Low 5-min Apgar Score Research Articles

Adolescent chronic pain and association to perinatal factors: linkage of Birth Registry data with the Young-HUNT Study.

The aim of this study was to examine the associations of birthweight, gestation and 5-min Apgar score with self-reported chronic nonspecific pain in a large, unselected adolescent population. The third population-based Nord-Trøndelag Health Study (HUNT) included 8200 adolescents aged 13-19 years, constituting 78.2% of adolescents in Nord-Trøndelag County. In the target age group, 13-18 years, data on pain frequency from 10 localizations were available from 7373 adolescents. Chronic nonspecific pain was defined as pain at least once a week during the last 3 months, not related to any known disease or injury. Chronic multisite pain was defined as chronic pain in at least three localizations, and chronic daily pain was defined as chronic pain almost every day. Perinatal data were retrieved from the Medical Birth Registry of Norway, and data were available for 7120 of the 7373 adolescents. Covariates included adolescent and maternal general health measures from the HUNT study. We found no consistent association between preterm birth and chronic pain and no clear association between birthweight and chronic pain complaints in adolescence. Post-term birth in boys and a low 5-min Apgar score in both sexes tended to increase the reporting of chronic pain in adolescence. Perinatal factors, and especially preterm birth and low birthweight, did not seem to have a major impact on pain complaints in adolescence.

The effect of maternal obesity on outcomes in patients undergoing tertiary or higher cesarean delivery

Objective: To estimate the association between maternal obesity and adverse outcomes in patients without placenta previa or accreta undergoing a tertiary or higher cesarean delivery.Study design: Retrospective cohort of patients cared for by a single MFM practice undergoing a tertiary or higher cesarean delivery from 2005 to 2013. Patients attempting vaginal delivery and patients with placenta accreta and/or placenta previa were excluded. We estimated the association of maternal obesity (prepregnancy BMI ≥ 30 kg/m2) and maternal outcomes. The primary outcome was a composite of severe maternal morbidity (uterine rupture, hysterectomy, blood transfusion, cystotomy requiring repair, bowel injury requiring repair, intensive care unit admission, thrombosis, re-operation, or maternal death).Results: Three hundred and forty four patients met inclusion criteria, 73 (21.2%) of whom were obese. The composite outcome was significantly higher in the obese group (6.8% versus 1.8%, p = 0.024, aOR 4.36, 95% CI 1.21, 15.75). The incidence of several individual adverse outcomes were also increased in obese women, including blood transfusion (4.1% versus 0.7%, p = 0.033, aOR 7.36, 95% CI 1.19, 45.34), wound separation or infection (20.5% versus 5.9%, p < 0.001, aOR 4.05, 95% CI 1.75, 9.36) and 1-min Apgar score less than 7 (6.8% versus 1.9%, p = 0.024, aOR 4.40, 95% CI 1.21, 15.94).Conclusions: In patients undergoing a tertiary or higher cesarean delivery without placenta previa or accreta, obesity increases the risk of adverse outcomes. Obese patients are at risk for blood transfusion, low 1-min Apgar scores and postoperative wound complications.

Clinical differences between early- and late-onset severe preeclampsia and analysis of predictors for perinatal outcome.

To analyze the clinical differences between early- and late-onset cases of severe preeclampsia and to evaluate parameters that could help to predict perinatal outcome. Over a period of 6 years, all cases of severe preeclampsia (n=68) at our institution were included in a retrospective cohort analysis. Differences between early (<34 weeks, n=44) and late (≥34 weeks, n=24) onset of the disease were evaluated. Risk factors for low 5-min Apgar score (≤7), small-for-gestational-age (SGA) infants and neonatal acidosis (umbilical arterial pH <7.20) were identified and considered in a multiple logistic regression model. Early- and late-onset severe preeclampsia differed from each other remarkably. Perinatal outcome was unfavorable in early-onset disease and seemed to be mainly a result of premature delivery and development of fetal growth restriction. Abnormal uterine Doppler velocimetry increased the risk of low 5-min Apgar values [odds ratio (OR) 8.0, P=0.012] and preterm birth <34+0 weeks (OR 17.9, P<0.001). An increased resistance of the umbilical artery was associated with a higher risk for SGA birth weight (OR 4.9, P=0.010). Preeclampsia is a heterogeneous syndrome even if only severe cases were analyzed. Abnormal Doppler flow characteristics facilitated the identification of patients who were at increased risk for worse perinatal outcome.

Sleep disorders in pregnancy: A prospective observational study

This study aimed to find out different patterns of sleep disturbances in pregnancy and their effect on mother and fetus. A questionnaire-based prospective observational study was conducted at the Department of Gynaecology and Obstetrics, Nil Ratan Sircar Medical College, Kolkata, West Bengal, India. Women with sleep disturbances at start and during pregnancy included in the study were interviewed and examined at recruitment, at 24–32 weeks of gestation, and at term. Of 103 enrolled patients, 99 were followed up till delivery. All the recruited patients developed insomnia. “Changes in sleep-disordered breathing status” was associated with development of hypertension (p = 0.003), albuminuria (p = 0.037), and gestational diabetes mellitus (p = 0.012). It was also associated with 1-min APGAR score of <7 in newborns (p = 0.013). Association between sleep parameters and other fetomaternal outcomes, labor, and delivery is statistically insignificant. Insomnia is the most common sleep problem among women having sleep disorders. Little short-term effect on babies’ health (such as low 1-min APGAR score) was found in women having sleep disorders, but no comment can be made on the longterm effects as these were not assessed in this study.

Gene–environment interactions in severe intraventricular hemorrhage of preterm neonates

Intraventricular hemorrhage (IVH) of the preterm neonate is a complex developmental disorder, with contributions from both the environment and the genome. IVH, or hemorrhage into the germinal matrix of the developing brain with secondary periventricular infarction, occurs in that critical period of time before the 32nd – 33rd week post-conception and has been attributed to changes in cerebral blood flow to the immature germinal matrix microvasculature. Emerging data suggest that genes subserving coagulation, inflammatory and vascular pathways, and their interactions with environmental triggers may influence both the incidence and severity of cerebral injury and are the subject of this review.Polymorphisms in the Factor V Leiden gene are associated with the atypical timing of IVH suggesting an as yet unknown environmental trigger. The methylenetetra-hydrofolate reeducates (MTHFR) variants render neonates more vulnerable to cerebral injury in the presence of perinatal hypoxia. The present study demonstrates that the MTHFR 677C>T polymorphism and low 5 minute Apgar score additively increase the risk of IVH. Finally, review of published preclinical data suggests the stressors of delivery result in hemorrhage in the presence of mutations in collagen 4A1 (COL4A1), a major structural protein of the developing cerebral vasculature. Maternal genetics and fetal environment may also play a role.

Male disadvantage for neonatal complications of term infants, especially in small-for-gestational age neonates

Objective: Sex differences in long and short-term outcomes for infants are observed. This has also been shown for several neonatal complications in preterm neonates. We aimed to evaluate whether sex impacts neonatal outcome among term neonates. Furthermore, we were interested in whether small-for-gestational age male and female neonates at term presented with different patterns of neonatal complications.Methods: Data on all term singleton deliveries and respective neonatal outcomes between 2004 and 2008 at a single tertiary medical center were utilized for this retrospective cohort study. Immediate neurological complications were defined as one or more of the following: intraventricular hemorrhage, convulsions, asphyxia and acidosis. Neonatal complications were compared between male and female term infants, as well as male and female term small-for-gestational age (SGA) neonates.Results: 37 342 singleton neonates were born ≥37 weeks’ gestation. 19 112 neonates were males. Birth weight, cesarean sections and operative deliveries were significantly higher for males. Neonatal hypoglycemia and immediate neurological complications were significantly more frequent in males. For term SGA’s, low 5-min apgar scores (<7) at 39–40 weeks were 2.65 times higher for males compared with females, as was hypoglycemia.Conclusions: Male infants at term, especially male SGA infants, are more likely to encounter complications during labor and require special neonatal care due to metabolic and/or neurological complications.

Trajectories and predictors of developmental skills in healthy twins up to 24 months of age

BackgroundLow birth weight and low 5-min Apgar scores have been associated with developmental delay, while older maternal age is a protective factor. Little is known about trajectories and predictors of developmental skills in infant twins, who are generally born with lower birth weights, lower Apgar scores and to older mothers. MethodsDevelopmental skills were assessed at 3, 6, 9, 12, 18 and 24 months using the Ages and Stages Questionnaires in 152 twins from the Birmingham Registry for Twin and Heritability Studies. Multilevel spline and linear regression models (adjusted for gestational age, gender, maternal age) were used to estimate developmental trajectories and the associations between birth weight, maternal age and Apgar scores on developmental skills. ResultsTwins performed worse than singletons on communication, gross motor, fine motor, problem solving and personal-social skills (p<0.001). Twins caught up around 6 months (score within −1 standard deviation of norm), except on gross motor skills, which did not catch up until after the age of 12 months. A one-year increase in maternal age was significantly associated with decreases in gross motor and personal–social z-scores of up to −0.09, whereas one unit increases in Apgar score increased z-scores up to 0.90 (p<0.01). ConclusionsHealthy twins should be considered at a higher risk for developmental delay. Whether these results are comparable to preterm singletons, or whether there are twin-specific issues involved, should be further investigated in a study that uses a matched singleton control group.

Safety of low-dose prostaglandin E2 induction in grandmultiparous women with previous cesarean delivery

Objective: To determine the safety and efficacy of labor induction with low-dose vaginal prostaglandin E2 (PGE2) in grandmultiparous women with a previous cesarean delivery.Methods: We conducted a retrospective cohort study of 219 grandmultiparous women with a previous cesarean delivery (study group) who underwent induction of labor with low dose PGE2. These patients were compared to 1376 grandmultiparous women without a previous cesarean section (control group) who underwent induction of labor with low dose PGE2. The primary outcome was uterine rupture and secondary outcomes included mode of delivery, post-partum hemorrhage (PPH) and a low 5-min Apgar score (≤7).Results: One patient in the study group as well as one patient in the control group were diagnosed with uterine rupture (0.4% versus 0.07%). In the study group, vaginal delivery was achieved in 204 (93.16%) patients, whereas 15 (6.84%) patients had emergent cesarean delivery. Five minutes Apgar score ≤7 was recorded in two cases (0.9%) in the study group. Patients in the study group had a significantly higher rate of cesarean delivery (6.84%, versus 3.4%, respectively, p < 0.001) as well as operative vaginal delivery (4.56% versus 2% respectively, p < 0.05) compared to the control group. There were no significant differences between the groups regarding the rate of PPH (0.91% versus 0.90%, p = 0.2) or 5-min Apgar score ≤7 (0.91% versus 0.22%, p = 0.28).Conclusions: Low dose PGE2 is a relative safe method for induction of labor in grandmultiparous women with a previous cesarean section.

Influenza H1N1 vaccination and adverse pregnancy outcome

Although vaccines against influenza can reduce maternal morbidity and mortality, large-scale data on adverse effects in the offspring are scarce. Historical cohort study in Stockholm County, Sweden. We linked H1N1 vaccination data (Pandemrix(®), a mono-valent AS03 adjuvanted H1N1 vaccine) with pregnancy and birth data from 21,087 women with singleton offspring conceived between February 2009 and January 2010 (vaccinated during pregnancy: n=13,297 vs. unvaccinated: n=7,790). Data were analysed by conceptualizing the observational cohort as a series of nested cohorts defined at each week of gestation. Logistic regression estimated odds ratios (ORs) for low birth weight (LBW,<2,500g), preterm birth (<37 completed weeks), small-for-gestational age (SGA,<10th percentile of the gestational age-specific birth weight within the cohort), low 5-min Apgar score (<7), and caesarean section. Data were adjusted for potential confounders, including maternal age, body mass index, smoking, parity, civil status and comorbidities. Compared with infants of non-vaccinated women, infants of vaccinated women had similar adjusted ORs (95% CI) for LBW (0.91; 0.79-1.04), preterm birth (0.99; 0.89-1.10), SGA (0.97; 0.90-1.05), low Apgar score (1.05, 0.84-1.31), and a marginal risk reduction for caesarean section (0.94, 0.89-0.99). H1N1 vaccination during pregnancy, using an AS03-adjuvanted vaccine, does not appear to adversely influence offspring risks of LBW, preterm birth, SGA, or low Apgar score. Our results suggest that this vaccine is safe for the offspring when used in different stages of pregnancy.

Effects of Maternal Epilepsy and Antiepileptic Drug Use during Pregnancy on Perinatal Health in Offspring: Nationwide, Retrospective Cohort Study in Finland

Perinatal health outcomes other than major congenital anomalies in offspring of women with epilepsy (WWE) have not been widely studied, and results of previous studies are conflicting and are mostly based on small numbers. Antiepileptic drugs (AEDs) pass through the placenta and may affect neonatal outcome. This register-based study is based on information on all pregnancies ending in birth in Finland between 1996 and 2008. The data were obtained from the Finnish national health registers with data linkages based on the unique personal identification numbers. Information on maternal epilepsy diagnosis, AED purchases and other background factors was obtained to evaluate data on perinatal and infant health for all singleton births (n=751,139). Drug purchases were considered to be an indicator for drug use. The outcomes included mode of delivery (vaginal birth or Caesarean section), preterm birth, low birth weight, weight for gestational age, low Apgar score, need for respiratory treatment, admission to neonatal care unit, perinatal death and infant death. In total, 4,867 (0.6 %) infants (including live births and stillbirths) were exposed to maternal epilepsy. More than half of the offspring of WWE were exposed to AED (n=3,067, 63.0%) during pregnancy or 1month prior to and/or during pregnancy, and mostly in monotherapy (n=2,566, 83.7%). The most commonly used AED was carbamazepine (n=1,292, 42.1%; mostly in monotherapy 83.9%). WWE were more likely to smoke and to have previous miscarriages, lower socioeconomic status, and more co-morbidity than the reference women with no epilepsy diagnosis and no AED use (WOE). A slightly increased risk for most of the perinatal health outcomes was found in offspring of WWE in relation to offspring of WOE (adjusted odds ratio [aOR] 1.19, 95% CI 1.04-1.36 for low 5-min Apgar score to aOR 2.10, 95% CI 1.57-2.81 for needing respiratory care). The risks increased by the number of different maternal AEDs used. In relation to offspring of WWE with no AED exposure (n=1,800), a slightly increased risk for treatment in a neonatal care unit (aOR 1.48, 95% CI 1.21-1.82) was observed for offspring of WWE on AED therapy. Offspring of WWE have a slightly increased risk for adverse pregnancy-related and perinatal health outcomes when compared with WOE, and AED exposure further increases the risk. The results should be interpreted with caution, as information on type of epilepsy was unavailable.

Association between umbilical cord artery pCO2 and the Apgar score; elevated levels of pCO2 may be beneficial for neonatal vitality after moderate acidemia

To determine the association between 5-min Apgar score and umbilical cord artery carbon dioxide tension (pCO₂). Observational study. European hospital labor wards. Data from 36,432 newborns ≥36 gestational weeks were obtained from three sources: two trials of monitoring with fetal electrocardiogram (the Swedish randomized controlled trial and the European Union Fetal ECG trial) and Mölndal Hospital data. After validation of the acid-base values, 25,806 5-min Apgar scores were available for analysis. Validation of the umbilical cord acid-base values was performed to obtain reliable data. 5-min Apgar score was regressed against cord artery pCO₂ in a polynomial multilevel model. Five-min Apgar score, umbilical cord pCO₂, pH, and base deficit. Overall, a higher cord artery pCO₂ was found to be associated with lower 5-min Apgar scores. However, among newborns with moderate acidemia, lower umbilical cord artery pCO₂ (≤median pCO₂ for the specific cord artery pH) was associated with lower 5-min Apgar scores, with a relative risk of 2.0 (95% confidence interval: 1.4-2.8) for 5-min Apgar scores 0-6. Metabolic acidosis affects the newborn's vitality more than respiratory acidosis. In addition, elevated levels of pCO₂ may be beneficial for fetuses with moderate acidemia, and thus cord artery pCO₂ is a factor that should be considered when assessing the compromised newborn.

Perinatal outcomes of idiopathic polyhydramnios

To investigate the perinatal outcomes of cases with idiopathic polyhydramnios. Retrospective analysis of 160 singleton pregnancies that were under routine surveillance at the department of obstetrics from 2008 to 2010 was performed to assess perinatal outcomes. Finally, 59 cases were included as idiopathic polyhydramnios, and 101 cases were included as controls. Preterm delivery (<37 weeks), gestational age at birth, low birth weight (<2500 g), very low birth weight (<1500 g), macrosomia (>4000 g), 1- and 5-min APGAR scores <7, small for gestational age (SGA) fetuses, large for gestational age (LGA) fetuses, C-section rates, number of fetal distress, admission to neonatal intensive care unit (NICU) after delivery, neonatal death within the first 7 days, and deaths before the age of 1 year were selected as perinatal outcome variables. Significantly higher preterm labors and low 1- and 5-min APGAR scores were noted in the idiopathic polyhydramnios group compared with the control group. Although perinatal outcomes are conflicting in literature, idiopathic polyhydramnios warrants close surveillance especially near term.

Risk factors for adverse neurocognitive outcomes in school-aged patients after the Fontan operation

As the surgical results for Fontan candidates improve, much attention has been given to the long-term cognitive outcomes. This study aimed to assess the neurocognitive outcomes after Fontan completion, and to determine the factors associated with an extremely low intelligence quotient (IQ <70). A total of 70 local eligible school-aged patients were enrolled in the study (hypoplastic left heart syndrome, 17; right atrial isomerism, 15 and others, 38). Fontan operations were performed at a median age of 1.8 (range, 0.5-8.9) years (primary Fontan, 4 of 70 [6%]). The Wechsler Intelligence Test was taken at a median age of 9 (range, 5.1-14.4) years for the purpose of neurocognitive evaluation. Patients' data were collected from medical records, and a retrospective analysis of potential predictors for an IQ <70 was performed. The median full-scale IQ (FSIQ) for the entire cohort was 85 (range, 43-118). Of the lower order composites, the perceptual reasoning index and the working memory index were significantly lower in low-FSIQ patients (P < 0.05). Overall, 15 of 70 (21%) of the cohort had an IQ <70. Univariate analysis identified three significant risk factors for FSIQ <70 (15 of 70, 21%): body weight <2.5 kg at initial palliative surgery (P < 0.05), low 5-min Apgar score <4 (P < 0.05) and inter-stage events requiring cardiopulmonary resuscitation (CPR) (P < 0.05). No other patient-specific factors (e.g. cardiac morphology) or modifiable surgical factors (e.g. the use of hypothermic cardiac arrest) were associated with FSIQ <70. Low body weight (<2.5 kg) at initial operation, low 5-min Apgar score (<4) and inter-stage CPR were significant risk factors for impaired neurocognitive outcomes. An evolving strategy for preventing inter-stage CPR may improve cognitive outcomes.

Fluid overload and mortality are associated with acute kidney injury in sick near-term/term neonate.

Acute kidney injury (AKI) is common and portends mortality in several neonatal cohorts. Fluid overload is independently associated with poor outcomes in children and adults but has not been extensively studied in neonates. Between February 2010 and May 2011, we followed 58 neonates who met the following criteria: birth weight >2,000 g, gestational age ≥ 34 weeks, 5-min Apgar ≤ 7, and parental consent. Serum creatinine (SCr) was measured daily for first 4 days of life. AKI was defined as a rise in SCr of > 0.3 mg/dl or persistent SCr above 1.5 mg/dl. AKI was present in 9/58 (15.6 %) neonates and was associated with higher birth weight, being male, lower 5-min Apgar scores, lower cord pH, delivery room intubation, and absence of maternal pre-eclampsia. Percent weight accumulation at day 3 of life was higher in those with AKI [median=8.2, interquartile range (IQR) =4.4-21.6)] than without AKI (median= -4 (IQR= -6.5 to 0.0) (p<0.001). Infants with AKI had lower survival rates than those without AKI [7/9 (72 %) vs. 49/49 (100 %) (p<0.02)]. AKI incidence in this neonatal population is similar to other neonatal cohorts. Near-term/term infants with AKI have a higher mortality rate and a net positive fluid balance over the first few days of life.

Maternal “isolated” obesity and obstetric complications

Objective: To investigate pregnancy outcomes, particularly cesarean delivery (CD), among women with “isolated” obesity (i.e. without additional comorbidities). Study design: We conducted a retrospective population-based study between the years 1988–2010. The pregnancy outcomes of obese (prepregnancy BMI ≥30 kg/m2) and nonobese patients were compared. Patients with chronic hypertension, pregestational diabetes mellitus, other preexisting chronic morbidities, multiple gestations, age above 40 years, grand multiparity (above 5 deliveries), lack of prenatal care, and following fertility treatments were excluded from the analysis. Stratified analyses, using multiple logistic regression models, were performed to control for confounders. Results: During the study period, a total of 173,628 deliveries met the inclusion criteria; 1605 (0.9%) occurred in patients with “isolated” obesity. Higher rates of CD were found among patients with “isolated” obesity (30.7% vs. 12.3%; odds ration [OR] = 3.2; p < 0.001). When controlling for possible confounders, using a multivariable model with CD as the outcome variable, the association between “isolated” obesity and CD remained significant (adjusted OR = 2.6; p < 0.001). No significant differences were found in the risks of perinatal complications including perinatal mortality, shoulder dystocia, congenital malformations, and low 5-min Apgar score. Conclusion: “Isolated” obesity, although not a risk factor for adverse perinatal outcomes, is an independent risk factor for CD.

287: Breech deliveries in the Netherlands: effect of increased caesarean section rate on perinatal outcome

287: Breech deliveries in the Netherlands: effect of increased caesarean section rate on perinatal outcome

The effects of multiple pre- and perinatal risk factors on the occurrence of cerebral palsy. A Norwegian register based study

Aims To examine the effects of multiple risk factors on cerebral palsy (CP). Materials/methods For 176,591 Norwegian infants born 1996–98 and surviving the early neonatal period, data on a number of potential pre- and perinatal risk factors (RFs) for CP were available in the Medical Birth Registry of Norway. For 241 children with CP detailed clinical data were available in the Norwegian CP registry. Results In children born at term, 31% had no RF, and none had five or more, while in children born preterm, 9% had no RF in addition to prematurity ( p < 0.001 vs. term), and 5% had five or more ( p < 0.02 vs. term). In both groups, few children shared the same combination of RFs. Interdependent sequences were more often observed among children born preterm than at term ( p < 0.001 vs. term). The most detrimental effect was observed for the combination of maternal disease and low 5-min Apgar score, registered in 11.2% of children with CP. The combination of maternal disease and premature birth had an interaction contrast ratio of 9.25 (CI: 3.56; 14.94), which may be consistent with biological interaction. Conclusions The majority of children with CP born at term most likely had an antenatal or single cause, suggesting individual susceptibility to an injury. The majority of children born preterm, had combinations or sequences of antenatal and perinatal risk factors as the most likely cause of CP.

Risk factors and perinatal outcome of pregnancies complicated with cephalopelvic disproportion: a population-based study

To characterize risk factors and perinatal outcome following cephalopelvic disproportion (CPD). A retrospective population-based study comparing all singleton deliveries of women with and without CPD, between 1988 and 2010, was conducted. A multiple logistic regression model was used to control for confounders. Out of 242,520 patients, 0.3% (n = 673) were diagnosed with CPD. Using a multivariable analysis, the following obstetric risk factors were significantly associated with CPD: fetal macrosomia (birth weight above 4 kg, OR = 3.3, 95% CI 2.7-4.1, P < 0.001), infertility treatment (OR = 2.6, 95% CI 1.8-3.8, P < 0.001), previous caesarean delivery (OR = 2.2, 95% CI 1.9-2.7, P < 0.001), maternal obesity (OR = 2.1, 95% 1.3-3.4, P < 0.001), and polyhydramnios (OR = 1.7, 95% CI 1.3-2.3, P < 0.001). Deliveries complicated by CPD resulted in Caesarean delivery in 99%, and were more likely to have laceration of the cervix (1.2 vs. 0.3%, P < 0.001), rupture of uterus (0.4 vs. 0.1%, P < 0.001), intrapartum mortality (0.6 vs. 0.1% in control, P < 0.001), and low 1-min Apgar scores (<7; 27.2 vs. 6.5%, P < 0.001). In our population, independent risk factors for CPD include fetal macrosomia, infertility treatment, previous caesarean delivery, maternal obesity and polyhydramnion. These pregnancies had higher rates of adverse perinatal outcomes and accordingly high index of suspicion should be pursued when commencing trial of labor of such pregnancies.

Risk Factors for Pulmonary Artery Hypertension in Preterm Infants with Moderate or Severe Bronchopulmonary Dysplasia

Background: Despite the potential importance of pulmonary artery hypertension (PAH) in preterm infants with bronchopulmonary dysplasia (BPD), little is known about the risk factors for PAH. Objectives: To investigate the risk factors for PAH in preterm infants with BPD. Methods: Infants diagnosed with BPD were assigned to the PAH group or non-PAH group except for infants with mild BPD who had no PAH. PAH was diagnosed on the basis of echocardiograms demonstrating elevated right ventricle pressure beyond the postnatal age of 2 months. Logistic regression analysis was done for the multivariate assessment of the risk factors for PAH in preterm infants with moderate or severe BPD. Results: A total of 98 infants among 145 infants with BPD were divided into a PAH group (n = 25) or non-PAH group (n = 73), while the remaining 47 infants had mild BPD with no PAH. Among the study patients, survival rate of the PAH group was significantly lower than that of the non-PAH group. Infants with PAH had more severe cases of BPD and underwent longer durations of oxygen therapy, conventional or high-frequency ventilation, and hospitalization compared to those without PAH. Low 5-min Apgar scores (≤6; relative risk (RR) 6.2; 95% confidence interval (CI) 1.4–28.0; p = 0.017) and oligohydramnios (RR 7.7; 95% CI 2.0–29.6; p = 0.030) were found to be significant risk factors for PAH according to multivariate analysis. Conclusions: The present study shows that oligohydramnios is a specific risk factor for PAH in preterm infants with moderate or severe BPD.

Evaluation of umbilical cord thickness, cross-sectional area, and coiling index as predictors of pregnancy outcome

Aims:This study was designed to evaluate the relationship of sonographic measurements of umbilical cord thickness, cross-sectional area, and coiling index with pregnancy outcome (low birth weight, 5-min Apgar score, and meconium staining).Materials and Methods:From January 2010 to January 2011, among 255 singleton pregnant women who were referred for routine pregnancy USG after 20 weeks of gestation, 223 fulfilled the study criteria. In these patients, the diameter, cross-sectional area, and coiling index were measured in a free loop of umbilical cord. The pregnancies were followed till delivery, when birth weight, presence of meconium staining, and 5-min Apgar score were recorded. The sonographic measurements and clinical findings were analyzed to determine any correlation.Results:A statistically significant correlation was observed between small umbilical cord thickness and cross-sectional area and low birth weight (LBW), with sensitivity of 52.9% and 57.9%, specificity of 95.0% and 94.4%, positive predictive value of 52.6% and 52.0%, and negative predictive value of 95.0% and 95.0%, respectively. Also noted was significant correlation between small umbilical cord thickness and cross-sectional area with meconium staining (P<0.001). No significant correlation was seen between umbilical cord thickness and cross-sectional area with low 5-min Apgar score. There was no statistically significant correlation between umbilical cord coiling index and LBW, 5-min Apgar score, and meconium staining.Conclusion:Umbilical cord diameter and cross-sectional area measured after 20 weeks of gestation are useful for predicting LBW and meconium staining and have the potential to serve as markers for adverse pregnancy outcome.