Early Neonatal Complications Research Articles

Perinatal morbidity and early neonatal mortality in twin pregnancies

Purpose: The purpose of this study was to investigate the impact of maternal, fetal and obstetric parameters in twin pregnancies due to chorionicity, perinatal morbidity and early neonatal mortality. Methods: Early neonatal outcome parameters were retrospectively analysed in 240 twin pregnancies (51 monochorionic [MC], 189 dichorionic [DC] twins) over a 7.5 years period. Beside chorionicity, we focused on risk factors affecting perinatal morbidity and early neonatal outcome in the overall study cohort and subgroups 1) late preterm and 2) pregnancies conceived by artificial fertilization (IVF/ICSI). Mixed effects logistic regression models were used for multivariate risk analyses. Results: MC vs DC pregnancies showed significantly lower birth weights (p 25% and amniotic inflammation (amniotic infection syndrome [AIS]). A gestational age >36 completed weeks was accompanied by a decrease of early neonatal complications (p

Amniotic Fluid Oxidative and Nitrosative Stress Biomarkers Correlate with Fetal Chronic Hypoxia in Diabetic Pregnancies

Background: In spite of improvement in obstetrical care, pregnancy in women with type 1 diabetes mellitus is associated with increased perinatal morbidity and mortality. Hyperglycemia during pregnancy causes excessive fetal growth and chronic fetal hypoxia as reflected in increased erythropoietin (EPO) levels in amniotic fluid (AF). Objectives: We hypothesized that the degree of fetal hypoxia would correlate with fetal oxidative and nitrosative stress as evidenced by the concentration of specific biomarkers in AF. Material and Methods: 19 pregnant women with type 1 or insulin-treated gestational diabetes mellitus were studied. AF samples were collected and processed for EPO, meta-tyrosine, nitro-tyrosine and 8-hydroxy-2-deoxiguanosine by chemiluminescent immunoassay and high-performance liquid chromatography coupled to tandem mass spectrometry methods, respectively. Results: The mean (SD) of the last HbA_1c concentration before delivery was 7.7% (1.1). Median gestational age was 258 days (range 231–268). Birth weight was 3,868 ± 695 g with a z-score >2 SD in 47% of the cases. A significant correlation was found between the concentrations of AF EPO and meta-tyrosine/phenylalanine ratio (p < 0.001), nitro-tyrosine (p < 0.01) and 8-oxo-dG/2dG ratio (p < 0.001). Conclusions: We confirmed that fetuses of type 1 diabetes or insulin-treated gestational diabetes pregnancies experience chronic hypoxia as reflected by increased EPO concentrations in AF near term. Moreover, EPO levels significantly correlated with the concentration of oxidative and nitrosative stress biomarkers in AF. This pro-oxidant status may predispose newborn infants to poor postnatal adaptation and early neonatal complications.

985 Male Very-Low-Birth-Weight and Very-Low- Gestational-Age Infants have Adverse Perinatal Outcomes

BackgroundIt’s generally accepted that male Very Low Birth Weight (VLBW)/Very Low Gestational Age (VLGA) infants have a higher neonatal mortality rate (NMR), and this has been questioned recently (Arch Dis...

Short‐term outcome among term singleton infants with intrapartum oligohydramnios

To evaluate rates of early short-term neonatal complications among term singleton newborn infants with oligohydramnios. Retrospective data were collected on 456 term infants with prenatal diagnosis of oligohydramnios and on matched controls, including information on maternal condition and on infant perinatal complications. Infants in the study group were born with lower birthweight and were SGA compared with those in the control group. Rates of renal malformations were significantly higher in the study group compared with the controls (15-3.3% and 3-0.7%, respectively; p = 0.007). Among the severe oligohydramnios subgroup (Amniotic Fluid Index <2), renal anomalies were even more prevalent compared to other infants with oligohydramnios and to the controls (6-9.8%, 9-2.3% and 3-0.7%, respectively; p < 0.001). The incidence of skeletal deformities (developmental dislocation of hip and torticollis) was higher among the study group. Term infants with oligohydramnios that was detected near birth are associated with a greater prevalence of renal malformations (mostly mild hydronephrosis) as well as congenital torticollis and developmental dislocated hips compared with controls. Postnatal renal evaluation should be considered in infants with severe oligohydramnios.

Disruptive behaviour disorders: a systematic review of environmental antenatal and early years risk factors

Disruptive behaviour disorders (DBDs), including attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and conduct disorder (CD) are chronic disorders with significant overlap in aetiology and presentation. An integrative examination of environmental risk factors is lacking. Six literature searches of web-based bibliographic databases were completed to identify literature on DBDs in general and five disorders in particular: CD, ODD, ADHD, deficits of attention, motor control and perception, and reactive attachment disorder. Searches were filtered to focus on studies including diagnostic assessment, focussing on environmental risk and protective factors in the first 4 years of life. The database searches generated 9806 papers of which 47 were reviewed after filters had been applied. The evidence suggests links between a number of early life risk factors and DBDs, including prenatal cigarette smoking and alcohol use, prenatal viral illness, maternal stress and anxiety, low birthweight, peri-partum and early neonatal complications, parental stress and parenting styles in infancy, early deprivation, adoption and separation. Despite the understanding that there is sharing of risk factors between the DBDs, there has been a disproportionate focus on the role of certain risk factors at the expense of others and the field is weakened by difficulties in controlling for all potential confounding variables.

Neonatal status of twins

Multiple pregnancy is a pregnancy where more than one fetus develops simultaneously in the womb, as a result of the ovulation and fertilization of more than one egg. It is relatively rare in humans and represents the rest of the phylogenetic stages. The most common are twins and they indicate the development of two fetuses in the womb. The frequency of twin pregnancies is about 1%. Multiple pregnancies belong to a group of high-risk pregnancies because of the many complications that occur during the pregnancy: higher number of premature deliveries, bleeding, early neonatal complications and higher perinatal morbidity and mortality. Such pregnancies and infants require greater supervision and monitoring. The aim of this study was to determine the percentage of baby twins born at the maternity ward of the General Hospital in Prokuplje and their morbidity and mortality. Data on the total number of deliveries, number of twins, parity and maternal age, gestational age, body weight of twins, method of delivery, Apgar score and perinatal mortality were collected and statistically analyzed by means of retrospective analysis of operative birth and neonatal protocol for 6 years (2005 of 2010). Out of 4527 mothers who gave birth 43 were pairs of twins, or 0.95% of women gave birth to twins. These babies are more likely born by Caesarean section, but delivered with slightly lower birth weight.

Early neonatal complications from pulmonary arteriovenous malformations in hereditary hemorrhagic telangiectasia: case report and review of the literature

Hereditary hemorrhagic telangiectasia (HHT) is a rare but life-threatening disease characterized by multi system telangiectasias and arteriovenous malformations (AVM). Complications in adults have been reported extensively, but neonatal (NN) complications have only been published in incidental case reports. In this paper, we present a literature review on NN pulmonary AVM related to HHT, following our own experience with a NN death due to this disease. As prenatal diagnosis of pulmonary AVM is feasible, we recommend that a family history of HHT should be an indication for expertise prenatal anomaly scanning, in order to organise optimal NN support at birth.

Short-Term Outcome for Term and Near-Term Singleton Infants with Intrapartum Polyhydramnios

Objective: To evaluate rates of early short-term neonatal complications among term and near-term newborn infants with polyhydramnios. Methods: Retrospective data were collected on 788 term infants with prenatal diagnosis of polyhydramnios and 1,576 matched controls, including information on maternal condition and on infant perinatal complications. Results: The total rate of major congenital malformations among infants born to mothers with polyhydramnios was 2.3% compared to 0.13% for those with normal amniotic fluid index (p < 0.001). Infants in the study group were more likely to be born to diabetic mothers, were heavier and large for gestational age and were more likely to be delivered by cesarean section. Infants with polyhydramnios, but no major congenital malformations, are at increased risk for minor congenital malformations (4.2%) as well as for postnatal complications, such as respiratory distress (5.7%), cardiovascular manifestations (mainly delayed closure of the ductus arteriosus; 3.1%) and hypoglycemia (7%) compared to controls. Multivariate logistic regression revealed that polyhydramnios was associated only with postnatal respiratory distress and hypoglycemia. The severity of polyhydramnios was not associated with an increased rate of neonatal complications. Conclusion: Although infants with polyhydramnios, but no major congenital malformations, were found to have increased rates of respiratory distress and hypoglycemia, these clinical manifestations were mild and had little effect on the babies’ well-being and length of hospital stay.

Maternal pulse oximetry perfusion index as a predictor of early adverse respiratory neonatal outcome after elective cesarean delivery

Evidence suggests increased morbidity, in particular early neonatal respiratory complications, in newborns from elective cesarean section compared with those from vaginal delivery. No reliable maternal predictors of adverse neonatal outcome at elective cesarean section are known. Here, we prospectively tested the hypothesis that a low maternal perfusion index at the baseline phase (i.e., preanesthesia) of the elective cesarean section is a predictor of early adverse neonatal respiratory outcome. Prospective cohort study. Operating and delivery rooms of a public health hospital with a tertiary-level neonatal intensive care unit. Forty-four healthy pregnant women with no known risk factors undergoing elective cesarean section at term gestation. Elective cesarean section was divided into nine phases. Analysis of pulse oximetry-derived signals (perfusion index, pulse rate, and oximetry) and systolic, diastolic, and differential blood pressure were recorded. Maternal arterial and venous newborn cord blood gas analyses and placental histology were evaluated. Early respiratory complications (transient tachypnea of the newborn, n = 5; respiratory distress syndrome, n = 1) were observed in 13.6% (6 of 44) of the newborns. A maternal perfusion index < or = 1.9 (lower quartile) during the preanesthesia phase of the elective cesarean section was an independent predictor of early adverse neonatal respiratory outcome (odds ratio 68.0, 95% confidence interval 6.02-767.72; p < .0001). A decreased perfusion index value in the preanesthesia phase of elective cesarean section is a maternal predictor of increased neonatal morbidity and is significantly related to subclinical placental inflammatory disease. These observations suggest the feasibility of a noninvasive pulse oximeter prenatal screening of the high-risk fetus/newborn in elective cesarean section.

Long-term neurodevelopmental outcome of triplets

Objective To analyze the incidence of neurodevelopmental disabilities in triplets and to find out possible connection between the outcome and perinatal events. Design Retrospective cohort study of 94 triplets and their outcome at 24–144 months of age correlated with gestational age, birth weight, pregnancy complications, early neonatal period, neonatal cranial ultrasound, period of birth (1985–1995, 1996–2000) and type of antenatal care. Results Sixty-two triplets are healthy, 15 suffer cerebral palsy (CP) and 17 minimal cerebral dysfunction (MCD). Adverse outcome correlates significantly with prematurity, low birth weight and maternal age. In multivariate analysis, both cerebral palsy and minor disabilities correlate significantly with early neonatal complications, neonatal cranial ultrasound with later CP ( p < 0.01), and MCD with preterm rupture of membranes ( p = 0.047). Children conceived spontaneously do worse than those born after assisted reproduction ( p = 0.004), those born in the time period 1996–2000 do better than those born before ( p = 0.021). Seventy-seven percent (77%) of newborns delivered in the time period 1996–2000 and after level 1 antenatal care was introduced, compared with 54% being delivered in the time period before 1996 and with less meticulous types of antenatal care, remain healthy ( p = 0.015). Conclusion Triplets are still at high risk for long-term neurodevelopmental complications. Stringent perinatal care might appear important determinant of their long-term outcome.

Periventricular Hemorrhagic Infarction: Risk Factors and Neonatal Outcome

The aim of this study was to define the incidence, clinical associations, and short-term outcome of periventricular hemorrhagic infarction in the modern neonatal intensive care unit. From 5774 infants (birth weight<2500 gm), periventricular hemorrhagic infarction diagnosed by cranial ultrasound was identified and confirmed. gestational age-matched control infants were identified with normal cranial ultrasounds and detailed clinical data were obtained in both groups. Periventricular hemorrhagic infarction was confirmed in 58 infants. Incidence was 0.1% (1500-2500 gm), 2.2% (750-1500 gm), and 10% (<750 gm). Data across 6 study years reveal increased incidence in infants<750 gm. Compared with control infants, infants with periventricular hemorrhagic infarction had significantly greater association with assisted conception, intrapartum factors (emergency cesarean section, low Apgar scores), early neonatal complications (patent ductus arteriosus, pneumothorax, pulmonary hemorrhage), blood gas disturbances, and need for pressor, volume infusion, and respiratory support. Neonatal mortality of this group was 40% (n=23). Survivors had longer duration of mechanical ventilation and critical care stay compared with control subjects. Thirty-seven percent of survivors required cerebrospinal fluid shunt placement. Periventricular hemorrhagic infarction remains an important neurologic complication of prematurity. A growing population of survivors is apparent among infants with birth weight<750 gm. Multiple hemodynamic factors associated with periventricular hemorrhagic infarction cluster in the intrapartum and early neonatal periods.

The role of amniotic fluid index in the management of postdate pregnancy.

To evaluate the role of amniotic fluid index as a reliable fetal surveillance test in the management of postdate pregnancy. Cross-sectional analytical study. Hamdard University Hospital from May 2000 till May 2003. A total of 210 patients were studied. The antenatal fetal surveillance in these patients was based on ultrasound assessment of AFI twice weekly after 41 weeks. An abnormal AFI was defined as 6 cm , between 6 - 8 cm as equivocal and more than or equal to 8 as normal. Delivery outcome and early neonatal complications were main outcomes. Rate of caesarean section (35.8%) in the women with AFI 6 cm was found significantly higher than 8.9% rate of caesarean section of the women having AFI > 6 cm (p = 0.001). Proportion of early neonatal complications was also significantly higher in the women with AFI 6 cm (p = 0.03). Out of a total 210 fetuses, 38 (18.1%) neonates were found with early complications, of these, 24 (63.2%) neonates were those whose AFI was 6 cm. Sensitivity of AFI was 63.2% while specificity was 83.1% as the power of reliable fetal surveillance. AFI is a reliable fetal surveillance test. It may allow the conservative approach till 42 weeks to reduce the caesarean section rate due to failed induction of labour as well as perinatal morbidity and mortality.

Fetal inherited thrombophilias influence the severity of preeclampsia, IUGR and placental abruption.

To determine whether common inherited thrombophilias in the fetus influence the severity of severe preeclampsia, IUGR and placental abruption. A case-control study among patients with complicated pregnancies. Cases were defined as fetuses with thrombophilia. A university hospital with 3700 deliveries per year. Seventy cases with severe preeclampsia, IUGR or placental abruption. Mothers and neonates were tested for mutation of factor V Leiden, prothrombin gene and methylenetetrahydrofolate reductase. Gestational age at delivery, birth weight and early neonatal complications. Gestational age at delivery and birth weight were significantly lower in fetuses with factor V Leiden or prothrombin gene mutation compared to control fetuses. Fetal factor V Leiden mutation and prothrombin gene mutation may influence the course of severe preeclampsia, IUGR and placental abruption. These thrombophilic changes may cause an earlier appearance or lead to a late pregnancy complication of a greater severity.

Obstetrics and Perinatal Outcome of Adolescent Nulliparous Pregnant Women

Objective: To study obstetrics and perinatal outcome in nulliparous teenage singleton pregnancies at a referral teaching hospital in the eastern province of Saudi Arabia. Method: All singleton births during 1996–2000 of nulliparous mothers aged ≤17 years at King Fahd University Hospital were reviewed (n = 102) and compared with births of a control group of nulliparous mothers aged 20–24 years who delivered during the same period (n = 102). Results: The incidence of nulliparous teenage pregnancies was 0.8%. As compared with women aged 20–24 years, women of 17 years or less were at higher risk of very preterm birth (p < 0.05). The 5-min Apgar scores were not different between the two groups. Babies born to younger mothers had a significantly lower birth weight than those born to older mothers (p < 0.001); the incidence of a low birth weight (<2,500 g) was significantly lower in the control group (p < 0.04). There were no significant differences in distribution of mode of delivery, admission to the special care baby unit, antenatal complications, cesarean section indications, perinatal mortality rate, and early neonatal complications between the two groups. Conclusion: The increase in the very preterm births and the subsequently lower birth weight observed in nulliparous teenage women suggest that the maternal age may be a risk factor for very preterm births and associated long-term hazards.

Best evidence in anesthetic practice: Prevention: planned Cesarean delivery reduces early perinatal and neonatal complications for term breech presentations.

Question For the fetus that presents as breech at term, does a planned Cesarean birth reduce perinatal or neonatal mortality or serious neonatal morbidity compared to vaginal planned birth?

Perinatal Outcome in 41 Sets of Triplets

Objective: To determine the perinatal outcome associated with triplet pregnancies and to compare abdominal delivery with vaginal delivery. Methods: Retrospective analysis of maternal and neonatal medical records of 41 triplets. 21 were delivered vaginally and 20 were delivered by cesarean section. Main Outcome: To measure perinatal mortality and early neonatal complications. Results: Between January 1, 1994, and June 30, 1999, there were 41 triplets delivered at our institution. Of these 21 triplets were delivered vaginally and 20 triplets were delivered abdominally. The perinatal mortality rate was 32/123 (26.0%), primarily due to the respiratory distress syndrome. The perinatal deaths are mainly at a birth weight of 500–1,500 g (29/32; 90.6%). Breech presentation was associated with a significantly higher perinatal mortality rate than vertex presentation (62.5 vs. 37.5%). Cesarean delivery was associated with a higher perinatal mortality rate than vaginal delivery (30.0 vs. 22.2%). Conclusions: Abdominal delivery in triplets is not superior to vaginal delivery in terms of fetal and early neonatal outcome. The perinatal deaths are increased with low birth weight (500–1,500 g) and with breech presentation. The main cause of neonatal mortality is the respiratory distress syndrome.

Neonatal morbidity associated with disproportionate intrauterine growth retardation at term

We set out to compare neonatal morbidity between disproportionate intrauterine growth retarded newborn infants and proportionate retarded ones at term, based on ponderal index. This is a prospective study of 185 single pregnancies with evidence of intrauterine growth retardation at term. Sixty three cases (34%) were disproportionate and 122 (66%) proportionate in terms of ponderal index. All were born in the University Hospital 'Principe de Asturias' of Alcala de Henares, Madrid, Spain. Proportionate or disproportionate intrauterine growth retardation diagnosis was established using the ponderal index (weight/length3). The following outcomes of neonatal morbidity were investigated: (1) perinatal asphyxia (meconium-stained amniotic fluid, abnormal fetal heart rates, newborn acidosis or low Apgar score 7 at 5 minutes) and/or (2) early neonatal medical complications. Disproportionate intrauterine growth retardated newborn infants presented higher rates of perinatal asphyxia (54% vs. 32%, P 0.01), with higher abnormal fetal heart rates (37% vs. 15%, P 0.01), higher frequency of arterial pH 7.20 (31% vs. 16%, P 0.05); and also higher rates of early neonatal medical complications (40% vs. 11%, P 0.001), mainly hypoglycaemia (25% vs. 4%, P 0.01). Morbidity among disproportionate intrauterine growth retardated Aconates is significantly higher compared with proportionate ones, demonstrating the heterogeneity of the intrauterine growth retardation population. Proportionate and disproportionate intrauterine growth retardation should be diagnosed as early as possible, since the majority of the morbidity is intimately related to this difference.

Early neonatal complications after elective preterm delivery in hypertensive pregnancies.

We evaluated the rates of short-term neonatal complications, neonatal brain damage or mortality in a group of 96 singleton pregnancies complicated by hypertension and electively delivered before 36 weeks gestation. The neonatal outcome of these pregnancies was compared with that of a matched control group of 192 uneventful pregnancies delivered because of spontaneous preterm labor or premature rupture of membranes. Although the rates of acidosis, apneoic crises, bradycardia and ventilatory support were higher among cases than controls, the risk of intraventricular hemorrhage, severe brain damage (grade III-IV intraventricular hemorrhage or periventricular leucomalacia) or neonatal mortality were comparable between the two groups. Neonatal complications were more frequent among infants born to mothers with severe hypertension or severe proteinuria. In conclusion, this study has shown that short term neonatal complications after elective preterm delivery in hypertensive pregnancies are increased in comparison with low risk controls. However, these complications, which were well managed in our intensive care nursery, did not affected neonatal mortality or severe brain damage.