Neonatal Length Research Articles

ELAIDIC ACID AND VACCENIC ACID IN THE PLASMA OF PREGNANT WOMEN AND UMBILICAL BLOOD PLASMA

The studies suggest that trans fatty acids are the most harmful type of fatty acids, and their ingestion leads to an increase in oxidative stress, changes in the plasma levels of LDL cholesterol, and a reduction in n-6 and n-3 fatty acids utilization. The objective of this study was to determine the concentration profiles of elaidic and vaccenic acids in maternal blood plasma in the perinatal period, and in the plasma of blood collected from the umbilical vein. The article deals with the issue of the correlation between the levels of trans-unsaturated fatty acids in maternal and neonatal blood, which could suggest the transplacental transport of these acids. The potential correlations between the levels of trans-unsaturated fatty acids in maternal and umbilical blood and birth weight and body length in neonates was also verified. The study group comprised 53 pregnant patients of the Clinic of Obstetrics and Perinatology of the Pomeranian Medical University in Szczecin, aged 18-39 years, together with their newborn babies. Elaidic and vaccenic acid levels were determined in maternal and umbilical plasma. Fatty acid methyl esters were injected onto the capillary column of the Agilent 6890M gas chromatography system integrated with an autosampler. The content of individual fatty acids was determined from the reference curves and expressed in mg/mL. The lowest levels of both acids were observed in umbilical blood plasma. The level of elaidic acid was 0.0019 mg/mL ± 0.0013 mg/mL, while the level of vaccenic acid was 0.0007 mg/mL ± 0.0011 mg/mL. A statistically significant negative correlation was observed between maternal vaccenic acid levels and umbilical vaccenic acid levels. The presence of trans-unsaturated fatty acids (elaidic acid and vaccenic acid) in umbilical plasma is evidence of the transplacental transport of these acids. The significantly higher levels of elaidic acid compared to vaccenic acid in umbilical plasma suggests that vaccenic acid is more extensively metabolized in placenta. The levels of trans-unsaturated fatty acids had no effect on birth weight and body length in neonates.

Abstract 1782: Racial differences in maternal and cord blood leukocyte telomere length and their correlations

Abstract Background: Telomere length at birth is hypothesized to set the baseline for lifetime telomere shortening trajectory and influence adult disease risk including prostate cancer, which shows a pronounced racial disparity. Telomere length is heritable, but may also be a marker of exposures in utero, including those impacting adult cancer risk. Thus, we investigated racial differences in leukocyte telomere length in maternal blood and cord blood from their male neonates, and in telomere length correlations between mothers and neonates. The purpose of this work is to inform whether telomere length differences at birth may account for some of the racial disparity in adult disease risk. Methods: Black and white Baltimore women were recruited at the start of pregnancy in 2006-7 and followed to postpartum. They completed surveys at enrollment and at the first postpartum visit. Medical records were abstracted from each clinic visit, mothers provided blood each trimester, and cord blood was collected at birth. 55 mother-male neonate pairs with complete materials were included. Relative telomere length (telomere/single copy gene) was measured by quantitative PCR in leukocyte DNA. We used linear regression to estimate mean telomere length in mothers and neonates before and after adjusting for assay batch, mother's age and other factors. We calculated the Pearson correlation between mother and cord blood telomere length overall and by race. Results: Black mothers were younger, less likely to have a graduate degree and to be nulliparous, and more likely to be overweight/obese than white mothers. Adjusting for batch and mother's age, black mothers had shorter mean telomere length (2.18, 95% CI 1.81-2.56) than white mothers (2.65, 95% CI 2.35-2.95) and black neonates had shorter mean telomere length (2.64, 95% CI 2.27-3.01) than white neonates (3.02, 95% CI 2.73-3.31); differences were not significant (p = 0.08, 0.1). Differences were attenuated after further adjustment for education, nulliparity, and BMI. Adjusting for mother's age, mother and cord blood telomere lengths were highly correlated overall (r = 0.73, p<0.0001), and did not differ between blacks (r = 0.77) and whites (r = 0.67; p-interaction = 0.6). Correlations were similar after further adjustment for education, nulliparity, and BMI. Conclusion: Leukocyte telomere length was shorter in black compared with white mothers and in cord blood, but racial differences were attenuated after adjustment. Correlation between mother and neonate telomere length was high, did not differ by race, and was not attenuated after adjustment. Our results appear to support the hypothesis that telomere length differs by race at birth in part due to inherent differences and in part due to maternal factors, and thus, may inform the racial disparity in risk of adult diseases like prostate cancer. Funding: T32 CA009314, U54 CA091409, P30 CA006973, Dept of Epidemiology Doctoral Research Fund Citation Format: Kari A. Weber, Christopher M. Heaphy, Corinne E. Joshu, Sabine Rohrmann, Jessica L. Bienstock, Tanya Agurs-Collins, Alan K. Meeker, Elizabeth A. Platz. Racial differences in maternal and cord blood leukocyte telomere length and their correlations. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1782.

Gestational Age of Delivery in Pregnancies Complicated by Chronic Hypertension.

To identify the gestational age of planned delivery in pregnancies complicated by chronic hypertension that minimizes the risk of perinatal death and severe adverse events. This was a retrospective cohort study of all singletons complicated by hypertension. Detailed patient-level information was collected by chart review, including indication for delivery. Planned delivery at 36-36 6/7, 37-37 6/7, 38-38 6/7, and 39-39 6/7 weeks of gestation was compared with expectant management beyond each respective gestational age. Patients were excluded for fetal anomalies, inaccurate dating, and major medical problems other than hypertension, diabetes, or renal disease. The primary outcome was a composite of stillbirth, neonatal death, assisted ventilation, cord pH less than 7.0, 5-minute Apgar score of 3 or less, and neonatal seizures. Secondary outcomes were preeclampsia, severe preeclampsia, primary cesarean delivery, and neonatal length of stay greater than 5 days. Groups were compared using Student's t test and χ tests. Six hundred eighty-three women with hypertension reached 36 weeks of gestation. Patients with planned delivery at less than 39 weeks of gestation were more likely to have baseline renal disease. Before 37 weeks of gestation, planned delivery was associated with a statistically significant increase in the primary composite adverse neonatal outcome (10.0% compared with 2.6%, P=.04); after 38 weeks of gestation, expectant management was associated with a nonstatistically significant increase in the primary composite outcome (0% compared with 2.3%, P=.40). Expectant management beyond 39 weeks of gestation was associated with a statistically significant increase in severe preeclampsia (0% compared with 10.3%, P=.001). Expectant management beyond 39 weeks of gestation was associated with increasing incidence of severe preeclampsia; planned delivery before 37 weeks of gestation was associated with an increase in adverse neonatal outcomes. Further well-powered studies are needed to delineate the optimal gestational age of delivery.

Comparing First- and Second-Season Palivizumab Prophylaxis in Patients with Hemodynamically Significant Congenital Heart Disease (HSCHD) in the ‘Caress’ Database (2005-2014)

Abstract BACKGROUND: Compared with normal children, RSV-related hospi-talization (RSVH) rates in children with HSCHD are 2-4 fold higher even up to 2 years of age with an overall weighted mean mortality rate of 5.2%. Pediatric advisory guidelines recommend prophylaxis against respiratory syncytial virus (RSV) for infants with HSCHD. However, current recommendations cast doubt as to whether prophylaxis is beneficial beyond 1 year of age. OBJECTIVES: To determine whether there are differences in RSVH in HSCHD infants receiving palivizumab during the first versus second RSV season in the Canadian Registry of palivizumab (CARESS). DESIGN/METHODS: CARESS is a prospective registry of infants who received ≥1 dose of palivizumab at one of 32 sites across Canada during the 2005-2014 RSV seasons. Demographic data were collected at enrollment and respiratory-illness-related hospitalization events recorded monthly. In the event of a hospitalization, the relevant hospital records were reviewed by the site’s research nurse for detailed information on criteria for hospital-ization, length of stay (regular ward vs. ICU), days on respiratory support and/or intubation, and RSV test type and diagnosis. Infants aged <24 months with cyanotic or acyanotic HSCHD were recruited. RESULTS: 1306 (64.9%) of 2013 infants received prophylaxis only for the first season. 707 (35.1%) were prophylaxed during the second season (average age in months: 4.7 [first season] vs 14.7 [second season]). Baseline demographics for both seasons were similar. However, infants aged >1year had a more complicated neonatal course, with significantly longer neonatal length of stay (46.7 versus 25.6 days). Infants received: 4.5±1.4 injections; 90.5% of their expected injections and 88.2% of their injections within the appropriate time intervals. 26 infants in the first year (RSVH rate: 2.26%) and 11 infants in the second year (RSVH rate: 2.09%) were hospitalized. Cox regression analysis showed no significant differences in hazards between infants in their first or second year of prophylaxis in the time to first RSVH (Hazard ratio: 1.4, 95%CI 0.5-4.0, p=0.52) CONCLUSION: Infants enrolled in the CARESS database in the second RSV season had a similar hazard of RSVH as those in the first year of life. These findings suggest that infants aged >1 year with HSCHD who remain unstable, are equally at risk for RSVH and merit palivizumab prophylaxis.

Fetal and neonatal outcomes after term and preterm delivery following betamethasone administration in twin pregnancies

ObjectiveTo investigate effects of betamethasone on fetal growth and neonatal outcomes in twins. MethodsA retrospective cohort study was conducted of twins delivered at one center in Berlin, Germany, between 1993 and 2011. The betamethasone group included twin pregnancies with preterm labor, cervical shortening, preterm premature rupture of membranes, or vaginal bleeding, and exposure to betamethasone between 23+5 and 33+6 weeks. The control group included twin pregnancies with no betamethasone exposure matched for length at delivery. Fetal growth and neonatal anthropometric data were analyzed by twin-pair structure, dose, and gestational age (linear mixed model). ResultsOverall, 1922 live-born twin pairs (653 betamethasone group, 1269 controls) were included. Compared with controls, late-preterm twins exposed to betamethasone were lighter (mean difference –126g), had a smaller head circumference (–0.4cm), and a shorter body length (–0.8cm) after adjustment for confounders (P<0.05). Female neonates from mixed or same-sex twin pairs had a lower birth weight than controls (betamethasone ≤16mg: –114g; betamethasone 24mg: –124g; betamethasone >24mg: –187g), with no detectable improvement in neonatal morbidity (hyperbilirubinemia, respiratory distress, asphyxia) or mortality. ConclusionBetamethasone reduced birth weight, head circumference, and length of female preterm neonates in twin pairs in a dose-dependent manner. The neonatal mortality and morbidity were not improved by betamethasone.

Normal Values of Spleen Length and Volume: An Ultrasonographic Study in Children

We aimed to determine normal ultrasonographic limits of spleen length and volume in healthy Caucasian neonates and children. A total of 458 healthy cases (age, 1 d to 15 y; sex, 241 males and 217 females) with normal body measurements were included. Spleen length and volume were obtained ultrasonographically. The two genders were comparable for the mean spleen length and volume. Lower and upper normal limits were tabulated according to age and sex groups. Significant correlations (Pearson r > 0.80; p < 0.001) were present between spleen length/volume and age, height and weight. Two equations were created to estimate spleen length and volume by age. Normal spleen lengths and volumes and their lower and upper limits were obtained ultrasonographically in a large sample of Caucasian pediatric patients.

Reproductive cycles of the coral snake Micrurus nigrocinctus (Serpentes: Elapidae) in Costa Rica

The coral snake Micrurus nigrocinctus has two reproductive patterns in Costa Rica. Specimens of the Pacific population (M. n. nigrocinctus) mate during the early dry season (November, January). Oviposition takes place in February and March; the mean number of eggs was 7.9 (5-14) in this population. Births occur between April and June after 47-81 days of incubation. The total length of neonates is 168-212 mm, and the weight is 1.2-2.0 g. Specimens of the Atlantic population (M. n. mosquitensis) seem to have an extended breeding season. Oviposition in this subspecies was observed in March and June; the mean number of eggs was 6.7 (5-8). Births take place in May and August, after two months of incubation. Neonates have 173-189 mm in total length and 1.9-2.4 g in mass. Adult females are longer than males, especially in M. n. mosquitensis.

Neonatal anthropometry at 3400 m above sea level compared with INTERGROWTH 21st standards

Objective: To determine the 3rd, 10th, 50th, 90th and 97th percentile of weight, length and head circumference (HC) of male and female neonates born at 3400 m above sea level and compare with published INTERGROWTH 21st standards.Methods: Observational, transverse analytical study conducted in the National Hospital Adolfo Guevara Velazco of the ESSALUD hospital system in Cusco, Peru, at 3400 m altitude, during the period of January 2005 to December 2010. Using inclusion criteria, 7635 newborns were selected. The 3rd, 10th, 50th, 90th and 97th percentiles for the anthropometric measurements of birthweight, length and HC were determined for each sex and the results analyzed via polynomial regression for each percentile in order to compare the results with INTERGROWTH 21st standards.Results: No statistically significant difference was observed with the exception of female HC at the 97th percentile when compared with the INTERGROWTH 21st standards.Conclusions: Based on tables generated in the present study, neonatal anthropometric percentiles at term at 3400 m above sea level demonstrate no appreciable difference with INTERGROWTH 21st standards with the exception of female HC at the 97th percentile.

Prenatal exposure to cannabis and maternal and child health outcomes: a systematic review and meta-analysis

ObjectiveTo assess the effects of use of cannabis during pregnancy on maternal and fetal outcomes.Data sources7 electronic databases were searched from inception to 1 April 2014. Studies that investigated the...

Accuracy of a Weight-Based Formula for Neonatal Gastric Tube Insertion Length.

Gastric tubes are used in nurseries on a daily basis. Various methods of estimating gastric tube length for insertion using anatomical landmarks are used to assist correct placement. Sometimes, however, they can be up to 55% inaccurate. In 2012, we published a weight-based formula to estimate gastric tube length for insertion. This study reviews the rates of correct gastric tube placement, as confirmed by radiography, after the incorporation of this weight-based formula into bedside practice. A 6-month prospective study was performed in a tertiary neonatal intensive care unit. The formula estimating gastric tube length for insertion had been derived in an earlier study. This was incorporated into the hospital's policies and procedures guideline for the insertion of gastric tubes. Neonates with gastric tubes who required radiography for clinical reasons were included. The infant's weight and the type (orogastric or nasogastric) and length of tube were documented. A single radiologist assessed the tube position to be high, borderline, correct, or long. A total of 195 chest radiographs were obtained. Correct tube position was found in 84% of instances. This was a statistically and clinically significant improvement. Implementation of a simple weight-based estimate for gastric tube length improves correct position rates. Further studies comparing accuracy of length/height and weight-based estimations for gastric tube insertion lengths in very preterm and extremely preterm infants are needed.

HIV infection is associated with a lower rate of gestational weight gain and reduced neonatal length

BackgroundAdequate gestational weight gain (GWG) and neonatal growth are important, respectively, for favorable birth outcomes and survival of infants through the first year. In sub‐Saharan Africa, underlying infections, such as HIV, may adversely impact GWG and neonatal growth. We investigated trends in GWG among HIV‐infected and ‐uninfected women in northern Uganda; and, examined growth parameters of their HIV‐exposed and ‐unexposed neonates.Methods403 (133 HIV‐infected and on treatment vs. 270 ‐uninfected) pregnant women were recruited into this study from the antenatal clinic of Gulu Hospital. Women's height and weight were measured at enrollment (mean (±SD) gestational age =19.4 (±−3.8) weeks) and weight was measured at each follow‐up visit. After delivery, a subsample (n=246) of dyads was enrolled into a postnatal cohort. At one month postpartum, length and weight were measured and growth indicators (HAZ, WAZ and WHZ) were evaluated using the 2006 WHO standards. Other important variables were documented at recruitment using a detailed questionnaire. Multivariate regression models were employed to determine whether HIV status was associated with 1) the weekly rate of GWG and 2) neonatal indicators of growth.ResultsAdjusted models indicated a quadratic trend in GWG in both HIV infected and uninfected pregnant women. The rate of GWG among HIV infected women was significantly lower than that of HIV uninfected women (p=0.001). Prenatal HIV exposure was associated with significantly lower HAZ (p=0.013) and a nonsignicant trend towards lower WAZ; but, HIV exposure was not associated with WHZ at one month postpartum. HIV‐exposed neonates were more likely to be stunted (HAZ≤−2) than those who were –unexposed (adjusted odds ratio (aOR) (95%CI): 3.48 (1.29; 9.40).ConclusionThese results provide strong justifications for studies to understand mechanisms that underlay the negative effects of HIV infection or exposure on gestational weight gain and linear growth of HIV exposed neonates in this context.Support or Funding InformationThis research was funded in part by Cornell University Weill Medical College Intercampus Seed Funds, K01 MH098902 from NIMH and USAID Cooperative Agreement AIDOAAL1000006

Comparación de dos protocolos de manejo en preeclampsia severa, lejos del término, y resultados maternos y neonatales: una cohorte histórica Hospital Universitario San José, Popayán (Colombia)

&lt;p&gt;&lt;strong&gt;Objetivo:&lt;/strong&gt; determinar si existe una diferencia en la seguridad del protocolo de manejo expectante o activo en gestantes con embarazos menores de 34 semanas y preeclampsia severa en resultados maternos y fetales.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materiales y métodos:&lt;/strong&gt; cohorte histórica de gestantes entre las 24 y 34 semanas, con diagnóstico de preeclampsia severa, que después de recibir un curso de corticoesteroides fueron manejadas con protocolo expectante o activo según criterio de equipo responsable en una institución universitaria de referencia en la región suroccidental de Colombia. Muestreo consecutivo. Se midió como resultado primario la mortalidad y las complicaciones maternas, y una medida compuesta de pobres resultados maternos. Como resultados secundarios se midieron mortalidad neonatal, días de estancia hospitalaria en la unidad de cuidado intensivo neonatal (UCIN), horas de ventilación mecánica y una medida compuesta de complicaciones neonatales. Se compararon las características basales y clínicas de las dos poblaciones, y los resultados maternos y neonatales por medio de test exacto de Fisher o chi cuadrado para variables categóricas, y pruebas no paramétricas para variables continuas.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Resultados:&lt;/strong&gt; los grupos fueron comparables con respecto a sus características basales. La prolongación del embarazo en el manejo expectante fue en promedio 8,8 días con DS +/- 8,74 días. No se presentaron diferencias estadísticas entre los dos protocolos respecto a la morbimortalidad materna o perinatal en la estancia hospitalaria posparto, los días de hospitalización del recién nacido y las horas de ventilación mecánica (p &amp;gt; 0,05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusión:&lt;/strong&gt; no se encontraron diferencias en términos de seguridad en resultados maternos y fetales con el manejo expectante en relación con el manejo activo en pacientes con preeclampsia severa temprana.&lt;/p&gt;

Initial research of cord blood leptin, adiponectin and IGF-I with fetus growth and development

Objective: In order to reveal the relationship between cord blood leptin, adiponectin and insulin-like growth factor-I (IGF-I) and the fetus growth and development, and discuss the interaction and clinical significance on fetus growth and development. Methods: The levels of cord blood leptin, adiponectin, IGF-I in 86 newborns were examined by radio immunoassay, according to gestation age and birth weight percentile relation, the objects were divided into the SGA group (n = 16), the AGA group (n = 41), the LGA group (n = 29), meanwhile, neonatal birth weight, body length, head circumference, foot length, and placental weight were measured, and body mass index (BMI) was computed. Dependability analysis was taken. Results: The levels of cord blood leptin, adiponectin and IGF-I were as follows: LGA group > AGA group > SGA group. The level of cord blood adiponectin was positively correlated with birth weight, placental weight and BMI ( p .05); the levels of cord blood IGF-I had no statistical significance with neonatal sexuality ( p > .05), but had statistical significance with deliver style ( p < .05). Conclusions: Cord blood leptin, adiponectin and IGF-I played an important part in adjusting fetus growth and development as well as participating in the process of fetus growth and development, and could be regarded as one of the clinical indexes to evaluate fetus growth and development or state of nutrition. The abnormal level of cord blood leptin and IGF-I might be one of the reasons to cause intrauterine growth retardation and fetal macrosomia.

Preterm neonatal morbidity and mortality by gestational age: a contemporary cohort

Although preterm birth <37 weeks' gestation is the leading cause of neonatal morbidity and mortality in the United States, the majority of data regarding preterm neonatal outcomes come from olderstudies, and many reports have been limited to only very preterm neonates. Delineation of neonatal outcomes by delivery gestational age isneeded to further clarify the continuum of mortality and morbidity frequencies among preterm neonates. We sought to describe the contemporary frequencies of neonatal death, neonatal morbidities, and neonatal length of stay across the spectrum of preterm gestational ages. This was a secondary analysis of an obstetric cohort of 115,502 women and their neonates who were born in 25 hospitals nationwide, 2008 through 2011. All liveborn nonanomalous singleton preterm (23.0-36.9 weeks of gestation) neonates were included in this analysis. The frequency of neonatal death, major neonatal morbidity (intraventricular hemorrhage grade III/IV, seizures, hypoxic-ischemic encephalopathy, necrotizing enterocolitis stage II/III, bronchopulmonary dysplasia, persistent pulmonary hypertension), and minor neonatal morbidity (hypotension requiring treatment, intraventricular hemorrhage grade I/II, necrotizing enterocolitis stage I, respiratory distress syndrome, hyperbilirubinemia requiring treatment) were calculated by delivery gestational age; each neonate was classified once by the worst outcome for which criteria was met. In all, 8334 deliveries met inclusion criteria. There were 119 (1.4%) neonatal deaths. In all, 657 (7.9%) neonates had major morbidity, 3136 (37.6%) had minor morbidity, and 4422 (53.1%) survived without any of the studied morbidities. Deaths declined rapidly with each advancing week of gestation. This decline in death was accompanied by an increase in major neonatal morbidity, which peaked at 54.8% at 25weeks of gestation. As frequencies of death and major neonatal morbidity fell, minor neonatal morbidity increased, peaking at 81.7% at 31weeks of gestation. The frequency of all morbidities fell >32 weeks. After 25 weeks, neonatal length of hospital stay decreased significantly with each additional completed week of pregnancy; among babies delivered from 26-32 weeks of gestation, each additional week in utero reduced the subsequent length of neonatal hospitalization by a minimum of 8 days. The median postmenstrual age at discharge nadired around 36 weeks' postmenstrual age for babies born at 31-35 weeks of gestation. Our data show that there is a continuum of outcomes, with each additional week of gestation conferring survival benefit while reducing the length of initial hospitalization. These contemporary data can be useful for patient counseling regarding preterm outcomes.

The impact of fetal growth restriction on latency in the setting of expectant management of preeclampsia

Fetal growth restriction is a common complication of preeclampsia. Expectant management for qualifying patients has been found to have acceptable maternal safety while improving neonatal outcomes. Whether fetal growth restriction influences the duration of latency during expectant management of preeclampsia is unknown. The objective of the study was to determine whether fetal growth restriction is associated with a reduced interval to delivery in women with preeclampsia being expectantly managed prior to 34 weeks. We performed a retrospective cohort of singleton, live-born, nonanomalous deliveries at the University of Cincinnati Medical Center between 2008 and 2013. Patients were included in our analysis if they were diagnosed with preeclampsia prior to 34 completed weeks and if the initial management plan was to pursue expectant management beyond administration of steroids for fetal lung maturity. Two study groups were determined based on the presence or absence of fetal growth restriction. Patients were delivered when they developed persistent neurological symptoms, severe hypertension refractory to medical therapy, renal insufficiency, nonreassuring fetal status, pulmonary edema, or hemolysis elevated liver low platelet syndrome or when they reached 37 weeks if they remained stable without any other indication for delivery. Our primary outcome was the interval from diagnosis of preeclampsia to delivery, measured in days. Secondary outcomes included indications for delivery, rates of induction and cesarean delivery, development of severe morbidities of preeclampsia, and select neonatal outcomes. We performed a multivariate logistic regression analysis comparing those with fetal growth restriction with those with normally grown fetuses to determine whether there is an association between fetal growth restriction and a shortened interval to delivery, neonatal intensive care unit admission, prolonged neonatal stay, and neonatal mortality. A total of 851 patients met the criteria for preeclampsia, of which 199 met inclusion criteria, 139 (69%) with normal growth, and 60 (31%) with fetal growth restriction. Interval to delivery was significantly shorter in women with fetal growth restriction, median (interquartile range) of 3 (1.6) days vs normal growth, 5 (2.12) days, P < .001. The association between fetal growth restriction and latency less than 7 days remained significant, even after post hoc analysis controlling for confounding variables (adjusted odds ratio, 1.66 [95% confidence interval, 1.12-2.47]). There were no differences in the development of severe disease (85.9 vs 91.7%, P = .26), need for intravenous antihypertensive medications (47.1 vs 46.7%, P = .96), and the development of severe complications of preeclampsia (51.1 vs 42.9%, P = .30) in normally grown and growth-restricted fetuses, respectively. Fewer women with fetal growth restriction attained their scheduled delivery date, 3 of 60 (5.0%), compared with normally grown fetuses,12 of 139 (15.7%), P = .03. Admission to the neonatal intensive care unit, neonatal length of stay, and neonatal mortality were higher when there was fetal growth restriction; however, after a logistic regression analysis, these associations were no longer significant. Fetal growth restriction is associated with a shortened interval to delivery in women undergoing expectant management of preeclampsia when disease is diagnosed prior to 34 weeks. These data may be helpful in counseling patients regarding the expected duration of pregnancy, guiding decision making regarding administration of steroids and determining the need for maternal transport.

Umbilical cord abnormalities

Objective: Stillbirths and neonatal outcome after delivery has been associated with umbilical cord findings. Cord abnormalities may put the baby in higher risk of certain diseases or low birth weight. The etiology of the umbilical cord abnormalities are not clear diagnosis. Although the fetal mortality associated with umbilical cord abnormalities is very high, identification of the fetus at risk has remained a difficult problem. The aim of this academic work is to study the human umbilical cord (UC) congenital abnormalities including length, diameter, coiling pattern, and placental insertion site in full term Sudanese neonates. Materials and Methods: One thousand and twenty UC of full-term birth neonates of both sexes, single and twin, of normal vaginal delivery in 2013, were studied in the Department of Obstetrics and Gynecology, Omdurman Maternity Hospital. UC length was entirely measured in centimeters using flexible plastic meter and the diameter was measured by Vernier caliper. The number of UC coils, coils pattern, insertion site, knots, cysts, and the blood vessels were fully studied. Results: The average UC length was about 58 cm, with minimal difference between male to female, single to twin birth. In majority of the cases, true knots occur without any clinical significance, whereas the tight knot may impede the circulation and may lead to low birth or intrauterine death. Thin cord places fetus at risk during pregnancy and may result in restricted growth, low birth weight, and neonates which are small for gestational age. This appears to be a consequence of reduction in the area of Wharton's jelly or small cord diameter. Very helical designs may predispose the fetus to certain blood flow changes, and very straight designs may be susceptible to compression. In both these types of coils, the degree of coils vary depending on cord length, diameter, fetal gender, and number of pregnancy. Hypercoiled coils may predispose the fetus to certain blood flow changes and hypocoiled cords may lead to the fetus being susceptible to compression; however in both cases, the blood flow and fetal weight may be affected. These factors were considered regarding possible interactions and correlation to pregnancy and perinatal outcome. Conclusion: Average length of UC in Sudanese neonates about 55 cm, being long in males and single birth, and there is no big difference in the cord length measurement before and after birth, comparing the two methods (ultrasound and manual measurements). 20cm of the cord length is suitable for fetus to be delivered vaginally. Average UC diameter in Sudanese neonates about 1.5 cm, big in males and single birth, Maximum UC coils about 45 coils, more in males and single birth, eccentric insertion is more common than central or marginal false knots of the are also more common than true knots. Most of the cord true knots located near to the fetal end of the umbilical cord, and they were commonly coiled to the left side (anticlockwise direction) incidence of a SUA in Sudanese neonate about 1% more common in males

Correlation of foot length and gestational maturity in neonates

Background: Accurate assessment of gestation maturity is not possible in all newborn infants specially when they are sick and need intensive care support . The aim was to study correlation of foot length (FL) with gestational age and other anthropometric measures at birth among preterm, term and post-term neonates. Methods: Prospective observational study was done. 800 babies born at MGM Medical College Aurangabad from December 2012 to November 2014 were enrolled. FL at birth was measured from the center of the back of the heel to the tip of the big toe. Gestational assessment was done using modified Ballard’s scoring on day one. Based on gestational age, babies were grouped as preterm, term and post term babies. All the three groups of babies were categorised into small for gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA) groups using lubchenco intrauterine growth curves. Linear regression analysis was done to investigate the relation of FL to gestational age, birth weight (BW), head circumference (HC) and crown heel length (CHL). Results: There were 52.5% males and 47.5% females. Of the 800 newborns, preterm babies were 124 (15.5%), term babies were 604 (75.5%) and post-term babies were 72 (9%). The mean foot length was 7.42 cm with a range of 4.5-8.8 cm. Foot length correlated significantly (p &lt;0.05) with gestational age, birth weight, head circumference and crown heel length in preterm small for gestational age (SGA), preterm appropriate for gestational age (AGA), term Small for gestational age (SGA) and term appropriate for gestational age (AGA) groups. The correlation coefficient of foot length with gestational age was maximum in preterm AGA (r=0.81) and preterm SGA groups (r=0.75) followed by term SGA (r=0.48) and term AGA (r=0.44). Other groups had no correlation between foot length and gestational age. Post-term AGA and post-term SGA groups had correlation between foot length and birth weight. Conclusions: Foot length correlated significantly with gestational age and other anthropometric parameters in preterm and term infants.

Cub biometry, litter size and reproductive period of giant oters (Pteronura brasiliensis) at the Balbina Hydroelectric Reservoir, Amazonas, Brazil

According to the literature, giant otters produce one to six cubs at each gestation, with birth peaks occurring from the end of the flood season to the beginning of the low-water period. With the aim of describing some reproductive parameters of the giant otters living in a hydroelectric lake, 56 field excursions to Balbina Hydroelectric Reservoir, hereafter Balbina Lake, were carried out between September 2001 and September 2010 in order to gather information about cub weight and length, litter size and reproductive period of the species in that area. About 80% of the birth records occurred between September and December, characterized by the receding water season and the beginning of the dry season. The number of cubs per gestation varied from one to three animals (mean = 2; n = 36) and average weight and length of neonates were 316.25 ± 64.21g (n = 4) and 31.75 ± 4.86cm (n = 4), respectively. The reproductive period and the litter size produced by giant otters in Balbina Lake were within the range reported in literature for non-dammed areas, indicating that these reproductive parameters were not changed by the reservoir. The weight of cubs analyzed in the reservoir was in average 35% greater than the weight of captive newborn cubs reported in the literature. However, as the animals here analyzed were healthy, it is reasonable to assumethat they represent the weight of free-ranging newborn cubs. Artificial lakes had been reported in the literature as favorable environments for giant otters in Guyana, and the results obtained here seem to corroborate this hypothesis and show the plasticity of the species in its use of different habitats as long as the habitats are inside some category of protection, in this way minimizing additional impacts caused by an intense human occupation of the area.

Low Birth Weight and Maternal and Neonatal Deaths are Complications of Systemic Lupus Erythematosus in Pregnant Pristane Induced Lupus Mice

Objectives: This study aims to investigate the relationship between systemic lupus erythematosus and pregnancy in pristane induced lupus mice model, including the pregnancy outcome for mothers and neonates. Materials and methods: Sixteen female Balb/c mice 6-8 week-old were separated into two groups: pristane induced lupus (PIL) mice group that received a single intraperitoneal injection of 0.5 ml of pristane and healthy control (HC) group that received phosphate-buffered saline injection. At one month after injection, all mice were mated with 8-10 week-old male Balb/c mice. All mice from both groups were observed for body weight and survival. On the day of births; number of neonates born, birth weight, and length of neonates were calculated. Neonates were also monitored for survival rate and their ages along the study. Results: There was no statistically significant difference in body weight before and after delivery, survival rate during pregnancy, number of neonates born, and gestational ages of mothers from both groups. Mothers began to die in the postpartum period. On third day after delivery, 0% of mothers from PIL group survived whereas 100% mothers from HC group survived (p=0.000). Of neonates born from PIL group, 15% survived at the end of fifth day after birth whereas 100% of neonates from HC group still survived (p=0.000). Neonates from PIL group also had significantly lower body weight and body length at birth compared to HC group (p=0.000 and p=0.000, respectively). Conclusion: Maternal and neonatal death, low birth weight, and low birth length are complications of systemic lupus erythematosus at pregnancy in pristane induced lupus mice model.

Buprenorphine and Naloxone Compared With Methadone Treatment in Pregnancy

OBJECTIVE: To compare neonatal abstinence syndrome prevalence and characteristics among neonates born to women prescribed buprenorphine and naloxone compared with methadone during pregnancy. METHODS: Retrospective cohort analysis of mother– neonate dyads treated with either buprenorphine and naloxone or methadone during pregnancy. Primary neonatal outcomes included diagnosis of neonatal abstinence syndrome, neonatal abstinence syndrome peak scores, total amount of morphine used to treat neonatal abstinence syndrome (mg), and duration of treatment for neonatal abstinence syndrome (days). Secondary outcomes included head circumference, birth weight, length, preterm birth, neonatal intensive care unit admission, Apgar scores, and overall length of hospitalization. RESULTS: From January 1, 2011, to November 30, 2013, we identified 62 mother–neonate dyads, 31 treated with methadone and 31 treated with buprenorphine and naloxone. Sixteen neonates (51.6%) in the methadone group were diagnosed with neonatal abstinence syndrome compared with eight (25.1%) in the buprenorphine and naloxone group (adjusted odds ratio 2.55, 95% confidence interval [CI] 1.31–4.98, P5.01). The buprenorphine and naloxone-exposed neonates had lower peak neonatal abstinence syndrome scores (9.064.4 compared with 10.763.7, multivariate-adjusted mean difference522.77, 95% CI 24.99 to 20.56, P5.02) and shorter overall hospitalization (5.665.0 compared with 9.867.4 days, multivariate-adjusted mean difference523.90, 95% CI, 27.13 to 20.67, P5.02). We found no other differences in primary or secondary outcomes. CONCLUSION: In a cohort of pregnant patients treated with either methadone or buprenorphine and naloxone in pregnancy, newborns exposed to maternal buprenorphine and naloxone had less frequent neonatal abstinence syndrome. Additionally, neonates exposed to buprenorphine and naloxone had shorter overall hospitalization lengths.