Frequency Of Respiratory Distress Syndrome Research Articles

Effect of the New Diagnostic Criteria of Fetal Growth Restriction on Obstetric and Neonatal Outcomes [ID: 1376466

INTRODUCTION: The diagnostic criteria of fetal growth restriction (FGR) was modified by the Society of Maternal-Fetal Medicine in 2020 to include both an abdominal circumference (AC) and estimated fetal weight (EFW) less than the 10th percentile as opposed to previous definition using only the EFW. We sought to evaluate the outcomes of this criteria modification. METHODS: This retrospective study compared the incidence, obstetrical and neonatal outcomes before (group 1, 2020) and after (group 2, 2021) the implementation of the modified diagnostic criteria at a single institution. This is an IRB-approved study. RESULTS: Of the 459 pregnancies with FGR included in this study, 100 were diagnosed in 2020 (group 1) and 359, in 2021 (group 2). An increase in the incidence of FGR was noted after the modification, 1.5% versus 5.3% (P<.05). Median gestational age (weeks) at delivery decreased from 38.1 (Q1, 37.1; Q3, 39.1) in 2020 to 37.4 (Q1, 36.1; Q3, 38.3) in 2021 (P<.05). There were no statistically significant differences in obstetrical outcomes. An increase in the frequency of respiratory distress syndrome was observed, 6 (6%) versus 51 (14.2%), P<.05, and median length of neonatal stay 2.0 (Q1, 1.0; Q3, 3.0) and 2.0 (Q1, 2.0; Q3, 12.0) in group 1 compared to group 2 (P<.05). CONCLUSION: The new diagnostic criteria for FGR is associated with increased incidence of diagnosis, neonatal respiratory distress, longer neonatal hospital admissions, and lower gestational age of delivery with no difference in obstetrical outcomes. It remains uncertain whether this modification will translate to improved outcomes, and larger multicenter prospective studies are needed.

Impact of breast milk miR-155 on the health of preterm neonates

Background. Breast milk (BM) is an important source of microRNAs (miRs). MicroRNAs are highly resistant to gastrointestinal enzymes and are well absorbed in the intestine. MiR-155 is one of the most expressed miR of BM. Currently, the effect of miR-155 of BM on the health of preterm neonates has not been almost studied. The objective was to determine the effect of miR-155 of BM on the health of preterm neonates. Materials and methods. We examined 74 newborns, who were treated in neonatal departments. We determined the level of miR-155 in the BM of 44 mothers of exclusively breastfed children. In parallel, we evaluated gene expression of the transcription factor FOXP3 in buccal smears of all neonates. Three comparison groups were selected: group 1 consisted of 32 newborns of up to 37 weeks of gestation; group 2 — of 30 preterm newborns on artificial feeding; control group — of 12 full-term breastfed newborns. Results. The gestational age median in group 1 was 33 (31; 34) weeks; in group 2 — 32.5 (32; 35) weeks; it was higher in the control group (p < 0.001) — 40 (39; 41) weeks. Neonatal encephalopathy as the main diagnosis occurred more often among full-term newborns (p < 0.001). Children of groups 1 and 2 did not differ significantly in the frequency of respiratory distress syndrome and the duration of the necessary respiratory support (p > 0.05). In group 2 compared to group 1, manifestations of necrotizing enterocolitis were detected significantly more often (p < 0.05): 30.0 ± 8.4 % vs 9.4 ± 5.2 %. The results of evaluating the miR-155 expression level in the BM of mothers of group 1 children prove that the corresponding indicator in the control group was exceeded by an average of 6.2 (4.1; 9.2) times (p < 0.001). Analysis of FOXP3 levels in buccal smears showed that all preterm newborns had significantly lower FOXP3 levels than that of full-term neonates (< 0.001). However, the expression of this factor was the lowest in group 2 (< 0.001): 0.08 (0.04; 0.16) c.u. in group 2 vs 0.21 (0.14; 0.38) c.u. in group 1. We found a direct moderate correlation between the expression levels of miR-155 of the BM and the FOXP3 in the mucosal cells of breastfed preterm neonates: r = 0.442 (p = 0.014). A significant decrease was noted in the expression of FOXP3 in children with necrotizing enterocolitis (0.11 (0.04; 0.25) c.u.) compared to newborns without such pathology (0.22 (0.09; 0.91) c.u.) (p < 0.05). Conclusions. The results of the study confirm a lower number of necrotizing enterocolitis cases among preterm breastfed babies. BM of mothers, whose children were born prematurely, has a higher level of miR-155 expression, which promotes FOXP3 expression of mucous membranes. Thus, it is likely that miR-155 of BM stimulates maturation and maintains the level of T-reg cells of the mucous membranes that prevents the development of necrotizing enterocolitis in premature infants.

Frequency of Respiratory Distress Syndrome in Preterm Infants Delivered at Pak Emirates Military Hospital, Rawalpindi

Objective: To determine the frequency of Respiratory Distress Syndrome among preterm neonates born at the Pak Emirates Military Hospital.
 Study Design: Cross-Sectional Study.
 Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, from Aug 2020 to Mar 2021.
 Methodology: One hundred and sixty-nine neonates with a gestational age of ≤34 weeks of either gender were included in this study. RDS was confirmed by reviewing neonatal medical charts. The frequency of RDS was seen in different groups according to gestational age, gender, weight, hypothermia, sepsis and jaundice.
 Results: There were 169 patients; among them were 94 (55.6%) males and 75 (44.4%) females. 105 (62.1%) were born by caesarean section, and 64 (37.9%) were normal vaginal delivery. There were 26 (15.4%) neonates, with RDS, and 143 (84.6%) did not have RDS. Among our 169 sample, 26 (15.4%) were in <28 weeks, 96 (56.8%) were in the 28 to 32 weeks and 47 (27.8%) were in >32 week gestational groups. There were 34 (20.1%) who were <1000 g, there were 96 (56.8%) were between 1000 to 1500 g, and 39 (23.1%) were > 1500 g. Hypothermia was found in 43 (25.4%) of neonates; 126 (74.6%) did not have hypothermia. 63 (37.3%) neonates had sepsis, and 39 (23.1%) had jaundice.
 Conclusion: RDS is a serious problem in our country. Health care providers must plan cost-effective and efficient strategies to detect and treat RDS in the developing world.

Incidence of Respiratory Distress Syndrome and Its Associated Factors among Preterm Neonates: Study from West Java Tertiary Hospital

Respiratory distress syndrome (RDS) or hyaline membrane disease is the most frequent cause of respiratory failure and mortality in preterm infants. As a result, many infants are brought to a neonatal intensive care unit (NICU). There may also be other factors that affect the incidence rate of RDS as well. Our research goals are to find out the incidence rate of RDS among three preterm groups and its related factors. In a cross-sectional-descriptive analytical study, newborn data was gathered and assessed by using hospital medical records. One hundred forty-two preterm infants with gestational age ≤ 36 weeks were hospitalized in the NICU. All participants were divided into three groups: extremely preterm ( 28 weeks), very preterm (28 to 32 weeks), and moderate-to-late preterm (32 to 36 weeks). The frequency of RDS and some related factors were compared among three groups. Finally, we analyzed the relationship between variables by SPSS statistics software version 19. The level of significance was considered P 0.05. Respiratory distress syndrome was observed in 64.68% of all participants; RDS is more common in infants within 28-32 weeks of gestation (81%), while infants with 28 weeks of gestation and 33-36 weeks of gestation have lower rates (50% and 52 Our study shows a positive correlation between birthweight and RDS as well as between birthweight and gestational age. (P value: 0.001, 0.003). Infants between 28 to 32 gestational age have a higher risk of RDS. The risk of RDS also increases in low birth weight and male infants.

Genetic polymorphisms and preterm neonatal respiratory distress syndrome among women treated with betamethasone

Antenatal glucocorticoids can reduce the frequency and severity of neonatal lung disease by 60%. Variations in maternal and fetal steroid metabolism may affect modify the efficacy of this crucial intervention. We studied the associations between maternal and fetal single nucleotide gene polymorphisms (SNPs) and the frequency of respiratory distress syndrome (RDS) after antenatal exposure to betamethasone.

Two-port, exteriorized uterus, fetoscopic meningomyelocele closure has fewer adverse neonatal outcomes than open hysterotomy closure

In utero closure of meningomyelocele using an open hysterotomy approach is associated with preterm delivery and adverse neonatal outcomes. This study compared the neonatal outcomes in inutero meningomyelocele closure using a 2-port, exteriorized uterus, fetoscopic approach vs the conventional open hysterotomy approach. This retrospective cohort study included all consecutive patients who underwent in utero meningomyelocele closure using open hysterotomy (n=44) or a 2-port, exteriorized uterus, fetoscopic approach (n=46) at a single institution between 2012 and 2020. The 2-port, exteriorized uterus, fetoscopic closure was composed of the following 3 layers: a bovine collagen patch, a myofascial layer, and a skin. The frequency of respiratory distress syndrome and a composite of other adverse neonatal outcomes, including retinopathy of prematurity, periventricular leukomalacia, and perinatal death, were compared between the study groups. Regression analyses were performed to determine any association between the fetoscopic closure and adverse neonatal outcomes, adjusted for several confounders, including gestational age of <37 weeks at delivery. The fetoscopic closure was associated with a lower rate of respiratory distress syndrome than the open hysterotomy closure (11.5% [5 of 45] vs 29.5% [13 of 44]; P=.037). The proportion of neonates with a composite of other adverse neonatal outcomes in the fetoscopic group was half of that observed patients in the open hysterotomy group; however, this difference did not reach statistical significance (4.3% [2 of 46] vs 9.1% [4 of 44]; P=.429). Here, regression analysis has demonstrated that fetoscopic meningomyelocele closure was associated with a lower risk of respiratory distress syndrome (adjusted odds ratio, 0.23; 95% confidence interval, 0.06-0.84; P=.026) than open hysterotomy closure. In utero meningomyelocele closure using a 2-port, exteriorized uterus, fetoscopic approach was associated with a lower risk of respiratory distress syndrome than the conventional open hysterotomy meningomyelocele closure.

Midterm neuromotor development results of preterm babies less than 34 weeks gestational age

Objectives:This study aimed to evaluate the neuromotor development of premature babies and to determine the risk factors affecting neuromotor development in the middle time (3 years).Methods:All babies with ≤34 weeks gestational age and born between 2011-2014 and hospitalized in our neonatal clinic were included in this study. Prenatal, perinatal and postnatal features of the babies were recorded. Consent was obtained from the families who had an outpatient follow-up and agreed to participate in this study. Neurological examination and Denver II Developmental Screening Test (DDST-II) were applied to babies and their results were recorded. Factors affecting neurodevelopment were evaluated.Results:Complete data for 96 of the study infant were obtained. Fifty (52.1%) of the cases were female. The mean birth weight was 1542±518 grams. The mean corrected age was 20.9±10.7 months at the time of the examination. It was found cerebral palsy in 11 babies (11.5%) with the neurological examination and developmental retardation in 15 babies (15.6%) with DDST-II. Low birth weight, a gestational period of 25-26 weeks, Apgar score at 5th minute <7 were found to be the main risk factors for cerebral palsy and abnormal DDST-II result (p<0.05). In babies with abnormal neurological examination, the frequency of bronchopulmonary dysplasia, sepsis and intraventricular hemorrhage were found to be high (p<0.05), and in babies with abnormal DDST-II results the frequency of respiratory distress syndrome, bronchopulmonary dysplasia and sepsis were found to be high (p<0.05).Conclusion:In our study, abnormal neurological examination rate was found 11.5% in preterm infants with gestational age ≤34 weeks, and the rate of abnormal DDST-II was found 15.6%. The main factors affecting neuromotor development were gestational week, birth weight and 5th minute Apgar score. The frequency of bronchopulmonary dysplasia, sepsis and intraventricular hemorrhage in babies with abnormal neurological examination, and the frequency of respiratory distress, bronchopulmonary dysplasia and sepsis were found to be high in babies with abnormal DDST-II.

Risk of intra-amniotic infection/inflammation and respiratory distress syndrome according to the birth order in twin preterm neonates

Objective: Prior studies have suggested that nonpresenting twins are more likely to develop respiratory distress syndrome (RDS) than presenting twins. While the underlying mechanism is not known, exposure to intra-amniotic infection/inflammation (IAI) has been associated with a reduced risk of RDS in singleton gestations. In the current study, we compared the risk of RDS in preterm twin neonates according to birth order with adjustment for the presence or absence of IAI.Methods: The study population consisted of consecutive twin neonates who delivered ≤35 weeks and underwent amniocentesis within 7 days of delivery. The frequency of RDS and IAI was compared between presenting and nonpresenting twin pairs. Amniotic fluid (AF) was cultured for aerobic/anaerobic bacteria and genital mycoplasma. IAI was defined as a positive AF culture or an AF white cell count ≥19/mm3.Results: A total of 120 twin pairs were enrolled. Compared with presenting twins, nonpresenting twins had a lower risk of IAI (36 vs. 26%, respectively, p < .05), but a higher risk of RDS (18 vs. 25%, respectively, p < .05). In multivariate analysis, only IAI remained significantly associated with RDS (OR 0.18, 95% CI 0.05–0.65), whereas birth order was not.Conclusions: In preterm twin neonates, the increased risk of RDS in nonpresenting twins is likely due to lower exposure to IAI and not birth order.

VAGINAL PROGESTERONE PESSARY FOR PRETERM LABOR PREVENTION IN WOMEN WITH A SHORT CERVIX EARLY IN THE SECOND TRIMESTER

Background: The prevention of preterm birth is a major health care priority. Objective: To evaluate the efficacy of vaginal progesterone pessary in reducing the rate of preterm delivery and subsequent neonatal morbidity and mortality events in pregnant women with a short cervical length early in the 2nd trimester. Methods: Women with a singleton pregnancy without a history of preterm labor nor a history of second trimester miscarriage, underwent cervical length measurement at 14+0 to 15+6 weeks of gestation. Women found to have a cervical length less than 30 mm received vaginal progesterone pessary (400 mg per pessary) on daily basis, or no treatment. Primary outcome was preterm delivery rate before 37 weeks gestation. Secondary outcome includes neonatal morbidity and mortality events. Results: From the 7725 pregnant women screened between the period from April 2015 to January 2017, 613 were found to have a cervical length less than 30 mm and only 518 pregnant women met the inclusion criteria and agreed to participate in this study. However, only 492 were followed up till the time of delivery. From those 252 women administered 400 mg vaginal progesterone pessary once daily at night and the remaining 240 women did not receive any form of progesterone and served as control. There was a significant reduction in preterm delivery rate less than 37 weeks gestation among women receiving progesterone vaginal pessary compared to the control group 11 (4.4%) vs 38 (15.8%), p value &lt; 0.001. Regarding neonatal outcome, there were significant reduction in the frequency of respiratory distress syndrome, low birth weight neonates and admissions to neonatal intensive care unit in women taking vaginal progesterone pessary compared to the control. While other neonatal morbidity and mortality events, incidence of neonatal congenital anomalies were not significantly different between the two groups. Conclusion: Vaginal progesterone pessaries in women with a cervical length less than 30 mm early in the second trimester are found to be effective in reducing the rate of preterm birth and some of the prematurity related morbidity events. Keywords: preterm labor, vaginal progesterone pessaries, short cervix, premature delivery Citation: Khazaali EAA. Vaginal progesterone pessary for preterm labor prevention in women with a short cervix early in the second trimester. Iraqi JMS. 2018; 16(2): 133-143. doi: 10.22578/IJMS.16.2.4

A Retrospective Database Analysis of Neonatal Morbidities to Evaluate a Composite Endpoint for Use in Preterm Labor Clinical Trials.

Objective To propose and assess a composite endpoint (CE) of neonatal benefit based on neonatal mortality and morbidities by gestational age (GA) for use in preterm labor clinical trials. Study Design A descriptive, retrospective analysis of the Medical University of South Carolina Perinatal Information System database was conducted. Neonatal morbidities were assessed for inclusion in the CE based on clinical significance/risk of childhood neurodevelopmental impairment, frequency, and association with GA in a mother–neonate linked cohort, comprising women with uncomplicated singleton pregnancies delivered at ≥24 weeks' GA. Results Among 17,912 mother–neonate pairs, neonates were at a risk of numerous severe but infrequent morbidities. Clinically important, predominantly rare events were combined into a CE comprising neonatal mortality and morbidities, which decreased in frequency with increasing GA. The highest CE frequency occurred at <31 weeks. High frequency of respiratory distress syndrome, bronchopulmonary dysplasia, and sepsis drove the CE. Median length of hospital stay was longer at all GAs in those with the CE compared with those without. Conclusions Descriptive epidemiological assessment and clinical input were used to develop a CE to measure neonatal benefit, comprising clinically meaningful outcomes. These empirical data and CE allowed trials investigating tocolytics to be sized appropriately.

Antenatal corticosteroids in perspective: rationalising current practice.

A landmark meta-analysis published in BJOG (Crowley et al. 1990;97:11–25) underpins the recommendation that women presenting in threatened preterm labour (TPTL) should receive antenatal corticosteroids (ACS) (Preterm labour and birth, Guideline 25; NICE 2015). This simple intervention has become an icon of evidence-based practice, with the forest plot of the initial trials depicted in the Cochrane Collaboration logo (Roberts D, Dalziel SR. Cochrane Database of Systematic Reviews 2006;3:CD004454). Graham Collingwood Liggins, a senior lecturer in Obstetrics and Gynaecology at the National Women's Hospital in Auckland, New Zealand, is credited for discovering that corticosteroids cross the placenta and accelerate fetal lung maturation. In the 1960s, experimental observations in lambs sparked the groundbreaking randomised placebo-controlled trial in humans (Liggins GC, Howie R. Paediatrics 1972;50:515–25). This trial provided the first evidence that betamethasone reduces the frequency of respiratory distress syndrome (RDS) in infants born <32 weeks of gestation, and secures a five-fold reduction in mortality; however, it was not until Crowley's meta-analysis was published in this journal almost 20 years later that a clear change in clinical practice was appreciable. In addition to reducing RDS, a significant reduction in periventricular haemorrhage and was confirmed (see Figure 1, reproduced from the original publication). By 1999, the administration of ACS to women in TPTL was practiced almost universally. However that the symptoms of TPTL are poor predictors of delivery (over 80% remain undelivered 7 days after presentation), the majority of infants are exposed to steroids unnecessarily. Indeed, 98% of those not delivered within a week were offered a further treatment course (Brocklehurst et al. BJOG 1999;106:979–9). Although the health and economic benefits of appropriate ACS are proven, if treated outside the 7-day window, even with a single course, infants demonstrate lower birthweight (mean difference −147 g, 95% CI −291 to −2 g), head circumference, and length. This is compounded by the potential need for repeat courses, with similar further insult. More concerning still, the 2006 Cochrane Review described a worrying trend towards an increased risk of death for babies who go on to deliver at full term (relative risk 3.25; 95% CI 0.99–10.66). Other human consequences of ACS during this critical developmental period are less certain, but animal models imply adverse neurodevelopmental outcomes and decreased fetal brain growth. Concerns have been raised in emerging long-term follow-up studies regarding hyperactivity in childhood and impact on glucose metabolism, an implied predictor of cardiovascular disease (Kelly et al. Pediatrics 2012;129:1282–90). Although the ubiquitous implementation of ACS is a triumph of evidence-based medicine, it requires continual reappraisal. Accurate prediction of delivery within the desired therapeutic window may help. The benefit of accurate prediction models and thus timely administration is further reinforced by new evidence suggesting important outcomes (death and intraventricular haemorrhage) may be improved if delivery occurs <48 hours after treatment (WHO. Recommendations on Interventions to Improve Preterm Birth Outcomes. 2015). Although simplifying the management quandary, a treat-all strategy (NICE 2015) may expose this vulnerable population to unnecessary risk. To optimise care we must re-evaluate evidence as long-term studies and prediction tools become more sophisticated. Full disclosure of interests available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Mild to Moderate, but Not Minimal or Severe, Acute Histologic Chorioamnionitis or Intra-Amniotic Inflammation Is Associated with a Decrease in Respiratory Distress Syndrome of Preterm Newborns without Fetal Growth Restriction

Background: Acute histologic chorioamnionitis (acute-HCA) is known to be associated with a decreased risk of respiratory distress syndrome (RDS) in newborns. However, there is no information about whether the severity of acute-HCA or intra-amniotic inflammation (IAI) is associated with the development of RDS. Objectives: To assess the relationship between the severity of acute-HCA or IAI and the development of RDS in preterm newborns due to preterm labor and intact membranes (PTL) or preterm premature rupture of membranes (preterm-PROM) without fetal growth restriction (FGR). Methods: The frequency of RDS was examined in 378 singleton preterm neonates (24.5-34 weeks' gestation) due to PTL or preterm-PROM without FGR. Patients were divided into 4 groups according to the severity of acute-HCA (i.e. total grade: minimal, 1; mild, 2; moderate, 3-4; severe, 5-6) or IAI (i.e. amniotic fluid MMP-8: minimal, 23-100 ng/ml; mild, 100-400 ng/ml; moderate, 400-800 ng/ml; severe, ≥800 ng/ml). Amniotic fluid MMP-8 was measured in 196 patients delivered within 7 days of amniocentesis. Results: Mild to moderate, but not minimal or severe, acute-HCA (minimal, 24%; mild, 13%; moderate, 19%; severe, 41%; preterm-reference group, 26%) or IAI (minimal, 24%; mild, 11%; moderate, 17%; severe, 25%; preterm reference group, 23%) was associated with a significant decrease in RDS as compared with the preterm reference group (each for p < 0.05 after the adjustment of gestational age at delivery, antenatal corticosteroid use, newborn gender, cesarean delivery and preterm-PROM as a cause of preterm birth). Conclusions: Mild to moderate, but not minimal or severe, acute-HCA or IAI is associated with a significant decrease in RDS among preterm neonates due to PTL or preterm-PROM without FGR.

Cesarean delivery on maternal request in China: what are the risks and benefits?

The purpose of this study was to describe the risks and benefits of cesarean delivery on maternal request (CDMR) in a Chinese population. A retrospective cohort study of mode of delivery was conducted at the largest obstetric center in Shanghai, China, from 2007-2013. Eligibility criteria included singleton term nulliparous women with vertex presentation; women with major fetal anomalies or stillbirth before labor were excluded. A total of 66,226 women were included in the analysis: 40,560 women (61.2%) had planned vaginal birth, with 32,833 spontaneous vaginal deliveries (80.9%), 4990 intrapartum CDs (12.3%), and 2737 assisted vaginal deliveries (6.7%). A total of 16,333 women (24.7%) underwent CDMR. We observed no significant difference between the CDMR and planned vaginal delivery groups in the frequencies of maternal intensive care unit admission (0.2% vs 0.2%), severe postpartum hemorrhage (0.5% vs 0.5%), maternal infection (1.3% vs 1.3%), organ injuries (0.4‰ vs 0.5‰), and thromboembolic disorders (0.1‰ vs 0.1‰). The perinatal mortality rate was similar in the 2 groups (0.4‰ vs 0.6‰; adjusted odds ratio, 0.51; 95% confidence interval, 0.20-1.30; P = .159). The frequencies of birth trauma (0.2‰ vs 1.1‰), neonatal infection (0.4% vs 0.7%), hypoxic ischemic encephalopathy (0.4‰ vs 1.8‰), and meconium aspiration syndrome (0.2‰ vs 0.6‰) were lower; the frequency of respiratory-distress syndrome (0.6% vs 0.4%) was higher in the CDMR group. Compared with nulliparous women who tried vaginal delivery, women who underwent CDMR had similar short-term maternal outcomes with some neonatal benefit.

The Incidence of Respiratory Distress Syndrome among Preterm Infants Admitted to Neonatal Intensive Care Unit: A Retrospective Study

Background: Respiratory distress syndrome (RDS) or hyaline membrane disease (HMD) is the most common cause of neonatal morbidity and mortality in preterm infants. We aimed to determine the frequency of RDS among 3 groups of preterm infants and the value of some related factors. Methods: A cross-sectional, descriptive analytical investigation was carried out in the NICU ward of Akbarabadi Hospital (Tehran-Iran) during spring 2011. Newborns’ data were collected and assessed by using their hospital medical records. Seventy-three preterm infants with gestational age < 34 weeks were hospitalized in the NICU. All participants were divided into 3 groups: extremely preterm (<28 weeks), very preterm (28 to <32 weeks) and moderate preterm (32 to 34 weeks). Frequency of RDS and some related factors were compared among 3 groups. Results: RDS was observed in 65.6% of all participants; however frequency of RDS was not different between three groups. An inversely correlation was found between gestational age and mortality rate (p = 0.05). In regard to Betamethasone administration prior to birth, this interval was significantly longer in alive neonates in comparison to infants who died (p < 0.05). Conclusion: RDS was frequent in preterm neonates with gestational age < 32 weeks. Time of Betamethasone administration prior to birth can significantly influence on neonatal mortality rate.

The Effect of Transabdominal Amnioinfusion on Perinatal Outcomes in Preterm Premature Rupture of Membranes

ABSTRACT Objective To evaluate the role of transabdominal amnioinfusion in improving the latency period and perinatal outcomes of pregnancies complicated by preterm premature rupture of membranes (PPROM). Materials and methods A randomized controlled trial was carried out at MCH Centre, Unit I, PIMS, Islamabad, from Jan 2008 to Dec 2008. Sixty women with singleton pregnancies between 28 and 32 completed weeks of gestation, complicated with PPROM was randomly allocated into two groups viz transabdominal amnioinfusion (amnioinfusion group) and expectant management (control group), within 24 hours of admission. Results The demographic characteristics were comparable in both the groups. Amnioinfusion group showed significant improvement in PPROM to delivery interval (18.47 ± 6.699 vs 8.93 ± 4.741 days; p = 0.001), neonatal birth weight (p = 0.019) and Apgar scores at 1 and 5 minutes (p = 0.007 for 1 minute and p = 0.012 for 5 minutes). There was less frequency of respiratory distress syndrome (p = 0.032), neonatal sepsis (p = 0.020) and neonatal jaundice (p = 0.002) in the amnioinfusion group. Fewer neonates were admitted to NICU (p = 0.010) and higher survival rate was found in amnioinfusion group (p = 0.023). Conclusion The treatment with transabdominal amnioinfusion in pregnancies complicated with PPROM resulted in significant prolongation of pregnancy and better neonatal outcomes as compared to women who were managed with traditional expectant management. How to cite this article Fatima S, Tasnim N, Mahmud G. The Effect of Transabdominal Amnioinfusion on Perinatal Outcomes in Preterm Premature Rupture of Membranes. J South Asian Feder Obst Gynae 2014;6(1):28-32.

Respiratory distress syndrome in preterm neonates of Lahore

Compromised health facilities in developing countries often result in inadequate care for both mothers and their newborns. Consequently, a large number of neonates who are born prematurely with serious prepartum difficulties develop additional postpartum complications. Respiratory distress syndrome (RDS) in infants is a complex pulmonary state in which the lungs are not properly developed and therefore produce very little surfactant, resulting in morbidity of many preterm newborns. The present study investigated the frequency of RDS in neonates born at various gestational ages and of various birthweights. Out of 180 subjects, 50 (27.8%) developed RDS, the diagnosis of which was based on radiological findings and symptoms such as tachypnoea, nasal flaring and central cyanosis. The frequency of RDS is inversely, and significantly, associated with both gestational age and birthweight, which were found to be good predictors of the likelihood of a newborn developing RDS. Preterm newborns of low birthweight have a higher risk of developing RDS than full-term newborns of heavier birthweight. In light of these observations, proper management strategies should be devised for the assessment and treatment of preterm neonates with, or without, RDS.

186: The presence of funisitis is associated with a decreased risk for the development of neonatal respiratory distress syndrome

Objectives: Fetal lung maturation and respiratory outcomes are influenced by the exposure to intrauterine inflammation. Funisitis is considered as the histologic hallmark of fetal inflammatory response. This study was performed to determine if there is a difference in the rate of neonatal respiratory distress syndrome (RDS) according to the presence or absence of funisitis in preterm gestations. Study design: The relationship between the presence of funisitis and the development of neonatal RDS was examined in 301 consecutive singleton preterm births (24e32 weeks’ gestation). Cases without placental histological examination and those with major congenital anomalies were excluded. Funisitis was diagnosed in the presence of neutrophil infiltration into the umbilical vessel walls or Wharton’s jelly on the placental histological examination. Results: Funisitis was diagnosed in 25% and RDS was diagnosed in 46% of cases. The rate of RDS in babies with funisitis was lower than in those without funisitis (28.4% vs. 51.1%, p ¼ 0.001). Logistic regression analysis demonstrated that the presence of funisitis was associated with a decreased risk for RDS after adjusting for confounding variables (Odds ratio ¼ 0.44, 95% CI 0.22e0.90). The downward trend of the frequency of RDS was related to the presence of histologic chorioamnionitis and funisitis (p < 0.001). Conclusions: The presence of funisitis is associated with a decreased risk for the development of neonatal RDS in preterm gestations. Furthermore, this observation suggests that the fetal involvement of placental inflammation may be beneficial to the maturation of the fetal lung.

The effects of antenatal corticosteroids and surfactant replacement on neonatal respiratory distress syndrome.

The goal of this study was to determine the effects of antenatal corticosteroids and surfactant replacement on the severity and frequency of Respiratory Distress Syndrome (RDS) in a cohort of premature infants born in Sarajevo, Bosnia and Herzegovina, from 2005 to 2007. The cohort consisted of 172 premature neonates with estimated gestational age between 26 and 34 weeks. Babies with IUGR, babies of diabetic mothers and babies with major congenital defects were excluded. Out of 172 neonates, 80 were treated antenatally with corticosteroids (single course of dexamethasone) and 92/172 were not. There was no statistical difference (p>0,5) in average gestational age (31,2 vs. 31,0 GW) and male/female ratio between investigated groups; there were significantly more male patients (p<0,05) in both groups. Frequency of RDS was significantly lower in the corticosteroid group (24/80) in relation to the control group (54/92) (p<0,001). Severe RDS was significantly (p<0,01) more frequent in the control group 34/53 (62,96%) then in the corticosteroid group 6/24 (25,0%). Bovine surfactant (Survanta) was given as a rescue therapy to 78 babies with clinical and radiological signs of RDS who required FiO2>0,40 and mechanical ventilation. Early surfactant administration within six hours after birth appeared to be effective at reducing mortality then later surfactant administration (p<0,005). In the group of babies requiring FiO2> or =0,6 at the time of surfactant replacement, the mortality rate was significantly higher (p<0,05). In conclusion, we confirm the efficacy of antenatal corticosteroid treatment and early surfactant treatment in a cohort of premature infants born in Sarajevo.

Impact of timing of antenatal corticosteroid exposure on neonatal outcomes

Objective. To evaluate morbidities among neonates with a history of remote antenatal corticosteroid (ACS) exposure compared to those with recent exposure.Study Design. This is a retrospective-cohort study of neonates born at 30–33 6/7 weeks gestational age. The primary outcome was newborn respiratory distress syndrome (RDS) defined by the persistent need for oxygen at 24 h of life. Maternal chart review established timing of ACS exposure. Data were stratified by the time interval of ACS administration to delivery: none or <48 h (Incomplete/Unexposed), 48 h to 7 days (Recent) and >7 days (Remote). Perinatal outcomes were compared between groups.Resuts. Five hundred and twenty-four infants were included: 273 Incomplete/Unexposed, 120 Recent and 131 with Remote ACS exposure. RDS was significantly less frequent with Recent vs. Remote exposure (RR: 1.73 [1.01–3.02]p = 0.04). This finding persisted in a logistic regression model.Conclusions. Infants delivering more than 1 week after ACS exposure have a higher frequency of RDS than those who deliver within 1 week.

When to deliver the stunted fetus?

Predicting when a stunted fetus will be safer outside the uterus than inside entails competing risks. Prolonging the pregnancy can lower the frequency of respiratory distress syndrome, cerebral palsy, and other complications of prematurity. However, continuing the pregnancy can risk hypoxia and stillbirth. Little evidence has been available to guide clinical decision-making, and, predictably, obstetricians' approaches vary widely. For example, when given identical clinical scenarios, experienced clinicians disagree on the preferred timing of delivery. 1 Lilford R Formal measurement of clinical uncertainty: prelude to a trial in perinatal medicine. the Fetal Compromise Group. BMJ. 1994; 308: 111-112 Crossref PubMed Scopus (31) Google Scholar Infant wellbeing at 2 years of age in the Growth Restriction Intervention Trial (GRIT): multicentred randomised controlled trialThe lack of difference in mortality suggests that obstetricians are delivering sick preterm babies at about the correct moment to minimise mortality. However, they could be delivering too early to minimise brain damage. These results do not lend support to the idea that obstetricians can deliver before terminal hypoxaemia to improve brain development. Full-Text PDF