores, and cesarean section had decreased risks for non-survival. Survival analysis found that there was a significant mean difference in gestational age (weeks) survival time between normal spontaneous vaginal delivery (NSVD) and cesarean section based on log-rank (Mantel-Cox) (p = 0.008). Conclusion Consistent with the literature, a greater prevalence of ELBW infants survived during hospital stay. Independent risk factors for non-survival include PROM, PVL, major IVH, and long length of stay. Cesarean section, increasing gestational, and APGAR scores were identified as the independent predictors of survival. Prospective studies in nature are required to determine these factors' cause and effect.
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Affiliation(s)
- Mohammad Alhasoon
- Department of Pediatrics, College of Medicine, Qassim University, Unaizah, SAU
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Survival and Neurodevelopmental Outcome of Extremely-Low-Birth-Weight Infants at One Year of Age-A Prospective, Descriptive Study. Indian J Pediatr 2023; 90:233-239. [PMID: 35727530 DOI: 10.1007/s12098-022-04252-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/06/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To study the survival rates at discharge and neurodevelopmental outcome at 1 y of corrected age (CA) of extremely-low-birth-weight ELBW neonates. METHODS This prospective, descriptive study was conducted in a tertiary care level III extramural NICU of a teaching hospital. Forty-nine extremely-low-birth-weight (ELBW) neonates were enrolled in the study from July 2017 to June 2018. Baseline demographic data, morbidities during NICU stay, and survival at discharge for the enrolled neonates were recorded. The enrolled infants were followed up to 1 y of CA at three-monthly intervals. During the follow-up, anthropometry, developmental screening by Denver Developmental Screening Test (DDST), and tone assessment by Amiel-Tison scale were done. Developmental Assessment Scale for Indian Infants (DASII) was administered at CA of 12 mo. RESULTS Thirty-seven (75.5%) neonates survived to discharge. Survival rate of neonates with birth weight > 750 g and with gestational age ≥ 26 wk was 90.2% and 85.7%, respectively. Amongst those < 750 g or < 26 wk (n = 8), none survived. Abnormal developmental quotient (DQ < 70%) was seen in 6 infants out of 33 infants (18.1%) followed at 1 y of CA. CONCLUSION Overall, 3/4th of ELBW infants survived to discharge and 80% of those who were followed up at 1 y of CA had normal neurodevelopmental outcome. However, survival rates of neonates born at < 26 wk and/or with birth weight < 750 g were less and needs to be improved.
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Kiatchoosakun P, Jirapradittha J, Paopongsawan P, Techasatian L, Lumbiganon P, Thepsuthammarat K, Sutra S. Mortality and Comorbidities in Extremely Low Birth Weight Thai Infants: A Nationwide Data Analysis. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121825. [PMID: 36553269 PMCID: PMC9776691 DOI: 10.3390/children9121825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022]
Abstract
This is the first nationwide study aimed to evaluate in-hospital mortality and comorbidities of extremely low birth weight (ELBW) infants in Thailand between 2015-2020. Data of ELBW infants were collected from the National Health Coverage Scheme. The incidence of ELBW Thai infants was 1.75 per 1000 live births. Sixty-five percent of ELBW infants were delivered in tertiary-care facilities, with 63% surviving until discharge. In-hospital mortality was 36.9%. Non-invasive respiratory supports were documented in just 17.6% of the study population, whereas total parenteral nutrition was used in 52.3% of neonates. There were several comorbidities, with the three most frequent including respiratory distress syndrome (70.7%), neonatal jaundice (66.7%), and sepsis (60.4%). The median hospitalization cost for one ELBW infant who survived was 296,438.40 baht ($8719). Conclusion: Thailand had an acceptable ELBW infant survival rate (63%), but comorbidities remained particularly severe and cost one hundred times the median hospital cost for one ELBW infant that survived in comparison to a normal newborn infant. Better health outcomes require strategies to raise awareness of the issues and the appropriate implementation of evidence-based solutions, particularly improving neonatal care facilities, as well as early referral of high-risk pregnant women and neonates, which will aid in the future reduction of neonatal morbidities and mortalities.
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Affiliation(s)
- Pakaphan Kiatchoosakun
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
- Correspondence: ; Tel.: +66-43-363012
| | - Junya Jirapradittha
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Pongsatorn Paopongsawan
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Leelawadee Techasatian
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Pagakrong Lumbiganon
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Kaewjai Thepsuthammarat
- Clinical Epidemiology Unit, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Sumitr Sutra
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
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Williamson N, Alcock G, Kandasamy Y. Being Small for Gestational Age does not Change Short-Term Outcomes for Extremely Low Birth Weight Babies at Townsville University Hospital. JOURNAL OF CHILD SCIENCE 2022. [DOI: 10.1055/s-0042-1757612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Abstract
Aim To determine whether being small for gestational age (SGA) is associated with increased mortality and short-term morbidity for extremely low birth weight (ELBW) babies at Townsville University Hospital (TUH).
Methods All babies with a birth weight of <1,000 g born at TUH between January 1, 2010 and January 1, 2021 were included. Data from the neonatal unit's NeoDATA database were used to compare mortality and short-term morbidity outcomes for babies categorized as SGA (birth weight <10th centile) or not. Statistical analyses were used to determine associations between being SGA and survival to discharge, intubation for mechanical ventilation, duration of respiratory support, chronic neonatal lung disease (CNLD), home oxygen, intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), sepsis, time to full enteral feeds, and duration of admission.
Results Of 461 ELBW babies, 62 (13.4%) were SGA. The SGA babies were significantly smaller at 714 (580–850) versus 810 (700–885) g (p < 0.001) and of advanced gestational age at 28.6 (26.6–30.2) versus 25.4 (24.4–26.6) weeks (p < 0.001). No significant difference in mortality existed, with 85% of SGA babies and 84% of others surviving. On univariate analysis, being SGA was associated with significant reductions in intubation for mechanical ventilation (p < 0.001), duration of respiratory support (p < 0.001), intraventricular hemorrhage (p = 0.002), NEC (p = 0.037), and admission duration (p = 0.038). After controlling for confounding factors, no outcomes were independently associated with being SGA. Logistic regression found survival was associated with birth weight (p = 0.030), gestational age (p = 0.007), and antenatal corticosteroids (p = 0.008).
Conclusions Being SGA is not an independent predictor of mortality nor adverse short-term morbidity for ELBW babies.
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Affiliation(s)
- Natalee Williamson
- Townsville University Hospital Neonatal Unit, Douglas, Queensland, Australia
| | - Gary Alcock
- Townsville University Hospital Neonatal Unit, Douglas, Queensland, Australia
| | - Yoga Kandasamy
- Townsville University Hospital Neonatal Unit, Douglas, Queensland, Australia
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Sherriff R, Preisz A, Adams S, Smyth J, Coudanaris E, Jacobs M, Tan K, Oei JL. Complex survival in extreme prematurity parents, their options and the need for a unified team approach. J Paediatr Child Health 2020; 56:1959-1962. [PMID: 32043681 DOI: 10.1111/jpc.14804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 01/15/2020] [Accepted: 01/20/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Renee Sherriff
- Department of Newborn Care, the Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Anne Preisz
- Department of Newborn Care, the Royal Hospital for Women, Randwick, New South Wales, Australia.,Clinical Ethics, Clinical Governance Unit, Sydney Children's Hospital Network, Westmead, New South Wales, Australia
| | - Susan Adams
- Department of Paediatric Surgery, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - John Smyth
- Department of Newborn Care, the Royal Hospital for Women, Randwick, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Eric Coudanaris
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of General Paediatrics, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Mark Jacobs
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Ophthalmology, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Kimberley Tan
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Ophthalmology, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Ju L Oei
- Department of Newborn Care, the Royal Hospital for Women, Randwick, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
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Whiles E, Shafafy R, Valsamis EM, Horton C, Morassi GL, Stokes O, Elsayed S. The Management of Symptomatic Lumbar Disc Herniation in Pregnancy: A Systematic Review. Global Spine J 2020; 10:908-918. [PMID: 32905728 PMCID: PMC7485082 DOI: 10.1177/2192568219886264] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES Lumbar disc herniation (LDH) has been reported to affect 1 in 10 000 pregnant women. There is limited evidence available regarding the optimal management of LDH in pregnant patients. We aimed to review the current evidence for the management of symptomatic LDH in pregnancy through critical appraisal and analysis of the available literature. METHODS Searches were conducted in Medline, Embase, PubMed, Science Direct, and The Cochrane Library from inception using predetermined search terms. All peer-reviewed studies of pregnant women with symptomatic LDH were included. The quality of eligible articles was assessed and extracted data and characteristics were pooled for analysis. References cited by studies were screened to identify other relevant publications. RESULTS Thirty studies involving 52 patients were identified. Compared to surgically managed patients, conservatively managed patients had a higher full recovery rate (61.54% vs 56.41%) and reported a lower rate of persistent symptoms (30.77% vs 38.54%). Compared to patients who were treated surgically for cauda equina syndrome, patients treated surgically for sciatica had a higher full recovery rate (80.95% vs 27.78%) and reported a lower rate of persistent symptoms (14.29% vs 66.67%). CONCLUSION There is limited evidence to guide the management of pregnant patients with LDH. Despite a suggestion toward improved outcomes with conservative management, the presence of selection bias and the overall poor quality of current research precludes reliable conclusions from being drawn. Decision making for this patient group should be undertaken within a multidisciplinary setting.
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Affiliation(s)
- Emily Whiles
- Brighton & Sussex University Hospitals NHS Trust, Brighton,
UK
| | - Roozbeh Shafafy
- Royal London Hospital, Barts Health NHS Trust, London, UK,Roozbeh Shafafy, Department of Spinal
Surgery, Royal London Hospital, Barts Health NHS Trust, Whitechapel, London E1
1RD, UK.
| | | | - Chris Horton
- Sir William Dunn School of Pathology, University of Oxford, Oxford,
UK
| | | | - Oliver Stokes
- Royal Devon & Exeter NHS Foundation Trust, London, UK
| | - Sherief Elsayed
- Brighton & Sussex University Hospitals NHS Trust, Brighton,
UK,NMC Spine, Dubai, United Arab Emirates
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7
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Sahoo T, Anand P, Verma A, Saksena M, Sankar MJ, Thukral A, Agarwal R, Deorari A, Paul VK. Outcome of extremely low birth weight (ELBW) infants from a birth cohort (2013-2018) in a tertiary care unit in North India. J Perinatol 2020; 40:743-749. [PMID: 32060359 DOI: 10.1038/s41372-020-0604-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 01/15/2020] [Accepted: 01/31/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate mortality and short-term morbidities in extremely low birth weight (ELBW) infants (<1000 g) in a birth cohort in North India. METHODS In-hospital data of 231 ELBW infants (Jan 2013 to Sept 2018) were collected from a prospectively maintained electronic database by using standard definitions. RESULTS The mean (SD) gestation and birth weight were 27.9 (2.2) weeks and 783 (133) g, respectively. Major morbidities included respiratory distress syndrome (n = 132, 57%), moderate-to-severe bronchopulmonary dysplasia (n = 62, 26.8%), hemodynamically significant patent ductus arteriosus (n = 65, 28%), intracranial hemorrhage ≥ grade II (n = 38, 16%), and culture-positive sepsis (n = 44, 19%). Median (IQR) duration of hospital stay (survivors) was 50 (17-79) days. The overall survival was 62%. On logistic regression, severe birth asphyxia, gestation ≤26 weeks, and respiratory distress syndrome were major predictors of mortality. CONCLUSION In the current ELBW cohort, nearly two-thirds survived until discharge, who had considerable morbidities needing prolonged hospital stay. This study can be utilized for counseling and planning of care of ELBW infants in similar settings.
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Affiliation(s)
- Tanushree Sahoo
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Pratima Anand
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ankit Verma
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Manju Saksena
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
| | - Mari Jeeva Sankar
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Anu Thukral
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ramesh Agarwal
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ashok Deorari
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Vinod K Paul
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Motlagh AJ, Asgary R, Kabir K. Evaluation of Clinical Risk Index for Babies to Predict Mortality and Morbidity in Neonates Admitted to Neonatal Intensive Care Unit. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2020. [DOI: 10.29333/ejgm/7902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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9
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Kardum D, Filipović-Grčić B, Müller A, Dessardo S. SURVIVAL UNTIL DISCHARGE OF VERY-LOW-BIRTH-WEIGHT INFANTS IN TWO CROATIAN PERINATAL CARE REGIONS: A RETROSPECTIVE COHORT STUDY OF TIME AND CAUSE OF DEATH. Acta Clin Croat 2019; 58:446-454. [PMID: 31969756 PMCID: PMC6971806 DOI: 10.20471/acc.2019.58.03.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We investigated mortality, causes, timing and risk factors for death until hospital discharge in very-low-birth-weight (VLBW) infants born in two Croatian perinatal care regions. This retrospective study included 252 live born VLBW infants. The mortality rate until hospital discharge was 30.5% (77/252). VLBW infants who died had by 4 weeks lower gestational age (GA) than surviving infants (median GA, 25 vs. 29 weeks), lower birth weight (BW) (mean BW, 756.4 vs. 1126.4 g), lower 5-minute Apgar score (median 5 vs. 8) and were more often resuscitated at birth (41.6 vs. 19.4%; p<0.001 all). Infants who survived were more often small-for-gestational age (SGA) (28.0 vs. 15.6%; p=0.04) and more often received continuous-positive-airway-pressure (CPAP) in delivery room (13.1 vs. 2.6%; p=0.01). Multivariate logistic regression revealed that parameters influencing death until hospital discharge were 5-minute Apgar score (OR 0.780, 95% CI 0.648-0.939) and higher Clinical Risk Index for Babies (CRIB) score (OR 1.677, 95% CI 1.456-1.931). ROC analysis showed that CRIB score (AUC 0.927, sensitivity 92.2, specificity 81.1; p<0.001) was the strongest predictor of death until hospital discharge. In infants who died within 12 hours, death was most commonly attributed to immaturity and in those surviving >12 hours to necrotizing enterocolitis.
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Affiliation(s)
- Darjan Kardum
- 1Neonatal Intensive Care Unit, Department of Pediatrics, Osijek University Hospital Centre, Osijek, Croatia; 2School of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia; 3Neonatal Intensive Care Unit, Department of Pediatrics, Zagreb University Hospital Centre, Zagreb, Croatia; 4School of Medicine, University of Zagreb, Zagreb, Croatia; 5Department of Gynecology and Obstetrics, Osijek University Hospital Centre, Osijek, Croatia; 6Neonatal and Pediatric Intensive Care Unit, Department of Pediatrics, Rijeka University Hospital Centre, Rijeka, Croatia; 7School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Boris Filipović-Grčić
- 1Neonatal Intensive Care Unit, Department of Pediatrics, Osijek University Hospital Centre, Osijek, Croatia; 2School of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia; 3Neonatal Intensive Care Unit, Department of Pediatrics, Zagreb University Hospital Centre, Zagreb, Croatia; 4School of Medicine, University of Zagreb, Zagreb, Croatia; 5Department of Gynecology and Obstetrics, Osijek University Hospital Centre, Osijek, Croatia; 6Neonatal and Pediatric Intensive Care Unit, Department of Pediatrics, Rijeka University Hospital Centre, Rijeka, Croatia; 7School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Andrijana Müller
- 1Neonatal Intensive Care Unit, Department of Pediatrics, Osijek University Hospital Centre, Osijek, Croatia; 2School of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia; 3Neonatal Intensive Care Unit, Department of Pediatrics, Zagreb University Hospital Centre, Zagreb, Croatia; 4School of Medicine, University of Zagreb, Zagreb, Croatia; 5Department of Gynecology and Obstetrics, Osijek University Hospital Centre, Osijek, Croatia; 6Neonatal and Pediatric Intensive Care Unit, Department of Pediatrics, Rijeka University Hospital Centre, Rijeka, Croatia; 7School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Sandro Dessardo
- 1Neonatal Intensive Care Unit, Department of Pediatrics, Osijek University Hospital Centre, Osijek, Croatia; 2School of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia; 3Neonatal Intensive Care Unit, Department of Pediatrics, Zagreb University Hospital Centre, Zagreb, Croatia; 4School of Medicine, University of Zagreb, Zagreb, Croatia; 5Department of Gynecology and Obstetrics, Osijek University Hospital Centre, Osijek, Croatia; 6Neonatal and Pediatric Intensive Care Unit, Department of Pediatrics, Rijeka University Hospital Centre, Rijeka, Croatia; 7School of Medicine, University of Rijeka, Rijeka, Croatia
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Kino T, Yamamoto Y, Saigusa Y, Aoki S, Miyagi E. Adverse pregnancy outcomes related to preterm cesarean delivery. Eur J Obstet Gynecol Reprod Biol 2019; 234:89-91. [DOI: 10.1016/j.ejogrb.2018.12.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/22/2018] [Accepted: 12/24/2018] [Indexed: 10/27/2022]
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Abolfotouh MA, Al Saif S, Altwaijri WA, Al Rowaily MA. Prospective study of early and late outcomes of extremely low birthweight in Central Saudi Arabia. BMC Pediatr 2018; 18:280. [PMID: 30134865 PMCID: PMC6106812 DOI: 10.1186/s12887-018-1248-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 08/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Survival of preterm neonates has steadily improved over the past five decades, due to changes in the neonatal intensive care. However, in Saudi Arabia, there are no written guidelines on the definition of the lower limit of viability, and there has been a call for such a limit. The aims of this study were: (1) to determine lower limits of viability and survival in extremely low birthweight (ELBW) infants, and (2) to determine incidence of neurodevelopmental and cognitive abnormalities within 3-6 years after birth. METHODS Prospective study of all live inborn ELBW infants admitted to the neonatal unit of King Abdulaziz Medical City, Riyadh, Saudi Arabia, within 3 years [between January 1st, 2005 and December 31st, 2007] was conducted (n = 117). Data were collected on demographic and birth data, neonatal complications & interventions and death on discharge. Prospective follow up of all survivors was done, within 6 years after birth, to assess the outcome in terms of neurodevelopmental and cognitive abnormalities. Predictors of survival were determined using logistic regression model. Significance was considered at p-value ≤0.05. RESULTS Of all ELBW infants, 41% died before discharge. Survival rate was directly correlated with gestational age (GA) and birthweight (p < 0.05). The 50% limits of viability were those at 25 weeks' gestation or with > 600 g. After adjusting for possible confounders, significant predictors of survival were birthweight (p = 0.001) and Apgar score (p < 0.001). The following impairments were reported during follow up of survivors: developmental delay (39.2%), cerebral palsy (36.2%), speech problems (33.3%), wasting (12.5%), intellectual disability (10%), visual problems (6.6%) and hyperactivity (5.6%). CONCLUSION More than one-third of ELBW died before discharge from NICU, and two-thirds of survivors had one or more neurodevelopmental and/or cognitive abnormalities during their first 6 years of life. The 50% limits of viability of ELBW infants were those at week 25 of gestation or with a birthweight of more than 600 g. Birthweight could be considered as more valid than gestational age in the prediction of viability of ELBW infants. The process of care of ELBW infants in Saudi Arabia may need to be revisited taking these findings into consideration.
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Affiliation(s)
- Mostafa A. Abolfotouh
- Research Training and Development Section, King Abdullah International Medical Research Center, King Saud bin-Abdulaziz University for Health Sciences - Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Saif Al Saif
- King Abdulaziz Medical City, King Saud bin-Abdulaziz University for Health Sciences, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Waleed A. Altwaijri
- King Abdulaziz Medical City, King Saud bin-Abdulaziz University for Health Sciences, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed A. Al Rowaily
- King Abdulaziz Medical City, King Saud bin-Abdulaziz University for Health Sciences, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
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Kolarova H, Krizova J, Hulkova M, Hansikova H, Hulkova H, Smid V, Zeman J, Honzik T, Tesarova M. Changes in transcription pattern lead to a marked decrease in COX, CS and SQR activity after the developmental point of the 22(nd) gestational week. Physiol Res 2018; 67:79-91. [PMID: 29137472 DOI: 10.33549/physiolres.933542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Tissue differentiation and proliferation throughout fetal development interconnect with changes in the oxidative phosphorylation system (OXPHOS) on the cellular level. Reevaluation of the expression data revealed a significant increase in COX4 and MTATP6 liver transcription levels after the 22(nd) gestational week (GW) which inspired us to characterize its functional impact. Specific activities of cytochrome c oxidase (COX), citrate synthase (CS), succinate-coenzyme Q reductase (SQR) and mtDNA determined by spectrophotometry and RT-PCR were studied in a set of 25 liver and 18 skeletal muscle samples at 13(th) to 29(th) GW. Additionally, liver hematopoiesis (LH) was surveyed by light microscopy. The mtDNA content positively correlated with the gestational age only in the liver. The activities of COX, CS and SQR in both liver and muscle isolated mitochondria significantly decreased after the 22(nd) GW in comparison with earlier GW. A continuous decline of LH, not correlating with the documented OXPHOS-specific activities, was observed from the 14(th) to the 24(th) GW indicating their exclusive reflection of liver tissue processes. Two apparently contradictory processes of increasing mtDNA transcription and decreasing OXPHOS-specific activities seem to be indispensable for rapid postnatal adaptation to high energy demands. The inadequate capacity of mitochondrial energy production may be an important factor in the mortality of children born before the critical developmental point of the 22(nd) GW.
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Affiliation(s)
- H Kolarova
- Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
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Downes KL, Grantz KL, Shenassa ED. Maternal, Labor, Delivery, and Perinatal Outcomes Associated with Placental Abruption: A Systematic Review. Am J Perinatol 2017; 34:935-957. [PMID: 28329897 PMCID: PMC5683164 DOI: 10.1055/s-0037-1599149] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective Risk factors for placental abruption have changed, but there has not been an updated systematic review investigating outcomes. Methods We searched PubMed, EMBASE, Web of Science, SCOPUS, and CINAHL for publications from January 1, 2005 through December 31, 2016. We reviewed English-language publications reporting estimated incidence and/or risk factors for maternal, labor, delivery, and perinatal outcomes associated with abruption. We excluded case studies, conference abstracts, and studies that lacked a referent/comparison group or did not clearly characterize placental abruption. Results A total of 123 studies were included. Abruption was associated with elevated risk of cesarean delivery, postpartum hemorrhage and transfusion, preterm birth, intrauterine growth restriction or low birth weight, perinatal mortality, and cerebral palsy. Additional maternal outcomes included relaparotomy, hysterectomy, sepsis, amniotic fluid embolism, venous thromboembolism, acute kidney injury, and maternal intensive care unit admission. Additional perinatal outcomes included acidosis, encephalopathy, severe respiratory disorders, necrotizing enterocolitis, acute kidney injury, need for resuscitation, chronic lung disease, infant death, and epilepsy. Conclusion Few studies examined outcomes beyond the initial birth period, but there is evidence that both mother and child are at risk of additional adverse outcomes. There was also considerable variation in, or absence of, the reporting of abruption definitions.
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Affiliation(s)
- Katheryne L. Downes
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
- Maternal and Child Health Program, University of Maryland, College Park, Maryland
- Department of Obstetrics and Gynecology, Center for Research in Reproduction and Women’s Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Katherine L. Grantz
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Edmond D. Shenassa
- Maternal and Child Health Program, University of Maryland, College Park, Maryland
- Department of Epidemiology and Biostatistics, University of Maryland, College Park, Maryland
- Department of Epidemiology and Biostatistics, University of Maryland, Baltimore, Maryland
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Savoy C, Mathewson KJ, Schmidt LA, Morrison KM, Krzeczkowski JE, Van Lieshout RJ. Respiratory sinus arrhythmia in the fourth decade of life depends on birth weight and the DRD4 gene: Implications for understanding the development of emotion regulation. Dev Psychobiol 2017; 59:767-775. [PMID: 28727140 DOI: 10.1002/dev.21539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/29/2017] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The long allele of the DRD4 gene can confer different behavioral and emotional phenotypes depending upon environmental exposure, although the physiological changes underlying these phenotypes are not fully known. We sought to extend this work by assessing the interaction of the DRD4 gene and exposure to perinatal adversity (indexed by extremely low birth weight [ELBW]) on resting respiratory sinus arrhythmia (RSA), a neurophysiological measure of emotion regulation, in adulthood. METHODS We examined the interaction between the DRD4 gene and perinatal adversity on RSA at age 30-35 in a longitudinal cohort of ELBW survivors (n = 49) and NBW controls (n = 63). Buccal DNA samples were genotyped for short and long carriers of the exon III DRD4 VNTR gene. Resting RSA was assessed by electrocardiogram. RESULTS We report an interaction between birth weight status and DRD4 gene (F = 9.42, p = 0.003) in predicting RSA, such that DRD4 long carriers had the highest and lowest resting RSA depending on whether they were born NBW or ELBW, respectively. DRD4 short carriers were less sensitive to birth weight. Additionally, reduced RSA was correlated with a history of major depressive disorder, suggesting it was a reliable index of emotion dysregulation. DISCUSSION These results suggest that the perinatal environment influences autonomic nervous system functioning in individuals with genotypes that confer additional sensitivity. Whether the long-term autonomic outcomes of this environmental sensitivity are beneficial or detrimental appears to depend on the quality of the early life environment, and may influence the development of emotion regulatory and psychiatric problems in adulthood.
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Affiliation(s)
- Calan Savoy
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario
| | - Karen J Mathewson
- Department of Psychology, Neuroscience and Behavior, McMaster University, Hamilton, Ontario
| | - Louis A Schmidt
- Department of Psychology, Neuroscience and Behavior, McMaster University, Hamilton, Ontario
| | | | - John E Krzeczkowski
- Department of Health Sciences, Neuroscience Graduate Program, McMaster University, Hamilton, Ontario
| | - Ryan J Van Lieshout
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario
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15
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Surgical Management of the Pregnant Patient With Lumbar Disc Herniation in the Latter Stage of the Second Trimester. Spine (Phila Pa 1976) 2017; 42:E186-E189. [PMID: 27310022 DOI: 10.1097/brs.0000000000001741] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report. OBJECTIVE To report on a pregnant woman successfully treated with microendoscopic discectomy in the left lateral position under general anesthesia at 24-week gestation. SUMMARY OF BACKGROUND DATA Treatment for lumbar disc herniation in pregnant women poses a particular challenge due to the complexity of the clinical situation. Review of the literature emphasizes timely diagnosis with adequate management specific for each gestational period. A surgical approach mandates consideration of the physiologic parameters of pregnancy and the effects of these stressors on the fetus. METHODS A 38-year-old primigravid woman presented with persistent and incapacitating low back and left leg pain. Magnetic resonance imaging demonstrated a herniated disc at L4-5 with a severely compressed left L5 nerve root. Symptoms were resistant to conservative treatment (acetaminophen; 1200 mg/day) and nerve root block with corticosteroids (1 mg/0.5 mL of betamethasone plus 0.5 mL of 1% lidocaine) provided only transient pain relief. Operative management with surgical discectomy was discussed. Anesthesiologists, obstetricians, and neonatologists were consulted for preoperative planning, focusing on appropriate anesthesia, ideal positioning for surgical access, and provision for emergent fetal care. Surgery was ultimately performed in the left lateral position, in contrast to the oft-used prone position. Microendoscopic discectomy was performed under general anesthesia at 24-week gestation. RESULTS The patient experienced complete relief from pain after surgical intervention and delivered a healthy baby at 39-week gestation after normal labor. Our methods, used in accordance with our preoperative simulation, resulted in a satisfactory outcome for both mother and child. CONCLUSION Although previously published cases noted the safety of operating in the prone position under epidural anesthesia, we performed minimally invasive microendoscopic discectomy in the left lateral position in combination with general anesthesia and found that this is a safe and preferable alternative for pregnant patients in the latter stage of the second trimester. LEVEL OF EVIDENCE N/A.
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16
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Savoy C, Ferro MA, Schmidt LA, Saigal S, Van Lieshout RJ. Prenatal betamethasone exposure and psychopathology risk in extremely low birth weight survivors in the third and fourth decades of life. Psychoneuroendocrinology 2016; 74:278-285. [PMID: 27693982 DOI: 10.1016/j.psyneuen.2016.09.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 09/26/2016] [Accepted: 09/26/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Mortality rates among extremely low birthweight (ELBW) infants have declined since the advent of antenatal glucocorticoid use. However, the long term neuropsychiatric effects of exposure are not well understood. We utilized the world's oldest longitudinally followed cohort of ELBW survivors to compare psychopathology over two decades in adulthood in those exposed to prenatal betamethasone and those who were not. METHODS ELBW survivors (n=179) and matched normal birth weight (NBW) controls (n=145) completed the Young Adult Self-Report questionnaire at 22-26 and 29-36 years, and the Beck Depression and Anxiety Inventories at 29-36 years. Symptom levels and rates of clinically significant psychiatric problems were compared in ELBW survivors whose mothers were administered steroids during pregnancy (ELBW-S n=63), ELBW participants who were not (ELBW-NS, n=79), and NBW controls. RESULTS At 22-26, ELBW-S had higher levels of anxiety, depressive, and avoidant personality symptoms, and a 3 to 5-fold increase in the odds of clinically significant levels of these problems compared to NBW controls, whereas ELBW-NS did not. These associations were maintained at 29-36, when ELBW-S participants exhibited a 3 to 10-fold increase in the odds of clinically significant anxiety and avoidant personality problems compared to NBW controls. At both time points, the odds of clinically significant anxiety problems were more than 3 times higher among ELBW-S than in ELBW-NS. CONCLUSION ELBW adults exposed to prenatal betamethasone manifest higher levels of anxiety and depression than those who were not, and may represent a group of preterm survivors at particularly high psychiatric risk.
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Affiliation(s)
- Calan Savoy
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z, Canada
| | - Mark A Ferro
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z, Canada; Department of Pediatrics, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z, Canada.
| | - Louis A Schmidt
- Department of Psychology, Neuroscience and Behaviour, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z, Canada
| | - Saroj Saigal
- Department of Pediatrics, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z, Canada
| | - Ryan J Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z, Canada
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17
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Ogawa M, Matsuda Y, Nakai A, Hayashi M, Sato S, Matsubara S. Standard curves of placental weight and fetal/placental weight ratio in Japanese population: difference according to the delivery mode, fetal sex, or maternal parity. Eur J Obstet Gynecol Reprod Biol 2016; 206:225-231. [PMID: 27750181 DOI: 10.1016/j.ejogrb.2016.09.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 08/29/2016] [Accepted: 09/07/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Placental weight (PW) and fetal/placental weight ratio (F/P) have been considered to be useful parameters for understanding the pathophysiology of fetal growth. However, there have been no standard data on PW and F/P in Asian populations. This study was conducted to establish nomograms of PW and F/P in the Japanese population and to clarify characteristics of PW and F/P in this population. STUDY DESIGN Included in the study were 79,590 Japanese cases: 58,871 vaginal and 20,719 cesarean deliveries at obstetrical facilities (2001-2002) and registered to the Japan Society of Obstetrics and Gynecology Database. Multiple pregnancies, stillbirths, and fetal anomalies were excluded. Nomograms of PW and F/P were created by spline methods in groups categorized by fetal sex (male or female) and maternal parity (primipara or multipara). RESULTS Standard curves of PW and F/P were established, which indicated that PW and F/P were lower in cesarean deliveries than vaginal deliveries, especially during preterm period. PW differed depending on fetal sex and maternal parity. F/P differed according to fetal sex. CONCLUSION We for the first time established standard curves of PW and F/P in the Japanese population with statistically sufficient data, which showed that PW and F/P were lower in cesarean deliveries. PW and F/P were also affected by fetal sex. These data might be useful to understand the pathophysiology between the fetus and placenta in utero.
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Affiliation(s)
- Masaki Ogawa
- Perinatal Medical Center, Tokyo Women's Medical University, Kawadacho 8-1, Shinjuku, Tokyo 1628666, Japan.
| | - Yoshio Matsuda
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3 Iguchi Nasushiobara, Tochigi 3292763, Japan
| | - Akihito Nakai
- Department of Obstetrics and Gynecology, Tama-Nagayama Hospital, Nippon Medical School, 1-7-1 Nagayama, Tama City, Tokyo 2068512, Japan
| | - Masako Hayashi
- Department of Obstetrics and Gynecology, Tama-Nagayama Hospital, Nippon Medical School, 1-7-1 Nagayama, Tama City, Tokyo 2068512, Japan
| | - Shoji Sato
- Maternal and Perinatal Care Center, Oita Prefectural Hospital Bunyo 476, Oita 8708511, Japan
| | - Shigeki Matsubara
- Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 3290498, Japan
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