[Morbidity and mortality of premature neonates after introduction of national in vitro fertilisation programme--our experience]

Assessing the Risk of Cerebral Palsy in Children Born after Assisted Conception – The Role of Multiple Pregnancy and Preterm Delivery / Procena rizika od cerebralne paralize kod dece začete vantelesnim oplođenjem – uloga višestruke trudnoće i prevremenog rođenja

For more than three decades, assisted reproductive techniques (ART) have been used as effective treatments to overcome infertility. Since then, numerous studies have been focused on different aspects of long-term health and development of children born after assisted conception. The aim of this paper is to summarize new data on multiple pregnancy and preterm delivery as one of the risk factors which might increase the risk of developing cerebral palsy (CP) in children born after assisted conception.

A comprehensive search of eight databases retrieved 108 papers, 10 of which met inclusion criteria and were relevant for this review.

Despite the dissimilarities in methodological and analytic approaches in the selected studies, in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are generally considered safe, still there is an ongoing discussion whether multiple pregnancy and preterm delivery increase or do not increase the risk of CP in children born after assisted conception.

All information about possible adverse maternal and/or infant outcomes should be made available to the couples seeking ART treatment

Intracranial haemorrhage after transport of premature newborns

Intracranial hemorrhage remains an important factor of premature newborns? morbidity. Its incidence is significantly influenced by adequate perinatal care and safe neonatal transport. Risk factors for the development of intracranial hemorrhage in premature newborns after neonatal transport were analyzed in the retrospective transversal clinical study. Out of 150 study subjects, 60% (n=90/150) had intracranial hemorrhage with a statistically significant difference in relation to Apgar score, gestational age, birth weight, age at the moment of transport and the prophylactic use of surfactant. In this group, grades I/II intracranial hemorrhage were detected in 77% (n=69/90), while grades III/IV intracranial hemorrhage were diagnosed in 23% (n=21/90). A statistically significant difference was observed in relation to gestational age, birth weight, antenatal use of tocolytics and steroids, delivery mode and age in the time of transport between these groups. All patients were transferred to Intensive Care Unit, the duration of transport was less than 5 minutes in 71% 9n=107/150), whereas longer transport was recorded in 29% (n=43/150). In the group of longer transport, prophylactic surfactant was less frequently used with a higher incidence of grades III/IV intracranial hemorrhage. In order to prevent the development of intracranial hemorrhage in premature newborns, the most important measures are the antenatal use of steroids and postnatal prophylactic use of surfactant.