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Winkler P, Cloppenburg E, Heep A, Malik E, Lüdders D, Lange M. [Influence of Fetomaternal Risk Factors on Mortality and Morbidity in Extremely Preterm Infants]. Z Geburtshilfe Neonatol 2024; 228:166-173. [PMID: 38081217 DOI: 10.1055/a-2198-9124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
INTRODUCTION The management of pregnant women at risk of preterm delivery poses a challenge to the interdisciplinary team. At the edge of viability, it is crucial to take into consideration maternal and fetal risk factors when determining individual counseling and therapeutic approaches. METHODS At a level 4 perinatal center, all preterm infants (PI) born in the years 2017 to 2020 who had a gestational age between 230/7 and 246/7 weeks and were cared for with a curative therapeutic approach were enrolled in a retrospective observational study. Divided into two groups (230/7-236/7 and 240/7-246/7 weeks of gestation), the PI were compared in terms of mortality and morbidity based on maternal and fetal risk factors. Thirteen risk factors and their prognostic relevance for survival were analyzed. RESULTS 41 mothers with 48 PI were included. 9 neonates received primary palliative treatment and were excluded from the analyses. The survival rates between the two groups (n=21, n=27) showed no significant difference (66.7% versus 74.1%, p=0.750). A significantly higher mortality was observed in PI with an increased number of risk factors (p=0.004), the most severe of which were hypertensive disorders of pregnancy and preterm premature rupture of membranes. Data regarding morbidity showed no significant difference. CONCLUSION Data regarding mortality correlate with national findings. Observed morbidity in the study population was recorded. The prediction of probability of survival is more precise when risk factors are taken into consideration.
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Affiliation(s)
- Paula Winkler
- Universitätsklinik für Gynäkologie und Geburtshilfe, Klinikum Oldenburg AoR, Oldenburg, Germany
| | - Eva Cloppenburg
- Universitätsklinik für Kinder- und Jugendmedizin, Elisabeth-Kinderkrankenhaus, Klinik für Neonatologie, Pädiatrische Intensivmedizin, Kinderkardiologie, Pädiatrische Pneumologie und Allergologie, Klinikum Oldenburg AoR, Oldenburg, Germany
| | - Axel Heep
- Universitätsklinik für Kinder- und Jugendmedizin, Elisabeth-Kinderkrankenhaus, Klinik für Neonatologie, Pädiatrische Intensivmedizin, Kinderkardiologie, Pädiatrische Pneumologie und Allergologie, Klinikum Oldenburg AoR, Oldenburg, Germany
| | - Eduard Malik
- Universitätsklinik für Gynäkologie und Geburtshilfe, Klinikum Oldenburg AoR, Oldenburg, Germany
| | - Dörte Lüdders
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Starnberg, Starnberg, Germany
| | - Matthias Lange
- Universitätsklinik für Kinder- und Jugendmedizin, Elisabeth-Kinderkrankenhaus, Klinik für Neonatologie, Pädiatrische Intensivmedizin, Kinderkardiologie, Pädiatrische Pneumologie und Allergologie, Klinikum Oldenburg AoR, Oldenburg, Germany
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Torremante P, Berge NK, Weiss C. Reducing the Rate of Premature Births through Early Diagnosis and Pregnancy-Adapted Treatment of Hypothyroidism. Geburtshilfe Frauenheilkd 2023; 83:1361-1370. [PMID: 38024217 PMCID: PMC10631574 DOI: 10.1055/a-2103-8143] [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: 07/11/2022] [Accepted: 05/31/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The aim of this study was to determine the extent to which regular monitoring of maternal free thyroxine level and pregnancy-adapted L-thyroxine replacement therapy before and during pregnancy in patients with existing or newly diagnosed latent and manifest hypothyroidism as well as hypothyroxinemia can influence the rate of premature births. Materials and Methods This is a retrospective cohort study assessing 1440 pseudonymized survey questionnaires to evaluate the risks of premature birth with two study groups from the same medical practice, and a nationally recruited control group. Study group A (n = 360) had already been taking L-thyroxine prior to conception, study group B (n = 580) started taking it after conception. Both study groups had a maximum gestational age of 12 + 0 GW. In the study groups, TSH and free thyroxine levels were determined regularly for dose adjustment purposes. The aim was to keep the free thyroxine level in the euthyroid hyperthyroxinemic range within the pregnancy adapted reference range. The control group (n = 500) had taken L-thyroxine during pregnancy according to criteria that were not known, as the questionnaire did not include any questions regarding this matter. Taking other risk factors into account, the influence of pregnancy-adapted L-thyroxine replacement therapy on the rate of premature births was determined using logistic regression analysis. Results Compared with the control group, the premature birth rate was 70% lower (p < 0.0001) in study group A and 42% lower in study group B (p = 0.0086), while the odds ratio, at 3.46, was particularly significant in study group A. High blood pressure (odds ratio 5.21), body mass index per kg/m 2 (odds ratio 0.91) and S. p. premature birth were identified as other independent risk factors. Conclusion The results show an association between more intensive thyroid diagnostics and pregnancy-adapted L-thyroxine replacement therapy and a decrease in premature births. Further studies should be conducted to confirm these results.
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Affiliation(s)
- Pompilio Torremante
- Frauenarzt/Spezielle Geburtshilfe und Perinatalmedizin, Ochsenhausen, Germany
| | - Nils Kristian Berge
- Abteilung für Medizinische Statistik, Biomathematik und Informationsverarbeitung, Universitätsmedizin Mannheim, Ruprecht-Karls-Universität Heidelberg Medizinische
Fakultät Mannheim, Mannheim, Germany
| | - Christel Weiss
- Abteilung für Medizinische Statistik, Biomathematik und Informationsverarbeitung, Universitätsmedizin Mannheim, Ruprecht-Karls-Universität Heidelberg Medizinische
Fakultät Mannheim, Mannheim, Germany
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Biedermann R, Schleussner E, Lauten A, Heimann Y, Lehmann T, Proquitté H, Weschenfelder F. Inadequate Timing Limits the Benefit of Antenatal Corticosteroids on Neonatal Outcome: Retrospective Analysis of a High-Risk Cohort of Preterm Infants in a Tertiary Center in
Germany. Geburtshilfe Frauenheilkd 2022; 82:317-325. [PMID: 35250380 PMCID: PMC8893984 DOI: 10.1055/a-1608-1138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/22/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction
A common problem in the treatment of threatened preterm birth is the timing and the unrestricted use of antenatal corticosteroids (ACS). This study was performed to
evaluate the independent effects of the distinct timing of antenatal corticosteroids on neonatal outcome parameters in a cohort of very low (VLBW; 1000 – 1500 g) and extreme low birth weight
infants (ELBW; < 1000 g). We hypothesize that a prolonged ACS-to-delivery interval leads to an increase in respiratory complications.
Materials and Methods
Main data source was the prospectively collected single center data for the German nosocomial infection surveillance system (KISS) between 2015 and 2018.
Multivariate regression analysis was performed to determine independent effects of the ACS-to-delivery interval on the need for ventilation, surfactant or the occurrence of bronchopulmonary
dysplasia, neonatal sepsis or necrotizing enterocolitis. Subgroup analysis was performed for ELBW and VLBW neonates.
Results
A total of 239 neonates were included. We demonstrate a significantly increased risk of respiratory distress characterized by the need for ventilation (OR 1.045; CI
1.011 – 1.080) and surfactant administration (OR 1.050, CI 1.018 – 1.083) depending on the ACS-to-delivery interval irrespective of other confounders. Every additional day between ACS and
delivery increased the risk for ventilation by 4.5% and for surfactant administration by 5%. Subgroup analysis revealed significant differences of respiratory complications in VLBW
infants.
Conclusions
Our data strongly support the deliberate use and timing of antenatal corticosteroids in pregnancies with threatened preterm birth versus a liberal strategy. When given
more than 7 days before birth, each day between application and delivery increases is relevant concerning major effects on the infant. Especially VLBW preterm neonates benefit from optimal
timing.
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Affiliation(s)
- Richard Biedermann
- University Hospital Jena, Unit Neonatology, Department of Paediatrics, Jena, Germany
| | | | - Angela Lauten
- University Hospital Jena, Department of Obstetrics, Jena, Germany
| | - Yvonne Heimann
- University Hospital Jena, Department of Obstetrics, Jena, Germany
| | - Thomas Lehmann
- University Hospital Jena, Institute of Medical Statistics and Computer Science, Jena, Germany
| | - Hans Proquitté
- University Hospital Jena, Unit Neonatology, Department of Paediatrics, Jena, Germany
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Prediction of Preterm Delivery from Unbalanced EHG Database. SENSORS 2022; 22:s22041507. [PMID: 35214412 PMCID: PMC8878555 DOI: 10.3390/s22041507] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/07/2022] [Accepted: 02/11/2022] [Indexed: 02/04/2023]
Abstract
Objective: The early prediction of preterm labor can significantly minimize premature delivery complications for both the mother and infant. The aim of this research is to propose an automatic algorithm for the prediction of preterm labor using a single electrohysterogram (EHG) signal. Method: The proposed method firstly employs empirical mode decomposition (EMD) to split the EHG signal into two intrinsic mode functions (IMFs), then extracts sample entropy (SampEn), the root mean square (RMS), and the mean Teager–Kaiser energy (MTKE) from each IMF to form the feature vector. Finally, the extracted features are fed to a k-nearest neighbors (kNN), support vector machine (SVM), and decision tree (DT) classifiers to predict whether the recorded EHG signal refers to the preterm case. Main results: The studied database consists of 262 term and 38 preterm delivery pregnancies, each with three EHG channels, recorded for 30 min. The SVM with a polynomial kernel achieved the best result, with an average sensitivity of 99.5%, a specificity of 99.7%, and an accuracy of 99.7%. This was followed by DT, with a mean sensitivity of 100%, a specificity of 98.4%, and an accuracy of 98.7%. Significance: The main superiority of the proposed method over the state-of-the-art algorithms that studied the same database is the use of only a single EHG channel without using either synthetic data generation or feature ranking algorithms.
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Zhu Y, Hedderson MM, Brown SD, Badon SE, Feng J, Quesenberry CP, Ferrara A. Healthy preconception and early-pregnancy lifestyle and risk of preterm birth: a prospective cohort study. Am J Clin Nutr 2021; 114:813-821. [PMID: 33900396 PMCID: PMC8326036 DOI: 10.1093/ajcn/nqab089] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/03/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Preterm birth (PTB) remains a leading cause of neonatal mortality and long-term morbidity. Individual factors have been linked to PTB risk. The impact of a healthy lifestyle, with multiple modifiable prenatal factors, remains unknown. OBJECTIVES We aimed to examine the associations of preconceptional and early-pregnancy low-risk modifiable factors (individually and in combination) with PTB risk. METHODS This prospective cohort study included 2449 women with singleton pregnancies in the Pregnancy Environment and Lifestyle Study. PTB was defined as ultrasound-confirmed obstetric estimate-based gestational age at delivery <37 wk. A set of low-risk modifiable factors were identified: healthy weight (prepregnancy BMI: 18.5-24.9 kg/m2) based on clinical measurements and high-quality diet (Alternate Healthy Eating Index-Pregnancy score ≥75th percentile) and low-to-moderate stress during early pregnancy (Perceived Stress Scale score <75th percentile) assessed at gestational weeks 10-13. Poisson regression estimated adjusted relative risk (aRR) of PTB in association with individual and combined low-risk modifiable prenatal factors, adjusting for sociodemographic, clinical, and other prenatal factors. RESULTS One hundred and sixty women (6.5%) delivered preterm. Risk of PTB was lower among women who had a healthy weight (aRR: 0.58; 95% CI: 0.39, 0.86), high-quality diet (aRR: 0.68; 95% CI: 0.39, 0.99), and low-to-moderate stress (aRR: 0.60; 95% CI: 0.41, 0.88). Women with 1, 2, or 3 low-risk modifiable prenatal factors compared with none had a 38% (aRR: 0.72; 95% CI: 0.45, 1.16), 51% (aRR: 0.49; 95% CI: 0.29, 0.84), or 70% (aRR: 0.30; 95% CI: 0.13, 0.70) lower PTB risk, respectively. Associations of having ≥1 low-risk factor with PTB risk were more pronounced for medically indicated than for spontaneous PTB and for late than for early or moderate PTB. Associations also varied by race or ethnicity, although with overlapping 95% CIs. CONCLUSIONS A healthy prenatal lifestyle with multiple low-risk modifiable factors was associated with lower risk of PTB. Our findings may inform multicomponent preconceptional or early-pregnancy prevention strategies to mitigate PTB risk.
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Affiliation(s)
- Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Monique M Hedderson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Susan D Brown
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Division of General Medicine, University of California, Davis, Davis, CA, USA
| | - Sylvia E Badon
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Juanran Feng
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | | | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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Abstract
The aim of the study is to present the problem of functional hypothalamic amenorrhea, taking into account any disease and treatment, diagnosis, and consequences of this disease. We searched PubMed (MEDLINE) and included 38 original and review articles concerning functional hypothalamic amenorrhea. Functional hypothalamic amenorrhea is the most common cause of secondary amenorrhea in women of childbearing age. It is a reversible disorder caused by stress related to weight loss, excessive exercise and/or traumatic mental experiences. The basis of functional hypothalamic amenorrhea is hormonal, based on impaired pulsatile GnRH secretion in the hypothalamus, then decreased secretion of gonadotropins, and, consequently, impaired hormonal function of the ovaries. This disorder leads to hypoestrogenism, manifested by a disturbance of the menstrual cycle in the form of amenorrhea, leading to anovulation. Prolonged state of hypoestrogenism can be very detrimental to general health, leading to many harmful short- and long-term consequences. Treatment of functional hypothalamic amenorrhea should be started as soon as possible, and it should primarily involve lifestyle modification. Only then should pharmacological treatment be applied. Importantly, treatment is most often long-term, but it results in recovery for the majority of patients. Effective therapy, based on multidirectional action, can protect patients from numerous negative impacts on fertility, cardiovascular system and bone health, as well as reducing mental morbidity.
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Al-Riyami N, Al-Badri H, Jaju S, Pillai S. Short-Term Outcomes of Atosiban in the Treatment of Preterm Labour at the Sultan Qaboos University Hospital, Muscat, Oman: A tertiary care experience. Sultan Qaboos Univ Med J 2021; 21:e260-e265. [PMID: 34221474 PMCID: PMC8219335 DOI: 10.18295/squmj.2021.21.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/27/2020] [Accepted: 08/03/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aimed to generate baseline evidence regarding the effectiveness of atosiban in delaying delivery by ≥48 hours among pregnant women presenting with threatened preterm labour (TPL). The secondary objective was to assess the relationship between atosiban success and various perinatal factors and neonatal outcomes. Methods This retrospective study was conducted between June 2008 and May 2018 at the Sultan Qaboos University Hospital, Muscat, Oman. The medical records of all pregnant women who received atosiban between 24–34 gestational weeks for TPL during this period were reviewed. Results A total of 159 women were included in the study. Atosiban was successful in delaying delivery by ≥48 hours in 130 cases (81.8%). Approximately half of the women (50.9%) achieved uterine quiescence in <12 hours. Failure to delay delivery by ≥48 hours was significantly lower among women with normal versus abnormal cervical findings (11.1% versus 25.6%; P = 0.023). Only 9.4% of women experienced minor side-effects. Mean birth weight (2,724.55 versus 1,707.59 g; P <0.001) and Apgar scores at 5 minutes (9.66 versus 8.28; P <0.001) were significantly higher among neonates delivered at ≥48 versus <48 hours post-atosiban, whereas the rate of neonatal respiratory distress syndrome was significantly lower (18.4% versus 81.6%; P <0.001). Conclusion Atosiban was highly effective in delaying delivery by ≥48 hours and resulted in few adverse maternal side-effects and neonatal outcomes. To the best of the authors’ knowledge, this is the first study conducted in Oman to evaluate the effectiveness of atosiban in preventing preterm labour.
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Affiliation(s)
- Nihal Al-Riyami
- Department of Obstetrics & Gynaecology, Sultan Qaboos University, Muscat, Oman
| | - Hanin Al-Badri
- College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Sanjay Jaju
- Department of Family Medicine & Public Health, Sultan Qaboos University, Muscat, Oman
| | - Silja Pillai
- Department of Obstetrics & Gynaecology, Sultan Qaboos University Hospital, Muscat, Oman
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Lorenz S, Ulrich SM, Sann A, Liel C. Self-Reported Psychosocial Stress in Parents With Small Children. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:709-716. [PMID: 33559586 DOI: 10.3238/arztebl.2020.0709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 12/06/2019] [Accepted: 04/06/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Psychosocial stress in early childhood can impair children's health and development. Data on the prevalence of psychosocial stress in families with infants and toddlers in Germany are lacking. Such data could be used to determine the need for prevention and to plan the appropriate preventive measures. METHODS In 2015, a representative cross-sectional study called Kinder in Deutschland- KiD 0-3 was conducted by questionnaire in pediatricians' practices across Germany. Parents taking their children to the U3-U7a child development checks were asked to self-report information about stress in their families. The data were analyzed with descriptive statistics and chi-square tests. RESULTS Data from 7549 families went into the analysis. Stressful situations commonly reported by the parents included unplanned pregnancy (21.3%), parenthoodrelated stress (e.g., self-doubt as to parenting competence, 29.6%), and lack of familial and social support for problems and questions arising in relation to the child, as well as for temporary child care (19.7%). Most types of psychosocial stress varied as a function of the child's age group, as categorized by the particular examination for which the child was presenting at the time of the survey (U3-U7a). Couple distress, lack of social support, signs of depression or anxiety symptoms, or inner anger were more commonly reported by parents attending the later examina - tions. Such problems could be addressed by supportive measures (e.g., parent counseling, early child intervention). CONCLUSION Psychosocial stress affects a large percentage of the parents of small children. A large proportion of parents of small children suffer from psychosocial stress. This should be monitored for accumulation and stability across child development checks and addressed as appropriate. Family practitioners and pediatricians are important partners for effective cooperation between the social system and the health-care system, and for the provision of preventive measures where appropriate.
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Affiliation(s)
- Simon Lorenz
- Department of Family and Family Politics, National Center for Early Prevention, German YouthInstitute (DJI, Deutsches Jugendinstitut e.V. ), Munich, Germany
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Fritze-Büttner F, Toth B, Bühren A, Schlosser K, Schierholz S, Rumpel B, Helm PC, Bauer UMM, Niethard M, Prediger S, Götzky K, Jähne J. Surgery during pregnancy - results of a German questionnaire. Innov Surg Sci 2020; 5:21-26. [PMID: 33506090 PMCID: PMC7798309 DOI: 10.1515/iss-2020-0025] [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: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 11/15/2022] Open
Abstract
Objectives Worldwide, not only the number of female medical students, but also of female surgeons increases. Simultaneously, younger generations take a closer look to their work-life balance. With this in mind, it seems necessary to evaluate the expectations of female surgeons in particular with respect to pregnancy during their surgical career. Methods Therefore, a nationwide survey was conducted in Germany from July to December 2016 under the auspices of the German Society of Surgery as well as the Professional Board of German Surgeons. The questionnaire involved 2,294 female surgeons and 1,843 complete records were evaluated. Results Of the analyzed answers, 62% of the women (n=781) were operating during pregnancy. The joy of surgery (91.6%), followed by team spirit (57.1%), were the main motivations to perform operations while pregnant. Operative activity decreased from 30.8% in the first 3 months of pregnancy to 21.5% during the last three months. Regarding the possible complaints, e.g., leg edema, back pain, premature labor and vaginal bleeding, there were no significant differences between the women with or without activity in the operating room. Sick leave due to pregnancy (1–10 days) was stated by 40.4% of respondents. Conclusion Despite strong legal regulations for pregnant surgeons, the survey showed that most female surgeons are eager to operate despite their pregnancy. The results also demonstrate no significant differences regarding complications during pregnancy- or pregnant-dependent absence from work. Hospitals and surgical departments are asked to establish proper working conditions for pregnant surgeons and pregnancy should not be an obstacle for a career in surgery.
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Affiliation(s)
- Frauke Fritze-Büttner
- Klinik für Allgemein- und Viszeralchirurgie, Sana Klinikum Lichtenberg, Berlin, Germany
| | - Bettina Toth
- Universitätsklinik für Gynäkologische Endokrinologie und Reproduktionsmedizin, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Astrid Bühren
- Praxis für Psychosomatik und Psychotherapie, Honorary President of the German Association of Female Physicians, Murnau, Germany
| | - Katja Schlosser
- Klinik für Allgemein-, Viszeral, Endokrine und Gefäßchirurgie, Agaplesion, Evangelisches Krankenhaus Mittelhessen, Giessen, Germany
| | - Stefanie Schierholz
- Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Beatrix Rumpel
- Klinik für Allgemein- und Viszeralchirurgie, Sana Klinikum Lichtenberg, Berlin, Germany
| | - Paul C Helm
- Kompetenznetz Angeborene Herzfehler e. V., Berlin, Germany
| | | | - Maya Niethard
- Klinik für Tumororthopädie, Helios Klinikum Berlin-Buch GmbH, Berlin, Germany
| | - Sarah Prediger
- III. Med. Klinik, Sektion Ausbildungsforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Kristina Götzky
- Klinik für Allgemein- und Viszeralchirurgie, DIAKOVERE Henriettenstift, Hannover, Germany
| | - Joachim Jähne
- Klinik für Allgemein- und Viszeralchirurgie, DIAKOVERE Henriettenstift, Hannover, Germany
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Zöllkau J, Hagenbeck C, Hecher K, Pecks U, Schlembach D, Simon A, Schlösser R, Schleußner E. [Update on Recommendations for SARS-CoV-2/COVID-19 During Pregnancy, Birth and Childbed]. Z Geburtshilfe Neonatol 2020; 224:217-222. [PMID: 32838449 PMCID: PMC7516367 DOI: 10.1055/a-1199-6404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 06/26/2020] [Indexed: 02/07/2023]
Abstract
With begin of the SARS-CoV-2 pandemic the german obstetric, peri-/neonatological and pediatric professional societies published recommendations for care of pregnant and newborn, as well as for necessary staff protection in March 2020 [1-3]. Because of the rapid emerging increase of knowledge an update is required. This work therefore perceives as prosecution of the existing recommendations [1-3].Worldwide national recommendations were recently compared and published in a consensual review [4]. In methodological dependence this update of recommendations comments on key questions of pre-, peri- and postnatal care at SARS-CoV-2 and COVID-19, based on publications up to 30.05.2020. Statements represent a carefully concerned expert consensus and can change contemporary as new knowledge appears.The responsibility for concrete management remains at the local medical team, decisions should be supported by these recommendations.
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Affiliation(s)
| | | | - Kurt Hecher
- Klinik für Geburtshilfe und Pränatalmedizin,
Universitätsklinikum Hamburg-Eppendorf
| | - Ulrich Pecks
- Klinik für Gynäkologie und Geburtshilfe,
Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | | | - Arne Simon
- Klinik für Pädiatrische Onkologie und
Hämatologie, Universitätsklinikum des Saarlandes,
Homburg/Saar
| | - Rolf Schlösser
- Klinik für Kinder- und Jugendmedizin, Schwerpunkt Neonatologie,
Universitätsklinikum Frankfurt
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Behnke J, Lemyre B, Czernik C, Zimmer KP, Ehrhardt H, Waitz M. Non-Invasive Ventilation in Neonatology. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:177-183. [PMID: 31014448 DOI: 10.3238/arztebl.2019.0177] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 05/29/2018] [Accepted: 01/21/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Invasive mechanical ventilation (IMV) has been replaced by early continuous positive airway pressure (CPAP) in the treatment of respiratory distress syndrome (RDS) in preterm infants aiming to reduce the rate of bronchopulmonary dysplasia (BPD). Subsequently, modern non-invasive ventilation strategies (NIV) were introduced into clinical practice with limited evidence of effects on pulmonary and neurodevelopmental outcomes. METHODS We performed a selective literature search in PubMed including randomized controlled trials (RCT) (n ≥ 200) and meta-analyses published in the field of NIV in neonatology and follow-up studies focusing on long term pulmonary and neurodevelopmental outcomes. RESULTS Individual studies do not show a significant risk reduction for the combined endpoint death or BPD in preterm infants caused by early CPAP in RDS when compared to primary intubation. One meta-analysis comparing four studies found CPAP significantly reduces the risk of BPD or death (relative risk: 0.91; 95% confidence interval [0.84;0.99]). Nasal intermittent positive pressure ventilation (NIPPV) as a primary ventilation strategy reduces the rate of intubations in infants with RDS (RR: 0.78 [0.64;0.94]) when compared to CPAP but does not affect the rate of BPD (RR: 0.78 [0.58;1.06]). CONCLUSION Early CPAP reduces the need for IMV and the risk of BPD or death in preterm infants with RDS. NIPPV may offer advantages over CPAP regarding intubation rates. Networking-based follow-up programs are required to assess the effect of NIV on long term pulmonary and neurodevelopmental outcomes.
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Affiliation(s)
- Judith Behnke
- Department of General Pediatrics & Neonatology, Center for Pediatrics and Youth Medicine, Justus Liebig University of Giessen; Division of Neonatology, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neonatology, Charité-Universitätsmedizin Berlin, Berlin; Member of the German Lung Research Center (DZL), Giessen
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Craniofacial growth in infants with deformational plagiocephaly: does prematurity affect the duration of head orthosis therapy and the extent of the reduction in asymmetry during treatment? Clin Oral Investig 2019; 24:2991-2999. [DOI: 10.1007/s00784-019-03159-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/14/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
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Santos S, Haslinger C, Mennet M, von Mandach U, Hamburger M, Simões-Wüst AP. Bryophyllum pinnatum enhances the inhibitory effect of atosiban and nifedipine on human myometrial contractility: an in vitro study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 19:292. [PMID: 31685022 PMCID: PMC6830012 DOI: 10.1186/s12906-019-2711-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 10/10/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND The herbal medicine Bryophyllum pinnatum has been used as a tocolytic agent in anthroposophic medicine and, recently, in conventional settings alone or as an add-on medication with tocolytic agents such as atosiban or nifedipine. We wanted to compare the inhibitory effect of atosiban and nifedipine on human myometrial contractility in vitro in the absence and in the presence of B. pinnatum press juice (BPJ). METHODS Myometrium biopsies were collected during elective Caesarean sections. Myometrial strips were placed under tension into an organ bath and allowed to contract spontaneously. Test substances alone and at concentrations known to moderately affect contractility in this setup, or in combination, were added to the organ bath, and contractility was recorded throughout the experiments. Changes in the strength (measured as area under the curve (AUC) and amplitude) and frequency of contractions after the addition of all test substances were determined. Cell viability assays were performed with the human myometrium hTERT-C3 and PHM1-41 cell lines. RESULTS BPJ (2.5 μg/mL), atosiban (0.27 μg/mL), and nifedipine (3 ng/mL), moderately reduced the strength of spontaneous myometrium contractions. When BPJ was added together with atosiban or nifedipine, inhibition of contraction strength was significantly higher than with the tocolytics alone (p = 0.03 and p < 0.001, respectively). In the case of AUC, BPJ plus atosiban promoted a decrease to 48.8 ± 6.3% of initial, whereas BPJ and atosiban alone lowered it to 70.9 ± 4.7% and to 80.9 ± 4.1% of initial, respectively. Also in the case of AUC, BPJ plus nifedipine promoted a decrease to 39.9 ± 4.6% of initial, at the same time that BPJ and nifedipine alone lowered it to 78.9 ± 3.8% and 71.0 ± 3.4% of initial. Amplitude data supported those AUC data. The inhibitory effects of BPJ plus atosiban and of BPJ plus nifedipine on contractions strength were concentration-dependent. None of the test substances, alone or in combination, decreased myometrial cell viability. CONCLUSIONS BPJ enhances the inhibitory effect of atosiban and nifedipine on the strength of myometrial contractions, without affecting myometrium tissue or cell viability. The combination treatment of BPJ with atosiban or nifedipine has therapeutic potential.
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Affiliation(s)
- S. Santos
- Department of Obstetrics, University Hospital Zurich, Schmelzbergstrasse 12/PF 125, 8091 Zurich, Switzerland
- Division of Pharmaceutical Biology, University of Basel, Basel, Switzerland
| | - C. Haslinger
- Department of Obstetrics, University Hospital Zurich, Schmelzbergstrasse 12/PF 125, 8091 Zurich, Switzerland
| | | | - U. von Mandach
- Department of Obstetrics, University Hospital Zurich, Schmelzbergstrasse 12/PF 125, 8091 Zurich, Switzerland
| | - M. Hamburger
- Division of Pharmaceutical Biology, University of Basel, Basel, Switzerland
| | - A. P. Simões-Wüst
- Department of Obstetrics, University Hospital Zurich, Schmelzbergstrasse 12/PF 125, 8091 Zurich, Switzerland
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Kyvernitakis I, Maul H, Bahlmann F. Controversies about the Secondary Prevention of Spontaneous Preterm Birth. Geburtshilfe Frauenheilkd 2018; 78:585-595. [PMID: 29962517 PMCID: PMC6018068 DOI: 10.1055/a-0611-5337] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/28/2018] [Accepted: 04/17/2018] [Indexed: 02/07/2023] Open
Abstract
Preterm birth is one of the major global health problems and part of the Millennium Development goals because of the associated high number of perinatal or neonatal mortality and long-term risks of neurodevelopmental and metabolic diseases. Transvaginal sonography has meanwhile been established as a screening tool for spontaneous preterm birth despite its relatively low sensitivity when considering only the cervical length. Vaginal progesterone has been shown to reduce prematurity rates below 34 weeks in a screening population of singleton pregnancies. Up to now, no positive long-term effect could be demonstrated after 2 years. It seems to have no benefit to prolong pregnancies after a period of preterm contractions and in risk patients without cervical shortening. Meta-analyses still demonstrate conflicting results dependent on quality criteria used for selection. A cerclage is only indicated in singleton pregnancies with previous spontaneous preterm birth and a combined cervical shortening in the current pregnancy. Nevertheless, the short- and long-term outcome has never been evaluated, whereas maternal complications may be increased. There is no evidence for a prophylactic cervical cerclage in twin pregnancies even in cases with cervical shortening. Emergency cerclage remains an indication after individual counseling. The effect of a cervical pessary in singleton pregnancy seems to be more pronounced in studies where a few investigators with increasing experience have treated and followed the patients at risk for preterm birth. Mainly in twin pregnancies, pessary treatment seems to be promising compared to other treatment options of secondary prevention when the therapy is started at early stages of precocious cervical ripening. At present, several international trials with the goal to reduce global rates of prematurity are in progress which will hopefully allow to specify the indications and methods of intervention for certain subgroups. When trials are summarized, prospective meta-analyses carry a lower risk of bias than the meanwhile uncontrolled magnitude of retrospective meta-analyses with conflicting results.
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Affiliation(s)
- Ioannis Kyvernitakis
- Dpt. of Obstetrics and Gynecology, Buergerhospital and Clementine Kinderhospital Frankfurt a. M., Dr. Senckenberg Foundation and Johann-Wolfgang-Goethe University of Frankfurt, Frankfurt, Germany
- Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
| | - Holger Maul
- Dpt. of Obstetrics and Prenatal Medicine, Asklepios Kliniken Barmbek and Nord-Heidberg, Hamburg, Germany
| | - Franz Bahlmann
- Dpt. of Obstetrics and Gynecology, Buergerhospital and Clementine Kinderhospital Frankfurt a. M., Dr. Senckenberg Foundation and Johann-Wolfgang-Goethe University of Frankfurt, Frankfurt, Germany
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Wu S, Sun J, Lv H, Zhang Y, Shang H, Zhang H, Belinson JL. Pregnancy in a woman with untreated bladder exstrophy: a case report. Case Rep Womens Health 2018; 17:11-13. [PMID: 29594008 PMCID: PMC5869060 DOI: 10.1016/j.crwh.2018.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/02/2018] [Accepted: 02/27/2018] [Indexed: 11/23/2022] Open
Abstract
Objective To report the management of urinary tract obstruction and infection in a pregnant woman with unrepaired bladder exstrophy. Case Report A 27-year-old pregnant woman with unrepaired bladder exstrophy was referred to our hospital with a complaint of bilateral flank pain in the second trimester. After two-dimensional abdominal ultrasound, magnetic resonance imaging and a urine analysis, she was diagnosed with an upper urinary tract infection due to ureteral obstruction secondary to unrepaired congenital bladder exstrophy and an intrauterine pregnancy. J-tube insertion was performed after locating the ureteral orifices and antibiotics were administered. Symptoms rapidly resolved. She delivered a normal male infant by caesarean section at 34 weeks of gestation. Conclusion Standard urological management of the ureteral obstruction in pregnancy was successful in this extreme case of unrepaired bladder exstrophy associated with an intrauterine pregnancy. The perinatal outcome was good. A rare case in a pregnant woman with unrepaired bladder exstrophy Urologic complications were successfully managed without major interventions. The renal status was not further compromised because of the pregnancy. The perinatal outcome was good.
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Affiliation(s)
- Suhui Wu
- Department of Obstetrics and Gynecology, Shanxi Academy of Medical Sciences & Shanxi Dayi Hospital, Taiyuan 030032, Shanxi, China
- Corresponding author at: No. 99 Longcheng Street, Taiyuan 030032, Shanxi Province, China.No. 99 Longcheng StreetTaiyuanShanxi Province030032China
| | - Jingfen Sun
- Department of Obstetrics and Gynecology, Shanxi Academy of Medical Sciences & Shanxi Dayi Hospital, Taiyuan 030032, Shanxi, China
| | - Huimin Lv
- Department of Obstetrics and Gynecology, Shanxi Academy of Medical Sciences & Shanxi Dayi Hospital, Taiyuan 030032, Shanxi, China
| | - Yangang Zhang
- Department of Urology, Shanxi Academy of Medical Sciences & Shanxi Dayi Hospital, Taiyuan 030032, Shanxi, China
| | - Haixia Shang
- Department of Obstetrics and Gynecology, Dayi Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi, China
| | - Huajun Zhang
- Department of Urology, Shanxi Academy of Medical Sciences & Shanxi Dayi Hospital, Taiyuan 030032, Shanxi, China
| | - Jerome L. Belinson
- Preventive Oncology International Inc. and Women’s Health Institute, Cleveland Clinic, Cleveland, OH, USA
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Schüler IM, Haberstroh S, Dawczynski K, Lehmann T, Heinrich-Weltzien R. Dental Caries and Developmental Defects of Enamel in the Primary Dentition of Preterm Infants: Case-Control Observational Study. Caries Res 2017; 52:22-31. [PMID: 29224001 DOI: 10.1159/000480124] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/07/2017] [Indexed: 12/20/2022] Open
Abstract
AIM Assessment of dental health in the primary dentition of preterm infants (PTI) including investigation of mother- and infant-related risk factors in a case-control study design. MATERIAL AND METHODS One hundred twenty-eight infants aged 3-4 years were included. Sixty-four PTI (27 males) were randomly selected from the preterm registry of the Jena University Hospital. As a control group served 64 full-term infants (FTI) recruited from the Department of Paediatric Dentistry, matched for age and sex. Dental examinations were provided by one dentist under standard clinical conditions. Caries was scored using the International Caries Detection and Assessment System (ICDAS II) and the DMFT, gingival health using the Periodontal Screening Index, and developmental defects of enamel using the DDE index. Mother- and infant-related factors were collected via a questionnaire and from medical records. RESULTS The caries prevalence was 50.0% (ICDAS II >0) in PTI and 12.5% (ICDAS II >0) in FTI. The caries experience was higher in PTI (DMFT 1.0 ± 3.1) than in FTI (DMFT 0.3 ± 1.0). PTI had a higher risk of caries (OR 7.0), initial lesions (OR 6.2), DDE (OR 7.5), and gingivitis (OR 6.5) than FTI. The highest risk occurred in PTI with an extremely low birth weight (<1,000 g). A higher risk of DDE was present when mothers suffered from illness during pregnancy (OR 3.9). A higher risk of caries was revealed in infants with respiratory syndrome (OR 6.2) or when their mothers had a lower socioeconomic status (OR 6.3). CONCLUSIONS PTI had less healthy teeth than FTI and are at a higher risk for DDE, caries, and gingivitis. The poorer dental health in PTI is associated with a low birth weight, a low socioeconomic status, and mothers' illness during pregnancy.
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Affiliation(s)
- Ina Manuela Schüler
- Department of Preventive and Pediatric Dentistry, Jena University Hospital, Jena, Germany
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Schiffner R, Rodríguez-González GL, Rakers F, Nistor M, Nathanielsz PW, Daneva T, Schwab M, Lehmann T, Schmidt M. Effects of Late Gestational Fetal Exposure to Dexamethasone Administration on the Postnatal Hypothalamus-Pituitary-Adrenal Axis Response to Hypoglycemia in Pigs. Int J Mol Sci 2017; 18:ijms18112241. [PMID: 29077038 PMCID: PMC5713211 DOI: 10.3390/ijms18112241] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 10/19/2017] [Accepted: 10/21/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Prenatal glucocorticoid administration alters the activity of the fetal hypothalamic-pituitary-adrenocortical axis (HPAA), and correspondingly the adenocorticotropic hormone (ACTH) and cortisol levels after birth. The dosages required for these effects are critically discussed. Activation of the HPAA is related to metabolic syndrome and diabetes mellitus. Hypoglycemia is the classic side effect of antidiabetic treatment. We hypothesized that a low dosage of dexamethasone in late pregnancy alters the HPAA response to hypoglycemia in pigs. METHODS 12 pregnant sows were randomly assigned to two groups which received either a low-dose intramuscular injection (99th and 100th day of gestation) of dexamethasone (0.06 μg/kg body weight) or vehicle. Three months after birth, 18 dexamethasone-treated anaesthetized offspring and 12 control offspring underwent a 75 min hypoglycemic clamp (blood glucose below 4 mmol/L) procedure. Heart rate (HR), blood pressure, ACTH and cortisol levels and body weight (at birth and after three months) were recorded. RESULTS Dexamethasone-treated animals exhibited significantly elevated ACTH (139.9 ± 12.7 pg/mL) and cortisol (483.1 ± 30.3 nmol/L) levels during hypoglycemia as compared to the control group (41.7 ± 6.5 pg/mL and 257.9 ± 26.7 nmol/L, respectively), as well as an elevated HR (205.5 ± 5.7 bpm) and blood pressure (systolic: 128.6 ± 1.5, diastolic: 85.7 ± 0.7 mmHg) response as compared to the control group (153.2 ± 4.5 bpm; systolic: 118.6 ± 1.6, diastolic: 79.5 ± 1.4 mmHg, respectively; p < 0.001). CONCLUSIONS Low-dose prenatal administration of dexamethasone not only exerts effects on the HPAA (ACTH and cortisol concentration) and vital parameters (HR and diastolic blood pressure) under baseline conditions, but also on ACTH, HR and systolic blood pressure during hypoglycemia.
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Affiliation(s)
- René Schiffner
- Department of Neurology, Jena University Hospital-Friedrich Schiller University, 07747 Jena, Germany.
- Orthopaedic Department, Jena University Hospital-Friedrich Schiller University, 07747 Jena, Germany.
| | | | - Florian Rakers
- Department of Neurology, Jena University Hospital-Friedrich Schiller University, 07747 Jena, Germany.
| | - Marius Nistor
- Department of Neurology, Jena University Hospital-Friedrich Schiller University, 07747 Jena, Germany.
| | - Peter W Nathanielsz
- Department of Animal Science, University of Wyoming, Laramie, 82071 WY, USA.
| | - Teodora Daneva
- Institute of Biology and Immunology of Reproduction, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria.
| | - Matthias Schwab
- Department of Neurology, Jena University Hospital-Friedrich Schiller University, 07747 Jena, Germany.
| | - Thomas Lehmann
- Institute of Medical Statistics, Computer Sciences and Documentation Science, Jena University Hospital-Friedrich Schiller University, 07743 Jena, Germany.
| | - Martin Schmidt
- Institute for Biochemistry II, Jena University Hospital-Friedrich Schiller University, 07743 Jena, Germany.
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Schwarz J, Scheckenbach V, Kugel H, Spring B, Pagel J, Härtel C, Pauluschke-Fröhlich J, Peter A, Poets CF, Gille C, Köstlin N. Granulocytic myeloid-derived suppressor cells (GR-MDSC) accumulate in cord blood of preterm infants and remain elevated during the neonatal period. Clin Exp Immunol 2017; 191:328-337. [PMID: 28963753 DOI: 10.1111/cei.13059] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2017] [Indexed: 12/17/2022] Open
Abstract
Preterm delivery is the leading cause of perinatal morbidity and mortality. Among the most important complications in preterm infants are peri- or postnatal infections. Myeloid-derived suppressor cells (MDSC) are myeloid cells with suppressive activity on other immune cells. Emerging evidence suggests that granulocytic MDSC (GR-MDSC) play a pivotal role in mediating maternal-fetal tolerance. The role of MDSC for postnatal immune-regulation in neonates is incompletely understood. Until the present time, nothing was known about expression of MDSC in preterm infants. In the present pilot study, we quantified GR-MDSC counts in cord blood and peripheral blood of preterm infants born between 23 + 0 and 36 + 6 weeks of gestation (WOG) during the first 3 months of life and analysed the effect of perinatal infections. We show that GR-MDSC are increased in cord blood independent of gestational age and remain elevated in peripheral blood of preterm infants during the neonatal period. After day 28 they drop to nearly adult levels. In case of perinatal or postnatal infection, GR-MDSC accumulate further and correlate with inflammatory markers C-reactive protein (CRP) and white blood cell counts (WBC). Our results point towards a role of GR-MDSC for immune-regulation in preterm infants and render them as a potential target for cell-based therapy of infections in these patients.
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Affiliation(s)
- J Schwarz
- Department of Neonatology, Tuebingen University Children's Hospital, Tuebingen, Germany
| | - V Scheckenbach
- Department of Neonatology, Tuebingen University Children's Hospital, Tuebingen, Germany
| | - H Kugel
- Department of Neonatology, Tuebingen University Children's Hospital, Tuebingen, Germany
| | - B Spring
- Department of Neonatology, Tuebingen University Children's Hospital, Tuebingen, Germany
| | - J Pagel
- Department of Pediatrics, University Clinic Schleswig Holstein, Campus Lübeck, Lübeck, Germany
| | - C Härtel
- Department of Obstetrics and Gynecology, University Hospital Tuebingen, Germany
| | | | - A Peter
- German Centre for Diabetes Research (DZD), Tuebingen, Germany.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tuebingen, Tuebingen, Germany.,Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, Tuebingen University Hospital, Tuebingen, Germany
| | - C F Poets
- Department of Neonatology, Tuebingen University Children's Hospital, Tuebingen, Germany
| | - C Gille
- Department of Neonatology, Tuebingen University Children's Hospital, Tuebingen, Germany
| | - N Köstlin
- Department of Neonatology, Tuebingen University Children's Hospital, Tuebingen, Germany
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Abstract
The menstrual cycle is a reproductive vital sign and provides insight into hormonal imbalance as well as pregnancy. The significance of estrogen, however, extends beyond fertility and plays a role on tissues and organs throughout the body. Functional hypothalamic amenorrhea is a common form of secondary amenorrhea resulting in estrogen deficiency in young premenopausal women. While reversible, the cause of this disorder is related to psychological stress, excessive exercise, disordered eating or a combination of these factors resulting in suppression of the hypothalamic–pituitary–ovarian axis. The resulting loss of estrogen has profound effects on many systems throughout the body including cardiac, skeletal, psychological and reproductive. Often, these young women are the ‘walking well’ as they do not have bothersome symptoms of low estrogen and are unaware of the consequences of estrogen deficiency. This review focuses on the health consequences of hypothalamic amenorrhea, current research and available treatment options.
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Affiliation(s)
- Chrisandra L Shufelt
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California
| | - Tina Torbati
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California
| | - Erika Dutra
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California
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Traitement de la menace d’accouchement prématuré. ACTUALITES PHARMACEUTIQUES 2017. [DOI: 10.1016/j.actpha.2017.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Baek MY, Hwang HS, Park JY, Chung JE, Lee KE, Lee GY, Seong JW, Yee J, Kim YJ, Gwak HS. Association between CACNA1C gene polymorphisms and ritodrine-induced adverse events in preterm labor patients. Eur J Clin Pharmacol 2017; 73:837-842. [PMID: 28391406 DOI: 10.1007/s00228-017-2222-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 02/17/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE As a tocolytic agent, ritodrine has been used in European and Asian countries but has lost popularity due to safety concerns. This study aimed to investigate the relationship between adverse drug events caused by ritodrine and the CACNA1C polymorphisms in preterm labor patients. METHODS Data were collected from medical records including maternal age, gestational age, body mass index, dilation score, effacement score, modified Bishop score, maximum infusion rate, and adverse drug events. Five single-nucleotide polymorphisms of the CACNA1C gene (rs10774053, rs215994, rs215976, rs2239128, and rs2041135) were analyzed. RESULTS One hundred eighty-six patients were included, 33 of whom had adverse drug events. A allele carriers of rs10774053 showed about 0.293-fold lower adverse drug events than GG genotype carriers (p = 0.012, absolute risk reduction = 16.5%) after adjusting for other confounding variables; the number needed to genotype for preventing one patient with GG genotype from suffering higher incidence of adverse drug events was calculated to be 14.6. Increase in maximum infusion rate of 1 mL/h was associated with a 1.03-fold (95% CI 1.01~1.06, p = 0.005) increased risk of adverse drug events. None of the patients with a CC genotype of rs215994 had adverse drug events, whereas 22.1% of the T allele carriers had adverse drug events. CONCLUSION This study showed that CACNA1C gene polymorphisms could alter the probability of adverse drug event risk when ritodrine is used in preterm labor.
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Affiliation(s)
- Min Young Baek
- College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, Republic of Korea
| | - Han Sung Hwang
- Department of Obstetrics and Gynecology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, 05030, Republic of Korea
| | - Jin Young Park
- College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, Republic of Korea
| | - Jee Eun Chung
- College of Pharmacy, Sungkyunkwan University, Suwon-si, Kyunggi-do, 16419, Republic of Korea
| | - Kyung Eun Lee
- College of Pharmacy, Chungbuk National University, Cheongju, Chungbuk, 28644, Republic of Korea
| | - Gwan Yung Lee
- College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, Republic of Korea
| | - Jin Won Seong
- College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, Republic of Korea
| | - Jeong Yee
- College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, Republic of Korea
| | - Young Ju Kim
- Department of Obstetrics and Gynecology, Ewha Womans University School of Medicine, Seoul, 07985, Republic of Korea.
| | - Hye Sun Gwak
- College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, Republic of Korea.
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Hassanzadeh A, Paknahad Z, Khoigani MG. The relationship between macro- and micro-nutrients intake and risk of preterm premature rupture of membranes in pregnant women of Isfahan. Adv Biomed Res 2016; 5:155. [PMID: 27713876 PMCID: PMC5046777 DOI: 10.4103/2277-9175.188949] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 11/07/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Since preterm premature rupture of membranes (PPROM) is one of the most important complications of pregnancy and its relationship with nutrition status have not been surveyed comprehensively, we decided to study the relationship of maternal received nutrients (36 macro- and micro-nutrients) in three trimesters and PPROM which could be considered as a unique study. MATERIALS AND METHODS In this prospective cohort study, data was collected by filling a questionnaire through interviews with 620 pregnant women who had no parameters to affect pregnancy outcome. 48-hr dietary recalls were completed for eligible women at 11th-15th, 26th, 34th-37th weeks of gestation. Physical activity was also assessed using a standard questionnaire. Also pregnant mother's reproductive and demographic characteristic and supplementation are considered. RESULTS The mean value of received saturated fatty acids, polyunsaturated fatty acids and energy, in the first trimester (P < 0.001, P = 0.007, and P < 0.001 respectively), the mean values of calcium, sodium intake in the second trimester (P = 0.045, P = 0.006, and P = 0.004 respectively), Vitamins C, A (mg), β-carotene, cartenoids intake in the second trimester (P = 0.03, P = 0.001, P = 0.007, and P = 0.01 respectively), and higher Vitamin C intake during the first trimester (P = 0.02) was significantly greater among subjects with PPROM compared to the others. CONCLUSIONS The mean value of mentioned received nutrients in subjects who experienced PPROM later in pregnancy was higher than the others, which is independent of demographic and reproductive characteristic, estimated physical activity, and supplementation. Therefore, these findings could be considered in the nutritional programming for pregnant women to manage the risk of PPROM.
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Affiliation(s)
- Akbar Hassanzadeh
- Department of Clinical Nutrition, Food Security Research Center, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zamzam Paknahad
- Department of Nutrition, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Predicting Preterm Labour: Current Status and Future Prospects. DISEASE MARKERS 2015; 2015:435014. [PMID: 26160993 PMCID: PMC4486247 DOI: 10.1155/2015/435014] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 06/02/2015] [Indexed: 11/24/2022]
Abstract
Preterm labour and birth are a major cause of perinatal morbidity and mortality. Despite modern advances in obstetric and neonatal management, the rate of preterm birth in the developed world is increasing. Yet even though numerous risk factors associated with preterm birth have been identified, the ability to accurately predict when labour will occur remains elusive, whether it is at a term or preterm gestation. In the latter case, this is likely due to the multifactorial aetiology of preterm labour wherein women may display different clinical presentations that lead to preterm birth. The discovery of novel biomarkers that could reliably identify women who will subsequently deliver preterm may allow for timely medical intervention and targeted therapeutic treatments aimed at improving maternal and fetal outcomes. Various body fluids including amniotic fluid, urine, saliva, blood (serum/plasma), and cervicovaginal fluid all provide a rich protein source of putative biochemical markers that may be causative or reflective of the various pathophysiological disorders of pregnancy, including preterm labour. This short review will highlight recent advances in the field of biomarker discovery and the utility of single and multiple biomarkers for the prediction of preterm birth in the absence of intra-amniotic infection.
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Schleussner E, Kamin G, Seliger G, Rogenhofer N, Ebner S, Toth B, Schenk M, Henes M, Bohlmann MK, Fischer T, Brosteanu O, Bauersachs R, Petroff D. Low-molecular-weight heparin for women with unexplained recurrent pregnancy loss: a multicenter trial with a minimization randomization scheme. Ann Intern Med 2015; 162:601-9. [PMID: 25938990 DOI: 10.7326/m14-2062] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND A daily injection of low-molecular-weight heparin (LMWH) is often prescribed to women with unexplained recurrent pregnancy loss (RPL), although evidence suggesting a benefit is questionable. OBJECTIVE To determine whether LMWH increases ongoing pregnancy and live-birth rates in women with unexplained RPL. DESIGN Controlled, multicenter trial with randomization using minimization conducted from 2006 to 2013. (ClinicalTrials.gov: NCT00400387). SETTING 14 university hospitals and perinatal care centers in Germany and Austria. PATIENTS 449 women with at least 2 consecutive early miscarriages or 1 late miscarriage were included during 5 to 8 weeks' gestation after a viable pregnancy was confirmed by ultrasonography. INTERVENTION Women in the control group received multivitamin pills, and the intervention group received vitamins and 5000 IU of dalteparin-sodium for up to 24 weeks' gestation. MEASUREMENTS Primary outcome was ongoing pregnancy at 24 weeks' gestation. Secondary outcomes included the live-birth rate and late pregnancy complications. RESULTS At 24 weeks' gestation, 191 of 220 pregnancies (86.8%) and 188 of 214 pregnancies (87.9%) were intact in the intervention and control groups, respectively (absolute difference, -1.1 percentage points [95% CI, -7.4 to 5.3 percentage points]). The live-birth rates were 86.0% (185 of 215 women) and 86.7% (183 of 211 women) in the intervention and control groups, respectively (absolute difference, -0.7 percentage point [CI, -7.3 to 5.9 percentage points]). There were 3 intrauterine fetal deaths (1 woman had used LMWH); 9 cases of preeclampsia or the hemolysis, elevated liver enzyme level, and low platelet count (HELLP) syndrome (3 women had used LMWH); and 11 cases of intrauterine growth restriction or placental insufficiency (5 women had used LMWH). LIMITATION Placebo injections were not used, and neither trial staff nor patients were blinded. CONCLUSION Daily LMWH injections do not increase ongoing pregnancy or live-birth rates in women with unexplained RPL. Given the burden of the injections, they are not recommended for preventing miscarriage. PRIMARY FUNDING SOURCE Pfizer Pharma.
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Affiliation(s)
- Ekkehard Schleussner
- From Friedrich Schiller University Hospital, Jena, Germany; University Hospital Carl Gustav Carus, Dresden, Germany; St. Elisabeth and St. Barbara Hospital, Halle (Saale), Germany; Ludwig Maximilians University, Munich, Germany; Centre for Human Genetics, Regensburg, Germany; Ruprecht-Karls University of Heidelberg, Heidelberg, Germany; University of Tübingen, Tübingen, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Leipzig University, Leipzig, Germany
- Klinikum Darmstadt, Darmstadt, Germany; Center for Thrombosis and Hemostasis, Mainz, Germany; Das Kinderwunsch Institut, Dobl, Austria; and Paracelsus Medical University, Salzburg, Austria
| | - Gabriele Kamin
- From Friedrich Schiller University Hospital, Jena, Germany; University Hospital Carl Gustav Carus, Dresden, Germany; St. Elisabeth and St. Barbara Hospital, Halle (Saale), Germany; Ludwig Maximilians University, Munich, Germany; Centre for Human Genetics, Regensburg, Germany; Ruprecht-Karls University of Heidelberg, Heidelberg, Germany; University of Tübingen, Tübingen, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Leipzig University, Leipzig, Germany
- Klinikum Darmstadt, Darmstadt, Germany; Center for Thrombosis and Hemostasis, Mainz, Germany; Das Kinderwunsch Institut, Dobl, Austria; and Paracelsus Medical University, Salzburg, Austria
| | - Gregor Seliger
- From Friedrich Schiller University Hospital, Jena, Germany; University Hospital Carl Gustav Carus, Dresden, Germany; St. Elisabeth and St. Barbara Hospital, Halle (Saale), Germany; Ludwig Maximilians University, Munich, Germany; Centre for Human Genetics, Regensburg, Germany; Ruprecht-Karls University of Heidelberg, Heidelberg, Germany; University of Tübingen, Tübingen, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Leipzig University, Leipzig, Germany
- Klinikum Darmstadt, Darmstadt, Germany; Center for Thrombosis and Hemostasis, Mainz, Germany; Das Kinderwunsch Institut, Dobl, Austria; and Paracelsus Medical University, Salzburg, Austria
| | - Nina Rogenhofer
- From Friedrich Schiller University Hospital, Jena, Germany; University Hospital Carl Gustav Carus, Dresden, Germany; St. Elisabeth and St. Barbara Hospital, Halle (Saale), Germany; Ludwig Maximilians University, Munich, Germany; Centre for Human Genetics, Regensburg, Germany; Ruprecht-Karls University of Heidelberg, Heidelberg, Germany; University of Tübingen, Tübingen, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Leipzig University, Leipzig, Germany
- Klinikum Darmstadt, Darmstadt, Germany; Center for Thrombosis and Hemostasis, Mainz, Germany; Das Kinderwunsch Institut, Dobl, Austria; and Paracelsus Medical University, Salzburg, Austria
| | - Susanne Ebner
- From Friedrich Schiller University Hospital, Jena, Germany; University Hospital Carl Gustav Carus, Dresden, Germany; St. Elisabeth and St. Barbara Hospital, Halle (Saale), Germany; Ludwig Maximilians University, Munich, Germany; Centre for Human Genetics, Regensburg, Germany; Ruprecht-Karls University of Heidelberg, Heidelberg, Germany; University of Tübingen, Tübingen, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Leipzig University, Leipzig, Germany
- Klinikum Darmstadt, Darmstadt, Germany; Center for Thrombosis and Hemostasis, Mainz, Germany; Das Kinderwunsch Institut, Dobl, Austria; and Paracelsus Medical University, Salzburg, Austria
| | - Bettina Toth
- From Friedrich Schiller University Hospital, Jena, Germany; University Hospital Carl Gustav Carus, Dresden, Germany; St. Elisabeth and St. Barbara Hospital, Halle (Saale), Germany; Ludwig Maximilians University, Munich, Germany; Centre for Human Genetics, Regensburg, Germany; Ruprecht-Karls University of Heidelberg, Heidelberg, Germany; University of Tübingen, Tübingen, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Leipzig University, Leipzig, Germany
- Klinikum Darmstadt, Darmstadt, Germany; Center for Thrombosis and Hemostasis, Mainz, Germany; Das Kinderwunsch Institut, Dobl, Austria; and Paracelsus Medical University, Salzburg, Austria
| | - Michael Schenk
- From Friedrich Schiller University Hospital, Jena, Germany; University Hospital Carl Gustav Carus, Dresden, Germany; St. Elisabeth and St. Barbara Hospital, Halle (Saale), Germany; Ludwig Maximilians University, Munich, Germany; Centre for Human Genetics, Regensburg, Germany; Ruprecht-Karls University of Heidelberg, Heidelberg, Germany; University of Tübingen, Tübingen, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Leipzig University, Leipzig, Germany
- Klinikum Darmstadt, Darmstadt, Germany; Center for Thrombosis and Hemostasis, Mainz, Germany; Das Kinderwunsch Institut, Dobl, Austria; and Paracelsus Medical University, Salzburg, Austria
| | - Melanie Henes
- From Friedrich Schiller University Hospital, Jena, Germany; University Hospital Carl Gustav Carus, Dresden, Germany; St. Elisabeth and St. Barbara Hospital, Halle (Saale), Germany; Ludwig Maximilians University, Munich, Germany; Centre for Human Genetics, Regensburg, Germany; Ruprecht-Karls University of Heidelberg, Heidelberg, Germany; University of Tübingen, Tübingen, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Leipzig University, Leipzig, Germany
- Klinikum Darmstadt, Darmstadt, Germany; Center for Thrombosis and Hemostasis, Mainz, Germany; Das Kinderwunsch Institut, Dobl, Austria; and Paracelsus Medical University, Salzburg, Austria
| | - Michael K. Bohlmann
- From Friedrich Schiller University Hospital, Jena, Germany; University Hospital Carl Gustav Carus, Dresden, Germany; St. Elisabeth and St. Barbara Hospital, Halle (Saale), Germany; Ludwig Maximilians University, Munich, Germany; Centre for Human Genetics, Regensburg, Germany; Ruprecht-Karls University of Heidelberg, Heidelberg, Germany; University of Tübingen, Tübingen, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Leipzig University, Leipzig, Germany
- Klinikum Darmstadt, Darmstadt, Germany; Center for Thrombosis and Hemostasis, Mainz, Germany; Das Kinderwunsch Institut, Dobl, Austria; and Paracelsus Medical University, Salzburg, Austria
| | - Thorsten Fischer
- From Friedrich Schiller University Hospital, Jena, Germany; University Hospital Carl Gustav Carus, Dresden, Germany; St. Elisabeth and St. Barbara Hospital, Halle (Saale), Germany; Ludwig Maximilians University, Munich, Germany; Centre for Human Genetics, Regensburg, Germany; Ruprecht-Karls University of Heidelberg, Heidelberg, Germany; University of Tübingen, Tübingen, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Leipzig University, Leipzig, Germany
- Klinikum Darmstadt, Darmstadt, Germany; Center for Thrombosis and Hemostasis, Mainz, Germany; Das Kinderwunsch Institut, Dobl, Austria; and Paracelsus Medical University, Salzburg, Austria
| | - Oana Brosteanu
- From Friedrich Schiller University Hospital, Jena, Germany; University Hospital Carl Gustav Carus, Dresden, Germany; St. Elisabeth and St. Barbara Hospital, Halle (Saale), Germany; Ludwig Maximilians University, Munich, Germany; Centre for Human Genetics, Regensburg, Germany; Ruprecht-Karls University of Heidelberg, Heidelberg, Germany; University of Tübingen, Tübingen, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Leipzig University, Leipzig, Germany
- Klinikum Darmstadt, Darmstadt, Germany; Center for Thrombosis and Hemostasis, Mainz, Germany; Das Kinderwunsch Institut, Dobl, Austria; and Paracelsus Medical University, Salzburg, Austria
| | - Rupert Bauersachs
- From Friedrich Schiller University Hospital, Jena, Germany; University Hospital Carl Gustav Carus, Dresden, Germany; St. Elisabeth and St. Barbara Hospital, Halle (Saale), Germany; Ludwig Maximilians University, Munich, Germany; Centre for Human Genetics, Regensburg, Germany; Ruprecht-Karls University of Heidelberg, Heidelberg, Germany; University of Tübingen, Tübingen, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Leipzig University, Leipzig, Germany
- Klinikum Darmstadt, Darmstadt, Germany; Center for Thrombosis and Hemostasis, Mainz, Germany; Das Kinderwunsch Institut, Dobl, Austria; and Paracelsus Medical University, Salzburg, Austria
| | - David Petroff
- From Friedrich Schiller University Hospital, Jena, Germany; University Hospital Carl Gustav Carus, Dresden, Germany; St. Elisabeth and St. Barbara Hospital, Halle (Saale), Germany; Ludwig Maximilians University, Munich, Germany; Centre for Human Genetics, Regensburg, Germany; Ruprecht-Karls University of Heidelberg, Heidelberg, Germany; University of Tübingen, Tübingen, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Leipzig University, Leipzig, Germany
- Klinikum Darmstadt, Darmstadt, Germany; Center for Thrombosis and Hemostasis, Mainz, Germany; Das Kinderwunsch Institut, Dobl, Austria; and Paracelsus Medical University, Salzburg, Austria
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Preterm prelabor rupture of membranes and outcome of very-low-birth-weight infants in the German Neonatal Network. PLoS One 2015; 10:e0122564. [PMID: 25856083 PMCID: PMC4391753 DOI: 10.1371/journal.pone.0122564] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 02/23/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE It was the aim of our study to evaluate the independent effect of preterm prelabor rupture of membranes (PPROM) as a cause of preterm delivery on mortality during primary hospital stay and significant morbidities in very-low-birth-weight (VLBW) infants < 32 weeks of gestation. DESIGN Observational, epidemiological study design. SETTING Population-based cohort, German Neonatal Network (GNN). POPULATION 6102 VLBW infants were enrolled in GNN from 2009-2012, n=4120 fulfilled criteria for primary analysis (< 32 gestational weeks, no pre-eclampsia, HELLP (highly elevated liver enzymes and low platelets syndrome) or placental abruption as cause of preterm birth). METHODS Multivariable logistic regression analyses included PPROM as potential risk factors for adverse outcomes and well established items such as gestational age in weeks, birth weight, antenatal steroids, center, inborn delivery, multiple birth, gender and being small-for-gestational-age. RESULTS PPROM as cause of preterm delivery had no independent effect on the risk of early-onset sepsis, clinical sepsis and blood-culture proven sepsis, while gestational age proved to be the most important contributor to sepsis risk. The diagnosis of PPROM was associated with an increased risk for bronchopulmonary dysplasia (BPD; OR: 1.25, 95% CI: 1.02-1.55, p=0.03) but not with other major outcomes. CONCLUSIONS The diagnosis of PPROM per se is not associated with adverse outcome in VLBW infants < 32 weeks apart from a moderately increased risk for BPD. Randomized controlled trials with primary neonatal outcomes are needed to determine which subgroup of VLBW infants benefit from expectant or intentional management of PPROM.
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Tröbs RB, Sander V. Posthemorrhagic hydrocephalus in extremely low birth weight infants: Ommaya reservoir vs. ventriculoperitoneal shunt. Childs Nerv Syst 2015; 31:1261-6. [PMID: 26018211 PMCID: PMC4513217 DOI: 10.1007/s00381-015-2754-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 05/18/2015] [Indexed: 12/02/2022]
Abstract
PURPOSE The aim of this study was to analyze morbidity and initial surgery in infants with posthemorrhagic hydrocephalus (PHH) by comparing infants who were treated with a subcutaneous cerebrospinal fluid reservoir (Ommaya reservoir = CSF_R) with infants who primarily received a ventriculoperitoneal shunt (VPS). METHOD Inclusion criteria were infants born between January 2006 and June 2014 who had a diagnosis of intraventricular hemorrhage (IVH) and underwent surgical intervention for hydrocephalus. RESULTS Twenty-five infants, with a median gestational age (GA) of 26.5 (28 ± 4) weeks and a median birth weight (BW) of 980 g (1205 ± 837), were included. The median umbilical artery pH (UApH) was 7.30 (7.20 ± 0.25). The median Apgar score at 10 min was 8 (7.4 ± 2). Twenty-five peri- and postnatal adverse events were encountered preoperatively. The IVH grades were grade II (n = 1), grade III (n = 17), grade IV (n = 6), and unknown grade (n = 1). Primary treatment consisted of CSF_R (n = 18) or VPS (n = 7) placement. There was a statistically significant difference between the postnatal ages of infants with CSF_R (32.5 days; 42 ± 28) and infants with VPS (163 days; 161 ± 18). Furthermore, we found a difference regarding GA but not BW between both groups. Arrest of PHH with shunt independence occurred in two infants from the CSF_R group (11%). CONCLUSIONS In the present study, early insertion of CSF_R allowed stabilization of the infants and thus postponement of permanent VPS insertion. However, in a subgroup of patients, PHH develops over a more prolonged course, and VPS insertion can be performed initially without the need for CSF_R.
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Affiliation(s)
- Ralf-Bodo Tröbs
- Klinik für Kinderchirurgie, Marienhospital Herne, St. Elisabeth Gruppe Rhein-Ruhr, Ruhr-Universität Bochum, Widumer Str. 8, D-44627 Herne, Germany
| | - Volker Sander
- Klinik für Kinderchirurgie, Marienhospital Herne, St. Elisabeth Gruppe Rhein-Ruhr, Ruhr-Universität Bochum, Widumer Str. 8, D-44627 Herne, Germany
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.Schmid MB. In reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 111:58. [PMID: 24612499 PMCID: PMC3950826 DOI: 10.3238/arztebl.2014.0058b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Conradt A. Correspondence (letter to the editor): Primary prevention of premature labor was given short shrift. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:557-8. [PMID: 24069081 DOI: 10.3238/arztebl.2013.0557b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kiworr M. Correspondence (letter to the editor): Previous induced terminations. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:559. [PMID: 24069084 DOI: 10.3238/arztebl.2013.0559a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Schleußner E. Correspondence (reply): In reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:560. [PMID: 24069086 DOI: 10.3238/arztebl.2013.0560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Torremante P. Correspondence (letter to the editor): thyroid function as a possible cause. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:558. [PMID: 24069082 DOI: 10.3238/arztebl.2013.0558a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Daumann C. Correspondence (letter to the editor): Administration of vitamin D. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:558-9. [PMID: 24069083 DOI: 10.3238/arztebl.2013.0558b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kiesewetter H, Radtke H, Schmidt FP. Correspondence (letter to the editor): The coagulation status should be determined. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:559. [PMID: 24069085 DOI: 10.3238/arztebl.2013.0559b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Seifert R. Correspondence (letter to the editor): Numerous errors. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:557. [PMID: 24069080 DOI: 10.3238/arztebl.2013.0557a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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