Completed Weeks Of Gestational Age Research Articles

Hemi-diaphragmatic paralysis

Introduction: Diaphragmatic paralysis (DP) involving the phrenic nerve is related to brachial plexus injury in 80–90% of the cases. Other causes include iatrogenic procedure involving the cardiopulmonary area. It causes respiratory distress which can be severe requiring prolonged need for respiratory support. Recovery can be spontaneous, typically by the first 6–12 months of life though some infants may require surgical intervention if no improvement in DP is noted by 1–2 months of life in the setting of compromised quality of life. Case Report: We present a preterm infant, 31 completed weeks of gestational age, birth weight 1440 g born via emergency C-section due to preterm labor in breech presentation. During delivery, the patient suffered a left brachial plexus injury with phrenic nerve involvement. He developed respiratory distress requiring endotracheal intubation and mechanical ventilation. His clinical course involved multiple failed extubation attempts. Chest X-ray (CXR) and chest fluoroscopy confirmed the diagnosis of left hemi-diaphragmatic paralysis. The patient had a prolonged respiratory support course but was finally weaned to room air by three months of age. Conclusion: Preterm infants can sustain perinatal brachial plexus injury like term or near-term infants in the setting of a traumatic birth irrespective of birth weight. The time and indications for conservative (non-surgical) versus surgical intervention remains debatable. Each case should be tailored to the child’s severity of injury and quality of life and growth. Clinical recovery can occur even with considerable persistence weakness on radiography or chest ultrasound.

Race, hypoxaemia and oxidative stress in prematurely-born infants

BackgroundDisparities in neonatal respiratory outcomes in prematurely-born infants might be partially explained by racial differences and the relationship of hypoxia and oxidative stress. AimsTo determine if Black, preterm infants were exposed more frequently to hypoxaemia compared to White infants and had a higher level of oxidative damage. Study designSingle-centre retrospective cohort study at King's College Hospital, London, UK between 2018 and 2021. SubjectsInfants born before 32 completed weeks of gestational age. Outcome measuresThe median arterial oxygen saturation (SaO2) over the first seven days was measured. The maximum carboxyhaemoglobin (COHb) level for the first three days was also recorded as an index of oxidative stress. ResultsTwo thousand and sixty blood gases from 87 infants (38 Black) with a median (IQR) gestational age of 26.4 (24.6–28.3) weeks were analysed. The median (IQR) SaO2 was not significantly different in Black [96.1 (95.2–96.8) %] compared to White infants [96.7 (95.6–97.7) %, p = 0.24]. The median (IQR) COHb was not significantly different in Black infants [1.9 (1.7–2.4) %] compared to White infants [1.9 (1.7–2.3) %, p = 0.77]. The highest COHb was significantly related to the median SaO2 in all infants (r = −0.51, p < 0.001) and separately in Black (r = −0.50, p = 0.002) and White (r = −0.56, p < 0.001) infants. ConclusionsPreterm, Black infants were not exposed more frequently to hypoxaemia compared to White infants. Lower saturation levels were associated with higher maximum carboxyhaemoglobin levels indicating a higher risk of oxidative stress, irrespective of racial background.

Detection of factor XIII polymorphism among Sudanese women with recurrent spotanuse abortion, Khartoum state, Sudan 2021

Recurrent Pregnancy Loss (RPL) is recognized as the loss of a clinical pregnancy before 20 completed weeks of gestational age. This was a descriptive-analytical case-control study conducted at the research laboratory of the national centre of neurological sciences (NCNS), Khartoum, Sudan. The study aimed to detect factor XIII gene polymorphisms among Sudanese women with recurrent spontaneous abortion. Women with more than three recurrent abortions were included in this study as cases and those healthy women with no history of abortion at reproductive age were included as controls. From each participant 3 ml of venous blood was gathered in sterile containers. The factor XIII gene was amplified using conventional PCR. All cases were positive 44 (100%) while 30 (60%) were positivein the control group and 20 (40%) were negative. There was a significant difference between the PCR result of the cases and that of controls (P= 0.000). A high frequency of factor XIII gene polymorphisms was found in women with recurrent spontaneous abortion than those healthy women at reproductive age without abortion.

Waiting to Be Seen: Provider-Patient Communication in the Emergency Room about Miscarriage

Miscarriage refers to “the spontaneous loss of an intra-uterine pregnancy prior to 22 completed weeks of gestational age” (Zegers-Hoschschild et al., 2017, p. 405). Around 20% of known pregnancies ...

Predicting the duration of supplemental home oxygen in prematurely-born infants at discharge from neonatal care

BackgroundDischarge home of preterm infants on supplemental oxygen has significant healthcare, parental psychological and financial implications, but the potential ability of clinical parameters at discharge to predict the duration of home oxygen has not been previously examined. AimsTo use clinical and epidemiological parameters available at discharge to predict the duration of home oxygen therapy. Study designRetrospective observational cohort study with a primary and a validation cohort. SubjectsSeventy one infants born <32 completed weeks of gestational age, born between 1/1/2013–1/1/2020 at King's College Hospital NHS Foundation trust and discharged home on supplemental oxygen were studied. Outcome measureDuration of home oxygen therapy. ResultsIn a primary cohort of 52 infants with a median (IQR) gestational age of 26.4 (25.0–28.1) weeks and birth weight of 0.81 (0.69–0.96) kg, the duration of home oxygen was four (3–7) months (range: 1–22 months). The postmenstrual age (adjusted p = 0.001) and oxygen flow at discharge (adjusted p = 0.046) were independently associated with the duration of home oxygen therapy. In a validation cohort of 19 infants, the correlation coefficient between the calculated and the observed duration of home oxygen was 0.62, p = 0.005 and the coefficient of determination was 0.38. ConclusionsInfants discharged home on higher oxygen flows and at a greater postmenstrual age require a longer duration of home oxygen therapy and these parameters can be used to predict the duration of home oxygen therapy.

Gestational Age-Dependent Variations in Effects of Prophylactic Indomethacin on Brain Injury and Intestinal Injury

To evaluate the impact of prophylactic indomethacin on early death (<10days after birth) or severe neurologic injury and on early death or spontaneous intestinal perforation by completed weeks of gestational age in neonates born <29weeks of gestation. This was a multicenter, retrospective cohort study of neonates (n=12 515) born at 236/7 weeks of gestational age, admitted to neonatal intensive care units participating in the Canadian Neonatal Network who received prophylactic indomethacin started within the first 12hours after birth. Univariate and multivariate analysis compared the composite outcomes of early death or severe neurologic injury and early death or spontaneous intestinal perforation. Of 12 515 eligible neonates, 1435 (11.5%) were exposed to prophylactic indomethacin; recipients were of lower gestational age and birth weight and had greater severity of illness (Score of Neonatal Acute Physiology with Perinatal Extension) on admission compared with nonrecipients. After we adjusted for confounders, prophylactic indomethacin was associated with reduced odds of early death or severe neurologic injury and early death or spontaneous intestinal perforation in neonates born at 23-24weeks of gestational age. However, prophylactic indomethacin was associated with increased odds of early mortality or spontaneous intestinal perforation for neonates born at 26-28weeks of gestational age. Prophylactic indomethacin use was associated with benefit in neonates born at 23-24weeks of gestational age, but with harm at 26-28weeks of gestational age. Given the observation of significantly improved survival, a randomized controlled trial is needed to investigate the effect of prophylactic indomethacin in babies born at 23-25weeks of gestational age.

Estimation of Gestational Age Using Neonatal Anatomical Anthropometric Parameters in Dessie Referral Hospital, Northeast Ethiopia.

IntroductionEstimation of gestational age is a key for the identification of a given low birth weight neonate is either preterm or growth retarded.ObjectiveTo estimate gestational age from neonatal anatomical anthropometric parameters in Dessie Referral Hospital, Ethiopia.MethodsInstitutional-based cross-sectional study design was employed in Dessie Referral Hospital from October 2019 to April 2020, with 424 consecutively live-born of 28–42 weeks of gestation. After considering the inclusion criteria, neonatal anthropometric parameters were measured within 3 days of birth. Foot length, hand length, mid-upper arm circumference, head circumference, crown-heel length, intermammary distance, umbilical nipple distance, and birth weight were measured and summarized using descriptive statistics, and the power of association was evaluated using correlation analysis. Regression equations of gestational age (GA) in completed weeks with anthropometric parameters were formulated using simple and multiple linear regression analysis.ResultsExcept for hand length, all other neonatal anthropometric measurements were positively correlated with GA in completed weeks at p< 0.05. Anthropometric parameters individually, mid-upper arm circumference (MUAC) and BW (birth weight) were correlated well with GA at correlation coefficient (r) of 0.406 and 0.334, respectively. Regression formula was formulated as GA (weeks) = 26.12+ [1.11×MUAC (cm)] and GA (Weeks) = 33.19 + [1.53×BW (kg)]. Multiple regression contributed correlation with GA and used for prediction of GA as GA (weeks) = 28.12 – [0.393×HL (cm)] + [1.07×BW (kg)] + [0.87×MUAC (cm)] (r= 0.458).ConclusionThe overall relative better correlation for prediction of GA, alone and in combination, is found by combined parameters (HL, MUAC, and BW). The relatively better individual anthropometric parameter for GA assessment is MUAC. Hence, using this neonatal parameter as a prediction of gestational age, the death of neonate due to preterm can be minimized.

Is vaginal misoprostol more effective than oral misoprostol for cervical ripening in obese women?

Objective: To determine if vaginal misoprostol is more effective than oral misoprostol for cervical ripening in obese women.Study design: A retrospective cohort study of obese women undergoing induction of labor from Jan 2013 to Dec 2016 with singleton, viable pregnancies beyond 37 completed weeks of gestational age. Women with an initial Bishop score of 7 or less, with a cervical dilatation of less than 2 cm, who received either vaginal or oral misoprostol as a cervical ripening agent, were included. Primary outcome was interval from the start of induction to the attainment of 3 cm cervical dilatation. Secondary outcomes included the interval from the start of induction to delivery and the rate of cesarean delivery (CD).Result: Of women who met the inclusion criteria, 966 (75.5%) women received oral misoprostol and 314 (24.5%) received vaginal misoprostol. The mean time-interval from the start of induction to attainment of 3-cm dilatation was shorter in the vaginal group (10.5 ± 10.4 h) compared to the oral group (17.2 ± 11.5 h), (p < .0001). Significantly shorter times to delivery were also noted in the vaginal group (17.4 h for vaginal vs. 24.8 h for oral, p < .0001). In the subgroup analysis of nulliparous women, shorter time intervals from the start of induction to attainment of 3-cm dilatation, as well as to delivery, were noted in the vaginal misoprostol group (p < .0001 for both). Multiple linear regression model confirmed route of misoprostol administration as an independent variable in predicting the outcomes (time from start of induction to 3 cm as well as to delivery). Significant findings amongst neonatal outcomes included lower umbilical artery pH and higher rates of neonatal jaundice in the oral misoprostol group.Conclusion: In a population of obese women undergoing induction of labor, vaginal administration of misoprostol was associated shorter time intervals from the start of induction to the attainment of 3 cm of dilatation, as well as to delivery, without increasing the rate of cesarean deliveries or the incidence of adverse maternal and neonatal outcomes.

Quantifying the burden of stillbirths before 28 weeks of completed gestational age in high-income countries: a population-based study of 19 European countries

International comparisons of stillbirth allow assessment of variations in clinical practice to reduce mortality. Currently, such comparisons include only stillbirths from 28 or more completed weeks of gestational age, which underestimates the true burden of stillbirth. With increased registration of early stillbirths in high-income countries, we assessed the reliability of including stillbirths before 28 completed weeks in such comparisons. In this population-based study, we used national cohort data from 19 European countries participating in the Euro-Peristat project on livebirths and stillbirths from 22 completed weeks of gestation in 2004, 2010, and 2015. We excluded countries without national data for stillbirths by gestational age in these periods, or where data available were not comparable between 2004 and 2015. We also excluded those countries with fewer than 10 000 births per year because the proportion of stillbirths at 22 weeks to less than 28 weeks of gestation is small. We calculated pooled stillbirth rates using a random-effects model and changes in rates between 2004 and 2015 using risk ratios (RR) by gestational age and country. Stillbirths at 22 weeks to less than 28 weeks of gestation accounted for 32% of all stillbirths in 2015. The pooled stillbirth rate at 24 weeks to less than 28 weeks declined from 0·97 to 0·70 per 1000 births from 2004 to 2015, a reduction of 25% (RR 0·75, 95% CI 0·65-0·85). The pooled stillbirth rate at 22 weeks to less than 24 weeks of gestation in 2015 was 0·53 per 1000 births and did not significantly changed over time (RR 0·97, 95% CI 0·80-1·16) although changes varied widely between countries (RRs 0·62-2·09). Wide variation in the percentage of all births occurring at 22 weeks to less than 24 weeks of gestation suggest international differences in ascertainment. Present definitions used for international comparisons exclude a third of stillbirths. International consistency of reporting stillbirths at 24 weeks to less than 28 weeks suggests these deaths should be included in routinely reported comparisons. This addition would have a major impact, acknowledging the burden of perinatal death to families, and making international assessments more informative for clinical practice and policy. Ascertainment of fetal deaths at 22 weeks to less than 24 weeks should be stabilised so that all stillbirths from 22 completed weeks of gestation onwards can be reliably compared. EU Union under the framework of the Health Programme and the Bridge Health Project.

Paths of causal influence from prenatal inflammation and preterm gestation to childhood asthma symptoms

Introduction: Long-lasting respiratory symptoms have a huge impact on the quality of life in prematurely born children. The aim was to investigate paths of assumed causality leading from foetal inflammatory response syndrome (FIRS) to asthma symptoms in preterms. Methods: Demographic, antenatal, delivery and outcome data were collected from 262 infants with less than 32 completed weeks of gestational age over a 10-year period in a prospective cohort study. The presence of symptoms of asthma beyond the age of 5 years was the primary outcome measure. The causal effect of FIRS on childhood asthma was tested with three different logistic regression models and two structural equation models (SEM). Results: FIRS (OR = 4.7) and subsequent chronic lung disease of prematurity (OR = 7.7) and early childhood wheezing (OR = 9.5) are the most important risk factors for development of asthma symptoms in children born with less than 32 weeks of gestational age. The path analysis showed that FIRS has a large direct (0.59), medium indirect (0.11) and large overall (0.70) effect on CLD; large negative direct effect on ECW (−0.34) and a large positive indirect effect (0.74), mediated by CLD. On the occurrence of asthma symptoms, FIRS has a medium negative direct effect (−0.18) and a medium positive indirect effect (0.26), mediated by CLD and ECW. Conclusion: Prenatal inflammation plays an important role in the development of chronic respiratory disturbances in preterm infants. This influence is mainly related to structural and developmental lung abnormalities initiated in utero as consequences of FIRS, resulting in CLD of prematurity, and overcoming the protective mechanisms of chorioamnionitis.

“I Just Don't Know”: An Exploration of Women's Ambivalence about a New Pregnancy

PurposeWe sought to examine how ambivalence manifests in women's lives after confirmation of a new pregnancy by exploring women's feelings, attitudes, and experiences regarding pregnancy intentions, the news itself, and related pregnancy decision making. Study DesignWe recruited women aged 15 to 44 and at less than 24 completed weeks of gestational age from urban, walk-in pregnancy testing clinics in New Haven, Connecticut, from June 2014 to June 2015. We obtained quantitative and qualitative data via an enrollment survey and face-to-face, semistructured interviews, respectively. Transcripts were analyzed using framework analysis. ResultsThe sample included 84 women. Participants had a mean age of 26 years and were on average 7 weeks estimated gestational age at enrollment. Most identified as Black (54%) or Hispanic (20%), were unmarried (92%), and had at least one other child (67%). More than one-half (55%) described feelings of ambivalence regarding their current pregnancy. We identified ambivalence as a frequent and complex thread that represented distinct but overlapping perspectives about pregnancy: ambivalent pregnancy intentions, ambivalent response to new diagnosis of pregnancy, and ambivalence as uncertainty or conflict over pregnancy decision-making. Sources of ambivalence included relationship status, pregnancy timing, and maternal or fetal health problems. ConclusionsThis study improves on previous findings that focus only on ambivalence related to pregnancy intention or to decision making, and explores women's mixed, fluctuating, or unresolved feelings and attitudes about pregnancy before many participants had completed pregnancy decision making. Acknowledging and exploring sources of ambivalence regarding pregnancy may help health providers and policymakers to comprehensively support women with respect to both their experiences and reproductive goals.

Short-term outcome of very-low-birthweight infants with arterial hypotension in the first 24 h of life

ObjectiveTo evaluate lowest mean arterial blood pressure during the first 24 h of life (minMAP24) in very-low-birthweight (VLBW) infants and to identify associations between hypotension and short-term outcome.DesignRetrospective cohort analysis...

Clasificación del recién nacido de bajo peso por peso de nacimiento, edad gestacional y crecimiento intrauterino, su morbimortalidad

Se ha revisado 4,668 nacimientos ocurridos entre los años 1970-1971. Se encontró 295 recién nacidos vivos de bajo peso, los cuales constituyen un 6.32%. En 278 casos (94%) se determinó el tiempo de gestación en semanas completas. Hemos relacionado el peso de nacimiento con la edad de gestación, habiéndose formado 7 grupos de recién nacidos vivos de bajo peso, estableciéndose la morbimortalidad en cada uno de estos grupos. Se elabora otra clasificación, que se basa en relacionar los 7 grupos anteriores con las curvas de crecimiento intrauterino, dándose lugar a 21 posibilidades de grupos específicas a estudiar, habiéndose registrado casos sólo en 13 de estos grupos, estableciéndose la morbimortalidad en cada uno de ellos. La distribución de la patología estudiada y los porcentajes de mortalidad neonatal son diferentes en nuestros grupos a la morbilidad y mortalidad establecidas en clasificaciones dadas para recién nacidos en general. Se plantea la necesidad de establecer las curvas de crecimiento intrauterino para cada medio socio-económico en particular, tanto para los recién nacidos de peso normal como para los recién nacidos de bajo peso.

Pasteurization of breastmilk decreases the rate of postnatally acquired cytomegalovirus infections, but shows a nonsignificant trend to an increased rate of necrotizing enterocolitis in very preterm infants--a preliminary study.

This study assessed whether feeding preterm infants unpasteurized breastmilk (1) decreases the rate of late-onset sepsis and necrotizing enterocolitis and (2) increases the rate of postnatally acquired cytomegalovirus infections. Between January 2008 and July 2013, preterm infants below 32 completed weeks of gestational age admitted to the neonatal intensive care unit of Innsbruck Medical University (Innsbruck, Austria) (n=344) were eligible for the study. Of those, 323 fed breastmilk were retrospectively enrolled in the study. Two groups were formed, with 164 infants being fed unpasteurized and 159 infants being fed pasteurized breastmilk. There was no significant difference in the rate of late-onset sepsis or necrotizing enterocolitis between the unpasteurized and pasteurized breastmilk groups (late-onset sepsis, 15.9% versus 15.1% [p=0.486]; necrotizing enterocolitis, 2.4% versus 4.4% [p=0.254]). The number of infants diagnosed with postnatally acquired cytomegalovirus infection was significantly higher in the unpasteurized group (39.3%) compared with the pasteurized group (4.2%) (p=0.008). Feeding preterm infants unpasteurized breastmilk increases the rate of postnatally acquired cytomegalovirus infections. However, we also demonstrate a nonsignificant trend to a decreased rate of necrotizing enterocolitis in the unpasteurized group, which needs to be confirmed in larger studies.

Chronic lung disease of prematurity and early childhood wheezing: Is foetal inflammatory response syndrome to blame?

BackgroundLong-lasting respiratory symptoms have a huge impact on the quality of life in prematurely born children. AimsWe aimed to investigate the perinatal and maternal risk factors involved in the development of chronic respiratory morbidity in preterm infants, with an emphasis on the importance of Foetal Inflammatory Response Syndrome (FIRS). Study designProspective cohort study. SubjectsDemographic, antenatal, delivery and outcomes data were collected from 262 infants with less than 32 completed weeks of gestational age, over a 10-year period. Outcome measuresPresence of chronic lung disease of prematurity and early childhood wheezing. ResultsIn multivariate logistic regression analysis the presence of FIRS appears to be the most important risk factor for both, chronic lung disease of prematurity (OR 31.05, 95% CI 10.7–87.75, p<0.001) and early childhood wheezing (OR 5.63, 95% CI 2.42–13.05, p=0.01). In the alternative regression model for early childhood wheezing, with chronic lung disease included as a variable, the statistical significance of FIRS completely vanished (OR 1.15, 95% CI 0.39–3.34, p=0.79), whilst chronic lung disease became the most important risk factor (OR 23.45, 95% CI 8.5–63.25, p<0.001). ConclusionsPrenatal and early neonatal events are of utmost importance in the development of chronic respiratory symptoms in children. The influence of FIRS on the development of chronic respiratory symptoms goes far beyond its impact on gestational age and may be related to direct inflammation-mediated lung tissue damage. CLD appears to be an intermittent step on the way from FIRS to ECW.

Timeliness of routine immunization in a population-based Italian cohort of very preterm infants: Results of the ACTION follow-up project

BackgroundAlthough very preterm infants are recommended to receive immunizations, according to their chronological age, immunization start in these infants is often delayed.Aim To measure coverage and timeliness of routine immunizations in Italian very preterm infants and to assess determinants of delay. MethodsWe followed up infants 22–31 completed weeks of gestational age discharged from intensive care. We measured the proportion of children with one dose of diphtheria–tetanus–pertussis–poliohepatitis, B-Hib vaccine (DTP–Pol–HBV-Hib), measles–mumps–rubella vaccine (MMR), conjugate pneumococcal vaccine (Pnc), conjugate meningococcal C vaccine (MenC), and varicella vaccine (Var) by 24 months. We used the Kaplan Meier method and Cox proportional hazard models to estimate the age, at immunization start and determinants of timeliness for each vaccine. ResultsData on 1102 (92.1%) children out of 1196 included in the cohort were analyzed. Immunization start by 24 months of age occurred in 95.9% of children for DTP–Pol–HBV-Hib; 84.0% for MMR; 49.7% for Pnc; 38.5% for MenC; and 4.1% for Var. Eighty-seven percent of participants received the first dose of DTP–Pol–HBV-Hib by 6 months of age, and 66.7% had their first MMR administered by 18 months. Hospitalization was associated with delay for all vaccines with the exception of MenC and Var. Maternal employment was associated with earlier immunization for MMR, Pnc, and MenC. DTP–Pol–HBV-Hib timeliness improved with increasing birthweight and paternal employment and decreased with a larger number of siblings in the household. MMR was delayed in children with cerebral palsy, and in those with a larger number of children in the household. Immunization for Pnc was delayed in children with larger number of siblings. ConclusionsImmunization start for all vaccines was considerably delayed in many very preterm infants. Public health strategies taking into account determinants of delay should be implemented to improve coverage and timeliness of vaccination in this group of infants.

Accurate Reporting of Expected Delivery Date by Mothers 9 Months After Birth

When information on the gestational age at birth is needed, and hospital records are unavailable, or too costly or time-consuming to obtain, retrospective maternity surveys or reports are used to estimate the expected date of delivery (EDD). Several studies have compared the accuracy of maternal reporting of gestational age by comparison with gestational age in medical records, but the results have been mixed. The aim of this study was to compare gestational age estimated from maternal reporting of EDD 9 months after delivery, with gestational age reported in routine hospital records. Another study aim was to determine whether perinatal and sociodemographic factors influenced agreement, and whether the potentially observed disagreement affected classification of preterm birth. Data on 8058 singleton infants from the UK Millennium Cohort Study were examined. Agreement between the maternal report and hospital data was 72.2% with respect to exact gestational age in completed weeks and 94.5% for agreement within 1 week of hospital-based gestational age. Disagreement was more common among infants who were not firstborn, women who had unplanned pregnancies or received late or no antenatal care, and had a low socioeconomic status. With maternal reporting of gestational age, slightly more children were classified as preterm than with gestational age based on hospital data (6.4% vs. 6.1%). There was also a poor agreement for postterm birth. These findings suggest that retrospective maternal reporting of EDD is reliable based on its overall agreement within 1 week of the gestation recorded in routine hospital data.

Accurate reporting of expected delivery date by mothers 9 months after birth

Objective To measure agreement between gestational age based on maternal report of expected date of delivery (EDD) 9 months after birth and gestational age at birth in routine hospital data. Furthermore, to examine whether sociodemographic and perinatal factors influenced agreement and whether disagreement affected classification of infants in preterm groups. Study Design and Setting The study used data on 8,058 singleton infants from the UK Millennium Cohort Study. Women were interviewed 9 months after birth and interviews were linked to routine hospital data. The infant’s date of birth and EDD were used to calculate gestational age in completed weeks. Results Agreement between maternal report and hospital data was 72% for exact number of weeks’ gestation and 94% for agreement within 1 week. Disagreement was associated with the infant not being firstborn, unplanned pregnancy, late or no antenatal care, and low socioeconomic status. Maternal report of gestational age resulted in slightly more children being classified as preterm (6.4%) than gestational age based on hospital data (6.1%). Agreement was found to be poor for postterm births. Conclusion Gestational age based on retrospective maternal reporting of EDD is reliable within 1 week or when used to assign infants to broad gestational groups.

Magnesium Sulfate Tocolysis and Intraventricular Hemorrhage in Very Preterm Infants

To estimate the contributory effect of tocolytic magnesium sulfate (MgSO4) exposure to intraventricular hemorrhage (IVH) in preterm infants born at 23-31 wks gestation to mothers without evidence of pregnancy induced hypertension and/or preeclampsia. Cases with IVH and controls without IVH were selected from a population-based cohort of preterm infants admitted from January 2004 through May 2008 to the Level III Neonatal Intensive Care Unit (NICU) at Robert Wood Johnson University Hospital. Cases and controls were matched primarily by exact gestational age in completed weeks and secondarily by the birth weight that was same or similar (+/-100 g). The odds of tocolytic MgSO(4) exposure among the cases and controls was tested in a regression model to control the difference in demographic and clinical factors between the IVH cases (IVH+) and controls without IVH (IVH-). Eighty-nine IVH cases and 89 controls were comparable for parity, mode of delivery, antenatal corticosteroid exposure, and surfactant administration. IVH cases were less likely to have preterm premature rupture of membranes and were more likely to be born with low Apgar scores and require ventilation. Among the IVH cases, 30.3% of infants were exposed to tocolytic MgSO4 as compared to 47.2% of controls (Odds Ratio adjusted 0.471, 95% Confidence Interval 0.241, 0.906). Among the preterm born infants with gestational age 23-31 wks and IVH, tocolytic MgSO4 exposure was less likely to be observed than in neonates with similar clinical characteristics but without IVH, thereby suggesting that antenatal exposure to MgSO(4) may have a protective effect against IVH.

Variation in Child Cognitive Ability by Week of Gestation Among Healthy Term Births

The authors investigated variations in cognitive ability by gestational age among 13,824 children at age 6.5 years who were born at term with normal weight, using data from a prospective cohort recruited in 1996-1997 in Belarus. The mean differences in the Wechsler Abbreviated Scales of Intelligence were examined by gestational age in completed weeks and by fetal growth after controlling for maternal and family characteristics. Compared with the score for those born at 39-41 weeks, the full-scale intelligence quotient (IQ) score was 1.7 points (95% confidence interval (CI): -2.7, -0.7) lower in children born at 37 weeks and 0.4 points (95% CI: -1.1, 0.02) lower at 38 weeks after controlling for confounders. There was also a graded relation in postterm children: a 0.5-points (95% CI: -2.6, 1.6) lower score at 42 weeks and 6.0 points (95% CI: -15.1, 3.1) lower at 43 weeks. Compared with children born large for gestational age (>90th percentile), children born small for gestational age (<10th percentile) had the lowest IQ, followed by those at the 10th-50th percentile and those at the >50th-90th percentile. These findings suggest that, even among healthy children born at term, cognitive ability at age 6.5 years is lower in those born at 37 or 38 weeks and those with suboptimal fetal growth.