Showing papers on "Gestational age published in 2000"
TL;DR: This study provides outcome data for this geographically defined cohort; survival and neonatal morbidity are consistent with previous data from the United Kingdom and facilitate comparison with other geographically based data.
Abstract: Objective. To evaluate the outcome for all infants born before 26 weeks of gestation in the United Kingdom and the Republic of Ireland. This report is of survival and complications up until discharge from hospital. Methodology. A prospective observational study of all births between March 1, 1995 and December 31, 1995 from 20 to 25 weeks of gestation. Results. A total of 4004 births were recorded, and 811 infants were admitted for intensive care. Overall survival was 39% (n 5 314). Male sex, no reported chorioamnio- nitis, no antenatal steroids, persistent bradycardia at 5 minutes, hypothermia, and high Clinical Risk Index for Babies (CRIB) score were all independently associated with death. Of the survivors, 17% had parenchymal cysts and/or hydrocephalus, 14% received treatment for reti- nopathy of prematurity (ROP), and 51% needed supple- mentary oxygen at the expected date of delivery. Failure to administer antenatal steroids and postnatal transfer for intensive care within 24 hours of birth were predic- tive of major scan abnormality; lower gestation was pre- dictive of severe ROP, while being born to a black mother was protective. Being of lower gestation, male sex, tocolysis, low maternal age, neonatal hypothermia, a high CRIB score, and surfactant therapy were all predic- tive of oxygen dependency. Intensive care was provided in 137 units, only 8 of which had >5 survivors. There was no difference in survival between institutions when di- vided into quintiles based on their numbers of extremely preterm births or admissions. Conclusions. This study provides outcome data for this geographically defined cohort; survival and neonatal morbidity are consistent with previous data from the United Kingdom and facilitate comparison with other geographically based data. Pediatrics 2000;106:659 - 671; ex- tremely preterm infant, survival, cerebral ultrasound scan, intraventricular hemorrhage, parenchymal cysts, hydro- cephalus, retinopathy of prematurity, chronic lung disease. ABBREVIATIONS. PMA, postmenstrual age; NNU, neonatal unit; LMP, last menstrual period; EDD, expected date of delivery; ROP, retinopathy of prematurity; CI, confidence interval; HR, heart rate; CRIB, Clinical Risk Index for Babies; RDS, respiratory distress syndrome; IQR, interquartile range; PROM, prolonged rupture of membranes .24 hours; Fio2, fraction of inspired oxygen; PDA, patent ductus arteriosus. T he care of the fetus considered to be at the threshold of viability raises some of the most difficult clinical problems for obstetricians and pediatricians. Advice given to parents needs to be based on reliable contemporary information drawn from appropriate populations. The number of these infants born in an individual unit is small and con- clusions based on their outcome are unreliable. Pub- lished reports derive from a range of populations including those from single tertiary centers with se- lected patients and others based on geographically defined areas. Furthermore, survival and morbidity are defined differently in different studies and show wide variation. For example, since 1990, for infants born at 25 weeks of gestational age, published rates of survival range from 35% to 79% 1,2 and published rates of severe disability range from 12% to 35%. 3,4 The EPICure study was designed to describe sur- vival and health problems for all infants born before 26 completed weeks of gestational age in the United Kingdom and the Republic of Ireland. In this article we describe the progress of these infants during their initial admission for intensive care.
1,066 citations
TL;DR: In this paper, the authors examined the association between intrauterine growth restriction and adverse neonatal outcomes in a population of 19,759 singleton very-low-birth-weight neonates without major birth defects.
840 citations
TL;DR: Mild- and moderate-preterm birth infants are at high RR for death during infancy and are responsible for an important fraction of infant deaths.
Abstract: ContextThe World Health Organization defines preterm birth as birth at less
than 37 completed gestational weeks, but most studies have focused on very
preterm infants (birth at <32 weeks) because of their high risk of mortality
and serious morbidity. However, infants born at 32 through 36 weeks are more
common and their public health impact has not been well studied.ObjectiveTo assess the quantitative contribution of mild (birth at 34-36 gestational
weeks) and moderate (birth at 32-33 gestational weeks) preterm birth to infant
mortality.Design, Setting, and ParticipantsPopulation-based cohort study using linked singleton live birth–infant
death cohort files for US birth cohorts for 1985 and 1995 and Canadian birth
cohorts (excluding Ontario) for 1985-1987 and 1992-1994.Main Outcome MeasuresRelative risks (RRs) and etiologic fractions (EFs) for overall and cause-specific
early neonatal (age 0-6 days), late neonatal (age 7-27 days), postneonatal
(age 28-364 days), and total infant death among mild and moderate preterm
births vs term births (at ≥37 gestational weeks).ResultsRelative risks for infant death from all causes among singletons born
at 32 through 33 gestational weeks were 6.6 (95% confidence interval [CI],
6.1-7.0) in the United States in 1995 and 15.2 (95% CI, 13.2-17.5) in Canada
in 1992-1994; among singletons born at 34 through 36 gestational weeks, the
RRs were 2.9 (95% CI, 2.8-3.0) and 4.5 (95% CI, 4.0-5.0), respectively. Corresponding
EFs were 3.2% and 4.8%, respectively, at 32 through 33 gestational weeks and
6.3% and 8.0%, respectively, at 34 through 36 gestational weeks; the sum of
the EFs for births at 32 through 33 and 34 through 36 gestational weeks exceeded
those for births at 28 through 31 gestational weeks. Substantial RRs were
observed overall for the neonatal (eg, for early neonatal deaths, 14.6 and
33.0 for US and Canadian infants, respectively, born at 32-33 gestational
weeks; EFs, 3.6% and and 6.2% for US and Canadian infants, respectively) and
postneonatal (RRs, 2.1-3.8 and 3.0-7.0 for US and Canadian infants, respectively,
born at 32-36 gestational weeks; EFs, 2.7%-5.8% and 3.0%-7.0% for the same
groups, respectively) periods and for death due to asphyxia, infection, sudden
infant death syndrome, and external causes. Except for a reduction in the
RR and EF for neonatal mortality due to infection, the patterns have changed
little since 1985 in either country.ConclusionsMild– and moderate–preterm birth infants are at high RR
for death during infancy and are responsible for an important fraction of
infant deaths.
833 citations
TL;DR: From the second trimester onward, the major adverse obstetrical outcome associated with raised TSH in the general population is an increased rate of fetal death, which would be another reason to consider population screening.
Abstract: Objective—To examine the relation between certain pregnancy complications and thyroid stimulating hormone (TSH) measurements in a cohort of pregnant women. Methods—TSH was measured in sera obtained from women during the second trimester as part of routine prenatal care. Information was then collected about vaginal bleeding, premature delivery, low birthweight, abruptio placentae, pregnancy induced hypertension, need for cesarean section, low Apgar scores, and fetal and neonatal death. Results—Among 9403 women with singleton pregnancies,TSH measurements were 6 mU/l or greater in 209 (2.2%).The rate of fetal death was significantly higher in those pregnancies (3.8%) than in the women with TSH less than 6 mU/l (0.9%, odds ratio 4.4, 95% confidence interval 1.9‐9.5). Other pregnancy complications did not occur more frequently Conclusion—From the second trimester onward, the major adverse obstetrical outcome associated with raised TSH in the general population is an increased rate of fetal death. If thyroid replacement treatment avoided this problem this would be another reason to consider population screening. (J Med Screen 2000;7:127‐130)
707 citations
TL;DR: Evaluate secular trends and provide new standards for small for gestational age for 16 to 44 weeks of gestation in Norway for the period 1967–1998 to describe birthweight by Gestational age in Norway.
Abstract: Objective. To describe birthweight by gestational age in Norway for the period 1967-1998, evaluate secular trends and provide new standards for small for gestational age for 16 to 44 weeks of gestation. Subjects and methods. The analyses were based on more than 1.8 million singleton births, covering all births in Norway for a 32 year period. Percentiles for birthweight by gestational age were estimated using smoothed means and standard deviations. In the preterm weeks, means and standard deviations were carefully screened for birthweight-gestational age consistency, adapting a method of Wilcox and Russell. Differences in birthweight by gestational age for stillbirths and livebirths in extremely preterm weeks (16-28) are presented, and the effects of cesarean section are evaluated. We observed a clear increase in birthweight by gestational age for all term weeks, but a decrease for most of the preterm weeks over the same period. This decrease was related to the increase in deliveries by cesarean section. C...
569 citations
TL;DR: It is shown that placental malaria causes prematurity even in high-transmission areas, and the impact of maternal malaria on infant mortality may be greater than was thought previously.
Abstract: Maternal malaria is associated with reduced birth weight, which is thought to be effected through placental insufficiency, which leads to intrauterine growth retardation (IUGR). The impact of malaria on preterm delivery is unclear. The effects of placental malaria‐related changes on birth weight and gestational age were studied in 1177 mothers (and their newborns) from Tanzania. Evidence of malaria infection was found in 75.5% of placental samples. Only massive mononuclear intervillous inflammatory infiltration (MMI) was associated with increased risk of low birth weight (odds ratio [OR], 4.0). Maternal parasitized red blood cells and perivillous fibrin deposition both were associated independently with increased risk of premature delivery (OR, 3.2; OR, 2.1, respectively). MMI is an important mechanism in the pathogenesis of IUGR in malaria-infected placentas. This study also shows that placental malaria causes prematurity even in high-transmission areas. The impact of maternal malaria on infant mortality may be greater than was thought previously. Despite recommendations that malaria be controlled among pregnant women in endemic areas [1], malaria during pregnancy remains a significant cause of maternal and infant mortality and morbidity. Problems related to compliance with drug regimens and the use of partially effective antimalarials are some of the reasons that have led many countries to question, and in many cases abandon, malaria control for pregnant women.
503 citations
TL;DR: Relative differences in short term morbidity and mortality persist between the sexes in very low birthweight infants attributable to sex.
Abstract: Objective—To determine the diVerences in short term outcome of very low birthweight infants attributable to sex. Methods—Boys and girls weighing 501‐ 1500 g admitted to the 12 centres of the National Institute of Child Health and Human Development Neonatal Research Network were compared. Maternal information and perinatal data were collected from hospital records.Infant outcome was recorded at discharge, at 120 days of age if the infant was still in hospital, or at death. Best obstetric estimate based on the last menstrual period, standard obstetric factors, and ultrasound were used to assign gestational age in completed weeks. Data were collected on a cohort that included 3356 boys and 3382 girls, representing all inborn births from 1 May 1991 to 31 December 1993. Results—Mortality for boys was 22% and that for girls 15%. The prenatal and perinatal data indicate few diVerences between the sex groups, except that boys were less likely to have been exposed to antenatal steroids (odds ratio (OR) = 0.80) and were less stable after birth, as reflected in a higher percentage with lower Apgar scores at one and five minutes and the need for physical and pharmacological assistance. In particular, boys were more likely to have been intubated (OR = 1.16) and to have received resuscitation medication (OR = 1.40). Boys had a higher risk (OR > 1.00) for most adverse neonatal outcomes.Although pulmonary morbidity predominated, intracranial haemorrhage and urinary tract infection were also more common. Conclusions—Relative diVerences in short term morbidity and mortality persist between the sexes. (Arch Dis Child Fetal Neonatal Ed 2000;83:F182‐F185)
493 citations
TL;DR: It is concluded that, with current methods of care, the limits of viability have been reached and the continuing toll of major neonatal morbidity and neurodevelopmental handicap are of serious concern.
451 citations
TL;DR: The Diabetes in Early Pregnancy Study showed that good maternal control was associated with normal neurodevelopmental outcome and there is a significant transmission rate of 2% of type I diabetes if the mother has insulin-dependent diabetic mother, whereas the rate is 6% for the father.
449 citations
TL;DR: Significantly higher concentrations of Th2 cytokines were produced by the first trimester normal group than by the RSA group, while significantly higher concentrations by the abortion group as compared to firsttrimester normal pregnancy, indicating a distinct Th2-bias in normal pregnancy and a Th1- bias in unexplained RSA.
Abstract: It has been proposed that successful pregnancy is a T helper 2-type phenomenon, and that T helper (Th)1-type reactivity is deleterious to pregnancy. The objective of this study was to compare the concentrations of Th1 and Th2 cytokines produced by peripheral blood mononuclear cells from women undergoing unexplained recurrent spontaneous abortion (RSA) with those produced during normal pregnancy at a similar gestational stage. The control group consisted of 24 women with a history of successful pregnancies and the abortion group comprised of 23 women with a history of unexplained RSA. Blood from the control group was obtained at the end of the first trimester as gestational age controls for the abortion group from whom blood was collected at the time of abortion. Phytohaemagglutinin-stimulated peripheral blood cell culture supernatants were analysed for concentrations of cytokines. Significantly higher concentrations of Th2 cytokines were produced by the first trimester normal group than by the RSA group, while significantly higher concentrations of Th1 cytokines were produced by the abortion group as compared to first trimester normal pregnancy, indicating a distinct Th2-bias in normal pregnancy and a Th1-bias in unexplained RSA.
428 citations
TL;DR: There is an urgent need for research into the etiology and prevention of neonatal morbidity in extremely low-birth-weight children and the significant predictors of outcome are identified.
Abstract: Objective To examine the neurosensory and cognitive status of extremely low-birth-weight (ELBW; Design An inception cohort of ELBW infants admitted to the neonatal intensive care unit (NICU) and observed to 20 months' corrected age. Setting A tertiary level urban NICU and follow-up clinic at a university hospital. Population Of 333 ELBW infants without major congenital malformations admitted to the NICU, 241 (72%) survived to 20 months' corrected age. We studied 221 children (92%) at a mean of 20 months' corrected age. The mean birth weight was 813 g; mean gestational age, 26.4 weeks. Main Outcome Measures Assessments of cognitive and neurosensory development. Results Major neurosensory abnormality was present in 54 children (24%), including 33 (15%) with cerebral palsy, 20 (9%) with deafness, and 2 (1%) with blindness. The mean (± SD) Bayley Mental Developmental Index (MDI) score was 74.7 ± 17. Ninety-two children (42%) had a subnormal MDI score ( 171 µmol/L [>10 mg/dL]) (OR, 4.80; 95% CI, 1.46-15.73). Conclusion There is an urgent need for research into the etiology and prevention of neonatal morbidity.
TL;DR: A retrospective cohort analysis of hemoglobin and birth outcome among 173,031 pregnant women who attended publicly funded health programs in ten states and delivered a liveborn infant highlighted the importance of considering anemia and high hemoglobin level as indicators for adverse pregnancy outcome.
TL;DR: The combination of short cervical length, previous preterm birth caused by preterm premature rupture of membranes, and positive fetal fibronectin screening results was highly associated with preterm delivery caused bypreterm premature rupturing of membranes in the current gestation.
TL;DR: It is suggested that maintaining exclusive breast-feeding until at least age 4 months may protect against asthma or atopy developing later in childhood.
Abstract: Some previous work suggests that exclusive breast-feeding protects against atopic disease and asthma, but other studies fail to support this conclusion. The best way of demonstrating protection against childhood asthma is to follow up a large cohort of children prospectively from birth, assessing both exposures and outcomes. Such a study recently was conducted in Western Australia in a cohort established in 1989–1992, in which 2187 children were followed up to age 6 years. An association between the duration of exclusive breast-feeding and the risk of atopy or asthma at age 6 was sought by logistic regression analysis, controlling for a number of confounding factors, such as gender, gestational age, early child care, and smoking in the household.
Introducing milk other than breast milk before age 4 months significantly increased the risk of asthma and atopy-related outcomes. The odds ratio for physician-diagnosed asthma was 1.25; for three or more episodes of wheezing since age 12 months, 1.41; and for wheezing in the past year, 1.31. The age at first wheezing and age when asthma was diagnosed both were less when nonbreast milk was introduced within the first 4 months of life. The odds ratios also were increased for sleep disorder secondary to wheezing in the past year (1.42) and a positive skin prick test reaction to at least one common aeroallergen (1.30). These findings suggest that maintaining exclusive breast-feeding until at least age 4 months may protect against asthma or atopy developing later in childhood.
Br Med J 1999;319:815–819
TL;DR: Routine ultrasound in early pregnancy appears to enable better gestational age assessment, earlier detection of multiple pregnancies andEarlier detection of clinically unsuspected fetal malformation at a time when termination of pregnancy is possible, however, the benefits for other substantive outcomes are less clear.
Abstract: Background Advantages of early pregnancy ultrasound screening are considered to be more accurate calculation of gestational age, earlier identification of multiple pregnancies, and diagnosis of non-viable pregnancies and certain fetal malformations. Objective The objective of this review was to assess the use of routine (screening) ultrasound compared with the selective use of ultrasound in early pregnancy (i.e. before 24 weeks). Search strategy The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register (up to July 1998) were searched. Selection criteria Adequately controlled trials of routine ultrasound imaging in early pregnancy. Data collection and analysis One reviewer assessed trial quality and extracted data. Study authors were contacted for additional information. Main results Nine trials were included. The quality of the trials was generally good. Routine ultra- sound examination was associated with earlier detection of multiple pregnancies (twins undiag- nosed at 26 weeks, OR 0.08; 95% CI, 0.04 to 0.16) and reduced rates of induction of labour for post- term pregnancy (OR 0.61; 95% CI, 0.52 to 0.72). There were no differences detected for substantive clinical outcomes such as perinatal mortality (OR 0.86; 95% CI, 0.67 to 1.12). When detection of fetal abnormality was a specific aim of the exam- ination, the number of terminations of pregnancy for fetal anomaly increased. Reviewers’ conclusions Routine ultrasound in early pregnancy appears to enable better gestational age assessment, earlier detection of multiple pregnancies and earlier detection of clinically unsuspected fetal malformation at a time when termination of pregnancy is possible. However, the benefits for other substantive outcomes are less clear.
TL;DR: In this paper, the authors evaluated the impact of intravenous immune globulin on obstetric and neonatal outcomes among women with antiphospholipid syndrome with anticoagulant and low-dose aspirin.
TL;DR: The cerebral cortex of extremely preterm infants when imaged at gestational age 38-42 weeks had less cortical surface area and was less complex than in normal infants born around term, suggesting a neural substrate for the neurocognitive impairment that is frequent among such pre term infants.
TL;DR: Even a slightly raised HbA1 c during early pregnancy in women with Type I diabetes carries an increased risk for fetal malformations, therefore normoglycaemia should be strived for during earlyregnancy.
Abstract: Aims/hypothesis. To assess the relation between glycaemic control in early pregnancy and the risk of congenital malformations in offspring of mothers with Type I (insulin-dependent) diabetes mellitus.¶Methods. From 1988–1997, we prospectively collected data from 691 pregnancies and 709 offspring of 488 women with Type I diabetes in a specific geographic area in Southern Finland. Glycated haemoglobin A1 c at less than 14 weeks of gestation was used as the indicator of glycaemic control. The malformations were diagnosed either by ultrasonography in pregnancy or during the neonatal period. We also studied 729 non-selected control pregnancies in women without diabetes.¶Results. The numbers of major fetal malformations were 30 (4.2 %) in patients with Type I diabetes and 10 (1.2 %) in the control subjects (relative risk 3.1; 95 % confidence interval: 1.6 to 6.2). Even women whose HbA1 c was only slightly raised (5.6 to 6.8 %, ie 2.0 to 5.9 standard deviation units) showed a relative risk of 3.0 (95 % confidence interval: 1.2 to 7.5). Haemoglobin A1 c retained its statistically significant association with the occurrence of malformations after adjusting for White's class, age at onset of diabetes, duration of diabetes, parity, smoking and participation in pre-pregnancy counselling.¶Conclusions/interpretation. Even a slightly raised HbA1 c during early pregnancy in women with Type I diabetes carries an increased risk for fetal malformations. Therefore normoglycaemia should be strived for during early pregnancy. [Diabetologia (2000) 43: 79–82]
TL;DR: A population-based birth cohort including 296 consecutive type 1 diabetic births in a geographically defined catchment area was used and a subgroup with a particular need of counselling and intensive feto-maternal monitoring can be identified.
TL;DR: Pregnancy issues should be discussed when making decisions about initiation of combination antiretroviral therapy for HIV-infected women, and elective caesarean section to reduce vertical transmission at 36 weeks rather than 38 weeks may be advisable in women on combination therapy with PI.
Abstract: Objective: To assess the association between type and timing of initiation of antiretroviral therapy in pregnancy and duration of pregnancy.
Design: Prospective study.
Methods: Data on 3920 mother-child pairs were examined (3015 mother-child pairs from the European Collaborative Study and 905 from the Swiss Mother + Child HIV Cohort Study). Factors examined included gestational age, antiretroviral therapy during pregnancy, maternal CD4 count, viral load, illicit drug use (IDU) and mode of delivery. Deliveries at less than 37 weeks were defined as premature.
Results: The prematurity rate was 17% and median gestational age 39 weeks. Twenty-three per cent (896 of 3920) of women received antiretroviral therapy during pregnancy: 64% (573 of 896) zidovudine monotherapy, 24% (215) combination therapy without protease inhibitors (PI) and 12% (108) combination therapy with PI. In multivariate analysis, adjusted for maternal CD4 count and IDU, odds ratio (OR) of prematurity was 2.60 [95% confidence interval (CI), 1.43-4.75] and 1.82 (95% CI, 1.13-2.92) for infants exposed to combination therapy with and without a PI, respectively, compared to no treatment. Exposure to monotherapy was not associated with prematurity, but severe immunosuppression and IDU in pregnancy were. Women on combination therapy from before pregnancy were twice as likely to deliver prematurely as those starting therapy in the third trimester (OR, 2.17; 95% CI, 1.03-4.58).
Conclusions: Pregnancy issues should be discussed when making decisions about initiation of combination antiretroviral therapy for HIV-infected women. Elective caesarean section to reduce vertical transmission at 36 weeks rather than 38 weeks may be advisable in women on combination therapy with PI.
TL;DR: Examining prospective impact of PNMS and dispositional optimism on birth weight and gestational age in a medically high-risk sample suggests that chronic stress in pregnancy may be a reflection of underlying dispositions that contribute to adverse birth outcomes.
Abstract: A sizable body of evidence indicates that prenatal maternal stress (PNMS) has an adverse impact on birth outcomes, including birth weight and gestational age at delivery. The authors hypothesized that effects of PNMS are attributable in part to dispositions such as pessimism that lead women to view their lives as stressful and that effects of PNMS and disposition on birth outcome are mediated by prenatal health behaviors. Using structural equations modeling procedures, the authors examined prospective impact of PNMS and dispositional optimism on birth weight and gestational age in a medically high-risk sample (N = 129), controlling for effects of risk and ethnicity. After its strong inverse association with optimism was accounted for, PNMS had no impact on birth outcomes. Women who were least optimistic delivered infants who weighed significantly less, controlling for gestational age. Optimists were more likely to exercise, and exercise was associated with lower risk of preterm delivery. Results suggest that chronic stress in pregnancy may be a reflection of underlying dispositions that contribute to adverse birth outcomes.
TL;DR: Among babies born at term, low birthweight predicts cardiovascular risk factors and disease in adulthood, and babies born prematurely, whether or not they have intrauterine growth retardation, are predisposed to similar risks as adults.
TL;DR: Several factors associated with an increased risk of unexplained fetal death were identified and identified in this study.
TL;DR: Observational data on perinatal mortality in Type 2 diabetes mellitus from a population with a high background rate of this disorder is reported.
Abstract: Summary
Aims In many parts of the world the number of pregnancies in women with Type 2 diabetes mellitus (DM) now exceeds that in women with Type 1 DM, but there are few data published on perinatal mortality in Type 2 DM. This study reports observational data on perinatal mortality in Type 2 DM from a population with a high background rate of this disorder.
Methods Over a 12-year period (1985–1997) at the Diabetes Clinic at National Women’s Hospital, Auckland, there were 434 pregnancies in women with Type 2 DM (256 known and 178 diagnosed with gestational diabetes mellitus (GDM), but confirmed to have Type 2 DM early post-partum), 160 pregnancies in women with Type 1 DM and 932 in women with GDM. Perinatal mortality was classified as either intermediate fetal death (20–28 weeks’ gestation), late fetal death (28 weeks’ gestation to term) or early neonatal death (up to 1 month post-partum).
Results The perinatal mortality in Type 2 DM was 46.1/1000, significantly higher than the rates for the general population (12.5), Type 1 DM (12.5) and GDM (8.9) (P < 0.0001). Congenital malformations accounted for only 10% of the perinatal mortality. There was a seven-fold increase in the rate of late fetal death and 2.5-fold increase in the rates of intermediate fetal and late neonatal death. Subjects with Type 2 DM were significantly older and more obese than subjects with Type 1 DM, and presented later to the diabetes service.
Conclusions Perinatal mortality in Type 2 DM is significantly increased, mainly owing to an excess of late fetal death. Maternal factors such as obesity may be important contributors to the high perinatal mortality. Women diagnosed with GDM who have unrecognized Type 2 DM are also at high risk, but perinatal mortality is low in women with milder degrees of glucose intolerance in pregnancy.
TL;DR: Elective induction significantly increased the risk of cesarean delivery for nulliparas, and increased inhospital predelivery time and costs.
TL;DR: Perinatal outcomes in pregnancies with oligohydramnios were compared with those with an amniotic fluid index of >50 mm and increased perinatal morbidity and mortality.
TL;DR: It is concluded that antenatal corticosteroid therapy is associated with higher systolic and diastolic blood pressures in adolescence, and might lead to clinical hypertension in survivors well beyond birth.
Abstract: Antenatal corticosteroid therapy substantially improves the survival rate of preterm infants, with few side effects. Higher blood pressure in adulthood has been described in several animal species after exposure to antenatal corticosteroids, but there are no similar reports in humans. The objective of the present study was to determine the relationship between exposure to antenatal corticosteroid therapy and blood pressure at 14 years of age. This was a cohort study of 210 preterm survivors with birthweights of <1501 g born in the Royal Women's Hospital, Melbourne, between 1 January 1977 and 31 March 1982. Blood pressure was measured in 177 subjects (84.3%) at 14 years of age with a standard mercury sphygmomanometer. Children exposed to antenatal corticosteroids (n=89) had higher systolic and diastolic blood pressures than those not exposed to corticosteroids (n=88) [mean difference (95% confidence interval) (mmHg): systolic, 4.1 (0.1-8.0); diastolic, 2.8 (0.05-5.6)]. However, few had blood pressure in the hypertensive range. It is concluded that antenatal corticosteroid therapy is associated with higher systolic and diastolic blood pressures in adolescence, and might lead to clinical hypertension in survivors well beyond birth.
TL;DR: Despite early pacing, CHB carries high mortality during the first 12 months of life, and high incidences of DCM and associated heart defects indicate close echocardiographic monitoring of all children with CHB.
Abstract: Objectives. Few data are available in the literature regarding the long-term outcome of newborns with congenital complete heart block (CHB). The aims of this retrospective study were to assess neonatal morbidity and mortality, incidences of dilated cardiomyopathy (DCM), and associated heart defects, and to establish prenatal and postnatal factors that might predict adverse outcome in children with CHB. Design and Setting. The cohort includes 91 infants with CHB diagnosed in 5 tertiary centers in Finland between 1950 and 1998. Patients. Maternal connective tissue disease was evident in 89% of the patients. At birth, the median gestational age was 37.1 weeks, and the median weight was 2969 g. Of the 91 infants, 60 (66%) were girls and 7 (8%) were twins. Results. Incidences of perinatal morbidity and mortality were 58% and 7%, respectively. The total mortality of CHB was 16%; 11 of 15 (73%) died during the first 12 months. Cumulative probability of survival at 10 years old was 82%. Pacing as a newborn was indicated in 48 of 90 cases (53%), and 36 received pacemakers at older ages. Cardiac defects not causally related to CHB were found in 38 of 90 patients (42%), of whom 22 were operated on. DCM was found in 21 (23%), of whom 13 died. During the follow-up, among 75 survivors with a median age of 9 years, 54 (72%) are free from symptoms. Poor outcome defined as clinically or pathologically evident congestive DCM was associated with intrauterine hydrops, low fetal and neonatal heart rate, low birth weight, male sex, and neonatal problems attributable to prematurity or neonatal lupus. Conclusions. Despite early pacing, CHB carries high mortality during the first 12 months of life. High incidences of DCM and associated heart defects indicate close echocardiographic monitoring of all children with CHB.
TL;DR: Low weight gain in pregnancy was associated with increased risk of preterm delivery, particularly if women were underweight or of average weight before pregnancy, and the magnitude of risk varied according to a woman's prepregnancy BMI.
TL;DR: Compared with neonates who have normal initial feeding assessments, neonates with disorganised or dysfunctional feeding were six times more likely to vomit and three times morelikely to cough when offered solid food at 6 months of age.
Abstract: The increased survival of sick and preterm neonates may be associated with long-term problems which must be recognised and managed if outcome is to be optimised. In a prospective study of 35 neonates (median gestational age at birth 34 weeks) admitted to a neonatal intensive care unit over a 3-month period, we have documented a high incidence (14 of 35) of immature or abnormal feeding patterns when infants were assessed at 36 to 40 weeks postmenstrual age. Neonates with prolonged respiratory support and delayed enteral and oral feeding were most affected. Compared with neonates who have normal initial feeding assessments, neonates with disorganised or dysfunctional feeding were six times more likely to vomit and three times more likely to cough when offered solid food at 6 months of age. At 12 months of age significant differences were also found in tolerating lumpy food and enjoying mealtimes. We hypothesise that these feeding problems contribute to failure to thrive and psychosocial distress after discharge from the neonatal unit and propose potential neonatal measures to reduce their incidence.