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Terada S, Nishimura H, Miyasaka N, Fujiwara T. Ambient temperature and preterm birth: A case-crossover study. BJOG 2024; 131:632-640. [PMID: 37984435 DOI: 10.1111/1471-0528.17720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/25/2023] [Accepted: 10/29/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE To investigate the association between ambient temperature and preterm birth (PTB) and to estimate the population attributable fraction (PAF) of PTBs due to low and high temperatures. DESIGN Time-stratified case-crossover design. SETTING Japan (46 prefectures, excluding Okinawa), 2011-2020. SAMPLE 214 050 PTBs registered in the Japan Perinatal Registry Network database among 1 908 168 singleton live births. METHODS A quasi-Poisson regression model with a distributed lag nonlinear model was employed to assess the associations between daily mean temperature and PTBs for a lag of 0-27 days in each prefecture. A random effects meta-analysis was conducted by combining effect estimates from the 46 prefectures to estimate pooled relative risks (RRs). The PAFs of the PTBs due to below or above the mean of the 46 median temperatures (16.0°C) were calculated. MAIN OUTCOME MEASURES Preterm singleton live births. RESULTS The association between daily mean temperature and PTB risk exhibited a U-shaped curve. The adjusted RRs were 1.15 (95% confidence interval [CI] 1.05-1.25) at the mean of the 1st percentiles (0.8°C) and 1.08 (95% CI 1.00-1.17) at the mean of the 99th percentiles (30.2°C) of 46 prefectures, with 16.0°C as the reference temperature. Approximately 2.3% (95% CI 0.6-4.0) of PTBs were attributable to low temperatures. CONCLUSIONS Both low and possibly high temperatures were associated with an increased risk of PTBs. These findings may help to inform preventive measures for pregnant women.
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Affiliation(s)
- Shuhei Terada
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hisaaki Nishimura
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoyuki Miyasaka
- Department of Obstetrics and Gynaecology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
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Swiercz G, Zmelonek-Znamirowska A, Szwabowicz K, Armanska J, Detka K, Mlodawska M, Mlodawski J. Navigating Uncertain Waters: First-Trimester Screening's Role in Identifying Neonatal Complications. J Clin Med 2024; 13:1982. [PMID: 38610747 PMCID: PMC11012773 DOI: 10.3390/jcm13071982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Contemporary diagnostic methods aimed at assessing neonatal outcomes predominantly rely on the medical history of pregnant women. Ideally, universal biomarkers indicating an increased risk of delivering infants in poor clinical condition, with a heightened likelihood of requiring hospitalization in a Neonatal Intensive Care Unit (NICU), would be beneficial for appropriately stratifying pregnant women into a high-risk category. Our study evaluated whether biochemical and ultrasonographical markers universally used in first-trimester screenings for non-heritable chromosomal aberrations could serve this purpose. Methods: This study encompassed 1164 patients who underwent first-trimester screening, including patient history, ultrasound examinations, and biochemical tests for pregnancy-associated plasma protein-A (PAPP-A) and the free beta-HCG subunit (fbHCG), from January 2019 to December 2021. The research concentrated on the correlation between these prenatal test results and neonatal outcomes, particularly Apgar scores, umbilical blood pH levels, and the necessity for NICU admission. Results: In our cohort, neonates scoring lower than 8 on the Apgar scale at birth exhibited lower concentrations of PAPP-A in the first trimester, both in raw and normalized values (PAPP-A MoM 0.93 vs. 1.027, p = 0.032). We also observed a higher pulsatility index in the venous duct in the first trimester in full-term neonates born with <8 points on the Apgar scale. Additionally, newborns born with an umbilical blood pH < 7.2 had lower normalized first-trimester PAPP-A concentrations (0.69 vs. 1.01 MoM, p = 0.04). We also noted that neonates requiring NICU hospitalization post-delivery had lower first-trimester bHCG concentrations (0.93 MoM vs. 1.11 MoM, p = 0.03). However, none of the correlations in our study translated into a robust prognostic ability for predicting dichotomous outcomes. All areas under the curve achieved a value < 0.7. Conclusions: Low concentrations of PAPP-A and free bHCG subunit in the first trimester may be associated with poorer clinical and biochemical conditions in neonates post-delivery. However, the relationship is weak and has limited predictive capability. Further research evaluating these relationships is necessary for the appropriate stratification of pregnant women into high-risk categories for neonatological complications.
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Affiliation(s)
- Grzegorz Swiercz
- Collegium Medicum, Jan Kochanowski University in Kielce, Zeromskiego Street 5, 25-369 Kielce, Poland
- Clinic of Obstetrics and Gynecology, Provincial Combied Hospital in Kielce, Grunwaldzka 45, 25-736 Kielce, Poland
| | - Anna Zmelonek-Znamirowska
- Collegium Medicum, Jan Kochanowski University in Kielce, Zeromskiego Street 5, 25-369 Kielce, Poland
- Clinic of Obstetrics and Gynecology, Provincial Combied Hospital in Kielce, Grunwaldzka 45, 25-736 Kielce, Poland
| | - Karol Szwabowicz
- Clinic of Obstetrics and Gynecology, Provincial Combied Hospital in Kielce, Grunwaldzka 45, 25-736 Kielce, Poland
| | - Justyna Armanska
- Clinic of Obstetrics and Gynecology, Provincial Combied Hospital in Kielce, Grunwaldzka 45, 25-736 Kielce, Poland
| | - Karolina Detka
- Clinic of Obstetrics and Gynecology, Provincial Combied Hospital in Kielce, Grunwaldzka 45, 25-736 Kielce, Poland
| | - Marta Mlodawska
- Collegium Medicum, Jan Kochanowski University in Kielce, Zeromskiego Street 5, 25-369 Kielce, Poland
- Clinic of Obstetrics and Gynecology, Provincial Combied Hospital in Kielce, Grunwaldzka 45, 25-736 Kielce, Poland
| | - Jakub Mlodawski
- Collegium Medicum, Jan Kochanowski University in Kielce, Zeromskiego Street 5, 25-369 Kielce, Poland
- Clinic of Obstetrics and Gynecology, Provincial Combied Hospital in Kielce, Grunwaldzka 45, 25-736 Kielce, Poland
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Sturrock S, Sadoo S, Nanyunja C, Le Doare K. Improving the Treatment of Neonatal Sepsis in Resource-Limited Settings: Gaps and Recommendations. Res Rep Trop Med 2023; 14:121-134. [PMID: 38116466 PMCID: PMC10728307 DOI: 10.2147/rrtm.s410785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023] Open
Abstract
Neonatal sepsis causes significant global morbidity and mortality, with the highest burden in resource-limited settings where 99% of neonatal deaths occur. There are multiple challenges to achieving successful treatment of neonates in this setting. Firstly, reliable and low-cost strategies for risk identification are urgently needed to facilitate treatment as early as possible. Improved laboratory capacity to allow identification of causative organisms would support antimicrobial stewardship. Antibiotic treatment is still hampered by availability, but also increasingly by antimicrobial resistance - making surveillance of organisms and judicious antibiotic use a priority. Finally, supportive care is key in the management of the neonate with sepsis and has been underrecognized as a priority in resource-limited settings. This includes fluid balance and nutritional support in the acute phase, and follow-up care in order to mitigate complications and optimise long-term outcomes. There is much more work to be done in identifying the holistic needs of neonates and their families to provide effective family-integrated interventions and complete the package of neonatal sepsis management in resource-limited settings.
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Affiliation(s)
- Sarah Sturrock
- Centre for Neonatal and Paediatric Infection, St George’s, University of London, London, UK
| | - Samantha Sadoo
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Carol Nanyunja
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Kirsty Le Doare
- Centre for Neonatal and Paediatric Infection, St George’s, University of London, London, UK
- UK Health Security Agency, Salisbury, UK
- Makerere University, Johns Hopkins University, Kampala, Uganda
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4
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Lee J, Lee CYM, Naiduvaje K, Wong Y, Bhatia A, Ereno IL, Ho SKY, Yeo CL, Rajadurai VS. Trends in neonatal mortality and morbidity in very-low-birth-weight (VLBW) infants over a decade: Singapore national cohort study. Pediatr Neonatol 2023; 64:585-595. [PMID: 36967293 DOI: 10.1016/j.pedneo.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 11/28/2022] [Accepted: 12/20/2022] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Very preterm infants are at risk for neurodevelopmental impairment because of postnatal morbidities. This study aims to (1) compare the outcomes of very-low-birth-weight (VLBW) infants in Singapore during two time periods over a decade; 2) compare performances among Singaporean neonatal intensive care units (NICUs); and 3) compare a Singapore national cohort with one from the Australian and New Zealand Neonatal Network (ANZNN). METHODS Singapore national data on VLBW infants born during two periods, 2007-2008 (SG2007, n = 286) and 2015-2017 (SG2017, n = 905) were extracted from patient medical records. The care practices and clinical outcomes among three Singapore NICUs were compared using SG2017 data. Third, using data from the ANZNN2017 annual report, infants with gestational age (GA) ≤29 weeks in SG2017 were compared with their Oceania counterparts. RESULTS SG2017 had 9.9% higher usage of antenatal steroids (p < 0.001), 8% better survival for infants ≤26 weeks (p = 0.174), and used 12.7% lesser nonsteroidal anti-inflammatory drugs for patent ductus arteriosus closure (p < 0.001) than those of SG2007 cohort. Rate of late-onset sepsis (LOS) was almost halved (7.4% vs. 14.0%, p < 0.001), and exclusive human milk feeding after discharge increased threefold (p < 0.001). SG2017, in contrast, had a higher rate of chronic lung disease (CLD) (20.0% vs. 15.1%, p = 0.098). Within SG2017, the rates of LOS, CLD, and human milk feeding varied significantly between the three NICUs. When compared with ANZNN2017, SG2017 had significantly lower rates of LOS for infants ≤25 weeks (p = 0.001), less necrotizing enterocolitis for infants ≤27 weeks (p = 0.002), and less CLD across all GA groups. CONCLUSION Postnatal morbidities and survival rates for VLBW infants in Singapore have improved over a decade. Outcomes for VLBW infants varied among three Singapore NICUs, which provide a rationale for collaboration to improve clinical quality. The outcomes of Singaporean VLBW infants were comparable to those of their ANZNN counterparts.
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Affiliation(s)
- Jiun Lee
- Department of Neonatology, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, Singapore.
| | - Cheryl Yen May Lee
- Department of Paediatrics, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, Singapore
| | - Krishnamoorthy Naiduvaje
- Department of Neonatology, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, Singapore
| | - Yoko Wong
- Singapore Clinical Research Institute, Singapore
| | - Ashwani Bhatia
- Department of Neonatology, KK Women's and Children's Hospital, Singapore
| | | | - Selina Kah Yin Ho
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - Cheo Lian Yeo
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
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Petch S, McCarthy CM, McLoughlin J, Dunn LE, Franta J, Ní Mhuircheartaigh R, Nölke L, Kennelly M, Donnelly JC. Multi-institutional and multi-disciplinary care: A successfully managed aortic dissection in the third trimester of pregnancy. Obstet Med 2022; 15:267-269. [PMID: 36523881 PMCID: PMC9745593 DOI: 10.1177/1753495x211017700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/08/2021] [Accepted: 04/25/2021] [Indexed: 12/03/2023] Open
Abstract
Multi-disciplinary collaborative care for pregnant women with complex and emergent conditions is essential. Logistical planning, clear communication and human factor awareness are all non-clinical skills which need to be utilised in order to maximise outcomes. We describe the case of a proximal aortic dissection in the late third trimester of pregnancy diagnosed in a peripheral hospital that was transferred to a cardiothoracic centre for successful operative management 160 km away. This required the time-sensitive mobilisation and liaison of a receiving cardiothoracic, anaesthesiology and perfusionist team in conjunction with obstetric and midwifery support from an affiliated maternity hospital, as well as the national neonatal transport team. We emphasise the importance of multidisciplinary team management in complex cases and how imperative good inter-disciplinary communication is to ensure safe inter-hospital transfer.
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Affiliation(s)
- S Petch
- Department of Obstetrics and Gynaecology, Wexford General
Hospital, Wexford, Ireland
| | - CM McCarthy
- Rotunda Hospital, Parnell Square, Dublin, Ireland
| | - J McLoughlin
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - LE Dunn
- Department of Obstetrics and Gynaecology, Wexford General
Hospital, Wexford, Ireland
| | - J Franta
- National Neonatal Transport Programme, National Maternity
Hospital, Dublin 2, Ireland
| | - R Ní Mhuircheartaigh
- Rotunda Hospital, Parnell Square, Dublin, Ireland
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - L Nölke
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - M Kennelly
- Rotunda Hospital, Parnell Square, Dublin, Ireland
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - JC Donnelly
- Rotunda Hospital, Parnell Square, Dublin, Ireland
- Mater Misericordiae University Hospital, Dublin, Ireland
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Martin A, Suff N, Seed PT, David AL, Girling J, Shennan A. The use of fetal fibronectin and cervical length measurements in the prediction of spontaneous preterm birth in women with an Arabin pessary in situ. Eur J Obstet Gynecol Reprod Biol 2022; 276:113-117. [PMID: 35853271 DOI: 10.1016/j.ejogrb.2022.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 05/25/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The ability to predict spontaneous PTB (sPTB) has improved greatly, allowing women at risk to be managed with prophylactic interventions such as cervical cerclage and the Arabin pessary. Cervicovaginal fetal fibronectin (qfFN) concentration and ultrasound measurement of cervical length (CL) are the two most established tools to predict sPTB. There is however limited data regarding the predictive value of qfFN and CL tests following insertion of an Arabin pessary. Our aim was therefore to determine the clinical use of qfFN and CL measurements to predict sPTB in women fitted with an Arabin pessary. STUDY DESIGN This study is a secondary analysis on the SUPPORT trial data. Data were prospectively collected from women attending high-risk preterm surveillance clinics in 3 London centres between July 2015 and April 2020. The matched control group was pregnant women attending the same high-risk preterm surveillance clinics who had not received an Arabin pessary. Receiver operating characteristic (ROC) curves for prediction of birth by 34 and by 37 weeks' gestation were generated for qfFN and CL measurements combined for both study groups. A formal comparison of area under the curve before 34 weeks' gestation (AUC < 34 weeks) was made between the two study groups. RESULTS At our primary endpoint of sPTB < 34 weeks' gestation, qfFN was a good predictor of sPTB in cases with an Arabin pessary in situ (AUC, 0.79, 95% CI: 0.62-0.90) and no worse than the control group who did not have an Arabin pessary, (AUC 0.74, 95% CI: 0.48-0.96). CL had good prediction for sPTB < 34 weeks' gestation in the control group (AUC 0.76, 95% CI: 0.63-0.88) but was lower and non-significant in the Arabin pessary case group (AUC 0.60, 95% CI: 0.43-0.76). CONCLUSIONS This study showed that cervicovaginal qfFN concentration is equally reliable in the prediction of sPTB in pregnant women at increased risk of sPTB with and without an Arabin pessary in situ, and significantly better than CL measurement alone for predicting delivery before 34 weeks. This commonly used test therefore has utility in predicting sPTB in pregnant women fitted with an Arabin pessary.
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Affiliation(s)
- Anastasia Martin
- University Hospital Sussex NHS Trust, Brighton BN2 5BE, United Kingdom.
| | - Natalie Suff
- Department of Women and Children's Health, King's College London, St Thomas' Hospital, United Kingdom
| | - Paul T Seed
- Department of Women and Children's Health, King's College London, St Thomas' Hospital, United Kingdom
| | - Anna L David
- Department of Women and Children's Health, King's College London, St Thomas' Hospital, United Kingdom; Elizabeth Garrett Anderson Institute for Women's Health, University College London, 74 Huntley Street, London WC1E 6AU, United Kingdom
| | - Joanna Girling
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, 149 Tottenham Court Road, London W1T 7DN, United Kingdom
| | - Andrew Shennan
- Department of Women and Children's Health, King's College London, St Thomas' Hospital, United Kingdom; West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, United Kingdom
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Abstract
Advances in perinatal care have seen substantial improvements in survival without disability for extremely preterm infants. Protecting the developing brain and reducing neurodevelopmental sequelae of extremely preterm birth are strategic priorities for both research and clinical care. A number of evidence-based interventions exist for neuroprotection in micropreemies, inclusive of prevention of preterm birth and multiple births with implantation of only one embryo during in vitro fertilisation, as well as antenatal care to optimize fetal wellbeing, strategies for supporting neonatal transition, and neuroprotective developmental care. Avoidance of complications that trigger ischemia and inflammation is vital for minimizing brain dysmaturation and injury, particularly of the white matter. Neurodevelopmental surveillance, early diagnosis of cerebral palsy and early intervention are essential for optimizing long-term outcomes and quality of life. Research priorities include further evaluation of putative neuroprotective agents, and investigation of common neonatal interventions in trials adequately powered to assess neurodevelopmental outcome.
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Najjarzadeh M, Asghari Jafarabadi M, Mirghafourvand M, Abbasalizadeh S, Mohammad-Alizadeh-Charandabi S. Validation of a Nomogram for Predicting Preterm Birth in Women With Threatened Preterm Labor: A Prospective Cohort Study in Iranian Tertiary Referral Hospitals. Clin Nurs Res 2022; 31:1325-1331. [PMID: 35485350 DOI: 10.1177/10547738221091878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this prospective cohort study, we aimed to investigate external validity of the Allouche's nomogram to predict preterm birth in symptomatic women in Iran. We employed six variables of cervical length, uterine contractions, rupture of membranes, vaginal bleeding, gestational age, and multiple pregnancy to draw the nomograms. These variables were examined in the first day of women's hospitalization and participants followed up until giving birth. The concordance index of area under the curve (AUC) was used for validation of the nomograms. Of the participants 10% gave birth within 48 hours and 29% before 34 weeks. The nomogram had sufficient accuracy in predicting birth within 48 hours (AUC 0.89 [95% CI 0.82-0.96]) and birth before 34 weeks (AUC 0.89 [95% CI 0.84-0.94]). The optimal risk threshold for nomogram predicting birth within 48 hours was 0.16. Use of these two nomograms, can improve the health of women and their neonates.
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Shipley L, Hyliger G, Sharkey D. Temporal trends of in utero and early postnatal transfer of extremely preterm infants between 2011 and 2016: a UK population study. Arch Dis Child Fetal Neonatal Ed 2022; 107:201-205. [PMID: 34281936 DOI: 10.1136/archdischild-2021-322195] [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: 04/02/2021] [Accepted: 07/08/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Early postnatal transfer (PNT) of extremely preterm infants is associated with adverse outcomes compared with in utero transfer (IUT). We aimed to explore recent national trends of IUT and early PNT. DESIGN Observational cohort study using the National Neonatal Research Database. SETTING Neonatal units in England, Scotland and Wales. PATIENTS Extremely preterm infants 23+0-27+6 weeks' gestation admitted for neonatal care from 2011 to 2016. MAIN OUTCOME The incidence of IUT or PNT within 72 hours of life. Secondary outcomes included mortality, hospital transfer level between centres and temporal changes across two equal epochs, 2011-2013 (epoch 1 (Ep1)) and 2014-2016 (epoch 2 (Ep2)). RESULTS 14 719 infants were included (Ep1=7363 and Ep2=7256); 4005 (27%) underwent IUT; and 3042 (20.7%) had PNT. IUTs decreased significantly between epochs from 28.3% (Ep1=2089) to 26.0% (Ep2=1916) (OR 0.90, 95% CI 0.84 to 0.97, p<0.01). Conversely, PNTs increased from 19.8% (Ep1=1416) to 21.5% (Ep2=1581) (OR 1.11, 95% CI 1.02 to 1.20, p=0.01). PNTs between intensive care centres increased from 8.1% (Ep1=119) to 10.2% (Ep2=161, p=0.05). Mortality decreased from 21.6% (Ep1=1592) to 19.3% (Ep2=1421) (OR 0.90, 95% CI 0.83 to 0.97, p=0.01). Survival to 90 days of age was significantly lower in infants undergoing PNT compared with IUT (HR 1.31, 95% CI 1.18 to 1.46), with the greatest differences observed in infants <25 weeks' gestational age. CONCLUSION In the UK, IUT of extremely preterm infants has significantly decreased over the study period with a parallel increase in early PNT. Strategies to reverse these trends, improve IUT pathways and optimise antenatal steroid use could significantly improve survival and reduce brain injury for these high-risk infants.
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Affiliation(s)
- Lara Shipley
- Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Gillian Hyliger
- Neonatal Intensive Care Unit, Nottingham Children's Hospital, Nottingham, UK
| | - Don Sharkey
- Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK
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Najjarzadeh M, Abbasalizadeh S, Mohammad‐Alizadeh‐Charandabi S, Asghari‐Jafarabadi M, Mirghafourvand M. Perceived stress and its predictors in women with threatened preterm labour: A cross-sectional study. Nurs Open 2022; 9:210-221. [PMID: 34553513 PMCID: PMC8685874 DOI: 10.1002/nop2.1055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/30/2021] [Accepted: 09/01/2021] [Indexed: 12/07/2022] Open
Abstract
AIM To determine prevalence and predictors of perceived stress in women with threatened preterm labour. DESIGN Cross-sectional. METHODS We recruited 409 women with threatened preterm labour, hospitalized at two tertiary hospitals. We assessed their socio-demographic and obstetrics characteristics, and their perceived stress, perceived social support, experience of violence using validated scales. Multiple linear regression was used to determine the predictors. RESULTS Data from all recruited women were analysed. Most of them had borderline (36%) or high (42%) level stress. Overall, 17 predictors were identified explaining 89.5% of variation in the stress score. Predictors of the higher stress score included: urban living, experience of sexual and psychological violence, perceived insufficient social support, experience of vaginal bleeding during current pregnancy, abnormal results in initial pregnancy tests, having multiple roles at home, being less than 28 weeks pregnant, being parous, sleep disorders, history of health problems, insufficient income and unwanted pregnancy.
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Affiliation(s)
- Maryam Najjarzadeh
- Students’ Research CommitteeFaculty of Nursing and MidwiferyTabriz University of Medical SciencesTabrizIran
| | - Shamsi Abbasalizadeh
- Women's Reproductive Health Research CenterTabriz University of Medical SciencesTabrizIran
| | - Sakineh Mohammad‐Alizadeh‐Charandabi
- Department of MidwiferyFaculty of Nursing and MidwiferySocial Determinants of Health Research CenterTabriz University of Medical SciencesTabrizIran
| | - Mohammad Asghari‐Jafarabadi
- Department of Statistics and EpidemiologyFaculty of HealthRoad Traffic Injury Research CenterTabriz University of Medical SciencesTabrizIran
| | - Mojgan Mirghafourvand
- Clinical Research Development UnitImam Reza General HospitalTabriz University of Medical SciencesTabrizIran
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11
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Abstract
Prematurity remains a leading cause of perinatal morbidity and mortality, and also has significant implications for long-term health. Obstetricians have a key role to play in improving outcomes for infants born at extremely preterm gestations. This review explores the evidence for interventions available to obstetricians caring for women at risk of birthing at extremely preterm gestations, including antenatal corticosteroids, magnesium sulfate, tocolysis and antibiotics. It also addresses the importance of strategies to facilitate safe in-utero transfer, to maximise the chance of extremely preterm births occurring in tertiary centers, and the clinical value of strategies by which preterm birth can be predicted. The paper concludes with an appraisal of evidence for different modes of birth at extremely preterm gestations, and for delayed cord clamping.
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12
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Watson HA, Carlisle N, Seed PT, Carter J, Kuhrt K, Tribe RM, Shennan AH. Evaluating the use of the QUiPP app and its impact on the management of threatened preterm labour: A cluster randomised trial. PLoS Med 2021; 18:e1003689. [PMID: 34228735 PMCID: PMC8291648 DOI: 10.1371/journal.pmed.1003689] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 07/20/2021] [Accepted: 06/08/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Preterm delivery (before 37 weeks of gestation) is the single most important contributor to neonatal death and morbidity, with lifelong repercussions. However, the majority of women who present with preterm labour (PTL) symptoms do not deliver imminently. Accurate prediction of PTL is needed in order ensure correct management of those most at risk of preterm birth (PTB) and to prevent the maternal and fetal risks incurred by unnecessary interventions given to the majority. The QUantitative Innovation in Predicting Preterm birth (QUIPP) app aims to support clinical decision-making about women in threatened preterm labour (TPTL) by combining quantitative fetal fibronectin (qfFN) values, cervical length (CL), and significant PTB risk factors to create an individualised percentage risk of delivery. METHODS AND FINDINGS EQUIPTT was a multi-centre cluster randomised controlled trial (RCT) involving 13 maternity units in South and Eastern England (United Kingdom) between March 2018 and February 2019. Pregnant women (n = 1,872) between 23+0 and 34+6 weeks' gestation with symptoms of PTL in the analysis period were assigned to either the intervention (762) or control (1,111). The mean age of the study population was 30.2 (+/- SD 5.93). A total of 56.0% were white, 19.6% were black, 14.2% were Asian, and 10.2% were of other ethnicities. The intervention was the use of the QUiPP app with admission, antenatal corticosteroids (ACSs), and transfer advised for women with a QUiPP risk of delivery >5% within 7 days. Control sites continued with their conventional management of TPTL. Unnecessary management for TPTL was a composite primary outcome defined by the sum of unnecessary admission decisions (admitted and delivery interval >7 days or not admitted and delivery interval ≤7 days) and the number of unnecessary in utero transfer (IUT) decisions/actions (IUT that occurred or were attempted >7 days prior to delivery) and ex utero transfers (EUTs) that should have been in utero (attempted and not attempted). Unnecessary management of TPTL was 11.3% (84/741) at the intervention sites versus 11.5% (126/1094) at control sites (odds ratio [OR] 0.97, 95% confidence interval [CI] 0.66-1.42, p = 0.883). Control sites frequently used qfFN and did not follow UK national guidance, which recommends routine treatment below 30 weeks without testing. Unnecessary management largely consisted of unnecessary admissions which were similar at intervention and control sites (10.7% versus 10.8% of all visits). In terms of adverse outcomes for women in TPTL <36 weeks, 4 women from the intervention sites and 12 from the control sites did not receive recommended management. If the QUiPP percentage risk was used as per protocol, unnecessary management would have been 7.4% (43/578) versus 9.9% (134/1,351) (OR 0.72, 95% CI 0.45-1.16). Our external validation of the QUiPP app confirmed that it was highly predictive of delivery in 7 days; receiver operating curve area was 0.90 (95% CI 0.85-0.95) for symptomatic women. Study limitations included a lack of compliance with national guidance at the control sites and difficulties in implementation of the QUiPP app. CONCLUSIONS This cluster randomised trial did not demonstrate that the use of the QUiPP app reduced unnecessary management of TPTL compared to current management but would safely improve the management recommended by the National Institute for Health and Care Excellence (NICE). Interpretation of qfFN, with or without the QUiPP app, is a safe and accurate method for identifying women most likely to benefit from PTL interventions. TRIAL REGISTRATION ISRCTN Registry ISRCTN17846337.
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Affiliation(s)
- Helena A. Watson
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, St Thomas’ Hospital, London
| | - Naomi Carlisle
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, St Thomas’ Hospital, London
| | - Paul T. Seed
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, St Thomas’ Hospital, London
| | - Jenny Carter
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, St Thomas’ Hospital, London
| | - Katy Kuhrt
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, St Thomas’ Hospital, London
| | - Rachel M. Tribe
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, St Thomas’ Hospital, London
| | - Andrew H. Shennan
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, St Thomas’ Hospital, London
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