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Depala KS, Chintala S, Joshi S, Budhani S, Paidipelly N, Patel B, Rastogi A, Madas N, Vejju R, Mydam J. Clinical Variables Associated With Grade III and IV Intraventricular Hemorrhage (IVH) in Preterm Infants Weighing Less Than 750 Grams. Cureus 2023; 15:e40471. [PMID: 37456494 PMCID: PMC10349592 DOI: 10.7759/cureus.40471] [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: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Despite innovative advances in neonatal medicine, intraventricular hemorrhage (IVH) continues to be a significant complication in neonatal intensive care units globally. OBJECTIVE The study aimed to discern the variables heightening the risk of severe IVH (Grade III and IV) in extremely premature infants weighing less than 750 grams. We postulated that a descending hematocrit (Hct) trend during the first week of life could serve as a predictive marker for the development of severe IVH in this vulnerable population. METHODS This retrospective case-control study encompassed infants weighing less than 750 grams at birth, diagnosed with Grade III and/or IV IVH, and born in a tertiary center from 2009 to 2014. A group of 17 infants with severe IVH was compared with 14 gestational age-matched controls. Acid-base status, glucose, fluid goal, urine output, and nutrient (caloric and protein) intake during the first four days of life were meticulously evaluated. Statistically significant variables from baseline data were further analyzed via univariable and multivariable logistic regression analyses, ensuring control for potential confounding variables. RESULTS The univariate logistic regression model delineated odds ratios (ORs) of 0.842 for day 2 average Hct (confidence interval [CI], 0.718-0.987) and 0.16 for urine output on day 3 (CI, 0.024-1.056), with the remaining six variables demonstrating no significant association. In the post-multivariable regression analysis, day 2 Hct was the only significant variable (OR, 0.731; 95% CI, 0.537-0.995; P=0.04). The receiver operating characteristic (ROC) curve analysis portrayed an area under the curve of 71% for the day 2 Hct variable. CONCLUSION The study revealed that a dip in Hct on day 2 of life augments the likelihood of Grade III and IV IVH among extremely premature infants with a birth weight of less than 750 grams. This insight amplifies our understanding of risk factors associated with severe IVH development in extremely preterm infants, potentially aiding in refining preventive strategies and optimizing clinical management and treatment of these affected infants.
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Affiliation(s)
- Kiran S Depala
- Department of Public Health and Social Justice, Saint Louis University, St. Louis, USA
| | - Soumini Chintala
- Department of Pediatrics, Phoenix Children's Hospital, Phoenix, USA
| | - Swosti Joshi
- Department of Neonatology, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Shaaista Budhani
- Department of Neonatology, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Nihal Paidipelly
- Department of Chemistry, Case Western Reserve University, Cleveland, USA
| | - Bansari Patel
- School of Medicine, American University of Barbados, Bridgetown, BRB
| | - Alok Rastogi
- Department of Neonatology, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Nimisha Madas
- Department of Internal Medicine, Northwestern Medicine McHenry Hospital, McHenry, USA
| | - Revanth Vejju
- Department of Biology, New Jersey Institute of Technology, Newark, USA
| | - Janardhan Mydam
- Department of Neonatology, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
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Chen YL, Hsiao RC, Chou WJ, Yen CF. Delivering high birth weight babies by emergency caesarean section may increase the risk of attention-deficit/hyperactivity disorder. Acta Paediatr 2023; 112:1233-1235. [PMID: 36794993 DOI: 10.1111/apa.16711] [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: 11/18/2022] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 02/17/2023]
Affiliation(s)
- Yi-Lung Chen
- Department of Psychology, and Department of Healthcare Administration, Asia University, Taichung, Taiwan
| | - Ray C Hsiao
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, and Department of Psychiatry, Seattle Children's, Seattle, WA, USA
| | - Wen-Jiun Chou
- Department of Child and Adolescent Psychiatry, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Fang Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,College of Professional Studies, National Pingtung University of Science and Technology, Pingtung, Taiwan
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Oltean I, Rajaram A, Tang K, MacPherson J, Hondonga T, Rishi A, Toltesi R, Gowans R, Jahangirnia A, Nasr Y, Lawrence SL, El Demellawy D. The Association of Placental Abruption and Pediatric Neurological Outcome: A Systematic Review and Meta-Analysis. J Clin Med 2022; 12:jcm12010205. [PMID: 36615006 PMCID: PMC9821447 DOI: 10.3390/jcm12010205] [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] [Received: 11/06/2022] [Revised: 12/17/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
Placental histopathology provides insights, or "snapshots", into relevant antenatal factors that could elevate the risk of perinatal brain injury. We present a systematic review and meta-analysis comparing frequencies of adverse neurological outcomes in infants born to women with placental abruption versus without abruption. Records were sourced from MEDLINE, Embase, and the CENTRAL Trials Registry from 1946 to December 2019. Studies followed the PRISMA guidelines and compared frequencies of neurodevelopmental morbidities in infants born to pregnant women with placental abruption (exposure) versus women without placental abruption (comparator). The primary endpoint was cerebral palsy. Periventricular and intraventricular (both severe and any grades of IVH) and any histopathological neuronal damage were the secondary endpoints. Study methodologic quality was assessed by the Ottawa-Newcastle scale. Estimated odds ratios (OR) and hazards ratio (HR) were derived according to study design. Data were meta-analyzed using a random effects model expressed as pooled effect sizes and 95% confidence intervals. We included eight observational studies in the review, including 1245 infants born to women with placental abruption. Results of the random effects meta-analysis show that the odds of infants born to pregnant women with placental abruption who experience cerebral palsy is higher than in infants born to pregnant women without placental abruption (OR 5.71 95% CI (1.17, 27.91); I2 = 84.0%). There is no statistical difference in the odds of infants born to pregnant women with placental abruption who experience severe IVH (grade 3+) (OR 1.20 95% CI (0.46, 3.11); I2 = 35.8%) and any grade of IVH (OR 1.20 95% CI (0.62, 2.32); I2 = 32.3%) vs. women without placental abruption. There is no statistically significant difference in the odds of infants born to pregnant women with placental abruption who experience PVL vs. pregnant women without placental abruption (OR 6.51 95% CI (0.94, 45.16); I2 = 0.0%). Despite our meta-analysis suggesting increased odds of cerebral palsy in infants born to pregnant women with placental abruption versus without abruption, this finding should be interpreted cautiously, given high heterogeneity and overall poor quality of the included studies.
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Affiliation(s)
- Irina Oltean
- Department of Surgery & Pathology, Children’s Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada; (I.O.); (K.T.)
| | - Ajay Rajaram
- Department of Pathology, McGill University, Montreal, QC H4A 3J1, Canada;
| | - Ken Tang
- Department of Surgery & Pathology, Children’s Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada; (I.O.); (K.T.)
| | - James MacPherson
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; (J.M.); (Y.N.)
| | | | - Aanchal Rishi
- Schulich School of Medicine & Dentistry, Western University, London, ON N6A 5C1, Canada;
| | - Regan Toltesi
- Faculty of Science, Engineering and Architecture, Laurentian University, Sudbury, ON P3E 2C6, Canada;
| | - Rachel Gowans
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Ashkan Jahangirnia
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; (A.J.); (S.L.L.)
| | - Youssef Nasr
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; (J.M.); (Y.N.)
| | - Sarah L. Lawrence
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; (A.J.); (S.L.L.)
- Division of Neonatology, Children’s Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Dina El Demellawy
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; (A.J.); (S.L.L.)
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
- Correspondence: ; Tel.: +1-613-737-7600
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Gaynetdinova DD, Karimova LK, Kazakova FM, Gamirova RG. Risk factors, trends of neurological disorders, and outcomes of neonatal periventricular hemorrhages. ROSSIYSKIY VESTNIK PERINATOLOGII I PEDIATRII (RUSSIAN BULLETIN OF PERINATOLOGY AND PEDIATRICS) 2022. [DOI: 10.21508/1027-4065-2022-67-5-143-152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Periventricular hemorrhage is bleeding from the subependymal germinal matrix, which results in severe motor disorders, mental and speech developmental delay.Purpose. The study aims to evaluate risk factors, the trends of neurological disorders, and the outcomes of neonatal periventricular hemorrhage in children whose mothers were on gravidary anticoagulant and/or antiplatelet therapy.Material and methods. The study examined 160 newborns with PVH: Group I — 53 (37.9%) children born from pregnancy on the background of antiplatelet and/or anticoagulant therapy for hypercoagulation syndrome; Group II — 87 (62.1%) children born from pregnancy on the background of antiplatelet and/or anticoagulant therapy to treat degree 1A uteroplacental blood flow disorders; Group III — 20 children born from pregnancy without corticosteroids and antiplatelet and/or anticoagulant therapy. All newborns underwent clinical and neurological examination and neurosonography; data on somatic and obstetric anamnesis were obtained from accompanying medical records.Results. In children of Groups I and II a more severe condition of newborns with periventricular hemorrhage at birth was noted, a slower dynamics of restoration of muscle-postural tone and the pace of psychomotor development were observed compared to children in Group III. In Groups I and II a high incidence of epilepsy (5.7%) and cerebral palsy (6.4%) by 12 months of corrected age was revealed compared with the population.Conclusion. Gravidary anticoagulant and antiplatelet therapy might be considered as a risk factor for the development of intracranial hemorrhages and severe neurological disorders: epilepsy, cerebral palsy, mental and motor developmental delays.
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Siffel C, Kistler KD, Sarda SP. Global incidence of intraventricular hemorrhage among extremely preterm infants: a systematic literature review. J Perinat Med 2021; 49:1017-1026. [PMID: 33735943 DOI: 10.1515/jpm-2020-0331] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 02/16/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To conduct a systematic literature review to evaluate the global incidence of intraventricular hemorrhage grade 2-4 among extremely preterm infants. METHODS We performed searches in MEDLINE and Embase for intraventricular hemorrhage and prematurity cited in English language observational studies published from May 2006 to October 2017. Included studies analyzed data from infants born at ≤28 weeks' gestational age and reported on intraventricular hemorrhage epidemiology. RESULTS Ninety-eight eligible studies encompassed 39 articles from Europe, 31 from North America, 25 from Asia, five from Oceania, and none from Africa or South America; both Europe and North America were included in two publications. The reported global incidence range of intraventricular hemorrhage grade 3-4 was 5-52% (Europe: 5-52%; North America: 8-22%; Asia: 5-36%; Oceania: 8-13%). When only population-based studies were included, the incidence range of intraventricular hemorrhage grade 3-4 was 6-22%. The incidence range of intraventricular hemorrhage grade 2 was infrequently documented and ranged from 5-19% (including population-based studies). The incidence of intraventricular hemorrhage was generally inversely related to gestational age. CONCLUSIONS Intraventricular hemorrhage is a frequent complication of extremely preterm birth. Intraventricular hemorrhage incidence range varies by region, and the global incidence of intraventricular hemorrhage grade 2 is not well documented.
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Affiliation(s)
- Csaba Siffel
- Global Evidence and Outcomes, Takeda, Lexington, MA, USA.,College of Allied Health Sciences, Augusta University, Augusta, GA, USA
| | - Kristin D Kistler
- Evidence Synthesis, Modeling & Communication, Evidera, Waltham, MA, USA
| | - Sujata P Sarda
- Global Evidence and Outcomes, Takeda, Lexington, MA, USA
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Mode of delivery and neonatal outcomes in extremely preterm Vertex/nonVertex twins. Am J Obstet Gynecol 2021; 224:613.e1-613.e10. [PMID: 33306970 DOI: 10.1016/j.ajog.2020.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 11/11/2020] [Accepted: 12/03/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND One of the controversies in the management of twin gestations relates to mode of delivery, especially when the second twin is in a nonvertex presentation (Vertex/nonVertex pairs) and birth is imminent at extremely low gestation. OBJECTIVE We hypothesized that, for Vertex/nonVertex twins born before 28 weeks' gestation, cesarean delivery would be associated with a lower risk of adverse neonatal outcomes than trial of vaginal delivery. Our aim was to test this hypothesis by comparing the neonatal outcomes of Vertex/nonVertex twins born before 28 weeks' gestation by mode of delivery using a large national cohort. STUDY DESIGN This work is a retrospective cohort study of all twin infants born at 240/7 to 276/7 weeks' gestation and admitted to level III neonatal intensive care units participating in the Canadian Neonatal Network (2010-2017). Exposure is defined a trial of vaginal delivery for Vertex/nonVertex twins. Nonexposed (control) groups are defined as cases where both twins were delivered by cesarean delivery, either in vertex or nonvertex presentation (control group 1) or owing to the nonvertex presentation of the first twin (control group 2). Outcome measures are defined as a composite of neonatal death, severe neurologic injury, or birth trauma. RESULTS A total of 1082 twin infants (541 twin pairs) met the inclusion criteria: 220 Vertex/nonVertex pairs, of which 112 had a trial of vaginal delivery (study group) and 108 had cesarean delivery for both twins (control group 1); 170 pairs with the first twin in nonvertex presentation, all of which were born by cesarean delivery (control group 2); and 151 pairs with both twins in vertex presentation (vertex or nonvertex). In the study group, the rate of urgent cesarean delivery for the second twin was 30%. The rate of the primary outcome in the study group was 42%, which was not significantly different compared with control group 1 (37%; adjusted relative risk, 0.93; 95% confidence interval, 0.71-1.22) or control group 2 (34%; adjusted relative risk, 1.20; 95% confidence interval, 0.92-1.58). The findings remained similar when outcomes were analyzed separately for the first and second twins. CONCLUSION For preterm Vertex/nonVertex twins born at <28 weeks' gestation, we found no difference in the risk of adverse neonatal outcome between a trial of vaginal delivery and primary cesarean delivery. However, a trial of vaginal delivery was associated with a high rate of urgent cesarean delivery for the second twin.
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Baser E, Celik IH, Bilge M, Kasapoglu T, Isik DU, Yalvac ES, Tapisiz OL, Ozdemirci S. Abnormal Umblical Artery Doppler is Utilized for Fetuses with Intrauterine Growth Restriction Birth at 28 0/7-33 6/7 Gestational Weeks. Fetal Pediatr Pathol 2020; 39:467-475. [PMID: 31997690 DOI: 10.1080/15513815.2020.1716900] [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] [Indexed: 10/25/2022]
Abstract
Purpose: To compare short-term perinatal outcomes in preterm infants with intrauterine growth restriction (IUGR) in those with absent or reversed end-diastolic umbilical artery blood flow (AREDF) to those with normal end-diastolic umbilical artery blood flow (NEDF). Methods: This study included preterm births (280/7-336/7 gestational weeks) with IUGR with AREDF (n = 86) or NEDF (n = 27). Results: There were lower mean gestational weeks, birth weights, and a higher ratio of corticosteroid application in the AREDF group (p < 0.05). The mean length of neonatal intensive care unit stay of the AREDF group was significantly longer (p < 0.001). Sepsis and feeding intolerance ratios in the AREDF group were also significantly higher (p = 0.041 and p < 0.001 respectively). Conclusions: Patients with IUGR and umbilical Doppler abnormalities have longer neonatal intensive care unit stays.
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Affiliation(s)
- Emre Baser
- Department of Obstetrics and Gynecology, Yozgat Bozok University, Faculty of Medicine, Yozgat, Turkey
| | - Istemi Han Celik
- Department of Neonatology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Health Science University, Ankara, Turkey
| | - Melek Bilge
- Department of Obstetrics, Clinic Ministry of Health Dr. Ali Kemal Belviranli Hospital for Obstetrics and Pediatrics, Konya, Turkey
| | - Taner Kasapoglu
- Department of Obstetrics and Gynecology, Perinatology & High-Risk Pregnancy Clinic, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Health Science University, Ankara, Turkey
| | - Dilek Ulubas Isik
- Department of Neonatology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Health Science University, Ankara, Turkey
| | - Ethem Serdar Yalvac
- Department of Obstetrics and Gynecology, Yozgat Bozok University, Faculty of Medicine, Yozgat, Turkey
| | - Omer Lutfi Tapisiz
- Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Health Science University, Ankara, Turkey
| | - Safak Ozdemirci
- Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Health Science University, Ankara, Turkey
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Castro JSD, Leslie ATFS, Guinsburg R. Perinatal factors associated with amplitude-integrated electroencephalography abnormalities in preterm infants on the first day of life. J Pediatr (Rio J) 2020; 96:644-651. [PMID: 31325413 PMCID: PMC9432229 DOI: 10.1016/j.jped.2019.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/07/2019] [Accepted: 06/18/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Evaluate the association between perinatal factors and amplitude-integrated electroencephalogram abnormalities in preterm infants on the first day of life. METHODS This was a cross-sectional study of 60 infants with gestational age between 23 and 32 weeks, without malformations. Infants were continuously monitored by amplitude-integrated electroencephalogram on the first day of life, for at least 3h. The tracings were recorded and analyzed in each column for the following: burst-suppression pattern, sleep-wake cycle, and amplitude of the lower margin (<3μV or <5μV). The association of maternal complications, mode of delivery, birth weight, gestational age, neonatal sex, resuscitation procedures, hypothermia on admission, and the Score for Neonatal Acute Physiology, Perinatal Extension, Version II [SNAPPE-II]) with amplitude-integrated electroencephalogram alterations was assessed by multiple logistic regression. RESULTS A discontinuous pattern occurred in 65% of infants, and a continuous pattern occurred in 23%. The burst-suppression pattern was associated with vaginal delivery (OR: 7.6; 95% CI: 1.1-53.1) and SNAPPE-II≥40 (OR: 13.1; 95% CI: 1.8-95.1). A lower margin of the amplitude-integrated electroencephalogram of <3μV was also associated with SNAPPE-II≥40 (OR: 10.6, 95% CI: 2.3-49.2), while a value <5μV was associated with lower GA (OR: 0.51, 95% CI: 0.34-0.76). There were no associations between the perinatal variables and the absence of a sleep-wake cycle in amplitude-integrated electroencephalogram recordings on the first day of life. CONCLUSION Biological variables and clinical severity are associated with electroencephalographic characteristics of preterm infants on the first day of life and should be considered in clinical practice when amplitude-integrated electroencephalogram is performed.
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Affiliation(s)
- Junia Sampel de Castro
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Divisão de Medicina Neonatal, São Paulo, SP, Brazil
| | | | - Ruth Guinsburg
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Divisão de Medicina Neonatal, São Paulo, SP, Brazil.
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Castro JSD, Leslie ATFS, Guinsburg R. Perinatal factors associated with amplitude‐integrated electroencephalography abnormalities in preterm infants on the first day of life. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2019.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Parodi A, De Angelis LC, Re M, Raffa S, Malova M, Rossi A, Severino M, Tortora D, Morana G, Calevo MG, Brisigotti MP, Buffelli F, Fulcheri E, Ramenghi LA. Placental Pathology Findings and the Risk of Intraventricular and Cerebellar Hemorrhage in Preterm Neonates. Front Neurol 2020; 11:761. [PMID: 32922347 PMCID: PMC7456995 DOI: 10.3389/fneur.2020.00761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 06/19/2020] [Indexed: 11/13/2022] Open
Abstract
Placental pathology as a predisposing factor to intraventricular hemorrhage remains a matter of debate, and its contribution to cerebellar hemorrhage development is still largely unexplored. Our study aimed to assess placental and perinatal risk factors for intraventricular and cerebellar hemorrhages in preterm infants. This retrospective cohort study included very low-birth weight infants born at the Gaslini Children's Hospital between January 2012 and October 2016 who underwent brain magnetic resonance with susceptibility-weighted imaging at term-equivalent age and whose placenta was analyzed according to the Amsterdam Placental Workshop Group Consensus Statement. Of the 286 neonates included, 68 (23.8%) had intraventricular hemorrhage (all grades) and 48 (16.8%) had a cerebellar hemorrhage (all grades). After correction for gestational age, chorioamnionitis involving the maternal side of the placenta was found to be an independent risk factor for developing intraventricular hemorrhage, whereas there was no association between maternal and fetal inflammatory response and cerebellar hemorrhage. Among perinatal factors, we found that intraventricular hemorrhage was significantly associated with cerebellar hemorrhage (odds ratio [OR], 8.14), mechanical ventilation within the first 72 h (OR, 2.67), and patent ductus arteriosus requiring treatment (OR, 2.6), whereas cesarean section emerged as a protective factor (OR, 0.26). Inotropic support within 72 h after birth (OR, 5.24) and intraventricular hemorrhage (OR, 6.38) were independent risk factors for cerebellar hemorrhage, whereas higher gestational age was a protective factor (OR, 0.76). Assessing placental pathology may help in understanding mechanisms leading to intraventricular hemorrhage, although its possible role in predicting cerebellar bleeding needs further evaluation.
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Affiliation(s)
- Alessandro Parodi
- Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Laura Costanza De Angelis
- Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Martina Re
- Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Sarah Raffa
- Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Mariya Malova
- Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | | | - Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giovanni Morana
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maria Grazia Calevo
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maria Pia Brisigotti
- Gynaecologic and Fetal-Perinatal Pathology Centre, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Francesca Buffelli
- Gynaecologic and Fetal-Perinatal Pathology Centre, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Ezio Fulcheri
- Gynaecologic and Fetal-Perinatal Pathology Centre, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Division of Pathology, Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - Luca Antonio Ramenghi
- Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
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Yeo KT, Thomas R, Chow SS, Bolisetty S, Haslam R, Tarnow-Mordi W, Lui K. Improving incidence trends of severe intraventricular haemorrhages in preterm infants <32 weeks gestation: a cohort study. Arch Dis Child Fetal Neonatal Ed 2020; 105:145-150. [PMID: 31201252 DOI: 10.1136/archdischild-2018-316664] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 05/08/2019] [Accepted: 05/14/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To describe the trend and risk factors for severe intraventricular haemorrhage (IVH) among infants <32 weeks gestation. DESIGN Population-based cohort study. SETTING Australia and New Zealand. PATIENTS All preterm infants <32 weeks gestation in the Australian and New Zealand Neonatal Network (ANZNN) from 1995 to 2012. INTERVENTIONS Comparison of IVH incidence between 6-year epochs. MAIN OUTCOME MEASURES Overall IVH and severe IVH incidence. RESULTS A total of 60 068 infants were included, and overall survival to discharge increased from 89% to 93% over the three epochs. As the percentage of infants with IVH decreased from 23.6% to 21.3% and 21.4% (p<0.001) from epoch 1 to 3, respectively, fewer survivors had severe IVH (4.0%, 3.3% and 2.8%, respectively, p<0.001). Over time, there were fewer antenatal complications, higher antenatal steroid usage and more caesarean-section births. Fewer infants were intubated at birth, had low 5 min Apgar score, had sepsis or pneumothorax needing drainage. Adjusted for perinatal confounders, there was significant reduction in odds of severe IVH from epoch 1 to 3 (adjusted OR (AOR) 0.8, 95% CI 0.7 to 0.9). Factors associated with development of severe IVH include no antenatal steroids (AOR 1.7, 95% CI 1.5 to 1.9), male (AOR 1.3, 95% CI 1.2 to 1.4), 5 min Apgar score <7 (AOR 2.0, 95% CI 1.9 to 2.2), intubated at birth (AOR 2.0, 95% CI 1.8 to 2.2), extremely low gestational age (AOR 4.0, 95% CI 3.7 to 4.4), outborn (AOR 1.6, 95% CI 1.5 to 1.8) and vaginal delivery (AOR 1.4, 95% CI 1.3 to 1.6). CONCLUSIONS Along with increased survival among infants born <32 weeks gestation, the incidence of severe IVH has decreased over the 18 years, especially in the most recent period. This coincided with reduction in rates of risk factors for severe IVH development.
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Affiliation(s)
- Kee Thai Yeo
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia.,Department of Neonatology, KK Women's and Children's Hospital, Singapore
| | - Reji Thomas
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia.,Mount Gambier Hospital, Mount Gambier, South Australia, Australia
| | - Sharon Sw Chow
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Women's & Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Srinivas Bolisetty
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia.,School of Women's & Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ross Haslam
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - William Tarnow-Mordi
- National Health & Medical Research Council Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Kei Lui
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia.,School of Women's & Children's Health, University of New South Wales, Sydney, New South Wales, Australia
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12
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Alotaibi WSM, Alsaif NS, Ahmed IA, Mahmoud AF, Ali K, Hammad A, Aldibasi OS, Alsaif SA. Reduction of severe intraventricular hemorrhage, a tertiary single-center experience: incidence trends, associated risk factors, and hospital policy. Childs Nerv Syst 2020; 36:2971-2979. [PMID: 32367164 PMCID: PMC7649152 DOI: 10.1007/s00381-020-04621-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/13/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the incidence, trends, maternal and neonatal risk factors of severe intraventricular hemorrhage (IVH) among infants born 24-32 weeks and/or < 1500 g, and to evaluate the impact of changing of hospital policies and unit clinical practice on the IVH incidence. STUDY DESIGN Retrospective chart review of preterm infants with a gestational age (GA) of 24-326 weeks and/or weight of < 1500 g born at King Abdulaziz Medical City-Riyadh (KAMC-R), Saudi Arabia, from 2016 to 2018. Multivariate logistic regression model was constructed to determine the probability of developing severe IVH and identify associations with maternal and neonatal risk factors. RESULTS Among 640 infants, the overall incidence of severe IVH was 6.4% (41 infants), and its rate decreased significantly, from 9.4% in 2016 to 4.5% and 5% in 2017 and 2018 (p = 0.044). Multivariate analysis revealed that caesarian section delivery decreased the risk of severe IVH in GA group 24-27 weeks (p = 0.045). Furthermore use of inotropes (p = 0.0004) and surfactant (p = 0.0003) increased the risk of severe IVH. Despite increasing use of inotropes (p = 0.024), surfactant therapy (p = 0.034), and need for delivery room intubation (p = 0.015), there was a significant reduction in the incidence of severe IVH following the change in unit clinical practice and hospital policy (p = 0.007). CONCLUSION Cesarean section was associated with decreased all grades of IVH and severe IVH, while use of inotropes was associated with increased severe IVH. The changes in hospital and unit policy were correlated with decreased IVH during the study period.
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Affiliation(s)
| | - Nada S. Alsaif
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ibrahim A. Ahmed
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia ,Neonatal Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Aly Farouk Mahmoud
- Neonatal Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Kamal Ali
- Neonatal Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdullah Hammad
- Medical Imaging Department, Pediatric Radiology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Omar S. Aldibasi
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia ,Department of Bioinformatics and Biostatistics, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Saif A. Alsaif
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia ,Neonatal Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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13
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Nijman TAJ, Goedhart MM, Naaktgeboren CN, de Haan TR, Vijlbrief DC, Mol BW, Benders MJN, Franx A, Oudijk MA. Effect of nifedipine and atosiban on perinatal brain injury: secondary analysis of the APOSTEL-III trial. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:806-812. [PMID: 28452086 DOI: 10.1002/uog.17512] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 04/03/2017] [Accepted: 04/11/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Brain injury in neonates born prematurely is associated strongly with poor neurodevelopmental outcome. The aim of this study was to evaluate whether tocolysis with nifedipine or atosiban in women with threatened preterm birth can reduce the incidence of overall brain injury in neonates born prematurely. METHODS This was a secondary analysis of the APOSTEL-III trial (Dutch Clinical Trial Registry, no. NTR2947), a randomized clinical trial in which women with threatened preterm labor between 25 and 34 weeks of gestation were allocated to treatment with nifedipine or atosiban. In this secondary analysis, women delivered at ≤ 32 weeks of gestational age in the two main contributing centers were included. Primary outcome was the presence of neonatal brain injury, which was defined as presence of abnormalities on ultrasound investigation and classified into mild and severe. To evaluate type and severity of brain injury, all neonatal ultrasounds performed during neonatal intensive and medium care admission were analyzed. To test the robustness of our results, a sensitivity analysis was performed assessing differences in baseline or known risk factors for brain injury. RESULTS A total of 117 neonates (from 102 women) were studied, of which 51 had been exposed to nifedipine and 66 to atosiban. Brain injury was observed in 22 (43.1%) neonates in the nifedipine group compared with 37 (56.1%) in the atosiban group (OR, 0.60; 95% CI, 0.29-1.24). Presence of mild brain injury was comparable between the nifedipine (33.3%) and atosiban (48.5%) groups (OR, 0.53; 95% CI, 0.25-1.13). Severe brain injury was also comparable between the groups, observed in 9.8% of neonates in the nifedipine vs 7.6% of those in the atosiban group (OR, 1.33; 95% CI, 0.36-4.85). Intraventricular hemorrhage (≥ Grade I) was the most frequently seen ultrasound abnormality, observed in 18 (35.3%) neonates in the nifedipine group vs 25 (37.9%) in the atosiban group (OR, 0.90; 95% CI, 0.42-1.91). The sensitivity analysis, with adjustment for maternal age and gestational age at randomization, showed no statistical difference between the groups for presence of brain injury (OR, 0.58; 95% CI, 0.27-1.27). CONCLUSION In children born before 32 weeks of gestation after the use of tocolytics, the prevalence of brain injury was high. No significant differences were found with respect to overall brain injury between neonates exposed to nifedipine and those exposed to atosiban. However, as this study was a secondary analysis of the APOSTEL III trial, it was underpowered for brain injury. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- T A J Nijman
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Obstetrics and Gynecology, Haaglanden Medical Center, The Hague, The Netherlands
| | - M M Goedhart
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C N Naaktgeboren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T R de Haan
- Department of Neonatology, Academic Medical Center, Amsterdam, The Netherlands
| | - D C Vijlbrief
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B W Mol
- The Robinson Research Institute, School of Pediatrics and Reproductive Health and The South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia
| | - M J N Benders
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A Franx
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M A Oudijk
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
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14
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Koschnitzky JE, Keep RF, Limbrick DD, McAllister JP, Morris JA, Strahle J, Yung YC. Opportunities in posthemorrhagic hydrocephalus research: outcomes of the Hydrocephalus Association Posthemorrhagic Hydrocephalus Workshop. Fluids Barriers CNS 2018; 15:11. [PMID: 29587767 PMCID: PMC5870202 DOI: 10.1186/s12987-018-0096-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/09/2018] [Indexed: 12/19/2022] Open
Abstract
The Hydrocephalus Association Posthemorrhagic Hydrocephalus Workshop was held on July 25 and 26, 2016 at the National Institutes of Health. The workshop brought together a diverse group of researchers including pediatric neurosurgeons, neurologists, and neuropsychologists with scientists in the fields of brain injury and development, cerebrospinal and interstitial fluid dynamics, and the blood-brain and blood-CSF barriers. The goals of the workshop were to identify areas of opportunity in posthemorrhagic hydrocephalus research and encourage scientific collaboration across a diverse set of fields. This report details the major themes discussed during the workshop and research opportunities identified for posthemorrhagic hydrocephalus. The primary areas include (1) preventing intraventricular hemorrhage, (2) stopping primary and secondary brain damage, (3) preventing hydrocephalus, (4) repairing brain damage, and (5) improving neurodevelopment outcomes in posthemorrhagic hydrocephalus.
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Affiliation(s)
| | - Richard F. Keep
- University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109 USA
| | - David D. Limbrick
- Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110 USA
| | - James P. McAllister
- Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110 USA
| | - Jill A. Morris
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Neuroscience Center, 6001 Executive Blvd, NSC Rm 2112, Bethesda, MD 20892 USA
| | - Jennifer Strahle
- Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110 USA
| | - Yun C. Yung
- Sanford Burnham Prebys Medical Discovery Institute, 10901 North Torrey Pines Rd., Building 7, La Jolla, CA 92037 USA
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OH KJ, PARK JY, LEE J, HONG JS, ROMERO R, YOON BH. The combined exposure to intra-amniotic inflammation and neonatal respiratory distress syndrome increases the risk of intraventricular hemorrhage in preterm neonates. J Perinat Med 2018; 46:9-20. [PMID: 28672753 PMCID: PMC5848500 DOI: 10.1515/jpm-2016-0348] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/12/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the impact of combined exposure to intra-amniotic inflammation and neonatal respiratory distress syndrome (RDS) on the development of intraventricular hemorrhage (IVH) in preterm neonates. METHODS This retrospective cohort study includes 207 consecutive preterm births (24.0-33.0 weeks of gestation). Intra-amniotic inflammation was defined as an amniotic fluid matrix metalloproteinase-8 concentration >23 ng/mL. According to McMenamin's classification, IVH was defined as grade II or higher when detected by neurosonography within the first weeks of life. RESULTS (1) IVH was diagnosed in 6.8% (14/207) of neonates in the study population; (2) IVH was frequent among newborns exposed to intra-amniotic inflammation when followed by postnatal RDS [33% (6/18)]. The frequency of IVH was 7% (8/115) among neonates exposed to either of these conditions - intra-amniotic inflammation or RDS - and 0% (0/64) among those who were not exposed to these conditions; and (3) Neonates exposed to intra-amniotic inflammation and postnatal RDS had a significantly higher risk of IVH than those with only intra-amniotic inflammation [odds ratio (OR) 4.6, 95% confidence interval (CI) 1.1-19.3] and those with RDS alone (OR 5.6, 95% CI 1.0-30.9), after adjusting for gestational age. CONCLUSION The combined exposure to intra-amniotic inflammation and postnatal RDS markedly increased the risk of IVH in preterm neonates.
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Affiliation(s)
- Kyung Joon OH
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea,Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Korea
| | - Jee Yoon PARK
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - JoonHo LEE
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Joon-Seok HONG
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea,Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Korea
| | - Roberto ROMERO
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, USA, and Detroit, Michigan, USA,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA,Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
| | - Bo Hyun YOON
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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16
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Gamaleldin I, Harding D, Siassakos D, Draycott T, Odd D. Significant intraventricular hemorrhage is more likely in very preterm infants born by vaginal delivery: a multi-centre retrospective cohort study. J Matern Fetal Neonatal Med 2017; 32:477-482. [DOI: 10.1080/14767058.2017.1383980] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - David Harding
- Women’s and Children’s Health, St. Michael’s Hospital, Bristol, UK
| | | | - Tim Draycott
- Women’s Health, Chilterns, Southmead Hospital, Bristol, UK
| | - David Odd
- Women’s and Children's Health, Southmead Hospital, Bristol, UK
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17
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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: 82] [Impact Index Per Article: 11.7] [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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18
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Humberg A, Härtel C, Paul P, Hanke K, Bossung V, Hartz A, Fasel L, Rausch TK, Rody A, Herting E, Göpel W. Delivery mode and intraventricular hemorrhage risk in very-low-birth-weight infants: Observational data of the German Neonatal Network. Eur J Obstet Gynecol Reprod Biol 2017; 212:144-149. [PMID: 28363188 DOI: 10.1016/j.ejogrb.2017.03.032] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/21/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Very-low-birth-weight infants (VLBWI) are frequently delivered by cesarean section (CS). However, it is unclear at what gestational age the benefits of spontaneous delivery outweigh the perinatal risks, i.e. intraventricular hemorrhage (IVH) or death. OBJECTIVES To assess the short-term outcome of VLBWI on IVH according to mode of delivery in a population-based cohort of the German Neonatal Network (GNN). STUDY DESIGN A total cohort of 2203 singleton VLBWI with a birth weight <1500g and gestational age between 22 0/7 and 36 6/7 weeks born and discharged between 1st of January 2009 and 31st of December 2015 was available for analysis. VLBWI were stratified into three categories according to mode of delivery: (1) planned cesarean section (n=1381), (2) vaginal delivery (n=632) and (3) emergency cesarean section (n=190). Outcome was assessed in univariate and logistic regression analyses. RESULTS Prevalence of IVH was significantly higher in the vaginal delivery (VD) (26.6%) and emergency CS group (31.1%) as compared to planned CS (17.2%), respectively. In a logistic regression analysis including known risk factors for IVH, vaginal delivery (OR 1.725 [1.325-2.202], p≤0.001) and emergency cesarean section (OR 1.916 [1.338-2.746], p≤0.001) were independently associated with IVH risk. In the subgroup of infants >30 weeks of gestation prevalence for IVH was not significantly different in VD and planned CS (5.3% vs. 4.4%). CONCLUSIONS Our observational data demonstrate that elective cesarean section is associated with a reduced risk of IVH in preterm infants <30 weeks gestational age when presenting with preterm labor.
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Affiliation(s)
- Alexander Humberg
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany.
| | - Christoph Härtel
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany
| | - Pia Paul
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany
| | - Kathrin Hanke
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany
| | - Verena Bossung
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany
| | - Annika Hartz
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany
| | - Laura Fasel
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany
| | - Tanja K Rausch
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany; Institute of Medical Biometry and Statistics, University of Luebeck, University Medical Center of Schleswig-Holstein, Campus Luebeck, Germany
| | - Achim Rody
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany
| | - Egbert Herting
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany
| | - Wolfgang Göpel
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany
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Hunter T, Shah J, Synnes A, Shivananda S, Ryan G, Shah PS, Murphy KE. Neonatal outcomes of preterm twins according to mode of birth and presentation. J Matern Fetal Neonatal Med 2017; 31:682-688. [DOI: 10.1080/14767058.2017.1295441] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Tiffany Hunter
- Department of Obstetrics & Gynaecology, University of Toronto, Toronto, Canada
- Department of Obstetrics & Gynaecology, Mount Sinai Hospital, Toronto, Canada
| | - Jyotsna Shah
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Canada
| | - Anne Synnes
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | | | - Greg Ryan
- Department of Obstetrics & Gynaecology, University of Toronto, Toronto, Canada
- Department of Obstetrics & Gynaecology, Mount Sinai Hospital, Toronto, Canada
| | - Prakesh S. Shah
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Canada
| | - Kellie E. Murphy
- Department of Obstetrics & Gynaecology, University of Toronto, Toronto, Canada
- Department of Obstetrics & Gynaecology, Mount Sinai Hospital, Toronto, Canada
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20
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Vesoulis ZA, El Ters N, Foster A, Trivedi SB, Liao SM, Mathur AM. Response to dopamine in prematurity: a biomarker for brain injury? J Perinatol 2016; 36:453-8. [PMID: 26890555 PMCID: PMC4882223 DOI: 10.1038/jp.2016.5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/07/2016] [Accepted: 01/08/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To identify factors associated with responsiveness to dopamine therapy for hypotension and the relationship to brain injury in a cohort of preterm infants. STUDY DESIGN The pharmacy database at St Louis Children's Hospital was retrospectively queried to identify infants who (a) were born <28 weeks gestation between 2012 and 2014, (b) received dopamine and (c) had blood pressure measurements from an umbilical arterial catheter. A control group was constructed from contemporaneous infants who did not receive dopamine. Mean arterial blood pressure (MABP) at baseline, 1 h and 3 h after initiating dopamine were obtained for each dopamine-exposed infant. MABP measurements at matched time points were obtained in the control group. RESULT Sixty-nine dopamine-treated and 45 control infants were included. Mean ΔMABP at 3 h was 4.5±6.3 mm of Hg for treated infants vs 1±2.9 for the control. Median dopamine starting dose was 2.5 μg kg(-1) min(-1). Dopamine-treated infants were less mature and of lower birth weight while also more likely to be intubated at 72 h, diagnosed with intraventricular hemorrhage (IVH) and to die. Failure to respond to dopamine was associated with greater likelihood of developing IVH (odds ratio (OR) 5.8, 95% confidence interval (CI) 1.1-42.3), while a strong response (ΔMABP>10 mm Hg) was associated with a reduction in risk of IVH (OR 0.1, 95% CI 0.01-0.8). CONCLUSION Low-moderate dose dopamine administration results in modest blood pressure improvements. A lack of response to dopamine is associated with a greater risk of IVH, whereas a strong response is associated with a decreased risk. Further research into underlying mechanisms and management strategies is needed.
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Affiliation(s)
- Zachary A. Vesoulis
- Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Nathalie El Ters
- Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Allison Foster
- Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Shamik B. Trivedi
- Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Steve M. Liao
- Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Amit M. Mathur
- Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
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21
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Yang F, Zubizarreta JR, Small DS, Lorch S, Rosenbaum PR. Dissonant Conclusions When Testing the Validity of an Instrumental Variable. AM STAT 2014. [DOI: 10.1080/00031305.2014.962764] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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Kim KR, Jung SW, Kim DW. Risk factors associated with germinal matrix-intraventricular hemorrhage in preterm neonates. J Korean Neurosurg Soc 2014; 56:334-7. [PMID: 25371784 PMCID: PMC4219192 DOI: 10.3340/jkns.2014.56.4.334] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 08/31/2014] [Accepted: 09/18/2014] [Indexed: 11/27/2022] Open
Abstract
Objective The purpose of this study is to identify the risk factors associated with the development of germinal matrix-intraventricular hemorrhage (GM-IVH) and the relationship of the severity of disease and prematurity. Methods A total of 168 premature neonates whose birth weight ≤1500 g or gestational age ≤34 weeks were examined by cranial ultrasound (CUS) for detection of GM-IVH among the babies admitted between January 2011 and December 2012 in our medical center neonatal intensive care unit. The babies were divided into two groups : GM-IVH and non-IVH. Clinical presentations, precipitating factors of the patients and maternal factors were analyzed. Results In univariate analysis, gestational age, birth weight, delivery method, presence of premature rupture of membrane (PROM) and level of sodium and glucose were statistically meaningful factors (p<0.05). But only two factors, gestational age and presence of patent ductus arteriosus (PDA) were statistically meaningful in multivariate logistic regression (p<0.05). Delivery method [normal vaginal delivery (NVD) to Caeserean section] was borderline significant (p<0.10). Conclusion Presence of PDA and gestational age were the important risk factors associated with development of GM-IVH.
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Affiliation(s)
- Kwang-Ryeol Kim
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Sang-Won Jung
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Dong-Won Kim
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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Al-Abdi SY, Al-Aamri MA. A Systematic Review and Meta-analysis of the Timing of Early Intraventricular Hemorrhage in Preterm Neonates: Clinical and Research Implications. J Clin Neonatol 2014; 3:76-88. [PMID: 25024973 PMCID: PMC4089133 DOI: 10.4103/2249-4847.134674] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A considerable number of intraventricular hemorrhages (IVH) occur within the first hours of life (HOL). Temporality between IVH and its antecedents as well as a consistent definition of "early IVH" is lacking in a large and growing body of literature. We performed a systematic review of prospective studies that reported onset of IVH in preterm neonates within the first HOL and afterwards. The English literature was searched using three databases up to March 2013. Four timing periods of IVH can be compared in 16 identified studies: 0-6; 7-12; 13-24; after 24 HOL. The 0-6 and after 24 HOL were the major modes of IVH timing. Pooled IVH proportions were estimated through a meta-analysis of studies that were conducted after antenatal steroid and surfactant era. In neonates weighing ≤1500 g at birth: 48% of IVH (95% CI: 42-58%, 5 studies, 279 IVH cases) occurred during 0-6 HOL and 38% (95% CI: 19-57%, 4 studies, 241 IVH cases) after 24 HOL. The 0-6 HOL is the shortest, most vulnerable period for IVH, thus, an early IVH is an IVH occurs in it. Such early IVH had prognostic, etiological/preventive and medicolegal implications. Accordingly, preterm neonates at risk of IVH should have their first routine screening head ultrasound at about 6 HOL. Future research exploring the antecedents of IVH should guaranty the temporality between these antecedents and IVH. Additional research will be required to determine whether the long term neurological outcomes of early and late IVH are the same.
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Affiliation(s)
- Sameer Yaseen Al-Abdi
- Department of Pediatrics, King Abdulaziz National Guard Hospital, Al-Ahsa, Saudi Arabia
| | - Maryam Ali Al-Aamri
- Department of Pediatrics, Maternity and Children Hospital, Al-Ahsa, Saudi Arabia
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Singh R, Gorstein SV, Bednarek F, Chou JH, McGowan EC, Visintainer PF. A predictive model for SIVH risk in preterm infants and targeted indomethacin therapy for prevention. Sci Rep 2014; 3:2539. [PMID: 23995978 PMCID: PMC3759046 DOI: 10.1038/srep02539] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 08/13/2013] [Indexed: 11/09/2022] Open
Abstract
Prophylactic indomethacin may decrease Severe Intraventricular Hemorrhage (SIVH). Our goal was to develop a predictive model for SIVH using parameters available by six hours of age. De-identified data for preterm infants born ≤ 34 weeks gestational age was abstracted from Vermont Oxford Network database. Using clinical variables available by 6 hrs of age the model was developed, and validated. Statistical methods were used to evaluate the ability of the model to discriminate infants with and without SIVH and, to compare observed and predicted risk. The model achieved excellent discrimination as indicated by ROC curve of 0·85. A good agreement was noted between observed and predicted risk (HLtest: p = 0·22). Application of the model to patients receiving indomethacin suggests a benefit at the highest risk levels. We have developed a valid predictive model for predicting SIVH as well as shown that exposure to indomethacin decreases the incidence of SIVH overall.
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Abstract
OBJECTIVE To examine the association of cesarean delivery and cerebral palsy using a systematic literature review and meta-analysis. DATA SOURCES MEDLINE, Embase, and ClinicalTrials.gov were systematically searched for articles relating to cerebral palsy and cesarean delivery from inception until December 2012. Only articles reporting confirmed cases of cerebral palsy were included. Meta-analysis was used to assess combined results and also the following subgroups: emergency cesarean; elective cesarean; term delivery; preterm delivery; and delivery of breech-presenting newborns. METHODS OF STUDY SELECTION Literature searches returned 1,874 articles with 58 considered in full. Studies were selected if they reported an endpoint of cerebral palsy, an intervention or risk of cesarean delivery, were in English, and gave sufficient details to perform meta-analysis. TABULATION, INTEGRATION, AND RESULTS Nine case-control and four cohort studies were included in the overall analysis. Meta-analysis showed no overall association of cesarean delivery with cerebral palsy (odds ratio [OR] 1.29; 95% confidence interval [CI] 0.92-1.79; 3,810 case group participants and 1,692,580 control group participants). Emergency cesarean delivery was associated with increased risk of cerebral palsy (OR 2.17; 95% CI 1.58-2.98), whereas there was no significant association between elective cesarean delivery and cerebral palsy (OR 0.81; 95% CI 0.41-1.58). Any type of cesarean delivery (elective or emergency) for term newborns was associated with cerebral palsy (OR 1.6; 95% CI 1.05-2.44), whereas there was no association between any type of cesarean delivery and cerebral palsy in preterm newborns (OR 0.81; 95% CI 0.47-1.40). Cesarean delivery did not significantly modify cerebral palsy risk for breech-presenting newborns (OR 0.51; 95% CI 0.13-2.05). CONCLUSION A review of the literature does not support the use of elective or emergency cesarean delivery to prevent cerebral palsy.
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Survival rate of extremely low birth weight infants and its risk factors: case-control study in Japan. ISRN OBSTETRICS AND GYNECOLOGY 2013; 2013:873563. [PMID: 24371528 PMCID: PMC3858981 DOI: 10.1155/2013/873563] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 10/09/2013] [Indexed: 11/18/2022]
Abstract
Aim. To clarify the effect of perinatal events on the survival of ELBW infants in Japan. Methods. 1,713 ELBW infants, from 92,630 live births in 2001 and 2002, born at 22–36 weeks of gestation were registered. Case was defined as death at discharge. The relevant variables were compared between the cases (n = 366) and the controls (n = 1,347). Results. The total survival rate was 78.6%. There was a significant difference between the survival rate in cesarean and vaginal delivery at 24–31 weeks of gestation. Cesarean delivery in infants with a birth weight >400 g was significantly advantageous to the survival rate of ELBW infants than vaginal delivery. The significant contributing factors were gestational age at delivery (OR: 0.97), Apgar score at 5 min (0.56), antenatal steroid (0.41), and birth weight (0.996). Nonvertex presentation (1.81), vaginal delivery (1.56), and placental abruption (2.50) were found to be significantly associated with neonatal death. Conclusions. Cesarean section might be advantageous for survival in ELBW infants over 24 gestational weeks or 400 grams of birth weight. Nonvertex presentation, vaginal delivery, and placental abruption could be significant risk factors for survival of ELBW infants.
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Treatment of intraventricular hemorrhages in premature infants: where is the evidence? Adv Neonatal Care 2013; 13:127-30. [PMID: 23532032 DOI: 10.1097/anc.0b013e31828ac82e] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Sabourin JN, Lee T, Magee LA, von Dadelszen P, Demianczuk N. Indications for, timing of, and modes of delivery in a national cohort of women admitted with antepartum hemorrhage at 22+0 to 28+6 weeks' gestation. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2012; 34:1043-1052. [PMID: 23231842 DOI: 10.1016/s1701-2163(16)35434-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Antepartum hemorrhage is associated with preterm birth and operative delivery. Since the Canadian Perinatal Network records obstetric interventions for women admitted to tertiary care hospitals with antepartum hemorrhage, our objective was to describe the delivery characteristics of this cohort. METHODS Trained abstractors collected data by chart review from women admitted with antepartum hemorrhage between 22+0 and 28+6 weeks' gestation. We included all women with complete follow-up postpartum and used descriptive statistics to report the indications for, timing of, and modes of delivery. RESULTS The study cohort included 806 women from 13 tertiary perinatal centres in six provinces. The most common causes of bleeding were placental abruption (n = 256) and placenta previa (n = 171). The median gestational age at delivery was 30 weeks, and 497 (61.7%) births occurred at less than 34 weeks. Over one half of the women began labour spontaneously, and 238 (29.5%) were delivered prior to the onset of labour. Overall, 370 (45.9%) women delivered vaginally, including 98 who had induction of labour. Of the 436 Caesarean sections (54.1%), 345 (79.1%) were emergencies. The most common indications for Caesarean section were placenta previa, abnormal fetal presentation, and placental abruption or vaginal bleeding. CONCLUSION This inpatient cohort of women with antepartum hemorrhage had high rates of spontaneous labour, preterm birth, and emergency Caesarean section. These results can be used as current Canadian benchmark rates of preterm delivery, induction of labour, and Caesarean section in women admitted to tertiary care centres with antepartum hemorrhage between 22+0 and 28+6 weeks' gestation, and can aid in the counselling of similar women.
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Affiliation(s)
| | - Tang Lee
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC
| | - Laura A Magee
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Department of Medicine, University of British Columbia, Vancouver BC
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC
| | - Nestor Demianczuk
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton AB
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Biswas A, Su LL, Mattar C. Caesarean section for preterm birth and, breech presentation and twin pregnancies. Best Pract Res Clin Obstet Gynaecol 2012; 27:209-19. [PMID: 23062593 DOI: 10.1016/j.bpobgyn.2012.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 09/11/2012] [Indexed: 11/25/2022]
Abstract
Caesarean section incidence is steadily rising worldwide; the major contributor to this rise is pregnancies with previous caesarean section. Hence, it is important to scrutinise carefully the indication of primary caesarean sections. Preterm births, breech presentation and twin pregnancies together complicate 12-18% of all births. The role of caesarean section in these pregnancies is controversial and lacks good evidence-based guidelines. Policy on mode of delivery in these three important obstetric groups is bound to influence overall primary caesarean section rates. In this chapter, we review the evidence on the place of caesarean delivery in these three important groups.
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Affiliation(s)
- Arijit Biswas
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, National University Health Systems and National University of Singapore, Level 12, NUHS Tower Block, 1E Kent Ridge Road, Singapore 119228, Singapore.
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Boussicault G, Branger B, Savagner C, Rozé JC. Survie et devenir neurologique à l’âge corrigé de 2 ans des enfants nés extrêmement prématurés. Arch Pediatr 2012; 19:381-90. [DOI: 10.1016/j.arcped.2012.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 12/21/2011] [Accepted: 01/23/2012] [Indexed: 10/28/2022]
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Robinson S. Neonatal posthemorrhagic hydrocephalus from prematurity: pathophysiology and current treatment concepts. J Neurosurg Pediatr 2012; 9:242-58. [PMID: 22380952 PMCID: PMC3842211 DOI: 10.3171/2011.12.peds11136] [Citation(s) in RCA: 162] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECT Preterm infants are at risk for perinatal complications, including germinal matrix-intraventricular hemorrhage (IVH) and subsequent posthemorrhagic hydrocephalus (PHH). This review summarizes the current understanding of the epidemiology, pathophysiology, management, and outcomes of IVH and PHH in preterm infants. METHODS The MEDLINE database was systematically searched using terms related to IVH, PHH, and relevant neurosurgical procedures to identify publications in the English medical literature. To complement information from the systematic search, pertinent articles were selected from the references of articles identified in the initial search. RESULTS This review summarizes the current knowledge regarding the epidemiology and pathophysiology of IVH and PHH, primarily using evidence-based studies. Advances in obstetrics and neonatology over the past few decades have contributed to a marked improvement in the survival of preterm infants, and neurological morbidity is also starting to decrease. The incidence of IVH is declining, and the incidence of PHH will likely follow. Currently, approximately 15% of preterm infants who suffer severe IVH will require permanent CSF diversion. The clinical presentation and surgical management of symptomatic PHH with temporary ventricular reservoirs (ventricular access devices) and ventriculosubgaleal shunts and permanent ventriculoperitoneal shunts are discussed. Preterm infants who develop PHH that requires surgical treatment remain at high risk for other related neurological problems, including cerebral palsy, epilepsy, and cognitive and behavioral delay. This review highlights numerous opportunities for further study to improve the care of these children. CONCLUSIONS A better grasp of the pathophysiology of IVH is beginning to impact the incidence of IVH and PHH. Neonatologists conduct rigorous Class I and II studies to advance the outcomes of preterm infants. The need for well-designed multicenter trials is essential because of the declining incidence of IVH and PHH, variations in referral patterns, and neonatal ICU and neurosurgical management. Well-designed multicenter trials will eventually produce evidence to enable neurosurgeons to provide their smallest, most vulnerable patients with the best practices to minimize perioperative complications and permanent shunt dependence, and most importantly, optimize long-term neurodevelopmental outcomes.
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Affiliation(s)
- Shenandoah Robinson
- Rainbow Babies and Children’s Hospital, Neurological Institute, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio
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Mousiolis A, Papantoniou N, Mesogitis S, Baglatzi L, Baroutis G, Antsaklis A. Optimum mode of delivery in gestations complicated by preterm premature rupture of the membranes. J Matern Fetal Neonatal Med 2011; 25:1044-9. [PMID: 21854136 DOI: 10.3109/14767058.2011.614659] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To provide evidence about the preferable mode of delivery, vaginal (VD) or caesarean section (CS), in PPROM. METHODS A retrospective study of 190 cases. Survival analysis was used to identify statistically significant differences in mortality rates. RESULTS A total of 126 pregnancies were included in our study. Mean gestational age of rupture was 28(+0) weeks (min = 15, max = 36(+4), sd = 5.796). Mean birth age was 30(+0) weeks (min = 15, max = 37(+2), sd = 5.353). CS was performed in 55 cases (43.7%), VD in 71 cases (56.3%). Data analysis showed that, regardless of presentation, there was a statistically significant benefit on survival in favor of the CS in births below 30 gestational weeks (n = 39, nCS = 18, nND = 21, χ(2) = 7.946, p = 0.005). Hazard ratio estimation set the critical gestational age at 28 weeks. For vaginal deliveries, breech presentation was associated with inferior survival outcome compared to vertex (nTotal = 71; nVertex = 63, nBreech = 8, χ(2) = 13.012, p < 0.001.Also in breech presentation, VD survival outcome was inferior to CS (nTotal = 9; nVD = 6, nCS = 3, χ(2) = 5.145, p < 0.05). CONCLUSIONS According to our results, in cases of PPROM, CS was beneficial below 28 weeks and in breech presentation below 30 weeks.
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Affiliation(s)
- Athanasios Mousiolis
- 1st Obstetrics and Gynecology Clinic, University Hospital Alexandra, Athens, Greece.
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Review of the recent literature on the mode of delivery for singleton vertex preterm babies. J Pregnancy 2011; 2011:186560. [PMID: 21811682 PMCID: PMC3147000 DOI: 10.1155/2011/186560] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Accepted: 05/26/2011] [Indexed: 11/17/2022] Open
Abstract
Choosing the safest method of delivery and preventing preterm labour are obstetric challenges in reducing the number of preterm births and improving outcomes for mother and baby. Optimal route of delivery for preterm vertex neonates has been a controversial topic in the obstetric and neonatal community for decades and continues to be debated. We reviewed 22 studies, most of which have been published over the last five years with an aim to find answers to the clinical questions relevant to deciding the mode of delivery. Findings suggested that the neonatal outcome does not depend on the mode of delivery. Though Caesarean section rates are increasing for preterm births, it does not prevent neurodisability and cannot be recommended unless there are other obstetric indications to justify it. Therefore, clinical judgement of the obstetrician depending on the individual case still remains important in deciding the mode of delivery.
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