Incidence Of Hyaline Membrane Disease Research Articles

Maternal and Neonatal Outcome in Pregnant Women with Chronic Energy Deficiency in Cipto Mangunkusumo General Hospital, Indonesia

Introduction : Malnutrition in pregnant women disrupts the First Thousand Days of Life (DOL). DOL is known as the Window of Opportunity or the Golden Period, which occurs for 1000 DOL to improve children's growth and development optimally. Disturbances that arise during this period will impact the survival of the child and child’s growth and development, which is permanent. However, malnutrition in pregnant women can be prevented by early intervention. Therefore, this study aims to describe the maternal and neonatal outcomes in pregnant women with chronic energy deficiency malnutrition.
 Method: This research is a retrospective cohort study with a descriptive research design. Eighty-one pregnant women with malnutrition who came to Cipto Mangunkusumo Hospital from 2017 to 2020 were included. Subject characteristic, maternal and neonatal outcome were collected from the medical record.
 Result : Some of our subjects had moderate (26%) and severe (16%) malnutrition before pregnancy. The average weight gain is 8.78 kg, lower than the recommendation. The results of this study showed a high incidence of anemia (51,9%) and perinatal maternal complications (54,4%). The neonatal outcome showed a high incidence of congenital defects and hyaline membrane disease (p = 0.031) and NICU care (p = 0.001). The incidence of hyaline membrane disease and congenital defects is 15(18,5%) and 5(6.1%) in this study.
 Conclusion : Chronic energy deficiency in pregnancy could lead to significant maternal and neonatal complications.
 Keywords: Maternal malnutrition, chronic energy deficiency, maternal outcome, neonatal outcomes.

Predictors of Mortality in Neonatal Shock: A Retrospective Cohort Study.

To study the incidence, clinical profile, and predictors of mortality in neonatal shock. We enrolled consecutive inborn neonates, who developed shock during hospital stay (between January 1, 2018 to December 31, 2019) at a tertiary-care, research center of northern India. We retrieved the clinical data from our electronic database, case record files, nursing charts, and laboratory investigations from the hospital's Health Information System. Non-survivors were compared with survivors to identify independent predictors of mortality. We had 3,271 neonatal admissions during the study period. We recorded 415 episodes of neonatal shock in 392 neonates [incidence 12.0% (95% confidence interval: 10.9%-13.2%)]. Of 415 episodes, 237 (57%) episodes were identified as septic shock, 67 (16%) episodes as cardiogenic shock, and six (1.4%) episodes as obstructive shock. Remaining 105 (25%) episodes were contributed by more than one etiology of shock. There were 242 non-survivors among 392 neonates with shock (case fatality rate: 62%). On univariate analysis, gestational age, birth weight, incidence of hyaline membrane disease, early-onset sepsis, Acinetobacter sepsis, and cardiogenic shock were significantly different between survivors and non-survivors. Female gender and small for gestational age (SGA) neonates showed a trend of significance. On multivariable regression analysis, we found gestational age, SGA neonates, female gender, and Acinetobacter sepsis to have an independent association with mortality. Septic shock was the commonest cause of neonatal shock at our center. Neonatal shock had very high case fatality rate. Gestational age, SGA, female gender, and Acinetobacter sepsis independently predicted mortality in neonatal shock.

A Clinical Study of Obstetrical and Perinatal Outcome In Teenage Pregnancies In Central Referral Hospital (CRH), Gangtok

Background: Teenage pregnancy can be defined as pregnancy that occurs after menarche up to the age of 19 years. It is one of the important causes of maternal as well as neonatal morbidity and mortality. There is an increased incidence of preterm deliveries in teenage girls with its associated complications in newborn such as increased incidence of hyaline membrane disease in newborn baby, anaemia of prematurity, neonatal hypoglycaemia, hyperbilirubinemia and need for neonatal intensive care unit admissions.
 Aims and Objectives: 1.To assess the quantum of problem of teenage pregnancy. 2. To ascertain the different risk factors associated with teenage pregnancy. 3. To evaluate outcome of pregnancy in teenage mothers. 4. Todetermine the extent and association of teenage pregnancy with poor obstetric outcome.
 Materials and Methods: It was a hospital based prospective case control study. All teenage pregnant patients who were admitted during the study period were included in the study and a representative group of equal number of non-teenage pregnant women who were admitted during the study period were included in the study. For statistical purposes p value less than 0.05 was taken as statistically significant.
 Results: The most common single complication in teenage pregnancies was found to be preterm deliveries which was seen in 15 (12%) patients followed by fetal distress (10.40%) Pre-Eclampsia (6.40%) and PROM (4.80%). Amongst non-teenage pregnancies the common complications seen were fetal distress (17.60%), PROM (8.80%). The incidence of PPH was found to be high in teenage pregnancies as compared to non-teenage pregnancies. The comparison of the neonates on the basis of incidence of low birth weight (LBW) showed that more LBW babies were born to teenage mother as compared to non-teenage pregnancies and the difference was found to be statistically significant (P<0.05).
 Conclusion: Teenage pregnancy is associated with increased incidence of maternal as well as neonatal complications. In additions to maternal and neonatal complications it also has an immense impact on psychosocial consequences on teenage mothers.

The burden of hyaline membrane disease, mortality and its determinant factors among preterm neonates admitted at Debre Tabor General Hospital, North Central Ethiopia: A retrospective follow up study.

BackgroundHyaline membrane disease (HMD) is a leading cause of morbidity and mortality in preterm newborn babies. Though, there are studies related to Hyaline membrane disease inclusive of all neonates, studies related to the burden among preterm neonates were limited. In addition, increasing neonatal mortality in Ethiopia could be related to increase in the burden of hyaline membrane disease among preterm neonates. Therefore, this study was aimed to assess the burden of hyaline membrane disease, mortality and its associated factors among preterm neonate admitted at neonatal intensive care unit, North Central Ethiopia.MethodologyAn institution-based retrospective follow-up study was conducted among 535 preterm neonates admitted at neonatal intensive care unit from January 1, 2014-December 30, 2017. Data were entered into EPi-data 4.2.0.0 and transferred to STATA version 14 statistical software for statistical analysis. Binary logistic regression was used for the analysis. All variables with P-value < 0.25 during bi-variable analysis were considered for multivariable logistic regression. Level of statistical significance was declared at P value ≤0.05.ResultsIn the current study, proportion of hyaline membrane disease was 40% (95% CI; 35.8, 44.3) of which 49.5% died. Preterm neonate born with Gestational age of less than 34 weeks of age (Adjusted odd ratio (AOR = 2.64; 95 CI: 1.49, 4.66)), 5th minute Apgar score less than 7 (AOR = 2.2; 95% CI: 1.20, 4.07), and newborn with birth weight of less than 1500 gram (AOR = 2.4, 95% CI: 1.3, 4.3) were predictors of hyaline membrane disease.ConclusionsThe mean gestational age (±) was 33.46 (±2.55) weeks. The incidence of hyaline membrane disease among preterm admissions was high. Preterm neonate born with gestational age of less than 34 weeks of age, asphyxiated newborns and newborn with birth weight of less than 1500 gram were predictors of hyaline membrane disease. So, emphasis should be given on early screening, follow up and timely interventions for preterm neonate.

Frequency of hyaline membrane disease in preterm infants after prenatal corticosteroid prophylaxis

Premature birth is a serious medical, social and economic problem. Its consequences are multiple health complications leading to high neonatal mortality worldwide. Respiratory insufficiency and surfactant deficiency significantly increase the risk of developing Hyaline Membrane Disease (HMD) and other forms of Respiratory Distress (RDS). These are the most common causes of death in premature babies. In prenatal and neonatal medicine, new and adaptive prophylaxis is being implemented to reduce the risk of death of premature babies and reduce the development of health complications. The goal of effective corticosteroid prophylaxis is to reduce mortality, reduce complications in prenatal new-borns, and shorten their stay in neonatal and intensive units respectively. A retrospective study of 167 preterm infants was conducted, of which 89 (53.3%) had prophylaxis with dexamethasone. In 25 (15%) of preterm infants, there was a Hyaline Membrane Disease (HMD) and 101 (60.5%) developed other forms of Respiratory Distress Syndrome (RDS). The results obtained show that the incidence of HMD in preterm infants is mediated by the early gestational age and advanced age of the mother, and decreased by corticosteroid therapy.

Relationship Between Incidence of Hyaline Membrane Disease and Maternal Hypertension During Pregnancy

There have been controversies over the eiTect of hypertension in pregnancy on the incidence of type I neonatal respiratory distress syndrome or hyaline membrane disease (HMD). We investigated the relationship between the incidence of HMD and maternal hypertension during pregnancy in 91 infants at 34 weeks gestation or less. This retrospective cross sectional study included all live born babies between May 1, 1994 and April 30, 1995 at Dr. Hasan Sadikin General Hospital, Bandung. Maternal hypertension during pregnancy was diagnosed in 38 mothers of91 infants studied. The incidence of HMD (5%) in the maternal hypertension during pregnancy group was significantly lower than the 62% in the normotensive group (p&lt;0.01). There was a negative correlation between the occurence of HMD and hypertension during pregnancy. We conclude that the risk of developing HMD in infants born to hypertensive mothers is significantly lower than those born to normotensive mothers.

Effect of gender and gestational age on short term morbidities and mortality in extremely low birth neonates

Background: The Aim of this study was to see the effect of gender and gestational age on early morbidities and mortalities of extremely low birth weight neonates.Methods: It was cross section retrospective. This retrospective study over a period of 5 years from June 2009 to May 2014 in a tertiary level teaching hospital. All the ELBW neonates admitted during the study period were recruited. Moving in a retrospective manner we collected previous case records relevant to our study from the institute and then categorized our data on the basis of gestational age and gender, then we compared and analysed our data on the basis of incidence of mortalities and morbidities and the effect of gender and gestational age on it.Results: Out of 115 ELBW neonates 61(53%) were born at ≤ 28 weeks, 26 (22%) were born between 29 to 31 weeks and 28(24%) babies were born at 32 to 37 weeks. The most common maternal risk factors responsible for ELBW deliveries were Pregnancy induced hypertension 27 (23%) followed by premature rupture of membranes 20 (17%). Out of short term outcomes HMD (66%), Apnea (71%), hyperbilirubinemia (53%) and sepsis (54.7%) were most common comorbidities. There was no effect of gender on any short-term morbidity and mortality of ELBW newborns. There was a significant higher incidence of hyaline membrane disease, hypoglycemia and neonatal sepsis in ELBW neonates born before 28 weeks of gestational age as compared to born after 28 weeks. 50% of the neonates survived below 28 weeks of gestation.Conclusions: Our study shows the high incidence of short-term neonatal morbidities. ELBW neonates born before 28 weeks of gestation had higher morbidity.

Perinatal Outcome in Relation to Chorionicity in Twin Pregnancy

The incidence of multiple gestations is increasing worldwide and many studies have shown higher perinatal morbidity and mortality rates in monochorionic twins compared to dichorionic. The aim of this study was to assess the twin population born at a tertiary center and to evaluate the impact of chorionicity on perinatal outcomes of twin pregnancies. Retrospective study of all twins born in a tertiary center from January 2004 to December 2013. In this period, 1051 twins were born, related to 540 gestations (26.7% monochorionic; 73.3% dichorionic). There was no statistical significant difference between the groups concerning obstetric complications. The monochorionic group had a higher incidence of intrauterine growth restriction (20.5 vs 11.3%, p < 0.001), lower mean maternal age (29.9 vs 31.9 years, p < 0.001), lower mean gestational age (33.4 vs 34.3 weeks, p < 0.05) and lower mean birth weight (1943 vs 2147 g, p < 0.001). Monochorionic twins had a higher incidence of hyaline membrane disease (7 vs 4%, p < 0.05), sepsis (10.3 vs 5.8%, p < 0.05) and anemia (9.5 vs 5.4%, p < 0.05). There were no statistical significant differences concerning necrotizing enterocolitis, intraperiventricular hemorrhage or retinopathy of prematurity. Perinatal mortality was higher in the monochorionic group (5.2 vs 2.9%, p < 0.05). Monochorionic twins represent considerable challenges to both obstetricians and neonatologists and should be monitored and delivered at tertiary centers. Currently gemelarity has a major impact on total births. It would be interesting to develop protocols to standardize clinical approach to twins.

Chorionicity and perinatal complications in twin pregnancy: a 10 years case series

OVERVIEW AND AIMS: Multiple pregnancy accounts for about 3% of all pregnancies. The monochorionic pregnancy presents a relatively constant incidence (1:250 pregnancies) unlike the dichorionic, which is influenced by race, heredity, maternal age, parity and medically assisted procreation. The purpose of this work was to evaluate the impact of chorionicity on perinatal morbidity of twin pregnancy. Retrospective, longitudinal, descriptive and analytical study of women with twin pregnancy whose birth occurred in our maternity hospital since January/1999 until December/2008. monochorionic and dichorionic twin pregnancies confirmed by ultrasound. monochorionic monoamniotic gestation. Demographic data, delivery variables and perinatal morbidity and mortality were studied. Data were evaluated using the χ2 test (qualitative variables), t-Student (continuous quantitative variables) and Mann-Whitney test (quantitative discrete variables). We studied 504 pregnancies (356 dichorionic diamniotic and 148 monochorionic diamniotic). The monochorionic pregnancy had a higher incidence of threatened preterm labor (43,9% vs 31,5%, p<0,05), of oligohydramnios/hydramnios (9,8% vs 3,3%, p<0,001), discordant fetal growth (26,8% vs 14,8%, p<0,001) and intrauterine growth restriction (7,4% vs 3,7%, p<0,05). Prematurity was more common in the monochorionic group (p<0,001). The cesarean delivery rate was higher in monochorionic pregnancy (58,8% vs 50,3%, p<0,05) and the average weight of newborns was lower in monochorionic pregnancies (1983g vs 2233g, p<0,001). Newborns in the monochorionic group had higher incidence of hyaline membrane disease (5,8% vs 2,8%, p<0,05) and intraventricular haemorrhage (2,1% vs 0,4%, p<0,05). The perinatal mortality was higher in the monochorionic group (7,8% vs 1,8%, p<0,001). As the morbidity and mortality associated with monochorionic pregnancies are higher, it is essential to perform an early detection of chorionicity by ultrasound (11-13 weeks) in order to place differentiated prenatal and appropriate peripartum surveillance.

Uso antenatal do corticosteroide e hemorragia peri-intraventricular

OBJETIVO: Realizar uma revisão bibliográfica sobre o uso antenatal do corticosteroide na prevenção da hemorragia peri-intraventricular. FONTES DE DADOS: Levantamento bibliográfico por meio do Pubmed e SciELO abrangendo os últimos 20 anos. Foram utilizadas as palavras chaves no idioma inglês: "cerebral hemorrhage", "steroids" e "newborn, infant". SÍNTESES DE DADOS: A hemorragia peri-intraventricular é uma importante patologia nos prematuros, sobretudo nos menores de 34 semanas, devido a suas graves sequelas neurológicas. Uma vez ocorrido o sangramento, não há tratamento específico. Desta forma, a prevenção torna-se o maior objetivo das pesquisas. O resultado da meta-análise de estudos randomizados demonstrou que o corticosteroide antenatal reduz a mortalidade e a incidência da doença de membrana hialina e da hemorragia peri-intraventricular. O efeito protetor na redução do risco da hemorragia peri-intraventricular não está completamente esclarecido. Além de acelerar a maturidade pulmonar, o corticosteroide antenatal estimula a maturação da microvasculatura da matriz germinativa, promove o espessamento da membrana basal, acelera a formação proteica nas junções firmes e estabiliza o fluxo sanguíneo cerebral. Também melhora as condições de nascimento dos fetos pré-termo. CONCLUSÕES: O uso antenatal do corticosteroide associado à implementação de melhores práticas de atendimento ao prematuro tem sido responsável pela evidente redução dos índices dessa doença. Apesar de comprovada eficácia e segurança, não é amplamente utilizado. Medidas devem ser tomadas para estimular seu uso como prática rotineira no atendimento de gestantes com risco de parto prematuro.

Impact of Cesarean Section on Intermediate and Late Preterm Births: United States, 2000–2003

Cesarean section appears to be associated with increased risk of neonatal mortality among infants of low-risk term pregnancies, but it may offer some survival advantage among the most extremely preterm infants. The impact on intermediate (32-33 wk) and late preterm (34-36 wk) deliveries remains uncertain. The objective of this analysis was to compare the neonatal mortality rate (death at 0-27 days), the mechanical ventilation usage rate, and the incidence of hyaline membrane disease among intermediate and late preterm infants delivered by primary cesarean section compared with those delivered vaginally. United States Linked Birth and Infant Death Certificate files from the years 2000 to 2003 were used. Maternal demographic characteristics, medical complications, and labor and delivery complications were abstracted from the files along with infant information. Because of concern for misclassification of gestational age, a procedure was used to trim away births in which the birthweight of an infant for a specific gestational age was inconsistent. Adjusted odds ratios were calculated using logistic regression for the risk of the three outcomes of interest relative to the mode of delivery. A total of 422,001 live births were available with complete data from the trimmed data set (60% of untrimmed data). After adjustment by logistic regression for infant size at birth, birthweight, sex, Apgar score at 5 minutes less than 4, multiple births, breech presentation, presence of an anomaly, the presence of any maternal medical condition or complication of labor and delivery, labor induction, maternal race, age, education, and gravidity, the adjusted odds ratios (95% CI for neonatal mortality at gestational ages of 32, 33, 34, 35, and 36 wk) were, respectively, 1.69 (1.31-2.20), 1.79 (1.40-2.29), 1.08 (0.83-1.40), 2.31 (1.78-3.00), and 1.98 (1.50-2.62). These data suggest that for low-risk preterm infants at 32 to 36 weeks' gestation, independent of any reported risk factors, primary cesarean section may pose an increased risk of neonatal mortality and morbidity.

Amniotic fluid concentration of surfactant proteins in intra-amniotic infection

Objective. Pulmonary surfactant is a complex molecule of lipids and proteins synthesized and secreted by type II alveolar cells into the alveolar epithelial lining. Both lipid and protein components are essential for lung function in postnatal life. Infection is a well-established cause of preterm delivery, and several inflammatory cytokines play a role in the mechanisms of preterm parturition. An increased concentration of inflammatory cytokines in amniotic fluid or fetal plasma has been linked to the onset of preterm parturition and fetal/neonatal injury, including cerebral palsy and chronic lung disease. Experimental evidence indicates that inflammatory mediators also regulate surfactant protein synthesis, and histologic chorioamnionitis is associated with a decreased incidence of hyaline membrane disease in neonates. This study was conducted to determine if amniotic fluid concentrations of surfactant protein (SP)-A, SP-B, and SP-D change in patients with and without intra-amniotic infection (IAI).Materials and methods. A case–control study was conducted to determine amniotic fluid concentrations of SP-A, SP-B, SP-D, and total protein in patients who had an amniocentesis performed between 18 and 34 weeks of gestation for the detection of IAI in patients with spontaneous preterm labor with intact membranes (n = 42) and cervical insufficiency prior to the application of cerclage (n = 6). Amniotic fluid samples were selected from a bank of biological specimens and included patients with (n = 16) and without (n = 32) IAI matched for gestational age at amniocentesis. Intra-amniotic infection was defined as a positive amniotic fluid culture for microorganisms. Each group was further subdivided according to a history of corticosteroid administration within 7 days prior to amniocentesis into the following subgroups: (1) patients without IAI who had received antenatal corticosteroids (n = 21), (2) patients with IAI who had received antenatal corticosteroids (n = 9), (3) patients without IAI who had not received antenatal corticosteroids (n = 11), and (4) patients with IAI who had not received antenatal corticosteroids (n = 7). Amniotic fluid was obtained by transabdominal amniocentesis. SP-A, SP-B, and SP-D concentrations in amniotic fluid were determined by enzyme-linked immunosorbent assay (ELISA). Non-parametric statistics were used for analysis.Results. Women with IAI had a higher median amniotic fluid concentration of SP-B and of SP-B/total protein, but not other SPs, than those without IAI (both p = 0.03). Among patients who had received antenatal corticosteroids, the median amniotic fluid concentration of SP-B and of SP-B/total protein was significantly higher in patients with IAI than in those without IAI (SP-B, IAI: median 148 ng/mL, range 37.3–809 ng/mL vs. without IAI: median 7.2 ng/mL, range 0–1035 ng/mL; p = 0.005 and SP-B/total protein, IAI: median 14.1 ng/mg, range 4.3–237.5 ng/mg vs. without IAI: median 1.45 ng/mg, range 0–79.5 ng/mg; p = 0.003). Among women who had not received antenatal corticosteroids, the median amniotic fluid concentrations of SP-B and of SP-B/total protein were not significantly different between patients with and without IAI (SP-B, IAI: median 4 ng/mL, range 0–31.4 ng/mL vs. without IAI: median 3.4 ng/mL, range 0–37 ng/mL; p = 0.8 and SP-B/total protein, IAI: median 0.55 ng/mg, range 0–6.96 ng/mg vs. without IAI: median 0.59 ng/mg, range 0–3.28 ng/mg; p = 0.9). The median amniotic fluid concentrations of SP-A, SP-A/total protein, SP-D, and SP-D/total protein were not significantly different between patients with and without IAI whether they received antenatal corticosteroids or not (all p > 0.05).Conclusions. IAI was associated with an increased amniotic fluid concentration of SP-B in patients who received antenatal corticosteroids within 7 days prior to amniocentesis.

The association between hyaline membrane disease and preeclampsia

The purpose of this study was to determine whether hyaline membrane disease is increased in newborn infants who are born to women with preeclampsia compared with control subjects. This was a historic cohort study of deliveries between 24 and 37 weeks of gestation at the Medical University of South Carolina from 1996 through 2002. Singleton infants who were born to women with preeclampsia were compared with nonpreeclamptic control subjects. The incidence of hyaline membrane disease was compared by chi 2 analysis and Fisher exact test, with significance at a probability value of <.05. Logistic regression analysis was performed to address potential confounders. There were 814 women with preeclampsia and 3021 control subjects. When we controlled for confounding factors, there was a significant increase in the incidence of hyaline membrane disease in the preeclamptic group overall (odds ratio, 1.35; 95% CI, 1.03-1.78). The risk was more pronounced in neonates who were born at 32 weeks of gestation (odds ratio, 1.93; 95% CI, 1.28-2.91). The risk of hyaline membrane disease in neonates at < 32 weeks of gestation is increased in patients with preeclampsia. This supports the contention that fetal lung maturity is not accelerated in preeclampsia.

Is the incidence of hyaline membrane disease increased in the newborns of patients with preeclampsia?

MORBIDITY ALICE GOEPFERT, WILLIAM ANDREWS, PATRICK RAMSEY, JOSEPH BIGGIO, JR, WALDEMAR CARLO, JOHN HAUTH, SUZANNE CLIVER, ROBERT GOLDENBERG, University of Alabama at Birmingham, Obstetrics & Gynecology, Birmingham, AL University of Alabama at Birmingham, Pediatrics, Birmingham, AL OBJECTIVE: To determine the cord IL-6 levels that best predict neonatal morbidity in infants born at 90%. Adjusting for GA, the odds ratio for each morbidity by IL-6 level was determined. SIRS, PVL, and NEC were associated with cord IL-6 levels. A dose response was noted between rising IL-6 levels and SIRS (OR 5, 9, 18, 25 for each category; all P 90%) levels of IL-6 were associated with PVL (OR 15, 95% CI 2-149) and NEC (OR 6, 95% CI 1.1-33).

Evaluación de la enfermedad de membrana hialina en recien nacidos

Para valorar la incidencia de la enfermedad de membrana hialina (EMH), caracterizar la población de riesgo, evaluar el tratamiento instaurado y las complicaciones más frecuentes en recien nacidos, se realizó un estudio retrospectivo descrip­tivo en los pacientes que ingresaron a la Unidad de Cuidado lntensivo Neonatal (UCIN) del Hospital de San Jose. Se incluyeron todos los pacientes en los cuales se diagnosticó clínica y paraclínicamente EMH, quienes fueron distribuidos en cuatro grupos seg(rn el peso. Los datos recopilados mostraron una mayor incidencia de EMH en los menores de 1.000 g (63%), en comparación con los mayores de 1.500 g (5%). La complicación encontrada con mayor frecuencia fue la enfermedad pulmonar crónica del recien nacido(24%), seguida del neumotorax (21 %). En el estudio, la mortalidad fue de (33,5%), la cual es mayor a la reportada en la literatura mundial, posiblemente secundaria a la alta incidencia de complicaciones, sobre todo en los pacientes menores de 1.000 g. Finalmente se plantean estrategias de manejo para disminuir la morbimortalidad de los pacientes con EMH.

Outcome of very premature infants with necrotising enterocolitis cared for in centres with or without on site surgical facilities

OBJECTIVETo determine if the presence of a neonatal surgical facility on site has any effect on mortality and morbidity of very premature infants with necrotising enterocolitis (NEC).DESIGN AND SETTINGRetrospective review...

Pregnancy-induced hypertension and hyaline membrane disease

Objectives: (1) To determine whether the incidence of hyaline membrane disease (HMD) is different among premature babies of pre-eclamptic women and those of normotensive controls; (2) to determine the relative risk (RR) of HMD according to the severity of pre-eclampsia and gestational age. Methods: A retrospective and prospective cohort of 271 pre-eclamptic women and 271 normotensive controls, with gestational age between 28 and 34 weeks was studied, including only singleton pregnancies, live fetuses and well-documented gestational age. Exclusion criteria were ruptured membranes > 24 h, other maternal diseases and previous use of corticosteroids. Statistical analysis included relative risk and multiple logistic regression model. Results: The RR of HMD for babies of pre-eclamptic women was 0.96 (95% CI: 0.78–1.17), and remained unchanged after controlling for gestational age and multiple logistic regression analysis. Conclusion: Preterm babies of pre-eclamptic mothers had the same probability of having HMD as newborns of normotensive mothers.

Why Do Some Premature Babies with a Germinal Matrix Hemorrhage (GMH) Develop a Severe Intraventricular Hemorrhage (IVH) While Others Do Not? 818

It is not clear why some premature babies who develop a GMH have an associated severe (S) IVH while others have only a GMH or minor (M) IVH. We reviewed the courses of 103 babies who developed a GMH within 7 postnatal days who were born with a gestational age (GA) of 23-32 wks from 1990-1995. Important differences between babies having only a GMH and those with an associated IVH included the following: Table There were no differences in gender distribution or the incidence of hyaline membrane disease requiring surfactant, prenatal steroids, or complications of prematurity. Clearly babies with an associated IVH were smaller, younger, and sicker. We then compared babies who had a GMH and M-IVH with those who had a GMH and S-IVH. Table

Hyaline membrane disease in black newborns: does fetal lung maturation occur earlier?

Debate has developed among several authors about possible accelerated maturation of black fetuses in comparison with whites. In Guadeloupe, French West Indies, where 85% of the population is of black African-American origin, it has been noted that the incidence of hyaline membrane disease (HMD) represents a significant drop beginning after the 32nd week of gestation. Over a 3-year period, 419 black low-birthweight singleton newborns were admitted in the University Hospital's Neonatal Department covering 70% of all births of the island. The incidence of HMD was 50% among very low birthweight (< 1500 g) and 8.3% among moderate low birthweight (≥ 1500 g; P < 0.001). The incidence of HMD was 48.8% among the very preterm (< 32 weeks) and 7.8% ( 26 331 ) among the moderate preterm (≥32 weeks; P < 0.001). These differences were similar for appropriate for gestational age and small for gestational age infants. Significant differences remained after controlling for several maternal risk factors. These results suggest that the 32nd week of gestation represents a significant drop in the risk for respiratory distress syndrome in black premature compared with that reported in literature on European infants (34th week) and therefore may implicate different obstetrical decisions in the management of critical pregnancies in this population.

Hyaline membrane disease: The role of ethnicity and maternal risk characteristics

Our objective was to explore the association between maternal ethnicity and maternal antepartum complications of pregnancy, maternal sociodemographic factors, and newborn characteristics with the incidence of hyaline membrane disease. By using a retrospective cohort analysis the incidence of hyaline membrane disease was determined for 2295 preterm infants. The study population consisted of all live, inborn infants delivered vaginally from 1982 to 1987. Statistical differences were assessed by use of chi 2 and Student's t tests. A logistic regression procedure determined the relationship of ethnicity and hyaline membrane disease after the study was controlled for all other significant population differences. The differences between black and white populations in marital status, were statistically significant years of education, prolonged rupture of membranes, anemia, and chronic hypertension were statistically significant. Infants of black mothers were diagnosed with hyaline membrane disease less often than infants of white mothers (overall and at each gestational age interval). After the study was controlled for population differences, infants of black mothers were still found to experience hyaline membrane disease less often. These data suggest that hyaline membrane disease occurs less frequently, is less severe, and is accompanied by fewer related complications in black preterm infants.