Higher Incidence Of Prematurity Research Articles

CARDIAC VALVE DISEASE IN DIABETIC PREGNANT WOMEN: FETAL COMPROMISE AND MATERNAL RISK

Introduction: Cardiac valve diseases represent a significant concern in the management of pregnant women, particularly those with diabetes mellitus, a condition that alters the hemodynamic profile and can exacerbate pre-existing cardiac issues. During pregnancy, a woman's body undergoes physiological changes that can affect the function of the cardiac valves. Diabetes mellitus can accelerate the progression of valvulopathies, leading to complications affecting both the mother and the fetus. Fetal compromise often results from maternal hemodynamic instability and changes in blood flow, while maternal risk includes worsening cardiac symptoms and an increased likelihood of adverse events during pregnancy. Objective: The objective of this systematic review was to analyze the available evidence on the impact of cardiac valve diseases in diabetic pregnant women, focusing on the consequences for the fetus and the risks for the mother. Methodology: To conduct the systematic review, the PRISMA checklist criteria were followed. The search was performed in electronic databases, including PubMed, Scielo, and Web of Science, using five main descriptors: "cardiac valve disease," "diabetic pregnant women," "fetal compromise," "maternal risk," and "diabetes mellitus." Studies published in the last 10 years were included, prioritizing peer-reviewed articles and original research. Inclusion criteria comprised: (1) studies specifically addressing valvulopathies in pregnant women with diabetes mellitus, (2) articles providing data on fetal and maternal outcomes, and (3) research published in peer-reviewed journals. Exclusion criteria included: (1) studies not directly focusing on diabetic pregnant women, (2) research with non-rigorous methodologies or lack of relevant data, and (3) articles published more than 10 years ago. Results: The results indicated that pregnant women with valvulopathies and diabetes mellitus face a heightened risk of complications. Key findings included increased neonatal mortality and maternal cardiovascular complications, such as heart failure and worsening valvular symptoms. Fetal compromise often involved intrauterine growth problems and a higher incidence of prematurity. Conclusion: The review highlighted that the combination of diabetes mellitus and cardiac valve diseases presents a significant challenge in managing pregnant women, with important implications for both maternal and fetal health. Early identification and appropriate management of valvulopathies are crucial to reducing associated risks and improving outcomes for both mother and baby. Future studies should focus on treatment strategies and monitoring approaches that can mitigate these complications and promote better outcomes.

An observational study for appraisal of clinical outcome and risk of mother-to-child SARS-CoV-2 transmission in neonates provided the benefits of mothers' own milk.

This observational study done during April–December 2020 at a tertiary-care hospital in Haryana (India) enrolled 152 SARS-CoV-2-exposed neonates. Among them, 150 neonates had perinatal SARS-CoV-2 exposure and 2 neonates had late postnatal exposure. Stable infant-mother dyads were roomed-in with precautions to support breastfeeding. Nasopharyngeal swabs collected from neonates were tested for SARS-CoV-2 by reverse transcriptase–polymerase chain reaction (RT-PCR) test. There was a high incidence of prematurity (23%), low birth weight (31%), intrauterine fetal distress (16%), perinatal asphyxia (6%), admission to neonatal intensive care unit (24%), and mortality (1.3%) among neonates with perinatal SARS-CoV-2 exposure. In this sub-group, 20 neonates tested positive for SARS-CoV-2 in nasopharyngeal swab sample(s). A recent official publication by the World Health Organization emphasizes that the perinatal SARS-CoV-2-exposed neonates found RT-PCR positive once in upper respiratory (non-sterile) sample must document viral persistence in another non-sterile sample for confirmation of mother-to-child virus transmission. With this approach, only one neonate was confirmed intrapartum transmission. A telephonic follow-up in discharged neonates at 1 month of age or 1 month postexposure recorded them all to be asymptomatic and doing well.Conclusion: Neonates with perinatal SARS-CoV-2 exposure constitute a high-risk group and it is not uncommon to get a positive RT-PCR report in upper respiratory sample(s) from these babies. Majority of them do not demonstrate viral persistence. Clinical outcomes are favorable in breastfed infants roomed-in with their asymptomatic-mild symptomatic SARS-CoV-2-infected mothers following appropriate safety protocols. What is Known:•Neonates with perinatal exposure suffer a high burden of morbidities and mortality.•Still, an uncertainty exists about rooming-in and breastfeeding among neonates born to SARS-CoV-2 positive mothers.What is New:•With the policy of mother-infant rooming-in and supporting breastfeeding, none of the neonate suffered clinical illness compatible with postnatal SARS-CoV-2 transmission and infection.•Around 13% perinatal exposed neonates demonstrated SARS-CoV-2 RNA in nasopharyngeal swab samples but the majority of them did not demonstrate viral persistence.

Spontaneous disruption of the dividing membrane in monochorionic diamniotic twin pregnancy.

Spontaneous disruption of the dividing membrane in MD twins is rare and be associated with a higher incidence of prematurity and neonatal morbidity. In the present case, a spontaneous disrupted dividing membrane could be noted by ultrasonography.

In utero exposure to Azathioprine in autoimmune disease. Where do we stand?

Azathioprine (AZA), an oral immunosuppressant, is safe during pregnancy. Some reports suggested different impairments in the offspring of mothers with autoimmune diseases (AI) exposed in utero to AZA. These observations are available from retrospective studies or case reports. However, data with respect to the long-term safety in the antenatally exposed child are still lacking. The aim of this study is to summarize the current knowledge in this field and to focus on the need for a prospective study on this population. We performed a PubMed search using several search terms. The actual data show that although the risk of congenital anomalies in offspring, as well as the infertility risk, are similar to those found in general population, there is a higher incidence of prematurity, of lower weight at birth and an intra-uterine delay of development. There is also an increased risk of materno- fetal infections, especially cytomegalovirus infection. Some authors raise the interrogations about neurocognitive impairment. Even though the adverse outcomes might well be a consequence of maternal illness and disease activity, interest has been raised about a contribution of this drug. However, the interferences between the external agent (in utero exposure to AZA), with the host (child genetic susceptibility, immune system anomalies, emotional status), environment (public health, social context, availability of health care), economic, social, and behavioral conditions, cultural patterns, are complex and represent confounding factors. In conclusion, it is necessary to perform studies on the medium and long-term outcome of children born by mothers with autoimmune diseases, treated with AZA, in order to show the safety of AZA exposure. Only large-scale population studies with long-term follow-up will allow to formally conclude in this field. TAKE HOME MESSAGES.

Disruption of the dividing membrane in monochorionic diamniotic twin pregnancy.

Disruption of the dividing membrane in monochorionic diamniotic twins is associated with a higher incidence of prematurity and neonatal morbidity. In the present case, a cramped fragment of the dividing membrane could be noted following fetoscopic laser photocoagulation.

Pregnancy stress, healthy pregnancy and birth outcomes - the need for early preventative approaches in pregnant Australian Indigenous women: a prospective longitudinal cohort study.

Adverse pregnancy outcomes including prematurity and low birth weight (LBW) have been associated with life-long chronic disease risk for the infant. Stress during pregnancy increases the risk of adverse pregnancy outcomes. Many studies have reported the incidence of adverse pregnancy outcomes in Indigenous populations and a smaller number of studies have measured rates of stress and depression in these populations. This study sought to examine the potential association between stress during pregnancy and the rate of adverse pregnancy outcomes in Australian Indigenous women residing in rural and remote communities in New South Wales. This study found a higher rate of post-traumatic stress disorder, depression and anxiety symptoms during pregnancy than the general population. There was also a higher incidence of prematurity and LBW deliveries. Unfortunately, missing post-traumatic stress disorder and depressive symptomatology data impeded the examination of associations of interest. This was largely due to the highly sensitive nature of the issues under investigation, and the need to ensure adequate levels of trust between Indigenous women and research staff before disclosure and recording of sensitive research data. We were unable to demonstrate a significant association between the level of stress and the incidence of adverse pregnancy outcomes at this stage. We recommend this longitudinal study continue until complete data sets are available. Future research in this area should ensure prioritization of building trust in participants and overestimating sample size to ensure no undue pressure is placed upon an already stressed participant.

Global Burden of Pediatric Neurological Disorders

Neurological conditions in children represent a significant proportion of the global burden of disease, since they contribute to premature mortality and years lived with disability. The burden of neurological conditions, as measured by the total disability adjusted live years has decreased significantly over the last 25 years (1990-2015), mainly due to the reduction in the mortality, as the years lived with disability has increased slightly. However, in some regions of the world, notably South Asia and sub-Saharan Africa, the burden remains high, driven by the high incidence of prematurity, neonatal encephalopathy and infections of the central nervous system.

Early outcome of surgical intervention of esophageal atresia and tracheo-esophageal fistula in erbil pediatric surgical center

Background: Esophageal atresia (EA) and treacheo-esophageal fistula occur in 1 out of every 3500 live births. Children born with EA have a higher incidence of prematurity than the general population EA. The treatment of EA and tracheo-esophageal fistula, although still a challenge, represents one of the true successes of newborn surgery. Objective: The aim of this study cases with EA and/or tracheo-esophageal fistula in Rapareen pediatric surgery center, Erbil, Iraq, regarding management, and early outcome. Materials and Methods: Fifty-three neonates were enrolled in this study from October 2011 to September 2015. Preoperative investigations included chest X-ray, ultrasound of the abdomen, and echocardiography. All patients were resuscitated before surgical intervention. Statistical Package for the Social Sciences version 20 was used for data analysis. Results: Out of 53 cases, 21 survived and 32 died. Thirty patients were male and 23 were female (male-to-female ratio 1.3:1). Twelve were premature and 41 term babies. The most common type was EA and distal fistula in 47 cases, pure atresia in 5 cases, and EA with both distal and proximal fistula in one case. Presenting features were excessive salivation in all cases, failure to pass nasogastric tube in 98.1%, cyanosis in 69.8%, and chocking in 37.7%. Prenatal history of polyhydramnios was present in 67.9%. Eighteen cases had associated anomalies, most of them were cardiac. Conclusion: EA with distal tracheo-esophageal fistula is the most common type of anomaly. Early diagnosis, weight, maturity, and associated anomalies are the most important factors that affect the outcome. Postoperative respiratory care is necessary, especially for those who have a preoperative chest infection.

Prematurity and neonatal outcome including congenital malformations after maternal malignancy within six months prior to or during pregnancy.

The proportion of women who postpone childbearing is increasing. As malignancy risk increases with age, pregnancy in connection with malignancy will become more common. We compared infants born 1994-2011 to women with a malignancy within six months prior to the last menstrual period or during pregnancy with offspring of women without a previous malignancy. Five national registers were used. A total of 790 women with a malignancy diagnosis from six months prior to the last menstrual period up to delivery were identified. Their 802 infants were compared with 1742757 infants of women without a malignancy. A high rate of prematurity was found, especially when the malignancy was diagnosed during the second or third trimesters (33%). Most of these premature births were the result of induced delivery before 35weeks (91%). The most remarkable finding is the observation that these premature infants had a significantly higher risk for neonatal morbidity than premature infants in the control group with an adjusted odds ratio of 2.67 (95% confidence interval; 1.86-3.84). We found a significantly increased risk of mainly relatively mild malformations among infants of women with a malignancy diagnosis within six months prior to the last menstrual period or during the first trimester with a risk ratio of 1.81 (95% confidence interval; 1.20-2.61). A high incidence of prematurity, mostly due to induced delivery, was found, including an increased risk for neonatal morbidity among these infants. An increased risk for relatively mild malformations was also found.

Outcome in twin gestations: A prospective observational study

Background: Incidence of twinning has increased due to the widespread use of assisted reproductive techniques. Twin gestation is associated with many maternal, fetal, and neonatal complications. Objective: The objective of the study is to study the fetal and neonatal complications and outcome of twin pregnancies. Materials and Methods: This is a prospective observational study conducted in a tertiary referral neonatal intensive care unit. 50 consecutive pairs of twins were recruited at the time of admission of the mother to the labor ward. Demographic details of the mother and of the infants were recorded. The outcome of the pregnancy was noted, and the live born infants were followed during the hospital stay and then up till 6 months of corrected gestational age. Results: Incidence of prematurity was 60%. Moderate to severe discordancy was identified in 17 (34%) pairs of twins and 43% infants were born small for gestational age (SGA). Intrauterine Fetal Death was noted in 6 out of 54 infants with discordant growth and 1 out of 46 infants with concordant growth (p=0.046). The overall mortality in our study was 13.9%. Mortality in SGA infants was 23% and 6% in appropriate for gestational age infants (p=0.036). Conclusion: Twinning is associated with high incidence of prematurity, growth discordance, congenital anomalies, intrauterine fetal death, and neonatal mortality.

Fetal blood vessel count increases in compensation of hypoxia in premature placentas

BACKGROUND Prematurity refers to live births before 37 weeks of gestation, wherein the baby is born before the body and its organ systems achieve perfect maturity, and this disorder is still a global problem. The high incidence of prematurity is a problem in developing and also in developed countries. Certain conditions accompanying pregnancies like preeclampsia, infection, and placental insufficiency, may trigger uterine hypoxia, causing premature birth. The placental condition is related to the intra-uterine fetal condition. In prolonged placental hypoxia, there occurs a compensatory mechanism, i.e. an increase in placental angiogenesis. This study aimed to evaluate the effect of hypoxia on fetal blood vessel count as compensatory mechanism for tissue hypoxia. METHODS An observational-analytical cross-sectional design using paraffin blocks of conserved premature placentas, comprising 31 samples of hypoxic premature placentas and 28 samples of non-hypoxic premature placentas, selected using non-random consecutive sampling. The samples were made into slides and stained with hematoxylin-eosin for assessment of histological structure, including fetal blood vessel count and integrity, villus conditions, syncytiotrophoblastic nuclear changes, and syncytiotrophoblastic nuclear aggregation. Mann-Whitney test was used to compare the difference of blood vessel count between groups. RESULTS Assessment of histological structure showed a significant increase in fetal blood vessel count in the hypoxic group [8.00 (5-15)] as compared with the non-hypoxic group [7.50 (3-15)]. CONCLUSION The hypoxia in premature placentas caused an increase in the number of fetal blood vessels as a form of compensation for disturbed oxygen homeostasis.

The Effect of Noncardiac and Genetic Abnormalities on Outcomes Following Neonatal Congenital Heart Surgery

Significant noncardiac and genetic abnormalities (NC and GA) are common in neonates with congenital heart defects. We sought to examine current-era effect of those abnormalities on early and late outcomes following cardiac surgery. The method from 2002-2012, 1538 neonates underwent repair (n = 860, 56%) or palliation (n = 678, 44%) of congenital heart defects. Regression models examined the effect of NC and GA on operative results, resource utilization, and late outcomes. Neonates with NC and GA (n = 312, 20%) had higher incidence of prematurity (21% vs 13%; P

The Effect of Noncardiac and Genetic Abnormalities on Outcomes Following Neonatal Congenital Heart Surgery

Significant noncardiac and genetic abnormalities (NC and GA) are common in neonates with congenital heart defects. We sought to examine current-era effect of those abnormalities on early and late outcomes following cardiac surgery. The method from 2002-2012, 1538 neonates underwent repair (n = 860, 56%) or palliation (n = 678, 44%) of congenital heart defects. Regression models examined the effect of NC and GA on operative results, resource utilization, and late outcomes. Neonates with NC and GA (n = 312, 20%) had higher incidence of prematurity (21% vs 13%; P < 0.001) and weight ≤2.5kg (24% vs 12%; P < 0.001) than neonates without NC and GA (n = 1226, 80%). Although the incidence of single ventricle was comparable (34% vs 31%; P = 0.37), neonates with NC and GA underwent more palliation (52% vs 42%; P = 0.001) and subsequently had higher percentage of STAT mortality categories (Society of Thoracic Surgeons (STS) and the European Association for Cardio-thoracic Surgery (EACTS) Congenital Heart Surgery Mortality Categories) 4 and 5 procedures (78% vs 66%; P < 0.001). Adjusted logistic regression models that included disparate patient and operative variables showed that the presence of NC and GA was associated with increased unplanned reoperation (odds ratio = 1.7; 95% CI: 1.1-2.7; P = 0.03) and hospital mortality (odds ratio = 2.2; 95% CI: 1.3-3.6; P = 0.002). Adjusted linear regression models showed significant association between NC and GA and increased postoperative mechanical ventilation duration, intensive care unit, and hospital stays (P < 0.001 each). Adjusted hazard analysis showed that the presence of NC and GA was associated with diminished late survival (hazard ratio = 2.4; 95% CI: 1.9-3.1; P < 0.001) and that was evident in all subgroups of patients (P < 0.001 each). Conclusion is neonates with NC and GA commonly have associated risk factors for morbidity and mortality such as prematurity and low weight. After adjusting for those factors, the presence of NC and GA continues to have significant association with increased unplanned reoperation, hospital mortality, and resource utilization after palliative and corrective cardiac surgery. Importantly, the hazard of death in those patients continues beyond the perioperative period for at least 1 year. Our findings show that the presence of NC and GA should be emphasized during parent counseling and decision making; and underscore the need to explore strategies to improve outcomes for this high-risk population that must address perioperative care, outpatient surveillance, and management.

Gender Disparity among Preterm Born Neonates

Introduction: Infants born preterm remain vulnerable to many complications. Objective was to identify gender differences in morbidity and adverse outcomes among premature and low birth weight born babies.Methods: A retrospective chart review of general pediatric clinic records was conducted for children and adolescents who were born premature and survived. Demographic, maternal, family, neonatal and postnatal data were abstracted. The data was then analyzed using a statistical calculator to perform one sample t-test between percentages.Results: Total 160 charts were reviewed. Out of 160, 58.8% males and 41% females were identified. The female babies were born at a higher rate as small for gestational age (SGA) babies, with a birth weight &lt; 10th percentile (60.8% vs. 39%; p &lt; 0.05), most of the male babies although pre-term were born as appropriate for gestational age (AGA). The incidence of complications associated with prematurity were found to be at a higher rate in male babies including jaundice (63.15% vs. 36.8%; p = 0.0198), metabolic issues (64.2% vs. 35.7%; p = 0.03), and respiratory distress syndrome (RDS) (60.5% vs. 39.4%; p =0.02). Sepsis was observed in 54% vs. 45.8% (p = 0.69), intracranial hemorrhage (ICH): 75% vs. 25% (p = 0.33), hypertension (HTN) 62% vs. 37% (p = 0.108).Conclusion: Gender related health disparity exists among pre-term born children although does not have a sufficient explanation. Most males, although born AGA, had a higher incidence of prematurity and its sequel requiring intensive healthcare support compared with females.

Maternal and fetal outcomes of pregnancy with Fontan circulation: A multicentric observational study

BackgroundDespite serious long-term sequel, women with Fontan palliation have reached childbearing age. However there is paucity of data on the pregnancy outcomes and management of this condition. We aimed to determine the maternal and fetal outcomes of pregnancy in women with Fontan palliation. MethodsThis multicentric, retrospective study included women with Fontan circulation followed in 13 French specialized centers from January 2000 to June 2014. All pregnancies were reviewed, including miscarriages, abortions, premature and term births. We reviewed maternal and fetal outcomes. ResultsThirty-seven patients had 59 pregnancies. Mean age was 27±5years at first pregnancy. There were 16 miscarriages (27%) and 36 live births with 1 twin pregnancy. Cardiac events occurred in 6 (10%) pregnancies, with no maternal death. The most common cardiac complication was atrial arrhythmia, which occurred in 3 patients. Hematological complications including thromboembolic/hemorrhagic events (n=3/7) occurred in 5 women antepartum (n=2/3), and 4 women postpartum (n=1/4). Two of the 3 thromboembolic events occurred in patients without anticoagulation. There was a high incidence of prematurity (n=25/36, 69%). Anticoagulation was associated with adverse neonatal outcome (OR=10.0, 95% CI [1.5–91.4], p<0.01). After a median follow-up of 24months, there was no significant worsening of clinical status and thromboembolic disease noted. ConclusionsPre-selected women can successfully complete pregnancy with Fontan circulation. There is an increase in cardiac and neonatal morbidity during pregnancy. Because thromboembolism could have a severe consequence on Fontan circulation, anticoagulation should be indicated during pregnancy and postpartum period.

PO-0901 Neonatal Outcomes Of Adolescent Pregnancies In A Secondary Level Maternity Hospital In Romania

<h3>Background and aims</h3> Pregnant adolescents have high rates of poor birth outcomes, but the causes are unclear. There is a very marked association between young age of mothers and low birth weight and preterm delivery and some of the apparent effect of young maternal age on birth weight may be because the birth is likely to be the mother’s first, and first births have a higher incidence of prematurity. The aim of present study was to investigate neonatal outcomes of teenage pregnancies controlling for parity, gestational age and perinatal interventions. <h3>Methods</h3> A retrospective study comparing singleton deliveries classified into three teenage groups:12–15, 15–17, 18–19, and a comparison group of 24–29 years was performed in a secondary level Maternity Hospital in Mures County, Romania. For the adult group, 736 charts of mothers between the age of 24 and 29 delivering singleton babies were selected. <h3>Results</h3> The study population consisted of 1 131 women, 75 12–15 years old, 163 16–17 years old, 157 18–19 years old, and 736 24–29 years old. A significant linear association was found between maternal age and preterm birth, low birth weight, and neonatal birth related trauma. Length of hospitalisation, as a marker of the healthcare costs involved in the care of these high risk cases, was significant associated with maternal age after controlling for perinatal interventions. <h3>Conclusions</h3> Teenage pregnancy is a risk factor for low birth weight, preterm delivery, neonatal birth related trauma and high healthcare costs.

Impact of Industrialization on Nutritional and Health Status of Pregnant Women and Their Obstetric Outcome

Sixty pregnant women 30 each in Group I(Industrial area ) and Group II (Non industrial area in the age group of 20 to 28 years, belonging to low income group having monthly per capita income of Rs 969.83 and Rs 631.87 of Bathinda city were selected during 7th month of pregnancy . The mean daily intake of energy, proteins, carbohydrates, vitamins B12, niacin, iron, folic acid, sodium and zinc was inadequate when compared with ICMR standards. Common symptoms of iron deficiency were pale conjunctiva, paleness of skin, pallor of tongue and fatigue. The mean birth weight was 1923.3+359.0 and 2320+-426.3 gram in Group I and II respectively. It was further observed that 16.67 and30.0 percent of newborns had respiratory infections and fever at the time of birth. It could be due to poor hygienic status, higher maternal exposure to pollutants in Group I. It is concluded that inadequate nutrient intake, poor sanitation and exposure to environmental pollutants resulted in higher incidence of prematurity and low birth weight in subjects of Group I.

Impact of Industrialization on Nutritional and Health Status of Pregnant Women and Their Obstetric Outcome

Sixty pregnant women 30 each in Group I(Industrial area ) and Group II (Non industrial area in the age group of 20 to 28 years, belonging to low income group having monthly per capita income of Rs 969.83 and Rs 631.87 of Bathinda city were selected during 7th month of pregnancy . The mean daily intake of energy, proteins, carbohydrates, vitamins B12, niacin, iron, folic acid, sodium and zinc was inadequate when compared with ICMR standards. Common symptoms of iron deficiency were pale conjunctiva, paleness of skin, pallor of tongue and fatigue. The mean birth weight was 1923.3+359.0 and 2320+-426.3 gram in Group I and II respectively. It was further observed that 16.67 and30.0 percent of newborns had respiratory infections and fever at the time of birth. It could be due to poor hygienic status, higher maternal exposure to pollutants in Group I. It is concluded that inadequate nutrient intake, poor sanitation and exposure to environmental pollutants resulted in higher incidence of prematurity and low birth weight in subjects of Group I.

Auditory brainstem response (ABR) results in NICU graduates

Purpose:Hearing loss is one of the most common birth defects, and early detection and intervention positively impact language/speech and cognitive development. It has been reported that NICU graduates have a high incidence of hearing loss. So we investigated the incidence, risk factors and clinical outcome of hearing loss in NICU graduates. Methods:This study involved neonatal auditory brainstem response (ABR) testing of newborn infants who graduated from the NICU of Kyungpook National University Hospital during a 3-year period (between July 2002 and June 2005) and subsequent follow-up of these infants. Results:ABR evaluations were performed on 474 infants. Of these infants, 64 showed abnormal ABR (13.5 percent). Of 128 ears from these 64 infants, two ears (1.6 percent) and 10 ears (7.8 percent) were classified as severe and profound hearing loss, respectively. The infants with abnormal ABR had higher incidence of prematurity, low birth weight, very low birth weight, neonatal asphyxia, cranio-facial malformation and amikacin treatment over 15 days (P

Two‐year neurodevelopmental outcome in children conceived by intracytoplasmic sperm injection: prospective cohort study

Primary outcome was to compare neurodevelopmental outcome at two years in intracytoplasmic sperm injection (ICSI) conceived children versus matched controls. Secondary outcome was to determine incidence of major congenital malformations and study perinatal outcome. Prospective cohort study. Tertiary care perinatal centre over a period of 13 months. Seventy-six ICSI conceived children and 261 matched controls selected by matching for maternal age, sex, date of delivery, race, plurality and parity. Mental Development Index (MDI) and Psychometric Development Index (PDI) of the Bayley's Scale of Development (BSID-II) and Vineland Adaptive Behaviour Scale (VABS) were used to assess the neurodevelopmental and functional outcome. The congenital malformations were classified according to ICD-9 code. Primary outcome measure--neurodevelopmental and functional outcomes. Secondary outcome measure--congenital malformations and perinatal outcomes. Neurodevelopmental and functional outcome were comparable in both groups. The mean MDI score was 92 [16] versus 90 [14] in the study and control groups respectively. Fourteen (18.4%) in the ICSI group had MDI <85 compared with 87 (33%) controls (P= 0.002). On linear regression the MDI was independently affected by plurality (P= 0.001), maternal education and socio-economic status (P= 0.01). The study group had a lower gestation (36 [3] vs 37.1 [2] weeks; P= 0.005) and a higher incidence of prematurity <34 weeks [19 (25%)] vs [31 (12%)] P= 0.012]. Six (7.9%) of the ICSI babies and seven (2.7%) of the controls had a major congenital malformation (P= 0.05). Children born by ICSI pregnancies did not have an adverse neurodevelopmental outcome. The incidence of major congenital malformations in ICSI needs further evaluation.