Late Term Research Articles

Optimal timing for induction of labor in normotensive women: A retrospective cohort study.

Labor induction is offered to reduce the risk of stillbirth at late term (41+0 to 41+6) but earlier induction in normotensive singleton pregnancies is supported by weak evidence. The aim of the present study was to investigate the optimal timing for induction in normotensive women. This was a retrospective cohort study including 70 293 singleton term births in Iceland during 1997-2018. Women with serious pre-gestational comorbidity, hypertension, stillbirth or previous cesarean birth were excluded. The risk of adverse maternal and neonatal outcomes for induction at each week from gestational age 37-41 weeks was compared with expectant management, defined as deliveries at a later gestational age. Risk ratios (RRs) and 95% confidence intervals (95% CI) were calculated using log-binomial regression adjusting for sociodemographics, parity, and pregnancy complications. The risk of cesarean was lower with induction at ≥40+0 than expectant management, especially at late term (RR 0.73, 95% CI: 0.63-0.83). Respiratory distress was diagnosed in 4.4% of infants after induction from 37+0 to 37+6 but 1.3% in the expectant management group (RR 3.08, 95% CI: 1.97-4.81). Induction between 37+0 and 38+6 compared with expectant management was associated with a reduced risk of shoulder dystocia, but this was non-significant in births of infants with normal birthweight. Labor induction from 40+0 compared with expectant management was associated with reduced risk of cesarean birth in Icelandic women without an increase in risk of adverse maternal or neonatal outcomes. No additional benefit appeared to be from inducing at earlier gestations in low-risk pregnancies.

Perinatal death in the Nordic countries in relation to gestational age: The impact of registration practice.

Although perinatal death rates in the Nordic countries are among the lowest in the world, the risk of perinatal death is unevenly distributed across the Nordic countries, despite similarity in health care systems and pregnancy care. Birth registration practices across countries may explain some of the differences. We investigated differences in national registration of perinatal mortality within the Nordic countries and its impact on perinatal mortality according to gestational age. Each country provided information by answering a questionnaire about registration of perinatal deaths. Furthermore, we collected aggregated count data based on Medical Birth Registries (MBR) from all Nordic countries in 2000 to 2021. Perinatal mortality was defined as stillbirth or neonatal death occurring within first 7 days of life. Data were grouped into six groups by gestational age (GA): extremely preterm (>28 + 0 weeks, subdivided into 22 + 0-23 + 6 and 24 + 0-27 + 6), very preterm (GA 28 + 0-31 + 6), moderate preterm (GA 32 + 0-33 + 6), late preterm (GA 34 + 0-36 + 6), term (GA 37 + 0-40 + 6) and late term or post-term birth (GA ≥ 41 + 0). Perinatal mortality rate and risk ratio with 95% confidence intervals were calculated per country for each gestational age group. For Denmark, separate analyses included and excluded induced abortions. The study included 6 343 805 live births, 22 727 stillbirths and 8932 liveborn infants who died within the first week of life after GA 22 + 0. Further 25 057 births were included with GA < 22 + 0, unknown GA and as a result of induced abortion. Overall, perinatal mortality rates decreased during year 2000-2021 in all Nordic countries. After exclusion of induced abortions, the perinatal mortality rate was similar in the five Nordic countries. The perinatal mortality rate for extremely preterm born infants was highest in Denmark, whereas the highest rate among infants born late term/post-term was in Sweden. The perinatal mortality rate in the Nordic countries is still decreasing, especially in the group of extremely preterm born infants. This study supports the need for further standardization of birth registration practices to ensure the validity of international comparisons.

Survival and Risk Factors for Late Preterm and Early Term Neonates Compared to Full-Term Infants at Garissa County Referral Hospital, Kenya

Preterm birth constitutes a significant health burden in Kenya, yet there is hardly any targeted research looking at the survival and specific risk factors associated with birth of late preterm neonates (LPNs) and early term neonates (ETNs), particularly in Garissa County. While studies on preterm birth determinants have been done in Kenya, factors specifically influencing LPNs and ETNs births and their survival relative to their full-term counterparts remain understudied. Studies done on preterm in general have identified maternal age, history of preterm birth, pregnancy-induced hypertension, and prolonged premature rapture of the membrane among others as significant risk factors, but their relevance to LPNs and ETNs specifically has not been fully investigated. This study aimed to address these gaps by determining maternal as well as fetal risk factors associated with LPN and ETN births compared to full-term neonates (FTNs) born at Garissa County Referral Hospital. Further, it sought to identify predictors of survival across these neonatal groups. The study conducted at Garissa County Referral Hospital employed a prospective cohort design. Mother-neonate dyads were enrolled using convenience sampling method until the required sample was achieved. Data was collected using pretested and validated questionnaires. STATA version 17 was used for analysis. Multinomial logistic regression analysis was performed to determine Relative Risk Ratio. The P-value was set α=0.05 and P&lt;0.05 was considered statistically significant. Survival rates were estimated using Kaplan-Meier survival analysis. Bivariate Cox regression analysis was employed to identify independent predictors at p&lt;0.20. However, since all variables had p-values &gt;0.02, multivariate Cox regression was not conducted. The study revealed that maternal age (P=0.042), occupation (P=0.024), ethnicity (P=0.021), religion (P=0.016) and absence of previous abortion/still birth/premature deliveries (P=0.015) were maternal related factors associated with birth of LPN, ETN and FTN. Birth weight was associated with LPN (P&lt;0.001), while FTN had higher likelihood of delayed initiation of breastfeeding (P=0.038) but were less likely to have feeding difficulties compared to LPN and ETN (P=0.012). A comparison of fit model with the complete set of predictors with an intercept-only, or null model revealed that P-values for maternal (P=0.0175) and fetal (P&lt;0.001) related risk factors were less than Fisher’s value of 0.05, hence the null hypothesis was rejected. The Kaplan-Meier survival analysis revealed high survival rates across all gestational age categories, with 100% survival among LPNs. In conclusion, the study showed that maternal- and fetal-related risk factors associated with LPNs and ETNs are distinct from those of FTNs.

Regional Differences in Lung Ventilation During the Early Transition Period in Late Preterm and Term Neonates Assessed by Electrical Impedance Tomography.

Changes in lung ventilation are well documented in term neonates while in late preterm neonates these patterns are poorly understood despite their increased risk of respiratory morbidity. The study aimed to compare and clarify the differences in regional lung ventilation of late preterm and term neonates during the early adaptation period using electrical impedance tomography (EIT). The case-control study was conducted in the years 2020-2022. It included 51 late preterm neonates (LPN, Study group) and 45 term neonates (TN, Control) born by normal vaginal delivery (NVD). EIT examinations were performed with a Swisstom BB2 (Switzerland) equipment. The data recordings were performed no later than 30 (I Record), 60 (II), and 90 (III) minutes after the birth. Statistically significant differences between LPN and TN were observed in the non-dependent lung areas at I record, with more silent spaces observed in the LPN (p < 0.001). Differences in the dependent lung regions were observed across all recordings, with LPN demonstrating more silent spaces (p < 0.001). LPN demonstrated greater stretch-related changes in the 10% and 20% stretch categories across all recordings, while TN showed greater changes in the 50%, 70%, and 90% categories. Tidal volumes in the right lung of TN are distributed more towards the ventral and central ventral regions. In contrast, tidal volumes of LPN are distributed to the central dorsal and dorsal regions of the right lung. LPN during the first 90 min after the birth show reduced lung ventilation assessed by EIT, suggesting a possible impairment of early postnatal adaptation.

Delayed effects of antibiotic therapy in endotoxinemia

BACKGROUND: Nowadays, due to the increasing number of infectious and inflammatory diseases, the problem of the use of antibacterial drugs becomes especially important. As a result of the action of toxins, inflammatory processes can affect the central nervous system with the subsequent development of neuroinflammation. Activation of neuroinflammation leads to dysregulation of many physiological functions. These negative appearances can be observed even after a long period. It is known that doxycycline is a tetracycline-type antibiotic, which is able to penetrate the blood-brain barrier and has anti-inflammatory activity. AIM: The aim of this study was to investigate the nature of delayed physiological changes in rats against the background of administration of the antibacterial drug doxycycline in the LPS-induced model of neuroinflammation. MATERIALS AND METHODS: Four groups of Wistar rats, 10 males in each group, were used in the experiment. The first group was injected once intraperitoneally with physiological solution, the second group — with lipopolysaccharide (1 mg/kg). Animals of the third and fourth groups received intragastrically doxycycline solution (25 mg/kg) daily for two weeks. On the 15th day of the experiment, rats from the fourth group were injected with lipopolysaccharide (1 mg/kg). Body weight of animals, mass coefficients of immunocompetent organs, as well as behaviour and motor activity of rats in the “Open Field” test were evaluated at several time points. RESULTS: It was shown that systemic injection of lipopolysaccharide led to an increase in the mass coefficients of spleen, kidneys and adrenal glands compared to the group of animals receiving doxycycline beforehand. These changes were noted 48 h and 2 months after the injection of endotoxin. In the “Open Field” test, animals that were injected with doxycycline and lipopolysaccharide showed no violations of motor activity and research behavior, unlike the group that received only lipopolysaccharide. CONCLUSIONS: It can be assumed that the physiological effects of doxycycline in the lipopolysaccharide-induced model of neuroinflammation revealed at early and late terms are not limited to the antibacterial effect of the drug and are mediated by anti-inflammatory and potential neuroprotective effects on the central nervous system.

Late outcomes of Fontan operation from the EUROFONTAN experience

Abstract Background Fifty years after the first Fontan operation, the persisting challenges and evolving landscape of post-Fontan complications are explored in the EUROFONTAN experience. Aim of the study is the evaluation of long term outcomes of a large cohort of Fontan patients, focusing on age at Fontan and onset of Fontan-associated liver disease (FALD). Methods A retrospective clinical study across 21 european congenital cardiac centers across Europe. Clinical and operative data of patients who underwent Fontan operation between January 1990 and December 2022 were gathered through a RedCap online database. Results 2606 patients were included in this analysis (M/F: 59%/41%, median age and median weight at Fontan of 4.3 y.o (IQR 3.3-6.4), and 16kg (IQR 14-20), respectively. Most frequent cardiac anomaly were tricuspid atresia and pulmonary atresia with intact ventricular septum (781, 30%). Ventricular morphology was left in 1379 patients (53%), and right in 1029 patients (40%). Extra cardiac conduit (ECC) was performed in the majority of patients (2335, 90%), with a median conduit size of 20mm (IQR 18-20). Early post-operative complications were present in 52% (1340), with an early reintervention in 349 patients (249 surgical , 99 catheter driven) At a median follow-up median of 10 years (IQR 4-15), there were 79 late deaths (3%). Adverse events occurred in 49% (1288 , non-surgical in 962 , surgical in 249). The clinical status was stage A in 60% (1288 patients), while only a minority (1.3%) was in status D. Systemic Ventricular function was normal in 1898 patients (73%), while absent or mild Atrioventricular Valve regurgitation was presnet in 86% (1816). Of note, FALD was detected in 388 (15 %) , and sinus rhythm was present in 99%. Statistical analysis shows that late death and adverse events are significantly associated right ventricular morphology of the systemic ventricle (p-value 0.019). Of note, when compared to lateral tunnel, TCPC extracardiac conduit demonstrated lower late mortality (2.3% vs 8.2%, p-value &amp;lt;0.001) and complication rates (60% vs 48%, p-value 0.001). Analyzing age at Fontan, a linear relationship exists between age and late mortality, whereby mortality increases with advancing age (graph 1). However, concerning the development of late adverse events, the risk decreases with age at Fontan up to 7 years; beyond 7 years, the risk increases with advancing age (graph 2). The analysis demonstrated growing FALD-prevalence with increasing time from Fontan completion (significant especially after 10 years). Conclusion current long term outcomes of Fontan operation are highly satisfactory. However, the longer survival is associated to an increasing incidence of late term extracardiac complications (namely FALD) which are more evident if Fontan is performed at older age.Data of Fontan PatientsCorrelation between age at Fontan and AE

Variation in NICU utilization: a narrative review and path forward.

Utilization of the Neonatal Intensive Care Unit (NICU) varies widely in the United States. Over recent decades, there has been a growth in NICUs, that varies by region, and has not been correlated to changes in demand or illness severity. Unnecessary NICU admissions are costly, stressful to families, may increase the risk of hospital acquired morbidities, and decrease breast feeding. Most of the variation in NICU utilization is based on the care of late preterm, early term, and term babies and is related to hospital level factors, including financial incentives, driving utilization. Improvement strategies to reduce variation include regionalization of care, certificate of need legislation, improving discharge processes, and caring for babies with some conditions such as Neonatal Opioid Withdrawal Syndrome or those with risk factors for sepsis outside of the NICU.

Application of Antithrombotic Drugs in Patients with Acute Type B Aortic Dissection Underwent Thoracic Endovascular Aortic Repair.

This study aimed to evaluate the safety and necessity of antithrombotic drugs for acute type B aortic dissection (TBAD) treated with thoracic endovascular aortic repair (TEVAR).The patients of acute TBAD treated with TEVAR were retrospectively enrolled from January 2007 to October 2022 in General Hospital of Northern Theater Command. The primary outcomes such as mortality and aortic adverse events [stroke, paraplegia, limb ischemia, organ failure (renal and intestinal tract), endoleak, redissection, aortic rupture, reintervention, and mortality] were recorded and evaluated at 1 month (early term) and 18 months (late term).The 697 patients of TBAD treated with TEVAR were divided into the antithrombotic (AT) group (n = 208) and nonantithrombotic (NAT) group (n = 489). The incidence of early mortality, early aortic adverse events, and the 18 months of cumulative freedom from all-cause mortality and aortic adverse events were not significantly different between the AT and NAT groups (2.4% versus 1.4%, 2.9% versus 4.5%, 94.7% versus 96.5% and 88.4% versus 89.9%, respectively). Log-rank tests also indicated that there were no significant differences. In multivariate Cox regression models, only pleural effusion, partially thrombosed of false lumen, maximum diameter of false lumen, and branch involvement were independent predictors of mortality, whereas the systolic blood pressure (SBP), pleural effusion, partially thrombosed of false lumen, true lumen compression, maximum diameter of false lumen, branch involvement were independent predictors of adverse aortic events.The antithrombotic drug for acute TBAD treated with TEVAR does not influence the mortality and aortic events in the early and late terms.

Remodeling of the structural components of the capsule and glomerular zone of the adrenal glands cortex of white rats under the influence of a complex of food additives at the late terms of the experimental study

With food additives, we can add flavour to food, extend its shelf life, and make it look good. However, even small amounts of these additives can lead to diseases of various organs and systems. The aim of our work is to establish metrics and morphological changes in the structure of the capsule and the glomerular zone of the cortex of the adrenal glands of rats at the later stages of the experimental study under the conditions of consumption of a complex of food additives: monosodium glutamate, sodium nitrite and Ponceau 4R. The control group of rats consumed oral drinking water and saline. The rats of the experimental groups were orally administered once a day with a 10 % solution of sodium nitrite (E250), sodium glutamate (E621) or Ponceau 4R. The dosages of food additives were two times lower than the permissible norm in food. The rats were withdrawn from the experiment after 8, 12 and 16 weeks. The adrenal glands were removed for the study. Paraffin sections were stained with hematoxylin and eosin, and semi-thin sections with toluidine blue, and examined using a light microscope Biorex with a digital microphoto attachment DSM 900. Ultrathin sections were examined in a TEM-125 K electron microscope. For morphometric analysis, the structure of the capsule and the glomerular zone of the cortex of the adrenal glands of rats at the later stages of the experimental study was studied. The study results were analysed using the software package “InStat”. At the late stages of the experimental study, the adrenal capsule underwent irreversible changes. The average thickness of the adrenal connective tissue capsule decreased by the end of the 16th week of the experimental research. Similarly, the average thickness of the cortex decreased with each subsequent week relative to the control values, indicating significant structural and functional disorders. The average thickness of the glomerular zone of the adrenal cortex periodically changed as a compensatory reaction in response to the administration of a complex of food additives to rats. The phenomena of nucleus pyknosis and sludge syndrome were detected, which indicated compensatory and adaptive processes at the microscopic level. The analysis of electron micrographs revealed destroyed granular endoplasmic reticulum cisternae and mitochondrial remnants. Thus, it has been established that using a complex of food additives (monosodium glutamate, sodium nitrite and Ponceau 4R) directly affects the adrenal glands of rats. This effect causes structural changes in the cortex and medulla, causing alteration and hypertrophy of cells in these areas. Additionally, hyperhydration of the connective tissue stroma and compensatory-restorative reactions aimed at transcription factors and internal mechanisms of nitric oxide formation were recorded.

Transperineal sonographic assessment of the angle of progression before the onset of labour: how well does it predict the mode of delivery in late-term pregnancy.

Predicting the success of vaginal delivery is an important issue in preventing adverse maternal and neonatal outcomes. This study sought to examine whether measurement of the angle of progression (AoP) can predict asuccessful vaginal delivery following induction of labour (IoL) among late term nulliparous women with a low (4>) Bishop score. This prospective study included consecutive nulliparous pregnant women whose gestational age was 41weeks and 1-6days (late-term). The AoP was measured atleast three times and their means were calculated. During the study period, data of 150 women wereincluded in the final analysis. Thirty-eight women underwent CS due to failure to progress (n=30) or NRGHR (n=8), while the remaining 112 women underwent NVD, with four women requiring vacuum extraction. The two groups were similar with respect to age, gestational age, BMI, estimated foetal weight, and birth weight. Women undergoing NVD differed significantly from those undergoing CS with respect to a greater ultrasonographic AoP (113.8±11.9° vs. 98.1±10.9°, p=0.0001), a shorter duration of dinoprostone use, shorter time to labour contraction, and a shorter duration oflabour. In ROC analysis, the cut-off value for AoP was 100° for the prediction of successful IoL for NVD, with a sensitivity of 96 % and a specificity of 63 %. AoP may be a useful sonographic parameter for predicting successful vaginal delivery among nulliparous women at late term undergoing IoL; an AOP wider than 100°is associated with a high rate of vaginal delivery.

Fetal development and growth of extensor tendons and their sheaths in the dorsal side of the wrist and hand: a histological study.

To understand considerable variations in number of adult extensor ten-dons at the dorsal side of the wrist and hand. We examined histological sections from 30 human fetuses of gestational age 7-39 weeks and crown-rump length 22-323 mm. At the carpal level, earlier or smaller fetuses showed a simpler configuration with fewer tendon slips, whereas later or larger fetuses had a greater number of tendon slips with considerable variations in number and topographical relationships. Tendon slips of the early extensor digitorum to the middle and ring fingers were always 1 or 2, but were seven or more at late term. A tendon of the extensor digitorum to the little fin-ger could not be distinguished from other tendons at the carpal bone level. At the meta-carpal bone level, however, it extended from the ring finger tendon toward two slips of the extensor digiti minimi tendon. At the distal carpal level at midterm and late term, in which the tendon sheath was lost, each of the extensor digitorum tendon slips further divided to provide a mediolateral linear cluster of thin bundles. This large number of tendon components joined and united together to provide a single tight tendon at the level of the metacarpophalangeal joints. The extensor pollicis longs tendon usually lost a membranous septation when it crossed the extensor carpi radialis brevis tendon. Tendon slips in the fourth and fifth canals of the sheath were most likely to reduce in number after birth depending on the mechanical demand.

Management and Clinical Outcomes of Neonatal Hypothermia in the Newborn Nursery.

Neonatal hypothermia has been shown to be commonly detected among late preterm and term infants. In preterm and very low birth weight infants, hypothermia is associated with increased morbidity and mortality. Little is known about the clinical interventions and outcomes in hypothermic late preterm and term infants. This study fills this gap in the evidence. Single-center retrospective cohort study using electronic health record data on infants ≥35 weeks' gestation admitted to a newborn nursery from 2015 to 2021. Hypothermia was categorized by severity: none, mild (single episode, 36.0-36.4°C), and moderate or recurrent (<36.0°C and/or 2+ episodes lasting at least 2 hours). Bivariable and multivariable logistic regression examined associations between hypothermia and interventions or outcomes. Stratified analyses by effect modifiers were conducted when appropriate. Among 24 009 infants, 1111 had moderate or recurrent hypothermia. These hypothermic infants had higher odds of NICU transfer (adjusted odds ratio [aOR] 2.10, 95% confidence interval [CI] 1.68-2.60), sepsis evaluation (aOR 2.23, 95% CI 1.73-2.84), and antibiotic use (aOR 1.73, 95% CI 1.15-2.50) than infants without hypothermia. No infants with hypothermia had culture-positive sepsis, and receipt of antibiotics ≥72 hours (surrogate for culture-negative sepsis and/or higher severity of illness) was not more common in hypothermic infants. Hypothermic infants also had higher odds of blood glucose measurement and hypoglycemia, slightly higher percent weight loss, and longer lengths of stay. Late preterm and term infants with hypothermia in the nursery have potentially unnecessary increased resource utilization. Evidence-based and value-driven approaches to hypothermia in this population are needed.

Assessment of fetal development during mid and late term pregnancies by standard B-Mode ultrasonography in Shetland ponies

Transrectal and transabdominal ultrasonography is an established method to monitor pregnancy, fetal growth and wellbeing in different species. Growth charts with multiple bio-morphometric parameters to estimate days of gestation and days before parturition exist in small companion animals, sheep and goats, riding type horses and large ponies but not in small horse breeds like Shetland ponies. The aim of this study was to apply fetal biometric assessment and detailed description of physiologic fetal development to mid and late term pregnancies in Shetland mares and to generate reference data for clinical practice and for future research. Fetal parameters were collected starting on day 101 of pregnancy in five Shetland mares. The fetal biometric parameters determined consisted of aortic diameter, eye diameter, combined rib and intercostal distance (CRID), stomach length and width and different heart morphology parameters in sagittal and frontal plane. Additionally, fetal activity and organ development in terms of differentiation and changes in echogenicity were recorded. Considering reliably assessable parameters, fetal CRID was the best predictor for gestational age with ± 13.6 days and fetal aortic diameter the most accurate for prediction of days until parturition with ± 16.2 days.

The Combined Delivery of the Vegf, Ang, and Gdnf Genes Stimulates Angiogenesis and Improves Post-Ischemic Innervation and Regeneration in Skeletal Muscle.

In this study, the effects of different combinations of the genes Vegf, Ang, and Gdnf injected both using direct virus-mediated injection (adenovirus, Ad5) and umbilical cord blood mononuclear cells (UCBCs) on the processes of stimulation of post-ischemic innervation, angiogenesis, and regeneration in skeletal muscle were investigated in a rat hindlimb chronic ischemia model. It was shown that more pronounced stimulation of angiogenesis and restoration of post-ischemic innervation were achieved both in the early (28 days post-ischemia, dpi) and late (42 dpi) terms of the experiment in the calf muscle when UCBCs delivered the combination of Ad5-Vegf and Ad5-Ang compared to the direct injection of the same vector combination into the area of ischemia. At the same time, the inclusion of Ad5-Gdnf in the combination of Ad5-Vegf and Ad5-Ang directly injected or administered by UCBCs provided a significant increase in the number of centronuclear muscle fibers, indicating stimulation of post-ischemic reparative myogenesis. This study allowed us to determine the most effective gene combinations for angiogenesis and neurogenesis, which, in the future, may serve as the basis for the development of gene and gene cell products for the treatment of chronic lower limb ischemia.

Parameters of physical development of term newborns with Intrauterine Growth Retardation, born in a 3B Level Perinatal Centre of St. Petersburg State Pediatric Medical University in 2022

BACKGROUND: Intrauterine growth retardation of a newborn child is an current problem in neonatology, obstetrics and pediatrics. Due to intrauterine development disorders, these newborns have increased morbidity and mortality rates. In the presence of Intrauterine growth retardation, the likelihood of developing complications in the early neonatal period increases (birth asphyxia, meconium aspiration, hypoglycemia, polycythemia, etc.), and the risk of developing infections and neurological disorders) is increased. AIM: The aim of this study is to study the parameters of physical development of term newborns born in the Perinatal Centre 3B level of the St. Petersburg State Pediatric Medical University in 2022 year, to determine the frequency and structure of disorders associated with Intrauterine growth retardation and malnutrition depending on the gestational age of term newborns for a differential approach in the management of children with Intrauterine growth retardation by neonatologists and paediatricians. MATERIALS AND METHODS: There were analyzed 1000 hospital neonatal records of newborns children born at the Perinatal Centre of Level 3B of St. Petersburg State Pediatric Medical University in 2022 year. Of these, 55 term babies were born with Intrauterine growth retardation. The study examined the physical development of term newborns, determined the frequency and structure of disorders associated with intrauterine growth retardation and malnutrition, depending on the gestational age of term newborns. RESULTS: Retardation of intrauterine growth and development in newborn children born in level 3B centres are represented by low body weight in relation to gestational age in 63.6% of cases, trophic disorders with normal body weight and reduced weight/length ratio in 34.6% of cases, and low height index with normal body weight in 1.8% of cases. Severe physical developmental disorders were found only in children with low body weight: in 13% of cases of low birth weight for gestational age, and in 55% of cases of small fetal size for gestational age. CONCLUSIONS: the distribution of physical development disorders (ICD code P05.2) in term infants, depending on the degree of maturity has a linear trend and occurs with maximum frequency (50%) in late term newborns, which is associated with the onset of aging of the placenta and the intensification of existing, even compensated, placental insufficiency.

Correlation between foetal growth velocity and birthweight in a cohort of late term singleton pregnancies

Correlation between foetal growth velocity and birthweight in a cohort of late term singleton pregnancies

Incidence of neonatal respiratory morbidity after vaginal and caesarean delivery in the late-preterm and term period - a retrospective cohort study.

Respiratory distress syndrome is a leading cause of neonatal intensive care unit admissions for late preterm (34-36 weeks gestational age) and term infants (37-41 weeks). The risk for respiratory morbidity appears to increase after an elective caesarean delivery and might be reduced after antenatal corticosteroids. However, before considering antenatal corticosteroids for women at high risk of preterm birth after 34 weeks, the incidence of respiratory distress syndrome and the effect of delivery mode on this incidence requires further evaluation. Therefore, this study aimed to investigate the relationship between respiratory distress syndrome incidence and delivery mode in late preterm and term infants. In this retrospective cohort study, the clinical databases of the University Hospitals of Zurich and Basel were queried regarding all live births between 34 + 0 and 41 + 6 weeks. Neonatal intensive care unit admissions due to respiratory distress syndrome were determined and analysed in regard to the following delivery modes: spontaneous vaginal, operative vaginal, elective caesarean, secondary caesarean and emergency caesarean. After excluding malformations (n = 889) and incomplete or inconclusive data (n = 383), 37,110 infants out of 38,382 were evaluated. Of these, 5.34% (n = 1980) were admitted to a neonatal intensive care unit for respiratory distress syndrome. Regardless of gestational age, respiratory distress syndrome in infants after spontaneous vaginal delivery was 2.92%; for operative vaginal delivery, it was 4.02%; after elective caesarean delivery it was 8.98%; following secondary caesarean delivery, it was 8.45%, and after an emergency caesarean it was 13.3%. The risk of respiratory distress syndrome was higher after an elective caesarean compared to spontaneous vaginal delivery, with an odds ratio (OR), adjusted for gestational age, of 2.31 (95% CI 1.49-3.56) at 34 weeks, OR 5.61 (95% CI 3.39-9.3) at 35 weeks, OR 1.5 (95% CI 0.95-2.38) at 36 weeks, OR 3.28 (95% CI 1.95-5.54) at 37 weeks and OR 2.51 (95% CI 1.65-3.81) at 38 weeks. At 39 weeks, there was no significant difference between the risk of respiratory distress syndrome after an elective caesarean vs. spontaneous vaginal delivery. Over the study period, gestational age at elective caesarean delivery remained stable at 39.3 ± 1.65 weeks. The incidence of respiratory distress syndrome following an elective caesarean is up to threefold higher in infants born with less than 39 weeks gestational age compared to those born by spontaneous vaginal delivery. Therefore - and whenever possible - an elective caesarean delivery should be planned after 38 completed weeks to minimise the risk of respiratory morbidity in neonates.

Childcare use and the social-emotional and behavioural outcomes of late-preterm and early-term born children at age 5: An analysis of the All Our Families longitudinal cohort.

Gestational age at birth (GA) shows an inverse gradient of risk with social-emotional and behavioural outcomes among children born late preterm (≥ 34 and < 37weeks) and early term (≥ 37 and < 39weeks). Childcare has the potential to influence this association. This study aimed to estimate the association between GA and social-emotional/behavioural problems among children born between ≥ 34 and < 41weeks gestation, determine whether this association was modified by childcare use, and describe the relationship between childcare and behavioural and social-emotional functioning at age 5. Using data from the All Our Families cohort (n = 1324), logistic regression models were used to model the association between GA and social-emotional/behavioural problems (BASC-2 composite scales at age 5). Models were fit with interaction terms between GA and childcare variables (amount, multiplicity, and type of childcare at age 3) to assess effect modification. GA showed no significant associations with social-emotional/behavioural problems at age 5, though the type of childcare significantly modified the association between GA and externalizing and internalizing problems. Neither the number of hours spent in childcare (amount) nor the number of childcare arrangements used (multiplicity) modified the association between GA and social-emotional/behavioural problems. However, multiplicity was associated with externalizing behavioural problems (aOR = 2.09, 95% CI 1.14‒3.83). This study found no significant association between GA and social-emotional/behavioural problems at age 5, though childcare type modified this association. Factors such as using multiple childcare arrangements to meet families' childcare needs have the potential to influence a child's social-emotional and behavioural functioning at age 5.

The transcriptome of MHV-infected RAW264.7 cells offers an alternative model for macrophage innate immunity research.

Macrophages are the primary innate immune cells encountered by the invading coronaviruses, and their abilities to initiate inflammatory reactions, to maintain the immunity homeostasis by differential polarization, to train the innate immune system by epigenic modification have been reported in laboratory animal research. In the current in vitro research, murine macrophage RAW 264.7 cell were infected by mouse hepatitis virus, a coronavirus existed in mouse. At 3-, 6-, 12-, 24-, and 48-h post infection (hpi.), the attached cells were washed with PBS and harvested in Trizol reagent. Then The harvest is subjected to transcriptome sequencing. The transcriptome analysis showed the immediate (3 hpi.) up regulation of DEGs related to inflammation, like Il1b and Il6. DEGs related to M2 differential polarization, like Irf4 showed up regulation at 24 hpi., the late term after viral infection. In addition, DEGs related to metabolism and histone modification, like Ezh2 were detected, which might correlate with the trained immunity of macrophages. The current in vitro viral infection study showed the key innated immunity character of macrophages, which suggested the replacement value of viral infection cells model, to reduce the animal usage in preclinical research.

Safety of different cord clamping strategies in the early postnatal period

BackgroundThis study aimed to evaluate the effect of ICC (cord clamping within the first 15 s), DCC (delayed cord clamping at 60 s), and cut-UCM (cut-umbilical cord milking, cord clamping within the first 15 s) groups on oxygen saturation (SpO2), heart rate (HR), and perfusion index (PI) up to 10 min after birth in newborn infants. MethodsWe conducted this randomized clinical trial in the delivery unit of a University Hospital with 189 infants born between 35 and 42 weeks of gestation. Participants were randomly assigned to one of three groups: ICC, DCC, and cut-UCM. The primary outcomes measured were SpO2, HR, and PI at the 1st, 3rd, 5th, and 10th minutes after birth. We utilized ANOVA and Bayesian calculations in this study. ResultsThere was no difference between the ICC, DCC, and cut-UCM groups in SpO2, HR, and PI values at the 1st, 3rd, 5th, and 10th minutes of life, which did not significantly alter between the three groups in one-way ANOVA. Bayesian repeated-measure ANOVA calculations showed that SpO2 and heart rate results at the 1st, 3rd, 5th, and 10th minutes did not differ between ICC, DCC, and cut-UCM techniques with strong evidence. At the 3rd minute, PI was slightly higher in the DCC and cut-UCM groups compared to the ICC group, with anecdotal evidence. We found no difference between DCC and cut-UCM regarding the 3rd-minute PI, with moderate evidence. ConclusionUmbilical clamping procedures (ICC, DCC, and cut-UCM) did not affect SpO2 and HR in the first ten minutes of life, but 3rd-minute PI values were slightly higher in DCC and cut-UCM compared with ICC among late preterm and term neonates.