Incidence Of Neonatal Morbidity Research Articles

Prevention of Spontaneous Premature Birth With Cervical Pessary: A Single-Center Prospective Cohort Study

To study and compare the clinical effects of cervical pessary and progesterone for preventing preterm birth in singleton pregnant women with a short cervical length (CL). This study was a prospective cohort study. A total of 148 pregnant women with CL≤25 mm, as determined by ultrasound examination performed before 28 weeks of pregnancy, were included in the study. All subjects were admitted to West China Second Hospital, Sichuan University between August 2020 and December 2022. According to their treatment plans, the pregnant women were divided into a cervical pessary group (n=55) and a progesterone group (n=93). Spontaneous preterm birth before 37 weeks of pregnancy was defined as the main outcome index. Preterm birth (abortion) or spontaneous preterm birth (abortion) before 37, 34, 32, 30, and 28 weeks of pregnancy, mean extended gestational age, neonatal morbidity, and neonatal mortality were the secondary outcome indicators. The pregnancy outcomes and the neonatal outcomes of the two groups were compared and statistically analyzed. There was no statistically significant difference in the incidence of preterm birth (including iatrogenic preterm birth, spontaneous preterm birth, and abortion) before 37, 34, 32, 30, and 28 weeks between the cervical pessary group and the progesterone group. When iatrogenic preterm birth was excluded, the incidence of spontaneous preterm birth before 37 weeks was lower in the cervical pessary group (23.6%) than that in the progesterone group (41.9%), with the difference between the two groups being statistically significant (P=0.024). There was no statistically significant difference in the incidence of spontaneous preterm birth (including miscarriage) before 34, 32, 30, and 28 weeks. There was no statistically significant difference in the incidence of neonatal morbidity, the rate of transfer to the neonatal care unit after birth, and the neonatal mortality rate between the two groups. Multivariate logistic analysis showed that treatment with cervical pessary was a protective factor for spontaneous preterm birth before 37 weeks compared to progesterone therapy. Using cervical pessary to prevent spontaneous preterm birth in singleton pregnant women with a short cervical length in the second trimester can significantly reduce the incidence of spontaneous preterm birth before 37 weeks.

Incidence of neonatal morbidity in small-for-gestational-age twins based on singleton and twin charts.

To compare morbidity, as measured by length of stay in the neonatal intensive care unit (NICU), in twin and singleton gestations classified as small-for-gestational age (SGA) according to estimated fetal weight < 10th percentile on twin or singleton growth charts. NICU length of stay was compared in 1150 twins and 29 035 singletons that underwent ultrasound assessment between 35 + 0 and 36 + 6 weeks' gestation. Estimated fetal weight was obtained from measurements of head circumference, abdominal circumference and femur length using the Hadlock formula. Gestational age was derived from the first-trimester crown-rump length measurement, using the larger of the two twins. Singletons and twins were compared in terms of NICU admission rate and length of stay according to classification as SGA by the Fetal Medicine Foundation singleton and twin reference distributions. The overall proportions of twins and singletons admitted to NICU were similar (7.3% vs 7.4%), but twins tended to have longer lengths of stay in NICU (≥ 7 days: 2.4% vs 0.8%; relative risk (RR), 3.0 (95% CI, 1.6-4.4)). Using the singleton chart, a higher proportion of twins were classified as SGA compared with singletons (37.6% vs 7.0%). However, the proportion of SGA neonates entering NICU was similar (10.2% for twins and 10.1% for singletons) and the proportion of SGA neonates spending ≥ 7 days in NICU was substantially higher for twins compared with singletons (3.7% vs 1.4%; RR, 2.6 (95% CI, 1.4-4.7)). When singleton charts are used to define SGA in twins and in singletons, there is a greater degree of growth-related neonatal morbidity amongst SGA twins compared with SGA singletons. Consequently, singleton charts do not inappropriately overdiagnose fetal growth restriction in twins and they should be used for monitoring fetal growth in both twins and singletons. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Maternal and Neonatal Morbidities by Race in College-Educated Women.

Objective Non-Hispanic black and Hispanic women experience significantly higher adverse maternal and neonatal outcomes compared with non-Hispanic white women. The purpose of this study is to explore whether disparities in obstetric outcomes exist by race among women who are college-educated. Study Design This is a retrospective cohort study from a multicenter observational cohort of women undergoing cesarean delivery. Women were defined as "college-educated" if they reported completion of a 4-year college degree. Race/ethnicity was categorized as non-Hispanic white, non-Hispanic black, Hispanic, Asian, Native American, or unknown. The primary outcome was a composite of maternal morbidity, and a composite of neonatal morbidity was evaluated as a secondary outcome. A multivariable logistic regression model was then utilized to assess associations of race with the primary and secondary outcomes. Results A total of 2,540 women were included in the study. After adjusting for potential confounding variables, maternal morbidity was found to be significantly higher for college-educated non-Hispanic black women compared with non-Hispanic white women (odds ratio [OR] 1.77, 95% confidence interval [CI] 1.12-2.80). The incidence of neonatal morbidity was significantly higher for non-Hispanic black (OR 1.91, 95% CI 1.31-2.79) and Hispanic (OR 3.34, 95% CI 2.23-5.01) women. Conclusion In this cohort, the odds of cesarean-related maternal and neonatal morbidities were significantly higher for college-educated non-Hispanic black women, compared with their non-Hispanic white counterparts. This demonstrates that even among women with higher level education, racial and ethnic disparities persist in obstetric outcomes.

EVALUATION OF NEONATAL MORBIDITY IN PRETERM BIRTH INFANTS

This study was designed to evaluate neonatal morbidities in late preterm births (38 weeks). A retrospective study was carried out in the hospital's Paediatrics &amp; Gynecology and Obstetrics department from May 2022- May 2023. A total of 100 late preterm infants that were born alive and normal-term infants were selected for the final analysis. Patients were categorized into two groups; Group A consisted of late preterm infants, and Group B included normal-term infants. The data regarding mode of birth, presence of sepsis, APGAR score, jaundice, hypoglycemia, and weight loss was recorded in all infants. In group A, were more male patients than female patients (40 vs 10). In group B, the number of male and female patients was almost equal (26 vs 24). The difference in morbidities of both groups was significant (p&lt;0.05). The incidence of neonatal morbidities was greater in the late preterm group except for hypoglycemia which was observed in more patients in normal-term infants (8% vs. 10%). The APGAR score in the preterm group was less than in the normal term group at 1 minute (7.28 vs. 7.92) (p=0.69) and at 5 minutes (8.38 vs. 8.65) (p=0.92). Neonatal morbidities like respiratory diseases, jaundice, hypoglycemia, sepsis, and weight loss of more than 10% are common in late preterm infants.

Comparative study of oral and vaginal natural micronized progesterone 300mg in preventing preterm labor in semi urban population

Preterm deliveries is the major contributors of neonatal mortalities and under 5 age group morbidities. Excessive use of Progesterone and its supplements, antenatal steroidal cover and tocolysis prevents this. In this study, there has been made an attempt to study the perinatal outcome of both mother and neonate revolving around premature deliveries by using two different routes for progesterone administration. A prospective study was done on randomly selected 300 patients who complained of pain abdomen after 24 weeks of pregnancy, and were followed up till delivery after administration of progesterone, after dividing into 2 separate groups. This leads to collection of data for interpretation of association of variation in various parameters with relation to use of different routes for micronized progesterone. When compared, users of Oral micronized progesterone (OMP) presented at 31.37±1.94 weeks for delivery and that of Vaginal micronized progesterone (VMP) presented at 33.49±2.49 weeks of gestation. 78.7% neonates of Oral group were asymptomatic at birth than those 90.7% of vaginal neonates. Incidence of neonatal morbidity, like signs of birth asphyxia (16.7% vs 3.3%), mean APGAR Score of 1 min (7.77±2.11 vs. 8.07±1.63), mean birth weight (2.89±0.67 vs. 3.19±0.61), NICU admission (13.3% vs 3.3%) were found to be higher in Oral group than Vaginal group. Administration of Vaginal micronized progesterone helps in reduction of preterm labor and the rate of neonatal NICU admissions, neonatal mortality and morbidity as compared to oral micronized progesterone. Vaginal progesterone surpasses the first pass metabolism explaining the better outcome of the vaginal in preventing preterm labor.

Effectiveness of Kangaroo Mother Care in Reducing Morbidity and Mortality among Preterm Neonates on Nasal Continuous Positive Airway Pressure: A Randomized Controlled Trial

Background. Prematurity is a major cause of neonatal death. Continuous positive airway pressure (CPAP) is the recognized initial intervention among preterm neonates in respiratory distress. Kangaroo mother care (KMC) may help improve neonatal outcomes.&#x0D; Objective. To determine the effectiveness of KMC in reducing morbidity and mortality among preterm neonates on CPAP via RAM nasal cannula (nCPAP).&#x0D; Methods. A prospective, non-blinded, randomized controlled trial was conducted on eligible preterm neonates requiring nCPAP due to respiratory distress. They were randomly allocated to either KMC (n=35) or conventional care groups (n=35). Outcome measures included duration of nCPAP and oxygen support, physiologic parameters, morbidity, mortality, and length of hospital stay.&#x0D; Results. The durations of nCPAP and oxygen support were both significantly shorter in the KMC group. Morbidities (air leak syndrome, necrotizing enterocolitis, and late-onset sepsis) were also significantly lower in the KMC group. Although the mortality rate and the hospital stay were lower in the KMC group, these were not statistically significant.&#x0D; Conclusion. KMC effectively decreased the duration of nCPAP and oxygen support, as well as the incidence of neonatal morbidities. There were trends towards reduced mortality and length of hospital stay in the neonates who received KMC.

Amino acid infusions in umbilical artery catheters enhance protein administration in infants born at extremely low gestational age.

It is challenging to provide extremely low gestational age neonates (ELGANs) with adequate protein supply. This study aimed to investigate whether amino acid (AA) infusion in the umbilical artery catheter (UAC) in ELGANs is safe and enhances protein supply and growth. A before and after study including infants born <27weeks, treated in Uppsala, Sweden, during 2004-2007, compared those receiving normal saline/10% dextrose in water with those receiving AA infusion in the UAC. Data were retrieved from the Extremely Preterm Infants in Sweden Study, hospital records and the Swedish Neonatal Quality Register. Group comparisons, univariate and multivariate analyses were conducted. AA group (n = 41, females 39%) received on average approximately 0.3g/kg/day more protein during the first postnatal week, compared to control group (n = 30, females 40%) (unstandardised coefficient (B) 0.26, p .001) but no difference was noted during 8-28 postnatal days. The type of infusion was not associated with growth variables. The incidence of neonatal morbidities and UAC-related thrombosis did not differ between the groups. AA infusions in the UACs in ELGANs is safe and enhances protein supply during the first postnatal week. However, this practice is not associated with growth during the first 28 postnatal days.

Effects of nutrition therapy on growth, inflammation and metabolism in immature infants: a study protocol of a double-blind randomized controlled trial (ImNuT)

BackgroundCurrent nutritional management of infants born very preterm results in significant deficiency of the essential fatty acids (FAs) arachidonic acid (ARA) and docosahexaenoic acid (DHA). The impact of this deficit on brain maturation and inflammation mediated neonatal morbidities are unknown. The aim of this study is to determine whether early supply of ARA and DHA improves brain maturation and neonatal outcomes in infants born before 29 weeks of gestation.MethodsInfants born at Oslo University Hospital are eligible to participate in this double-blind randomized controlled trial. Study participants are randomized to receive an enteral FA supplement of either 0.4 ml/kg MCT-oil™ (medium chain triglycerides) or 0.4 ml/kg Formulaid™ (100 mg/kg of ARA and 50 mg/kg of DHA). The FA supplement is given from the second day of life to 36 weeks’ postmenstrual age (PMA). The primary outcome is brain maturation assessed by Magnetic Resonance Imaging (MRI) at term equivalent age. Secondary outcomes include quality of growth, incidence of neonatal morbidities, cardiovascular health and neuro-development. Target sample size is 120 infants (60 per group), this will provide 80% power to detect a 0.04 difference in mean diffusivity (MD, mm2/sec) in major white matter tracts on MRI.DiscussionSupplementation of ARA and DHA has the potential to improve brain maturation and reduce inflammation related diseases. This study is expected to provide valuable information for future nutritional guidelines for preterm infants.Trial registrationClinicaltrials.gov ID: NCT03555019. Registered 4 October 2018- Retrospectively registered.

Review of the ophthalmic symptoms of preeclampsia

AbstractPreeclampsia is a severe, sometimes life-threatening complication of pathological pregnancies. The incidence of neonatal morbidity and mortality is usually increased. Besides general maternal symptoms like hemolysis, low platelet number, elevated liver enzyme level, proteinuria, cardiovascular problems, neurological and cerebral complications, serious ophthalmic symptoms might occur. These include focal or generalized narrowing of the arterioles, flame-shaped retinal haemorrhages, and cotton-wool spots. Rarely, disc swelling, exudative retinal detachment, cystoid macular edema, bilateral occipital lobe infarction, or cortical blindness might occur. In this article, I review the retinal and macular changes, retinal detachment, and the cause of blindness. Optical coherence tomography (OCT) allows ophthalmologists to diagnose early and late changes in choroid vasculature and circulation, and consequent retinal morphological changes. Spectral-domain OCT and enhanced depth imaging provide important insight and possible prognosis for the course of the disease. After termination of the pathological pregnancy, vision returns to normal in most cases; unfortunately, there are some exceptions.

Clinical outcomes of fresh versus frozen embryo transfers and its influence on mid-trimester miscarriage and fetal birth weight: A retrospective study

Aim: The aim of the study was to compare the clinical outcomes of fresh and frozen embryo transfer (FET) in women undergoing assisted reproductive technology and its influence on mid-trimester miscarriage and fetal birth weight.Materials and Methods: The study was conducted between June 2016 and June 2019. The study group comprised 778 cycles, of women, who were undertaken in this retrospective analysis of in vitro fertilization cycles who underwent fresh and FET. These women were randomly divided into two groups, fresh embryo transfers (n = 410) and FETs (n = 368). Both groups were compared with their respective outcome measures such as the clinical pregnancy rates (CPRs), miscarriage rates, multiple pregnancy rates as well as live births and birth weights.Results: The mean age of the participants in fresh and FET groups was 31.13 ± 4.39 and 31.45 ± 4.25, respectively. There were statistically significant differences with respect to clinical pregnancy (P = 0.002) between the groups. Fetal miscarriage rates (30.14% vs. 23.53%) as well as birth weights were not statistically significant (P = 0.164) between fresh versus FET. The results clinically signified that the FET gives a lower miscarriage rate and higher CPRs while not affecting the average fetal birth weight.Conclusion: Adjusting the baseline characteristics and exclusion criteria of participants, women undergoing FET were associated with better clinical outcomes than women undergoing fresh ET cycles Contrary to existing literature, our incidence of neonatal morbidities, or large birth weights were not increased and fetal macrosomia did not occur. Gaining debates on the advantage of frozen over fresh transfers and its effects on obstetric and neonatal outcomes may require a large multicenter pooling of data and analyses.

Comparison of Risk Factors and Neonatal Outcomes Among Women With a Spontaneous Versus Iatrogenic Preterm Birth [24O

INTRODUCTION: While spontaneous preterm birth (sPTB) has been trending down, iatrogenic preterm birth (iPTB) has been trending up. The purpose of this study is to examine the difference in risk factors and neonatal outcomes among women with a sPTB vs iPTB to identify areas for intervention. METHODS: Retrospective cohort study from 1/2012-12/2014 of singleton pregnancies without a history of prior sPTB undergoing routine cervical length screening between 18 0/7-23 6/7 weeks. Women were included if they delivered less than 37 weeks. RESULTS: Of 3678 women screened, 200 women (5.4%) had a PTB; 114 (57%) sPTB and 86 (43%) iPTB. Women with sPTB were on average younger than those with iPTB (27.3 ±6.2 vs 29.5 ±6.4, p=0.019). Women with iPTB were more likely to have a BMI of at least 30 (39% vs 23%, p=0.021), have a hypertensive disorder of pregnancy (74% vs 9%, p &lt; 0.001), and have fetal growth restriction (14% vs 0%, p &lt; 0.001) than women with sPTB. Women with a sPTB delivered earlier, with a mean gestational age of 32.7±4.9 vs 34.1±2.7 weeks (p=0.015), and an increased incidence of delivery less than 28 weeks (17% vs 4%, p=0.003). However, infants born from an iPTB were more likely to require intensive care admission (71% vs 54%, p=0.016). The incidence of neonatal morbidity was similar. CONCLUSION: Although sPTB tends to result in an earlier gestational age of delivery, iPTB is a more significant source of neonatal intensive care admission. Maternal obesity and hypertensive disorders are major modifiable risk factors for iPTB.

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Anti-D administration in pregnancy for preventing Rhesus alloimmunisation.

During pregnancy, a Rhesus negative (Rh-negative) woman may develop antibodies when her fetus is Rhesus positive (Rh-positive). These antibodies may harm Rh-positive babies. To assess the effects of antenatal anti-D immunoglobulin on the incidence of Rhesus D alloimmunisation when given to Rh-negative women without anti-D antibodies. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2015) and reference lists of retrieved studies. Randomised trials in Rh-negative women without anti-D antibodies given anti-D after 28 weeks of pregnancy, compared with no treatment, placebo or a different regimen of anti-D. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We included two trials involving over 4500 women, comparing anti-D prophylaxis with no anti-D during pregnancy in this review. Overall, the trials were judged to be at moderate to high risk of bias. The quality of the evidence for pre-specified outcomes was also assessed using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach.In regards to primary review outcomes, there did not appear to be a clear difference in the risks of immunisation when women who received anti-D at 28 and 34 weeks' gestation were compared with women who were not given antenatal anti-D: risk ratio (RR) for incidence of Rhesus D alloimmunisation during pregnancy was 0.42 (95% confidence interval (CI) 0.15 to 1.17, two trials, 3902 women; GRADE: low quality evidence); at birth of a Rh-positive infant the RR was 0.42 (95% CI 0.15 to 1.17, two trials, 2297 women); and within 12 months after birth of a Rh-positive infant the average RR was 0.39 (95% CI 0.10 to 1.62, two trials, 2048 women; Tau²: 0.47; I²: 39%; GRADE: low quality evidence). Neither of the trials reported on incidence of Rhesus D alloimmunisation in subsequent pregnancies.Considering secondary outcomes, in one trial, women receiving anti-D during pregnancy were shown to be less likely to register a positive Kleihauer test (which detects fetal cells in maternal blood) in pregnancy (at 32 to 25 weeks) (RR 0.60, 95% CI 0.41 to 0.88; 1884 women; GRADE: low quality evidence) and at the birth of a Rh-positive infant (RR 0.60, 95% CI 0.46 to 0.79; 1189 women; GRADE: low quality evidence). No clear differences were seen for neonatal jaundice (RR 0.26, 95% CI 0.03 to 2.30; 1882 infants; GRADE: very low quality evidence). Neither of the trials reported on adverse effects associated with anti-D treatment. Existing studies do not provide conclusive evidence that the use of anti-D during pregnancy benefits either mother or baby in terms of incidence of Rhesus D alloimmunisation during the pregnancy or postpartum, or the incidence of neonatal morbidity (jaundice) (low to very low quality evidence). However women receiving anti-D may be less likely to register a positive Kleihauer test in pregnancy and at the birth of a Rh-positive infant (low quality evidence). Fewer women who receive anti-D during pregnancy may have Rhesus D antibodies in a subsequent pregnancy, with benefits for the baby, however this needs to be tested in studies of robust design.

Birth weight and gestational age on retinopathy of prematurity in discordant twins in China.

To assess the relative effect of birth weight and gestational age on retinopathy of prematurity (ROP) using preterm twin pairs discordant for birth weigh in a tertiary neonatal intensive care unit in China. Fifty-six discordant twin pairs of 112 preterm infants were retrospectively analyzed. The twin pairs were divided into two subgroups based on birth weight in each pair. The occurrence of ROP and severe ROP requiring treatment were compared between the lower birth weight infants and their co-twins with the higher birth weight. Some neonatal morbidities related to prematurity and neonatal characteristics were also compared between the twin pairs. Based on the univariate analysis, gestational age and birth weight were significantly associated with the occurrence and progression of ROP. But no significant differences in ROP between larger and smaller infants were observed in the twin-paired analysis. The incidence of neonatal morbidities regarding respiratory distress syndrome (RDS), patent ductus arteriosus (PDA), intraventricular hemorrhage (IVH), sepsis and neonatal characteristics regarding gender distribution, one- and five-minute Apgar score, postnatal steroid treatment, blood transfusion, supplemental oxygen therapy, and mechanical ventilation were not different between the twins. However, gestational age of ≤28wk was significantly associated with significantly higher rates of ROP and severe ROP. Gestational age is a better predictor of ROP than birth weight in the twin-paired study.

Early versus late prophylactic iron supplementation in VLBW infants: a randomized controlled trial.

SUMMARY In this single blinded parallel-group randomized controlled trial (RCT), preterm very-low-birth-weight (VLBW) infants received early iron (EI) supplementation (starting at 2 weeks postnatal age), or late iron (LI) supplementation (starting at 6 weeks postnatal age) [1]. The primary outcome was serum ferritin level at 12 weeks, and the secondary outcomes were the incidence of neonatal morbidities, hemoglobin level, anthropometric parameters and blood transfusion requirements. Outcomes were analyzed in 46 and 47 babies in EI and LI groups, respectively. Serum ferritin level was significantly higher (P<0.001) at 12 weeks in the EI group. Hemoglobin and mean corpuscular hemoglobin concentration (MCHC) were also significantly (P<0.001) higher at 12 weeks in the EI group. There were no significant differences in the incidences of neonatal morbidities [necrotizing enterocolitis (NEC), periventricular leukomalacia, retinopathy of prematurity (ROP)], anthropometric parameters and blood transfusion requirements between the two groups. The authors concluded that EI supplementation in preterm VLBW infants improves serum ferritin and hemoglobin levels. COMMENTARIES Evidence - based - medicine Viewpoint This RCT on early versus late enteral iron supplementation in preterm VLBW babies is timely, generalizable and well conceived. The authors concluded that EI supplementation in preterm VLBW infants improves serum ferritin, hemoglobin and MCHC at 12 weeks of postnatal age without any concomitant difference in inflammation to account for the difference in ferritin levels. The study is justified because there is still substantial uncertainty about the optimal age at which enteral iron supplementation should commence in such infants. The method of randomization and allocation concealment in the study is appropriate. Measurement bias was restricted by masking the outcome analyzers. One of the potential dangers of EI supplementation is increase in free radical mediated diseases, such as NEC and ROP. The authors rightly concluded that although their trial was not able to detect a significant difference in these diseases, the study was underpowered to do so. The study confirms the efficacy of early iron supplementation but it is inconclusive regarding the safety of the intervention. Only a large study or a metaanalysis of existing trials may be able to shed light on the equally important issue of safety.

Early versus late enteral prophylactic iron supplementation in preterm very low birth weight infants: a randomised controlled trial

ObjectivesTo evaluate whether preterm very low birth weight (VLBW) infants receiving early iron (EI) supplementation (2 mg/kg/day elemental iron) at 2 weeks postnatal age have improved serum ferritin levels compared...

Early trophic feeding versus enteral fasting for very preterm or very low birth weight infants.

The introduction of enteral feeds for very preterm (< 32 weeks) or very low birth weight (< 1500 grams) infants is often delayed due to concern that early introduction may not be tolerated and may increase the risk of necrotising enterocolitis. However, prolonged enteral fasting may diminish the functional adaptation of the immature gastrointestinal tract and extend the need for parenteral nutrition with its attendant infectious and metabolic risks. Trophic feeding, giving infants very small volumes of milk to promote intestinal maturation, may enhance feeding tolerance and decrease the time taken to reach full enteral feeding independently of parenteral nutrition. To determine the effect of early trophic feeding versus enteral fasting on feed tolerance, growth and development, and the incidence of neonatal morbidity (including necrotising enterocolitis and invasive infection) and mortality in very preterm or VLBW infants. We used the standard search strategy of the Cochrane Neonatal Review Group. This included electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 12), MEDLINE, EMBASE and CINAHL (1980 until December 2012), conference proceedings and previous reviews. Randomised or quasi-randomised controlled trials that assessed the effects of early trophic feeding (milk volumes up to 24 ml/kg/day introduced before 96 hours postnatal age and continued until at least one week after birth) versus a comparable period of enteral fasting in very preterm or very low birth weight infants. We extracted data using the standard methods of the Cochrane Neonatal Review Group with separate evaluation of trial quality and data extraction by two authors and synthesis of data using risk ratio, risk difference and mean difference. Nine trials in which a total of 754 very preterm or very low birth weight infants participated were eligible for inclusion. Few participants were extremely preterm (< 28 weeks) or extremely low birth weight (< 1000 grams) or growth restricted. These trials did not provide any evidence that early trophic feeding affected feed tolerance or growth rates. Meta-analysis did not detect a statistically significant effect on the incidence of necrotising enterocolitis: typical risk ratio 1.07 (95% confidence interval 0.67 to 1.70); risk difference 0.01 (-0.03 to 0.05). The available trial data do not provide evidence of important beneficial or harmful effects of early trophic feeding for very preterm or very low birth weight infants. The applicability of these findings to extremely preterm, extremely low birth weight or growth restricted infants is limited. Further randomised controlled trials would be needed to determine how trophic feeding compared with enteral fasting affects important outcomes in this population.

Comparison of the Incidences of Neonatal Morbidities by Different Criteria of Histologic Chorioamnionitis in Extremely Low Gestational Age Newborns

목적: 다양한 기준으로 진단된 조직학적 융모양막염이 있는 임신나이 28주 미만 조산아 와 융모양막염이 없는 임신나이 28주 미만 조산아의 유병률의 차이를 비교해 보고자 하였다. 방법: 2007년 1월부터 2011년 12월까지 분당서울대학교병원에서 출생하여 입원한 62명의 임신나이 28주 미만 조산아를 대상으로 하였다. 조...

Neonatal morbidity after induction vs expectant monitoring in intrauterine growth restriction at term: a subanalysis of the DIGITAT RCT

The Disproportionate Intrauterine Growth Intervention Trial at Term (DIGITAT) compared induction of labor and expectant management in suspected intrauterine growth restriction (IUGR) at term. In this subanalysis, we report neonatal morbidity between the policies based on the Morbidity Assessment Index for Newborns (MAIN). We used data from the DIGITAT. For each neonate, we calculated the MAIN score, a validated outcome scale. There were no differences in mean MAIN scores or in MAIN morbidity categories. We found that neonatal admissions are lower after 38 weeks' gestational age compared with 36 and 37 weeks in both groups. The incidence of neonatal morbidity in IUGR at term is comparable and relatively mild either after induction or after an expectant policy. However, neonatal admissions are lower after 38 weeks of pregnancy, so if induction to preempt possible stillbirth is considered, it is reasonable to delay until 38 weeks, provided watchful monitoring.

Elective induction for pregnancies at or beyond 41 weeks of gestation and its impact on stillbirths: a systematic review with meta-analysis

BackgroundAn important determinant of pregnancy outcome is the timely onset of labor and birth. Prolonged gestation complicates 5% to 10% of all pregnancies and confers increased risk to both the fetus and mother. The purpose of this review was to study the possible impact of induction of labour (IOL) for post-term pregnancies compared to expectant management on stillbirths.MethodsA systematic review of the published studies including randomized controlled trials, quasi- randomized trials and observational studies was conducted. Search engines used were PubMed, the Cochrane Library, the WHO regional databases and hand search of bibliographies. A standardized data abstraction sheet was used. Recommendations have been made for input to the Lives Saved Tool (LiST) model by following standardized guidelines developed by the Child Health Epidemiology Reference Group (CHERG).ResultsA total of 25 studies were included in this review. Meta-analysis of 14 randomized controlled trials (RCTs) suggests that a policy of elective IOL for pregnancies at or beyond 41 weeks is associated with significantly fewer perinatal deaths (RR=0.31; 95% CI: 0.11-0.88) compared to expectant management, but no significant difference in the incidence of stillbirth (RR= 0.29; 95% CI: 0.06-1.38) was noted. The included trials evaluating this intervention were small, with few events in the intervention and control group. There was significant decrease in incidence of neonatal morbidity from meconium aspiration (RR = 0.43, 95% CI 0.23-0.79) and macrosomia (RR = 0.72; 95% CI: 0.54 – 0.98). Using CHERG rules, we recommended 69% reduction as a point estimate for the risk of stillbirth with IOL for prolonged gestation (> 41 weeks).ConclusionsInduction of labour appears to be an effective way of reducing perinatal morbidity and mortality associated with post-term pregnancies. It should be offered to women with post-term pregnancies after discussing the benefits and risks of induction of labor.