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Alhasoon M, Alqahtani B, Alreefi M, Homedi A, Alnami G, Alsaif S, Ali K. Retrospective Comparative Analysis of Neonatal Mortality and Morbidity in Preterm Singleton and Multiple Births -Single Center Experience. Glob Pediatr Health 2024; 11:2333794X241240571. [PMID: 38533296 PMCID: PMC10964436 DOI: 10.1177/2333794x241240571] [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] [Received: 05/04/2023] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 03/28/2024] Open
Abstract
Objective. To compare mortality and major neonatal morbidities between singleton preterm infants and preterm infants of multiple gestations born <33 weeks' gestation. Method. Case-control study of preterm multiples and singletons <33 weeks' born at King Abdul-Aziz Medical City Riyadh (KAMC-R) between January 2017 and December 2020. Out-born infants and infants with lethal congenital abnormalities were excluded from the study. Mortality and major neonatal morbidities including bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), sepsis and surgical necrotizing enterocolitis (NEC) were compared between preterm singletons and multiples. Results. A total of 803 preterm infants were included: 567 (70.6%) were singletons, 158 (19.6%) were twins and 36 (4.5%) infants were higher multiples. Adjusted mortality before hospital discharge was significantly higher among preterm infants of multiple gestations compared to preterm singletons (12.3% vs 7.9%; P = .003; AOR, 2.2; 95% CI, 1.3-3.7). Retinopathy of prematurity (ROP) needing treatment was significantly higher among preterm infants of multiple pregnancies compared to preterm singletons (11% vs 6.5%, P = .033, AOR 1.1, 95% CI, 1.04-2.99). In addition, the incidence of bronchopulmonary dysplasia (BPD) at 36 weeks post menstrual age (PMA) (29.7% vs 20.5%; P = .003; AOR, 1.7; 95% CI, 1.2-2.5) and culture positive sepsis (24.2% vs 17.5%; P = .044; AOR, 1.5; 95% CI, 1.01-2.2) were significantly higher among preterm infants of multiple pregnancy. There were no differences in mortality and adverse neonatal outcomes between twins and higher multiples. Conclusion. Preterm infants of multiple gestations suffered higher mortality and neonatal morbidities compared to preterm singleton infants despite a higher utilization of maternal antenatal steroids and better antenatal care.
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Affiliation(s)
- Mohammad Alhasoon
- Department of Pediatrics, College of Medicine, Qassim University, Buraydah, Saudi Arabia
| | - Bader Alqahtani
- Neonatal Intensive Care Department, King Abdulaziz Medical City-Riyadh, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Mohamad Alreefi
- Neonatal Intensive Care Department, King Abdulaziz Medical City-Riyadh, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Abdulaziz Homedi
- Neonatal Intensive Care Department, King Abdulaziz Medical City-Riyadh, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Ghadah Alnami
- Neonatal Intensive Care Department, King Abdulaziz Medical City-Riyadh, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Saif Alsaif
- Neonatal Intensive Care Department, King Abdulaziz Medical City-Riyadh, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Kamal Ali
- Neonatal Intensive Care Department, King Abdulaziz Medical City-Riyadh, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
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Bodnar LM, Himes KP, Parisi SM, Hutcheon JA. Gestational weight gain in triplet pregnancies in the United States. Am J Obstet Gynecol MFM 2022; 4:100716. [PMID: 35977703 PMCID: PMC10199757 DOI: 10.1016/j.ajogmf.2022.100716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The Institute of Medicine has published national recommendations for optimal pregnancy weight gain ranges for singletons and twins but not for higher-order multiples. A common clinical resource suggests weight gain targets for triplet pregnancies, but they are based on a single, small study conducted over 20 years ago. OBJECTIVE We sought to describe contemporary maternal weight gain patterns in triplet gestations in the United States, the weight gain patterns associated with good neonatal outcomes, and how these patterns compare with those of healthy twin pregnancies. STUDY DESIGN We used data from 7705 triplet pregnancies drawn from the United States live birth and fetal death files (2012‒2018). We calculated total pregnancy weight gain as weight at delivery minus the prepregnancy weight. A good neonatal outcome was defined as delivery at ≥32 weeks' gestation of 3 liveborn infants weighing ≥1500 g with 5-minute Apgar scores of ≥3. We described the weight gain patterns of triplet pregnancies with good neonatal outcomes by calculating week-specific percentiles of the total weight gain distribution for deliveries at 32 to 37 weeks' gestation. For comparative purposes, we plotted these values against the percentiles of a previously published weight gain chart for monitoring and evaluating twin pregnancies from a referent cohort. RESULTS Most participants were over weight (26%) or obese (30%), and 42% were normal weight or underweight. The 50th percentile (25th-75th) of total weight gain in triplet pregnancies was 17 (11-23) kg. As the body mass index category increased, the total weight gain declined: underweight or normal weight, median 19 (14-25) kg; overweight, 17 (12-23) kg; obese, 14 (7.7-20) kg. Approximately 46% of triplet pregnancies had a good neonatal outcome (n=3562). For underweight or normal weight triplet pregnancies with good neonatal outcomes, the 50th percentiles of weight gain at 32 weeks' and 36 weeks' gestation were 12.3 kg and 22.7 kg, respectively. The 10th and 90th percentiles were 12.3 kg and 32.7 kg, respectively, at 32 weeks, and 15.0 kg and 34.1 kg, respectively, at 36 weeks. Triplet pregnancies with prepregnancy overweight or obesity and a good neonatal outcome had lower weight gains. Compared with the reference values for pregnancy weight gain from a twin-specific weight gain chart, the median total weight gain in triplet pregnancies with good neonatal outcomes was approximately 3 to 5 kg more than twins, regardless of body mass index. CONCLUSION Our study fills an important gap in understanding how much weight gain can be expected among triplet pregnancies by body mass index category. These descriptive data are a necessary first step to inform science-based triplet gestational weight gain guidelines. Additional research is needed to determine whether monitoring triplet pregnancy weight gain is useful for promoting healthy outcomes for pregnant individuals and children and what targets should be used to optimize maternal and neonatal health.
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Affiliation(s)
- Lisa M Bodnar
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA (Dr Bodnar and Ms Parisi); Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA (Drs Bodnar and Himes).
| | - Katherine P Himes
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA (Drs Bodnar and Himes)
| | - Sara M Parisi
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA (Dr Bodnar and Ms Parisi)
| | - Jennifer A Hutcheon
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, Canada (Dr Hutcheon)
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Maternal, Perinatal and Neonatal Outcomes of Triplet Pregnancies According to Chorionicity: A Systematic Review of the Literature and Meta-Analysis. J Clin Med 2022; 11:jcm11071871. [PMID: 35407479 PMCID: PMC8999732 DOI: 10.3390/jcm11071871] [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] [Received: 03/07/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 11/17/2022] Open
Abstract
Triplet pregnancies are rare events that affect approximately 93 in 100,000 deliveries in the world, especially due to the increased use of assisted reproductive techniques and older maternal age. Triplet pregnancies are associated with a higher risk of fetal and maternal morbidity and mortality compared to twins and singletons. Chorionicity has been proposed as a major determinant of perinatal and maternal outcomes in triplet pregnancies, although further evidence is needed to clarify the extent and real influence of this factor. Thus, the aim of this study was to conduct a systematic review of the literature and a meta-analysis of the maternal and perinatal outcomes of triplet pregnancies, evaluating how chorionicity may influence these results. A total of 46 studies with 43,653 triplet pregnancies and 128,145 live births were included. Among the main results of our study, we found a broad spectrum of fetal and maternal complications, especially in the group of monochorionic and dichorionic pregnancies. Risk of admission to NICU, respiratory distress, sepsis, necrotizing enterocolitis, perinatal and intrauterine mortality were all found to be higher in non-TCTA pregnancies than in TCTA pregnancies. To date, our meta-analysis includes the largest population sample and number of studies conducted in this field, evaluating a wide variety of outcome measures. The heterogeneity and retrospective design of the studies included in our research represent the main limitations of this review. More evidence is needed to fully assess outcome measures that could not be studied in this review due to scarcity of publications or insufficient sample size.
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Money NM, Schroeder AR, Quinonez RA, Ho T, Marin JR, Wolf ER, Morgan DJ, Dhruva SS, Coon ER. 2021 Update on Pediatric Overuse. Pediatrics 2022; 149:184542. [PMID: 35059726 PMCID: PMC9004348 DOI: 10.1542/peds.2021-053384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 02/03/2023] Open
Abstract
This update on pediatric medical overuse identifies and provides concise summaries of 10 impactful articles related to pediatric medical overuse from the years 2019 to 2020.
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Affiliation(s)
- Nathan M. Money
- Department of Pediatrics, University of Utah School of Medicine, Primary Children’s Hospital, Salt Lake City, Utah
| | - Alan R. Schroeder
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Ricardo A. Quinonez
- Division of Pediatric Hospital Medicine, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
| | - Timmy Ho
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jennifer R. Marin
- Departments of Pediatrics, Emergency Medicine, and Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Elizabeth R. Wolf
- Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia
| | - Daniel J. Morgan
- University of Maryland School of Medicine and VA Maryland Health care System, Baltimore, Maryland
| | - Sanket S. Dhruva
- UCSF School of Medicine and San Francisco VA Medical Center, San Francisco, California
| | - Eric R. Coon
- Department of Pediatrics, University of Utah School of Medicine, Primary Children’s Hospital, Salt Lake City, Utah
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Mitsiakos G, Gialamprinou D, Chatziioannidis I, Pouliakis A, Kontovazainitis CG, Chatzigrigoriou F, Karagkiozi A, Lazaridou E, Papacharalambous E, Poumpouridou E, Theodoridis T, Babacheva E, Karagianni P, Grimbizis G, Soubasi V. Are neonatal outcomes of triplet pregnancies different from those of singletons according to gestational age? J Perinat Med 2021; 49:1145-1153. [PMID: 34107572 DOI: 10.1515/jpm-2020-0558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/27/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Multiple pregnancies sustain the high pace of extreme prematurity. Little evidence is available about triplet gestation given the evolution in their management during the last decades. The aim of the study was to compare the neonatal outcomes of triplets with those of matched singletons in a cohort study. METHODS An observational retrospective cohort study of triplets and matched singletons born between 2004 and 2017 matched by gestational age was conducted. Additionally, the investigation performed in regard to data from the overall Greek population of interest. The primary outcome was mortality or severe neonatal morbidity based on pregnancy type. RESULTS A total of 237 triplets of 24-36 weeks' gestation and 482 matched singletons were included. No differences in the primary outcome between triplets and singletons were found. Rates of severe neonatal morbidities did not differ significantly between triplets and singletons. A threshold of 1000 gr for birthweight and 28 weeks' gestation for gestational age determined survival on triplets [OR: 0.08 (95% CI: 0.02-0.40, p=0.0020) and OR: 0.13 (95% CI: 0.03-0.57, p=0.0020) for gestational age and birthweight respectively]. In Greece stillbirths in triplets was 8 times higher than that of singletons (OR: 8.5, 95% CI: 6.9-10.5). From 3,375 triplets, 94 were stillborn, whereas in singletons, 4,659 out of 1,388,273. In our center 5 times more triplets than the expected average in Greece were delivered with no significant difference in stillbirths' rates. CONCLUSIONS No significant differences were identified in mortality or major neonatal morbidities between triplets and matched singletons highlighting the significance of prematurity and birthweight for these outcomes.
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Affiliation(s)
- Georgios Mitsiakos
- 2nd Neonatal Department and Neonatal Intensive Care Unit (NICU), Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, Greece
| | - Dimitra Gialamprinou
- 2nd Neonatal Department and Neonatal Intensive Care Unit (NICU), Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, Greece
| | - Ilias Chatziioannidis
- 2nd Neonatal Department and Neonatal Intensive Care Unit (NICU), Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, Greece
| | - Abraham Pouliakis
- 2nd Department of Pathology, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Athens, Greece
| | - Christos Georgios Kontovazainitis
- 2nd Neonatal Department and Neonatal Intensive Care Unit (NICU), Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, Greece
| | - Fotini Chatzigrigoriou
- 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece, "Papageorgiou" Hospital, Thessaloniki, Greece
| | - Anastasia Karagkiozi
- 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece, "Papageorgiou" Hospital, Thessaloniki, Greece
| | - Eleni Lazaridou
- 2nd Neonatal Department and Neonatal Intensive Care Unit (NICU), Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, Greece
| | - Efthimia Papacharalambous
- 2nd Neonatal Department and Neonatal Intensive Care Unit (NICU), Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, Greece
| | - Effimia Poumpouridou
- 2nd Neonatal Department and Neonatal Intensive Care Unit (NICU), Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, Greece
| | - Theodoros Theodoridis
- 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece, "Papageorgiou" Hospital, Thessaloniki, Greece
| | - Evgenyia Babacheva
- 2nd Neonatal Department and Neonatal Intensive Care Unit (NICU), Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, Greece
| | - Paraskevi Karagianni
- 2nd Neonatal Department and Neonatal Intensive Care Unit (NICU), Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, Greece
| | - Grigorios Grimbizis
- 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece, "Papageorgiou" Hospital, Thessaloniki, Greece
| | - Vassiliki Soubasi
- 2nd Neonatal Department and Neonatal Intensive Care Unit (NICU), Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, Greece
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Kalikkot Thekkeveedu R, Dankhara N, Desai J, Klar AL, Patel J. Outcomes of multiple gestation births compared to singleton: analysis of multicenter KID database. Matern Health Neonatol Perinatol 2021; 7:15. [PMID: 34711283 PMCID: PMC8554969 DOI: 10.1186/s40748-021-00135-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background The available data regarding morbidity and mortality associated with multiple gestation births is conflicting and contradicting. Objective To compare morbidity, mortality, and length of stay (LOS) outcomes between multiple gestation (twin, triplet and higher-order) and singleton births. Methods Data from the national multicenter Kids’ Inpatient Database of the Healthcare Cost and Utilization Project from the years 2000, 2003, 2006, 2009, 2012, and 2016 were analyzed using a complex survey design using Statistical Analysis System (SAS) 9.4 (SAS Institute, Cary NC). Neonates with ICD9 and ICD10 codes indicating singletons, twins or triplets, and higher-order multiples were included. Mortality was compared between these groups after excluding transfer outs to avoid duplicate inclusion. To analyze LOS, we included inborn neonates and excluded transfers; who died inpatient and any neonates who appear to have been discharged less than 33 weeks PMA. The LOS was compared by gestational age groups. Results A total of 22,853,125 neonates were analyzed for mortality after applying inclusion-exclusion criteria; 2.96% were twins, and 0.13% were triplets or more. A total of 22,690,082 neonates were analyzed for LOS. Mean GA, expressed as mean (SD), for singleton, twins and triplets, were 38.30 (2.21), 36.39 (4.21), and 32.72 (4.14), respectively. The adjusted odds for mortality were similar for twin births compared to singleton (aOR: 1.004, 95% CI:0.960–1.051, p = 0.8521). The adjusted odds of mortality for triplet or higher-order gestation births were higher (aOR: 1.33, 95% CI: 1.128–1.575, p = 0.0008) when compared to the singleton births. Median LOS (days) was significantly longer in multiple gestation compared to singleton births overall (singletons: 1.59 [1.13, 2.19] vs. twins 3.29 [2.17, 9.59] vs. triplets or higher-order multiples 19.15 [8.80, 36.38], p < .0001), and this difference remained significant within each GA category. Conclusion Multiple gestation births have higher mortality and longer LOS when compared to singleton births. This population data from multiple centers across the country could be useful in counseling parents when caring for multiple gestation pregnancies. Supplementary Information The online version contains supplementary material available at 10.1186/s40748-021-00135-5.
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Affiliation(s)
| | - Nilesh Dankhara
- Newborn Medicine, University of Mississippi Medical Center, 2500 N State St, W154, Jackson, MS, 39216, USA
| | - Jagdish Desai
- Newborn Medicine, University of Mississippi Medical Center, 2500 N State St, W154, Jackson, MS, 39216, USA
| | - Angelle L Klar
- Newborn Medicine, University of Mississippi Medical Center, 2500 N State St, W154, Jackson, MS, 39216, USA
| | - Jaimin Patel
- Newborn Medicine, University of Mississippi Medical Center, 2500 N State St, W154, Jackson, MS, 39216, USA
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7
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Expectant management versus multifetal pregnancy reduction in dichorionic triamniotic (DCTA) triplets: Single centre experience. Eur J Obstet Gynecol Reprod Biol 2021; 264:200-205. [PMID: 34329945 DOI: 10.1016/j.ejogrb.2021.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 07/01/2021] [Accepted: 07/12/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES In trichorionic triplet pregnancies, multifetal pregnancy reduction (MFPR) reduces the risk of preterm birth, neonatal morbidity and mortality without increasing miscarriage. A similar benefit has been suggested in dichorionic triamniotic (DCTA) pregnancy, but multiple methods are currently used. This study investigates if the method of reduction used in DCTA triplet pregnancy influences the evidence of benefit from MFPR. METHODS This is a retrospective cohort study of DCTA pregnancies between 2010 and 2019 who attended a single UK fetal medicine tertiary referral center. Cohorts were defined based on MFPR decision and method. The primary outcome was offspring survival until neonatal discharge. The secondary outcomes included miscarriage, preterm birth, livebirth, rates of small for gestational age (SGA) neonates, ans maternal morbidity. To evaluate the differences in neonatal survival until discharge we used Cox proportional regression to calculate hazard rates (HR) and 95% confidence intervals (CI). Differences in secondary outcomes were compared using univariate analysis. RESULTS The study reports the outcomes for 83 DCTA pregnancies. MFPR to DCDA twins was chosen in 19 pregnancies (14 radiofrequency ablation, RFA; 5 intrafetal laser, IFL); in 9 pregnancies selective reduction to a singleton was performed by KCl injection. The rate of pregnancies in with ≥ 1 fetus born alive was not different between groups (p = 0.90). However, the number of expected neonates alive at discharge from hospital was highest in the RFA group (89%, HR 0.28, 95% CI 0.21-0.87, p = 0.02). Rates of premature delivery before 32 weeks (p = 0.02), low birth weight (p < 0.001) and birthweight < 10th percentile (p = 0.01) were all elevated in the expectant management group, compared to women who opted for reduction. There was no difference in miscarriage between groups. CONCLUSIONS Our study suggests that MFPR by RFA, an established and widely available procedure, is of benefit in promoting neonatal survival until discharge in DCTA triplets.
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Younes S, Samara M, Al-Jurf R, Nasrallah G, Al-Obaidly S, Salama H, Olukade T, Hammuda S, Ismail MA, Abdoh G, Abdulrouf PV, Farrell T, AlQubaisi M, Al Rifai H, Al-Dewik N. Incidence, Risk Factors, and Outcomes of Preterm and Early Term Births: A Population-Based Register Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5865. [PMID: 34072575 PMCID: PMC8197791 DOI: 10.3390/ijerph18115865] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/16/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022]
Abstract
Preterm birth (PTB) and early term birth (ETB) are associated with high risks of perinatal mortality and morbidity. While extreme to very PTBs have been extensively studied, studies on infants born at later stages of pregnancy, particularly late PTBs and ETBs, are lacking. In this study, we aimed to assess the incidence, risk factors, and feto-maternal outcomes of PTB and ETB births in Qatar. We examined 15,865 singleton live births using 12-month retrospective registry data from the PEARL-Peristat Study. PTB and ETB incidence rates were 8.8% and 33.7%, respectively. PTB and ETB in-hospital mortality rates were 16.9% and 0.2%, respectively. Advanced maternal age, pre-gestational diabetes mellitus (PGDM), assisted pregnancies, and preterm history independently predicted both PTB and ETB, whereas chromosomal and congenital abnormalities were found to be independent predictors of PTB but not ETB. All groups of PTB and ETB were significantly associated with low birth weight (LBW), large for gestational age (LGA) births, caesarean delivery, and neonatal intensive care unit (NICU)/or death of neonate in labor room (LR)/operation theatre (OT). On the other hand, all or some groups of PTB were significantly associated with small for gestational age (SGA) births, Apgar < 7 at 1 and 5 min and in-hospital mortality. The findings of this study may serve as a basis for taking better clinical decisions with accurate assessment of risk factors, complications, and predictions of PTB and ETB.
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Affiliation(s)
- Salma Younes
- Department of Research, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha 3050, Qatar; (S.Y.); (M.A.I.); (P.V.A.); (T.F.)
| | - Muthanna Samara
- Department of Psychology, Kingston University London, Kingston upon Thames, London KT1 2EE, UK; (M.S.); (S.H.)
| | - Rana Al-Jurf
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha 2713, Qatar; (R.A.-J.); (G.N.)
| | - Gheyath Nasrallah
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha 2713, Qatar; (R.A.-J.); (G.N.)
| | - Sawsan Al-Obaidly
- Obstetrics and Gynecology Department, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha 3050, Qatar;
| | - Husam Salama
- Department of Pediatrics and Neonatology, Neonatal Intensive Care Unit, Newborn Screening Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha 3050, Qatar; (H.S.); (T.O.); (G.A.); (M.A.); (H.A.R.)
| | - Tawa Olukade
- Department of Pediatrics and Neonatology, Neonatal Intensive Care Unit, Newborn Screening Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha 3050, Qatar; (H.S.); (T.O.); (G.A.); (M.A.); (H.A.R.)
| | - Sara Hammuda
- Department of Psychology, Kingston University London, Kingston upon Thames, London KT1 2EE, UK; (M.S.); (S.H.)
| | - Mohamed A. Ismail
- Department of Research, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha 3050, Qatar; (S.Y.); (M.A.I.); (P.V.A.); (T.F.)
| | - Ghassan Abdoh
- Department of Pediatrics and Neonatology, Neonatal Intensive Care Unit, Newborn Screening Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha 3050, Qatar; (H.S.); (T.O.); (G.A.); (M.A.); (H.A.R.)
| | - Palli Valapila Abdulrouf
- Department of Research, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha 3050, Qatar; (S.Y.); (M.A.I.); (P.V.A.); (T.F.)
- Department of Pharmacy, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha 3050, Qatar
| | - Thomas Farrell
- Department of Research, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha 3050, Qatar; (S.Y.); (M.A.I.); (P.V.A.); (T.F.)
- Obstetrics and Gynecology Department, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha 3050, Qatar;
| | - Mai AlQubaisi
- Department of Pediatrics and Neonatology, Neonatal Intensive Care Unit, Newborn Screening Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha 3050, Qatar; (H.S.); (T.O.); (G.A.); (M.A.); (H.A.R.)
| | - Hilal Al Rifai
- Department of Pediatrics and Neonatology, Neonatal Intensive Care Unit, Newborn Screening Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha 3050, Qatar; (H.S.); (T.O.); (G.A.); (M.A.); (H.A.R.)
| | - Nader Al-Dewik
- Department of Research, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha 3050, Qatar; (S.Y.); (M.A.I.); (P.V.A.); (T.F.)
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha 2713, Qatar; (R.A.-J.); (G.N.)
- Interim Translational Research Institute (iTRI), Hamad Medical Corporation (HMC), Doha 3050, Qatar
- Faculty of Health and Social Care Sciences, Kingston University, St. George’s University of London, London KT1 2EE, UK
- Clinical and Metabolic Genetics, Department of Pediatrics, Hamad General Hospital, Hamad Medical Corporation, Doha 3050, Qatar
- College of Health and Life Science (CHLS), Hamad Bin Khalifa University (HBKU), Doha 34110, Qatar
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Tataranno ML, Vijlbrief DC, Dudink J, Benders MJNL. Precision Medicine in Neonates: A Tailored Approach to Neonatal Brain Injury. Front Pediatr 2021; 9:634092. [PMID: 34095022 PMCID: PMC8171663 DOI: 10.3389/fped.2021.634092] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/14/2021] [Indexed: 11/27/2022] Open
Abstract
Despite advances in neonatal care to prevent neonatal brain injury and neurodevelopmental impairment, predicting long-term outcome in neonates at risk for brain injury remains difficult. Early prognosis is currently based on cranial ultrasound (CUS), MRI, EEG, NIRS, and/or general movements assessed at specific ages, and predicting outcome in an individual (precision medicine) is not yet possible. New algorithms based on large databases and machine learning applied to clinical, neuromonitoring, and neuroimaging data and genetic analysis and assays measuring multiple biomarkers (omics) can fulfill the needs of modern neonatology. A synergy of all these techniques and the use of automatic quantitative analysis might give clinicians the possibility to provide patient-targeted decision-making for individualized diagnosis, therapy, and outcome prediction. This review will first focus on common neonatal neurological diseases, associated risk factors, and most common treatments. After that, we will discuss how precision medicine and machine learning (ML) approaches could change the future of prediction and prognosis in this field.
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Affiliation(s)
| | | | | | - Manon J. N. L. Benders
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Neurodevelopmental outcome of preterm twins at 5 years of age. Pediatr Res 2020; 87:1072-1080. [PMID: 31830757 DOI: 10.1038/s41390-019-0688-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 09/26/2019] [Accepted: 11/11/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Twins are considered to be at an increased risk for perinatal mortality and morbidities, but it is unclear whether preterm twins are at an increased risk for poor developmental outcomes when compared to preterm singletons. Our aim was to compare the neurodevelopmental outcome of preterm twins vs singletons at 5 years of age. METHODS Very low birth weight and very low gestational age infants (twins n = 66, singletons n = 157) were recruited as a part of the PIPARI project in the Turku University Hospital, covering a regional population. Cognitive development, neuropsychological performance, and neurodevelopmental impairments (including cerebral palsy, hearing deficit, visual impairment, and intellectual disability) were evaluated at 5 years of age. RESULTS Twins and singletons had otherwise similar perinatal background factors, except for the higher proportion of preterm rupture of membranes in singletons. Twins had cognitive and neuropsychological outcomes that were otherwise comparable with singletons, but they had a slightly lower verbal intelligence quotient (estimate -5.81, 95% CI -11.14 to -0.48, p = 0.03). Being a twin was not a risk for neurodevelopmental impairments. CONCLUSIONS Our study shows that, contrary to a common hypothesis, the overall neurodevelopment of very preterm twins does not significantly differ from that of preterm singletons.
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Norman M, Håkansson S, Kusuda S, Vento M, Lehtonen L, Reichman B, Darlow BA, Adams M, Bassler D, Isayama T, Rusconi F, Lee S, Lui K, Yang J, Shah PS. Neonatal Outcomes in Very Preterm Infants With Severe Congenital Heart Defects: An International Cohort Study. J Am Heart Assoc 2020; 9:e015369. [PMID: 32079479 PMCID: PMC7335543 DOI: 10.1161/jaha.119.015369] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Very preterm infants are at high risk of death or severe morbidity. The objective was to determine the significance of severe congenital heart defects (CHDs) for these risks. Methods and Results This cohort study included infants from 10 countries born from 2007–2015 at 24 to 31 weeks’ gestation with birth weights <1500 g. Severe CHDs were defined by International Classification of Diseases, Ninth Revision (ICD‐9) and Tenth (ICD‐10) codes and categorized as those compromising systemic output, causing sustained cyanosis, or resulting in congestive heart failure. The primary outcome was in‐hospital mortality. Secondary outcomes were neonatal brain injury, necrotizing enterocolitis, bronchopulmonary dysplasia, and retinopathy of prematurity. Adjusted and propensity score–matched odds ratios (ORs) were calculated. Analyses were stratified by type of CHD, gestational age, and network. A total of 609 (0.77%) infants had severe CHD and 76 371 without any malformation served as controls. The mean gestational age and birth weight were 27.8 weeks and 1018 g, respectively. The mortality rate was 18.6% in infants with CHD and 8.9% in controls (propensity score–matched OR, 2.30; 95% CI, 1.61–3.27). Severe CHD was not associated with neonatal brain injury, necrotizing enterocolitis, or retinopathy of prematurity, whereas the OR for bronchopulmonary dysplasia increased. Mortality was higher in all types, with the highest propensity score–matched OR (4.96; 95% CI, 2.11–11.7) for CHD causing congestive heart failure. While mortality did not differ between groups at <27 weeks’ gestational age, adjusted OR for mortality in infants with CHD increased to 10.9 (95% CI, 5.76–20.70) at 31 weeks’ gestational age. Rates of CHD and mortality differed significantly between networks. Conclusions Severe CHD is associated with significantly increased mortality in very preterm infants.
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Affiliation(s)
- Mikael Norman
- Department of Neonatal Medicine Karolinska University Hospital and Karolinska Institutet Stockholm Sweden
| | - Stellan Håkansson
- Department of Clinical Sciences/Pediatrics Umeå University and Umeå University Hospital Umeå Sweden
| | - Satoshi Kusuda
- Neonatal Research Network of Japan Kyorin University Tokyo Japan
| | - Maximo Vento
- Division of Neonatology Health Research Institute Hospital La Fe Valencia Spain
| | - Liisa Lehtonen
- Department of Pediatrics and Adolescent Medicine Turku University Hospital and University of Turku Turku Finland
| | - Brian Reichman
- Gertner Institute for Epidemiology and Health Policy Research Sheba Medical Centre Tel Hashomer Israel
| | - Brian A Darlow
- Department of Paediatrics University of Otago Christchurch New Zealand.,Illinois Neonatal Network Saint Louis IL
| | - Mark Adams
- Department of Neonatology University Hospital Zurich and University of Zurich Zurich Switzerland
| | - Dirk Bassler
- Department of Neonatology University Hospital Zurich and University of Zurich Zurich Switzerland
| | - Tetsuya Isayama
- Division of Neonatology National Center for Child Health and Development Tokyo Japan
| | - Franca Rusconi
- Unit of Epidemiology Meyer Children's University Hospital and Regional Health Agency Florence Italy
| | - Shoo Lee
- Department of Pediatrics Mount Sinai Hospital and University of Toronto Toronto Canada.,Maternal-infant Care Research Centre Mount Sinai Hospital Toronto Canada
| | - Kei Lui
- Royal Hospital for Women National Perinatal Epidemiology and Statistics Unit University of New South Wales Randwick Australia
| | - Junmin Yang
- Maternal-infant Care Research Centre Mount Sinai Hospital Toronto Canada
| | - Prakesh S Shah
- Department of Pediatrics Mount Sinai Hospital and University of Toronto Toronto Canada.,Maternal-infant Care Research Centre Mount Sinai Hospital Toronto Canada
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Shah PS, Lui K, Reichman B, Norman M, Kusuda S, Lehtonen L, Adams M, Vento M, Darlow BA, Modi N, Rusconi F, Håkansson S, San Feliciano L, Helenius KK, Bassler D, Hirano S, Lee SK. The International Network for Evaluating Outcomes (iNeo) of neonates: evolution, progress and opportunities. Transl Pediatr 2019; 8:170-181. [PMID: 31413951 PMCID: PMC6675683 DOI: 10.21037/tp.2019.07.06] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 07/05/2019] [Indexed: 01/15/2023] Open
Abstract
Neonates born very preterm (before 32 weeks' gestational age), are a significant public health concern because of their high-risk of mortality and life-long disability. In addition, caring for very preterm neonates can be expensive, both during their initial hospitalization and their long-term cost of permanent impairments. To address these issues, national and regional neonatal networks around the world collect and analyse data from their constituents to identify trends in outcomes, and conduct benchmarking, audit and research. Improving neonatal outcomes and reducing health care costs is a global problem that can be addressed using collaborative approaches to assess practice variation between countries, conduct research and implement evidence-based practices. The International Network for Evaluating Outcomes (iNeo) of neonates was established in 2013 with the goal of improving outcomes for very preterm neonates through international collaboration and comparisons. To date, 10 national or regional population-based neonatal networks/datasets participate in iNeo collaboration. The initiative now includes data on >200,000 very preterm neonates and has conducted important epidemiological studies evaluating outcomes, variations and trends. The collaboration has also surveyed >320 neonatal units worldwide to learn about variations in practices, healthcare service delivery, and physical, environmental and manpower related factors and support services for parents. The iNeo collaboration serves as a strong international platform for Neonatal-Perinatal health services research that facilitates international data sharing, capacity building, and global efforts to improve very preterm neonate care.
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Affiliation(s)
- Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada
| | - Kei Lui
- Royal Hospital for Women, National Perinatal Epidemiology and Statistic Unit, University of New South Wales, Randwick, Australia
| | - Brian Reichman
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Ramat Gan, Israel
| | - Mikael Norman
- Department of Neonatal Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Satoshi Kusuda
- Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Liisa Lehtonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Mark Adams
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Maximo Vento
- Division of Neonatology and Health Research Institute La Fe, Valencia, Spain
| | - Brian A Darlow
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Neena Modi
- UK Neonatal Collaborative, Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster Hospital campus, London, UK
| | - Franca Rusconi
- Neonatal Intensive Care Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Stellan Håkansson
- Department of Clinical Sciences/Pediatrics, Umeå University Hospital, Umeå, Sweden
| | | | - Kjell K Helenius
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Shinya Hirano
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Shoo K Lee
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Obstetrics and Gynecology and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Modi N. Information technology infrastructure, quality improvement and research: the UK National Neonatal Research Database. Transl Pediatr 2019; 8:193-198. [PMID: 31413953 PMCID: PMC6675679 DOI: 10.21037/tp.2019.07.08] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Technological developments, coupled with strengthened governance and data security have led to increasing recognition of the potential of real-world health data to benefit patient care and health services. Real-world health data are those captured in the course of routine care. Here I describe a mature source of real-world health data, the UK National Neonatal Research Database and provide examples of the many types of uses it supports.
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Affiliation(s)
- Neena Modi
- Section of Neonatal Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK
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